← The Dr. Gabrielle Lyon Show
The Dr. Gabrielle Lyon Show
The Future of Prostate Cancer Treatments & Non-Invasive Techniques with Less Side Effects
01:28:23
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- [00:00]
Host
Do all cancers respond to radiation?
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Dr. Sanjay Mehta
There is no cancer that cannot be destroyed by radiation. The limiting factor is the human being around that cancer.
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Host
One in eight men will get prostate cancer.
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Dr. Sanjay Mehta
That's right.
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Host
That is insane.
- [00:15]
Dr. Sanjay Mehta
What has really revolutionized our field is we're not treating large parts of the body. I can make the radiation go exactly where the problem is. So in the case of a prostate cancer, I'll treat the prostate gland with just a few millimeter margin around it. And when you get just a few millimeters beyond that, the dose is very low. So we don't cause the, the collateral damage that we used to.
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Host
Gosh, that is unbelievable. What are some of the biggest myths surrounding radiation?
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Dr. Sanjay Mehta
Radiation is part of the electromagnetic spectrum. Just essentially light. Doesn't matter how much FM 88.7 you listen to, it's not going to hurt you. Your cell phone is a radio. So those are all non ionizing radiation. So the old tale about the cell phone giving you a brain tumor, not going to happen.
- [00:58]
Host
What about living next to an electrical tower?
- [01:02]
Dr. Sanjay Mehta
That's EMF again. And so that's electromagnet kinetic frequencies that are not, are not able to damage your DNA. No. On the other hand, as you mentioned, the lady who's afraid of going through an airport scanner because she might be pregnant, that is ionizing radiation. It's a very low dose to get us like an X ray to security area. But that is an X ray. X rays by definition are ionizing. And if I had a chance of being pregnant, I wouldn't go through it either.
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Host
Wait, wait, wait. This is this really important. Dr. Sanjay Mehta, welcome to the show.
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Dr. Sanjay Mehta
Thank you. Thanks for having me.
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Host
This episode. My goal is really twofold. Number one, to be a guide for men, men that have had prostate cancer, but also individuals that have been athletic or who suffer from any of the itises.
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Dr. Sanjay Mehta
Right.
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Host
Osteoarthritis, rheumatoid arthritis, you name it, you can treat it.
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Dr. Sanjay Mehta
Yes, ma'. Am.
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Host
Tell me a little bit about your treatment and your experience of treatment with prostate cancer with low dose radiation therapy.
- [02:10]
Dr. Sanjay Mehta
Sure. So for prostate cancer it's considered high dose. Relatively speaking, we use higher doses for any kind of cancer. So radiation is a viable alternative to a radical prostatectomy for most prostate cancer patients. So once the urologist does a biopsy and diagnoses the prostate cancer, then they get sent to me. They'll usually get a referral to a, a urologist who specializes in radical prostatectomy. And then in my case, I'm a radiation oncologist so I'm trained to treat all different types of cancer, but prostate cancer being the most common thing we see, I've done probably something like 10,000 cases over the years. So it's very common thing. But external beam radiation in high doses is usually. It's about six to eight weeks of treatment. It's Monday through Friday, five days a week, about a 15 minute per day treatment. It's basically just an X ray. So it's pain. Patients come in, they're happy, they get their treatment, they leave 15 minutes later without any sort of instrumentation or injections or anything. And by giving a small dose of radiation on a daily basis over several weeks, the cumulative dose is actually quite high enough to kill the cancer cells without dealing with some of the things people deal with with surgeries, for example, incontinence and nerve damage and things like that. So you avoid all of that with just a non invasive treatment. And people can live their life and get treated for prostate cancer simultaneously with no downtime. And depending on the the stage and the grade of the disease and whatnot, the. The cure rates are basically the same as a radical prostatectomy. So that's a very popular procedure.
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Host
And one in eight men will get prostate cancer.
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Dr. Sanjay Mehta
That's right. That's right. Very, very common.
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Host
That is insane. There is radiation, there is surgery.
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Dr. Sanjay Mehta
Right. Is chemo also utilized in metastatic disease if you have bone mets? Even then, like when people think of chemo, you think of like your hair falling out and being super sick. Like with breast cancer and leu and things like that. Typically an anti cancer drug is still chemo, but usually in the case of prostate cancer, it's an anti testosterone drug. So like Lupron, which is an LHRH agonist. So you starve the body of testosterone. So you do cause some side effects. But it's not like chemo chemo, which you traditionally think of, where people get sick. It's not that type of drug. So we usually don't have to use that. Because prostate cancer is usually a local disease. It's not a systemic disease the way other cancers that require chemo are.
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Host
Yeah. And as a radiation oncologist, tell me a little bit about the training surrounding that. Because you are not their primary line of defense.
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Dr. Sanjay Mehta
That's right.
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Host
Is that correct?
- [04:45]
Dr. Sanjay Mehta
I'm kind of a tertiary specialist. Because your typical patient will go to a primary care doctor, they'll get annual blood tests, maybe their PSA is rising. Or if it's a lady, maybe they've had their annual mammogram there's something that's unusual, then they'll go see a surgeon. If it's a. If it's a man, then of course, they'll go to a urologist and have an MRI and a biopsy. If indicated. Women will go to see their, you know, get a mammogram. If something's unusual, they go to a breast surgeon and they will remove the lump, and then they'll send them to me for radiation. After breast cancer, or in the case of a man, once the prostate cancer has been diagnosed by a biopsy, by the urologist, then they get referred to me, so I'm a little bit further downstream. They'll see a specialist. Whether it's a breast surgeon, a urologist, a ENT doctor. If it's a throat cancer, a neurosurgeon. If it's a brain tumor, they all send to me. Once they've been evaluated and staged, there.
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Host
Are those new full body MRI scans, the prinovo.
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Dr. Sanjay Mehta
Yeah.
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Host
And someone could come to you, for example. I'm gonna see you once this hamstring tear heals. If someone comes to you, they get a full body scan, and you see an isolated tumor, would you be able to treat it, or would they first go to someone else that would stage it, then come up with a treatment plan?
- [05:58]
Dr. Sanjay Mehta
We start with the biopsy first. And so there's a lot of things on these prenuvo scans that may be cancer or they may be completely benign. So they would need a biopsy. So either an interventional radiologist or a specialist of whatever part of the body it's in. You know, if it's something in the gut, they'll need to see a GI doctor. Or if it's a, you know, some prostate lesion, they'll see a urologist. So after the biopsy's done, then they can send to me, and I can help with the staging part in terms of ordering PET scans, MRIs, whatever's needed. And then depending on the stage, then we design the treatment plan and to.
- [06:28]
Host
Set the stage for people. Radiation is the kind of medicine that you practice.
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Dr. Sanjay Mehta
Correct? Radiation oncology is technically my specialty.
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Host
Right.
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Dr. Sanjay Mehta
And you hear oncology, which is the study of cancer, obviously, but there's different types of oncologists. When you just hear someone is an oncologist, they're usually medical oncologists. So they have a. They'll do a residency in internal medicine and then a fellowship in medical oncology. And that's the chemo side. Whereas radiation oncology, what I do it's a separate, completely separate residency program, which is actually, as we were talking about, it's an offshoot of radiology. So the radiologists are the guys. Even half of my patients are like, oh, yeah, that's Dr. Med. He's my radiologist. I'm like, close enough, but not, not quite. So the radiologists are the ones who interpret X ray films, whereas we use X rays and radiation oncology to actually treat. It's therapeutic versus diagnostic radiology. So I'll do a year, like a year of internship and then it's four years of radiation oncology. So we work hand in hand. The medical oncologist. Certain cancers need chemo and radiation combined modality treatment. Or then the third type of oncologist, of course, a surgical oncologist. So you got all three.
- [07:34]
Host
And when we think about a physician that is prescribing a medication or chemotherapy, there's a dose, a treatment length, all of those logistics. And you are delivering.
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Dr. Sanjay Mehta
Right.
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Host
Very similarly, you are delivering an energy source. I'd love for you to explain what radiation is, but to frame it for the listener or the viewer, you are delivering a dose of radiation.
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Dr. Sanjay Mehta
That's right.
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Host
We are radiophobic, you and I.
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Dr. Sanjay Mehta
Yes.
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Host
You spoke about this. People will be concerned about the radiation from a cell phone or the radiation from standing in front of a microwave. I may or may not have been one of those people when I was pregnant. You know, you're looking for all of these things or worried about, or your.
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Dr. Sanjay Mehta
Mom told you, don't sit too close to the tv.
- [08:18]
Host
Exactly.
- [08:19]
Dr. Sanjay Mehta
You're going to get, you're going to get a tumor. Yeah. So we can talk about all that. But you're right, we measure radiation just like you measure medication in milligrams or milliliters, depending what your, what your chemical is. In the case of radiation, it's measured in units called the gray. It's abbreviated gy, but it's called the gray, like the color gray. And that's just essentially the amount of energy you're putting in the tissue. So one gray is one joule per kilogram. So joule is a measure of energy, but joules can be, you know, calories. And joules are two different ways of measuring energy. You know all about calories. That's so that. So essentially, joules alone is just energy. But joules per kg of tissue is the absorbed dose of energy in the body. And that's how we measure radiation. So when we talk about low dose, it may be a dose of half a gray, whereas a cancer Dose, a high dose might be 50 to 75 to 80 gray. And it's just like with pills. It's very similar in terms of if you take one aspirin a day for a week, it might help whatever symptom you had. But if you take the whole bottle at once, not so good for you. So the dose is what makes it the difference between medicine and poison. And it's the same way with radiation. When given in low doses, it's very therapeutic. But as you mentioned, with radiophobia, people instantly are just trained to think about Hiroshima and Chernobyl and all these other things where they were mega doses that, that were given inadvertently obviously in disasters where the body got radiated to a very high dose. But that has literally nothing to do with the tiny focused doses. Not only is it a low dose, but we focus it anatomically. We have the. Now what has really revolutionized our field is we're not treating large parts of the body. I can make the radiation go exactly where the problem is. So in the case of a prostate cancer, I'll treat the prostate gland with just a few millimeter margin around it. And when you get just a few millimeters beyond that, the dose is very low. So we don't cause the collateral damage that we used to.
- [10:08]
Host
If you listen every week and feel like we are in this together, which I believe that we are learning, growing and building strength, then I created a way for us to get connected even more closely. It's called Forever Strong and Insider, a premium community for listeners who want to go deeper. You'll get ad free episodes, which I know you'll love. Bonus Q&As where your questions shape the conversation behind the scene moments. Because let's face it, I'm hilarious from my daily life and written takeaways to keep at your fingertips. But more than that, you'll be supporting the show so that we can keep creating content that matters. If you've ever wanted to feel part of the inner circle, this is your invitation. Join us at foreverstrong.super casp.com or through the link in the show notes. When I think about radiation, is it fair to say that it is? Is it a laser delivering. Walk us through.
- [11:01]
Dr. Sanjay Mehta
Sure. And that gets back to your previous question. What is radiation? So radiation is part of the electromagnetic spectrum. And so radiation is just essentially light. It's just there's different types of light, so. Or I should say light is a type of radiation is probably more accurate. And so when you look at the electromagnetic spectrum, human beings only detect you remember have you heard of Roy? G BIV R O Y G B I V so that little part of the electromagnetic magnetic spectrum is all we can see. We can see red, green, blue, yellow and all those colors, but that's a tiny fraction. That's part of the same electromagnetic spectrum that makes up microwaves and radio waves. And on the other side, as you get to the higher energy stuff, you have ultraviolet rays from the sun and then beyond that X rays and gamma rays. So it's all part of the spectrum. It just so happens that this tiny little sliver in the middle is all we can see for visible light. But as you go to less energetic electromagnetic radiation, that's where you have non ionizing or basically not dangerous radiation, which would include microwaves and radio waves. Doesn't matter how much you know FM 88.7 you listen to, it's not going to hurt you. Your cell phone is a radio. So those are all non ionizing radiation. So the old, you know, old wives tale about the cell phone giving you a brain tumor, not going to happen because those are low energy waves. Then of course visible light is as we know what that is. And then as you know, you go to ultraviolet and then X rays are beyond that. So as the energy gets higher and higher, when you get above the visible spectrum, the ultraviolet, as you know, you can get a sunburn because ultraviolet is ionizing. Now it's not as bad as an X ray, but if you get out in the sun long enough, the reason you get a sunburn is the UV rays. The electromagnetic radiation in the ultraviolet spectrum is damaging your skin's DNA causing that. And that's what. And by the same token, X rays do the same thing, but more so. And the higher the energy of the X ray, the more potential it has to damage your DNA. And the whole point of what I do as a radiation oncologist is I try to damage the cancer DNA and spare the normal DNA.
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Host
I mean it makes sense. Also sounds like we are exposed to various forms of radiation. If I'm hearing you correctly. There's non ionizing and then there's ion ionizing radiation.
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Dr. Sanjay Mehta
That's exactly right.
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Host
You deliver non ionizing.
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Dr. Sanjay Mehta
No, it's actually ionizing. So X rays and you'll hear of like things like gamma rays and things like that. But the non ionizing part would not treat anything. So even a tanning bed is ionizing because that's like ultraviolet basically. So the non ionizing is just going to be radio waves, microwaves, things like that that don't have any effect on the human body?
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Host
When you think about it, it's really interesting. It doesn't affect the human body. But is it inert? Does it cause any kind of damage? Are there ways that we get non ionizing radiation?
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Dr. Sanjay Mehta
Naturally there are. So non ionizing radiation is everything that's below the energy of visible stuff. And so radio waves are naturally occurring. You have astronomers who've got these big radar, the big satellites that are trying to detect extra, extraterrestrial life still waiting.
- [14:08]
Host
I'm here, come pick me up.
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Dr. Sanjay Mehta
That's exactly it. But that's, there are, there's cosmic background radiation. That's, that's basically all of the universe is full of electromagnetic radiation. It's just the, the spectrum of that. That's why as you probably remember, you remember when the James Webb telescope came out, it could see way more than the Hubble telescope. The Hubble was the big deal back in the 80s and 90s and it showed us an impressive picture of the universe. But then the James Webb, when that was launched a few years ago, that has an. So that can see a different spectrum of the electromagnetic spectrum than just visible light. So all of a sudden these dark pictures with a few stars, all of a sudden you see all this other stuff that we couldn't see as humans with our, the limitation of our eyes. But so yes, to answer your question, there is non ionizing radiation that in theory there are ways there actually I believe your husband probably know about some of this stuff. Some of the armed forces can use a very high frequency, lower energy X ray that can actually like microwave that could burn you if you, or it could at least make you can cause pain. It's not enough to damage the DNA, but it's enough to where it can damage the skin. So I think that's actually been used in combat in some situations. But that's, that's an outlier typically radio waves, cell phones, microwaves, all that stuff is non ionizing, meaning it doesn't have enough energy to eject an electron from the atoms that are near it. So it's not going to create ions and therefore it's not going to damage your DNA. And that's exactly what X rays do. They eject electrons from the nuclei of your cells and that's what creates ions and that's what damages the double strands of the DNA and that's what kills the cancer cells.
- [15:46]
Host
The utility of it is just, it's so interesting. Were you involved in physics? I mean this seems, I just enjoyed.
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Dr. Sanjay Mehta
I'm like, I'M like a mechanical type person. So I think if I wasn't a rad on radiation, oncologist is probably about as close to an engineer as an MD could be. And I've always loved mechanical things, cars and stuff like that. So it's like anything mechanical is interesting. And that's why this is an interesting sort of a amalgam of clinical medicine plus technology. And unlike radiology, where you're just looking at X rays, I still have patient care, so I enjoyed that part. What's kind of like being a radiologist but also being a clinical oncologist. So it's a, it's a really great area of medicine in my opinion.
- [16:23]
Host
I mean, certainly especially when I hear stories about you treating someone's arthritis that they couldn't play tennis and all of a sudden they can get back.
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Dr. Sanjay Mehta
It's a beautiful thing.
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Host
And the side effects seem to be very limited when you are using low dose radiation. What are some of the biggest myths and fallacies surrounding radiation?
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Dr. Sanjay Mehta
Sure. So the biggest thing is the danger of what am I going to do? Am I going to glow in the dark? Am I going to grow a third arm? Am I going to. I've even been asked, are you going to get superpowers when you watch too many, I guess, comic book movies or something like that. But basically the biggest thing is that is radiation going to cause more harm than good? That's what people are afraid of. And if it's done incorrectly, certainly it could. And that's when, you know, historically people have heard about the atom bomb. And everyone's, especially lately, the Oppenheimer movie came out a couple years ago. Very good, great movie, right? Fantastic movie, fantastic. But essentially all that was, was essentially a nuclear bomb is basically an uncontrolled, massive way of scattering electromagnetic radiation. So the people who were unfortunately in the area where the bomb was dropped in Hiroshima, for example, they got a very high dose of radiation. And the people who were in the immediate blast radius, they all died basically instantly. But we've learned a lot about what radiation does to human beings and to our tissues and to our organs. As you look at the people who died in those, in those unfortunate wartime bomb explosions, as you go 10 miles out, 20 miles out, 30 miles out, you see, as the dose goes lower and lower, you can examine different effects on people. So the immediate effect, the blast radius, they would die. If you get a few miles further out, they didn't die right away, but the high doses of radiation, the first thing it'll do is basically wipe out Your bone marrow and your entire GI tract, all your mucosal cells. So any fast growing cell in the body, which would be your bone marrow, your, your squamous cell lining of all your oral cavity, all the whole GI cavity, it just desquamates and goes away. So horrible way to die if that were to happen. But again, this is a full body, super high dose. We don't do that. But as you get another 10, 20, 30 miles out, it's actually been found now that a lot of the people who are further out in their, further out from the immediate exposure got a very low dose of radiation and they really didn't have any side effects at all. And it has now gotten to the point now that it's been studied long enough, it's actually been found that very low doses of radiation actually promote hormesis, just like exercise does. And back when I was in medical school, we hadn't even heard of hormesis. But now obviously you're an expert on that and a lot of people now that speak about it in the exercise realm and dealing with, you know, hot and cold plunges and things like that, a little bit of hormesis, a little bit of tissue damage makes the body stronger. And we're now finding out that that actually seems to be the case for radiation as well.
- [19:15]
Host
Low dose, I mean, yeah, low dose, not high dose. High dose. Radiation, obviously you said is lethal and lower dose seems to have positive effects when it.
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Dr. Sanjay Mehta
And high dose is lethal. But in some cases that can be, can actually be harnessed and be a good thing because if you can give a very focused high dose to a small part of the body, you can kill the cancer like we do for prostate cancer. You just don't want to treat too large of an area and damage the surrounding organs. And that's probably, as you asked about, what's the biggest fallacy about radiation is that it's toxic and it's going to make me really sick. But when done properly, it actually has less side effects than a lot of other treatments. Usually less than chemo or surgery, depending on where you're treating. If I treat a small enough area, I'm not damaging the rest of the body. Patients have excellent quality of life and we can still achieve the goal of killing the cancer without causing a lot of collateral damage.
- [20:08]
Host
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- [21:25]
Dr. Sanjay Mehta
Mechanisms, different mechanism of action. So in the case of ionizing radiation, it basically all the waves or the energy of the waves that determines how I aim it. It's still the same basic entity that we're bombarding the tumor with. But if I have a, a 250 pound guy with a pelvic tumor that's got to get through 10 inches of tissue versus a superficial scar or a skin cancer where I need the radiation to go. The depth of penetration is what I have to modulate. And that can be done based on, it's essentially all physics at that point. The different energies of X rays can be generated from different machines and you essentially can use a very low energy superficial radiation for certain things that would be useless on a deeper thing. And that's where things have really changed over the years. Because say 50 years ago when the modern radiation oncology discipline really started coming onto its own, there were a limited number of machines and they only had one or two energy. So if you wanted to treat something superficial, you could do that. But if you had to treat a deep pelvic tumor, you would cause a lot of superficial damage to get to that. But now we have the ability to use a high energy X ray, like millions of volts. The thing is, when you think about X rays, we use X rays all the time. Everyone's been to the dentist when they do a jaw X ray to look for cavities. It's a low energy X ray. It's the Same X ray that I use, but the difference is that's a kilovoltage X ray. I use a mega voltage X ray. So the kilovoltage, a thousand volts is enough to get a good image of a bone and you can see if there's any deterioration, you know, a cavity or what, or a broken bone. If you go to the, you know, you go to the er, you get a, an X ray of your arm if you fell down or something. The KV kilovoltage X rays will just take a picture, but they don't have enough energy in them to kill, to damage cancer cells or damage any cells for that matter. And so the higher energy stuff can penetrate deeper into the body and it has the amount of energy needed to damage the DNA to actually have a biological effect and not just an imaging effect.
- [23:22]
Host
But would you be able to use that tool for both when you go.
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Dr. Sanjay Mehta
And so actually the machines that we use now that what's really, really revolutionized what we do as radiation oncologists is not only being able to give a high dose of radiation to a small area, but to be able to aim it correctly. So we do what's called image guided radiation. So the imaging part is done by low energy X rays, like I mentioned, kilovoltage X rays like a CAT scanner or a regular X ray. And then the high energy or mega voltage X rays will treat the tumor. So when the patient gets on my table, we take a regular image first, whether it's a CAT scan or a plain film, and I can see where we're aiming. And then while they're in that position, then we turn on the high dose X ray and it'll actually be enough to treat the cancer. So we do it based on CT planning. We usually will do a CAT scan, map out the depth and the area. I'll actually literally take my mouse and contour out the volume of the prostate gland or the breast tumor or whatever it might be. And then with the modern software that we have now, we can take CAT scans, which are two dimensional images, and reconstruct into 3D so I have a full 3D image of the patient's body on the screen and we can make sure the beams come in from different angles and we can modulate the energy and the shape of the beam to match exactly what the tumor looks like. So I could create a tumor. I mean, I could create a ball of radiation that looks exactly like the shape and size of the tumor, even if it's got, got a little Mickey Mouse ear Sticking off one side. I can do that too. While simultaneously shaping it to stay away from all the normal tissue. So that's where you get the advantage. Basically what we call the therapeutic benefit, where you're radiating what needs to be radiated, but you're not radiating and damaging the normal tissue.
- [25:01]
Host
And do all, I mean, there's various types of cancers. Do all cancers respond to radiation?
- [25:08]
Dr. Sanjay Mehta
So the short answer is yes, and I won't bore you with too long of an answer, but it's a little, there's always a little more nuance to it than that. So yes, there is no cancer that cannot be destroyed by radiation. The limiting factor is the human being around that cancer. So I gotta be cognizant of the normal tissue. So if you took a tumor in a petri dish, anything can be radiated and it's gonna destroy those cells. But let's just say it's a, you know, a tumor in the tip of your pinky toe. There's not much around there. I don't have to worry about a kidney or, you know, or an eye or something like that. But if it's a brain tumor, I have to be very worried about what I'm treating to the normal brain tissue. The dose that's going to the lens of the things like that. So depending on which part of the body it's in, the surrounding normal tissue will dictate how much radiation I can safely deliver.
- [25:54]
Host
And it doesn't affect the dermis, you can just go right through the skin.
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Dr. Sanjay Mehta
Great question. So based on that energy. So if I have a skin cancer, I will use an energy of radiation or a type of radiation. One is called electron beam, which will literally only go in a few millimeters. So I can treat that superficial skin tissue and not affect anything deeper. Even if it's. I've treated like a squamous cell right on the temple of an old lady who was. She's a 90 year old who's on anticoagulants and she can't be off of her meds. So they couldn't cut it out. So we just radiated it. But with electron beam, the X rays stop a couple millimeters deep into the tissue. But if I'm treating a brain tumor, I'm going to treat the same area with a high energy X ray that will, like you said, it'll spare the dermis. They won't even get a sunburn. But the energy will go deeper into the brain.
- [26:41]
Host
Gosh, that is unbelievable. Someone would not have to be opened.
- [26:46]
Dr. Sanjay Mehta
Correct. And not even burned. So that's the big thing. People are like, oh, am I going to get burned? And that goes back to your previous question about what are people concerned about? Everyone thinks they're going to get burned really badly. And that again is based on seeing all these horrible pictures from nuclear disasters and with older radiation equipment. Back in the 1950s and 60s, we had what was called Cobalt 60, where it was just basically an actual chunk of radioactive cobalt that the patient was exposed to. It would burn the skin, and if you're trying to treat, say, a breast tumor, it would completely really burn or necrose the skin in order to get enough dose, deep enough to treat the breast tumor. But now we don't use cobalt. We use these high energy X rays that are, that are generated by a machine called a linear accelerator, or a linac for short. So the linac is our bread and butter machine that creates the X rays, the high energy X rays.
- [27:34]
Host
Does everyone use a linac?
- [27:36]
Dr. Sanjay Mehta
Almost everyone. The other things you'll hear that are alternatives. And being in Houston, we have MD Anderson up the street. The. They have proton therapy. So protons are different than photons or X rays. So they have their own, what's called a cyclotron, which is essentially a particle accelerator to create protons, but that's a completely different topic. But most cancer centers do use a linac. So a linear accelerator can generate the low or high energy X rays, depending on what I need to treat. So with a linac, I can treat a lung tumor, for example, and the surface of the skin will get a little dose, a little redness, but not a horrible skin reaction. And if it's a deep enough tumor, with a high enough X ray, sometimes the skin dose is almost undetectable. Like it's low, but not even enough. Like my prostate patients, they don't even get a sunburn. Maybe a little bit of a tan spot, but that's about it.
- [28:22]
Host
Which they're definitely not looking for in that area.
- [28:25]
Dr. Sanjay Mehta
Right.
- [28:26]
Host
Once you treat someone with radiation, obviously it's a few treatments, a handful of treatments.
- [28:33]
Dr. Sanjay Mehta
And that's another big topic in terms of how much do you. Because it's not just how much radiation you give, it's how frequently do you give it and how, how many pieces do you slice your pizza up into? Do you. What you get a. You know, when you get your pizza from Domino's, it has eight slices. If they, if you cut each one in half, you get 16 smaller slices. It's still the same pizza you're getting. So with, with radiation, for Someone with prostate cancer, you can do different protocols depending on. There's a lot of different data out there where you can give, say, nine weeks of treatment, or you can give four weeks or even one week. Now they're looking at different things, but it gets much more accelerated. You can give a higher dose per day. If you give a higher dose per day, there's a potential for more side effects. So you have to be careful the slower you give the radiation. If you give a tiny bit per day and you stretch it out over many, many weeks, you have a lot less normal tissue toxicity in most cases.
- [29:20]
Host
And is that all measured in grays?
- [29:22]
Dr. Sanjay Mehta
It is. So, like, for example, a prostate patient. Historically, if you asked me this 10 years ago, what do you give a prostate? We would give 81 gray, but given in 1.8 gray per day, which is 45 days. So. So 1.8 times 45. But that also requires the patient come in for nine weeks. It's a lot of visits. Whereas typically now we will use 70 gray. So it sounds like you're not giving as much radiation, but at 2.5 gray per day, rather than 1.8, you only have to give 28 days. So 70 gray in 28 days is the equivalent of getting 81 gray in 45 days. And it's a lot less visits to come in for.
- [29:58]
Host
It shrinks the cancer, but does it cure it?
- [30:01]
Dr. Sanjay Mehta
That's the key thing. And so, typically, yes, that's what we have to go for, is that if we were just shrinking it, then you would see these like, let's talk about prostate cancer. The cure rates for prostate cancer are essentially the same whether you use external beam radiation or whether you have a radical prostatectomy.
- [30:17]
Host
In one case, the cure rates are the same.
- [30:19]
Dr. Sanjay Mehta
They're literally the same, even though in one case, you're surgically removing the tumor on the other side. The prostate gland is never removed from the body, but the energy from the X ray sterilizes the cells. So even though the. The organ is physically still there, if you were to do a prostate biopsy on someone after radiation, you would just get scar tissue out. So the physical gland on an X ray is still there, but it's no longer active, viable tissue. So you are still curing the cancer. That's the goal anyway. And so an average prostate patient might have a 95% chance of being cured with radical prostatectomy. It's basically the same with radiation.
- [30:56]
Host
Oh. Oh, sorry. It's time to record an ad for the show. Thank you. To one of the Sponsors of the show Timeline. And listen, my kids still sleep with me and after 470 nighttime snack requests, bathroom breaks, my husband snoring, my cells, they're like, yo, gee, we're tapped out. Enter Mitopure. Timeline Nutrition is one of the most thoroughly researched products I have come across in over a decade. Look, carry it in my purse. They have peer reviewed published science and this is where it gets really interesting. So for this, those of you who are following the muscle centric lifestyle, when you increase bioenergetics, you improve muscle function and health in adults. 40 +, timeline has been shown to increase muscle strength and endurance and no change in activity. So whether you've been active resistance training your whole life or you're just getting started or you're not getting a lot of sleep and you've got a million requests, your muscles and your mitochondria need help. And they have just launched their low sugar vegan non GMO gluten free gummies, which by the way, I am eating by the handfuls, which I shouldn't, but they taste delicious. Timeline is offering our community 20% off your first order. Go to timelinenutrition.com doctorlion and use the code Dr. Lion to get 20% off. I recommend trying their starter pack with all the all three different formats and of course their gummies, which are incredible. What are the side effects of surgery or radical prostate?
- [32:29]
Dr. Sanjay Mehta
The biggest problem with surgery is usually incontinence because when the prostate is removed, the intra prostatic urethra comes out along with it and then the urinary sphincter muscle gets damaged as well. Because in the process of removing all that, there's always damage to those areas. There can be nerve damage as well that can lead to sexual dysfunction.
- [32:49]
Host
That is the biggest one that I've seen.
- [32:51]
Dr. Sanjay Mehta
And that and also it's not talked about as much, but penile shortening because they have to re anastomose the penile urethra to the bladder neck in order to create a new pathway. The intra prostatic urethra is gone. So that length is gone. And so I haven't met too many men who are okay with that either.
- [33:07]
Host
You are the second person in all of my years of speaking with physicians that have mentioned penile shortening.
- [33:17]
Dr. Sanjay Mehta
It's just not talked about much.
- [33:19]
Host
I don't think people even know about it. We had Dr. Tobias Kohler, he's a Mayo, Mayo Clinic doctor. He runs the Men's Health over in Minnesota and he was talking about if you don't use your Penis over a three month period of time.
- [33:33]
Dr. Sanjay Mehta
Yes.
- [33:34]
Host
That you can shorten your penis by a centimeter.
- [33:38]
Dr. Sanjay Mehta
That's, that's a lot. Yeah. And I think it's slightly reversible. Right. If you start to have penile therapy, you can get some of that back. But if you have a radical prostatectomy, that's irreversible at that point.
- [33:48]
Host
If you have a radical prostatectomy, which is removing the prostate, you can reduce penile length by how much?
- [33:59]
Dr. Sanjay Mehta
Probably a couple of centimeters on average. Yeah, depending. Because that's when you look at the anatomy, the penis or the prostate itself in depending on the size of the gland. You know, you get bph. Some men that are older have a really, really large 100 gram prostate. That's a lot of tissue to remove. And so the, the urethral length that's inside of that is, is gone after that. Now that's not to say, to be fair to the urologist who may be listening and shaking their status, there's plenty of side effects that potentially can happen from radiation too. But luckily in the modern era, this is called image guided radiation. And because it's so much more precise, the traditional problems with radiation were cystitis or proctitis. You would be radiating the tumor, of course, but you're also radiating the bladder and the rectum. And that could cause blood in the urine. With cystitis, it could cause severe diarrhea or blood in the stool. In some cases they were worried about. You hear this in the. It's all historical. It doesn't happen anymore just to, just to ruin the story, but fistula formation, you know, a colovesicular fistula from the scar tissue causing the organs to stick together and fistula. But that was in an era when we didn't have modern computer imaging. We didn't have CT scans, we didn't have PET scans. So many times the bladder and the rectum got almost as much dose as the prostate did. And that's where radiation kind of got part of its bad rap was because this is in the 70s and 80s, there was some really bad side effects or like I mentioned earlier, cobalt 60 causing severe sunburns. But now that we have modern image guided high energy radiation, we can have the radiation beams concentrated. Like just if the prostate is this big around, I can literally map the radiation just to that area. So the dose fall off, meaning the amount of radiation that's delivered just outside of that is very sharp. So you have a nice sharp fall off to where you're not getting a bunch of low dose radiation to all the surrounding tissue. It basically goes close to zero. And therefore you're not causing the cystitis and the proctitis like we used to. So that's gotten much better. But the one thing about radiation that people have to keep in mind is when you. And this has been discussed quite a bit whenever you're discussing the pros and cons. Even though we don't cause the impotence and the incontinence the way surgery potentially can. Many patients, if they have a more aggressive prostate cancer, the data shows they have to be on testosterone blockers along with, with the radiation. So that in itself, androgen deprivation, you hear it called ADT testosterone, basically a medicine like Lupron that's, that's, that's suppresses the body's ability to make testosterone. That is a potential side effect from radiation that many surgical patients don't have to deal with. And so you deal with hot flashes and decreased libido and all the usual because you're, you're not just lowering their, their testosterone. It's going to go close to zero.
- [36:42]
Host
And I think it from talking to our mutual friend Dr. Mohedkara and Abe Morgenthaler, both of which have been on the show, the joke is I have the number one men's health podcast and YouTube, but we'll save that for another day.
- [36:55]
Dr. Sanjay Mehta
Yeah, I'm not in their league. They're both the kings.
- [36:57]
Host
Well, I don't know. You've got. I'm working on it. Sanjay, you've got some pretty extraordinary skills that are very unique to a small subset of physicians to be able to really treat arthritis and things of this nature as well as cancer. But certain prostate cancers, they do well with testosterone therapy. It all just, I guess it just depends on that.
- [37:19]
Dr. Sanjay Mehta
Isn't that interesting? And Mohit is, he's obviously on the forefront of all the research they've done. Despite all of that and all his data is very valid. We still, the standard of care we still use for aggressive prostate cancers. We deprive the body of testosterone for a period of several months to even several years. And that still has shown a survival advantage in those situations. Situations. Now the good part is once they're cured, their PSA goes down. Mohit can put his patients back on testosterone, which in the old days they wouldn't. That would be a big no. No is no no t for life. But now he's shown that it can be brought back. So. But there is a temporary window that with radiation, even though the radiation Might only be six weeks. If it's a more aggressive prostate cancer, they might need 6 to 12 months of androgen suppression. But in the big scheme of things that go, that's all reversible. And there's better drugs now too. Some of the modern oral LHRH agonists, they don't cause as, as, as long or as severe of the hot flashes as the old Lupron shot did. And so it's gotten better. But for some of the lower grade patients who don't need the androgen suppression, if it's just radiation alone, extremely well tolerated, they really, the only thing that patients have is a little frequency or urgency. We're in Texas, so if either spicy foods, maybe a little bit of, bit of dysuria and as you're passing the spicy chemical, the capsaicin around of the urethra a little bit bit, but that's really minimal stuff. Patients are thrilled because they can go through their life. I have guys, I have bodybuilders that are, they're still training for competitions and they're coming in for their treatment. They get their treatment, go right back to whatever they were doing. We got retired guys, same day, the same day, same hour. I mean, literally 15 minutes head straight from my clinic straight to the gym. We got older guys that head straight to the golf course, straight to the, you know, back to whatever they were doing. They go, my dad, I treated my own father. Father. And he rides his bike three miles a day. And the only thing that was bothering him was his hand was getting sore. And I fixed that too.
- [39:07]
Host
Is there anyone who would not be a candidate for radiation therapy, for example, prostate, breast?
- [39:15]
Dr. Sanjay Mehta
Very few. There are rare situations. Like there's certain hereditary disorders of DNA repair like zero derma pigmentosum and stuff that you probably haven't heard about since med school.
- [39:25]
Host
I don't even think I heard about that.
- [39:26]
Dr. Sanjay Mehta
Like, those are, you know, there's. You'll hear about a case where a patient can't be out in the sun at all.
- [39:31]
Host
Yes.
- [39:31]
Dr. Sanjay Mehta
And so 0 dermapigmentosin, these patients have no DNA repair. So even the minor amount of UV exposure, they'll have horrible like sunburns and things like that. So in those. And again, I, I don't think I've ever seen one of those people in real life. But theoretically there are cases like that. And there's individual situations, like not an absolute contraindication, but a relative contraindication. Could be an active autoimmune disease, like really bad. Had rheumatoid arthritis or Sjogren's disease. Any of those things might cause the radiation type of the DNA damage caused by radiation to be more severe. I've still treated people with all of these things, and as long as you do it properly and you modify the dose appropriately, it's still very doable. But that is a potential issue. Or if they've had a previous tumor in the same area been previously radiated, we have to be very careful. It's not an absolute contraindication, but relatively speaking speaking, I have to make sure that my dose doesn't overlap with what was previously treated and, you know, things like that.
- [40:25]
Host
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- [41:34]
Dr. Sanjay Mehta
No, it's. That's a little. Probably a little too much of a blanket statement. As much. As much as I'm a, you know, a believer in what we do, there's many, many different situations. So depending on what part of the body it's in, if it's a cancer that has a metastatic potential, like a lung tumor or maybe a lymphoma or something, where it's more of a systemic disease, chemo and radiation are many times needed. There's many situations where chemo alone can work because, you know, as, you know, cancer is not just one disease, it's so many. So for certain diseases, radiation alone works very well, like prostate cancer. But for most other ones, radiation is more of a, of a, a part of the multidisciplinary approach. So in many cases, it may be chemo, radiation and surgery. Sometimes surgery first followed by chemo radiation in Other cases, like for a rectal tumor, the randomized data shows that chemo radiation combined will shrink the tumor enough to where then the surgeon can go in and remove it and reduce the risk of them losing their sphincter or things like that. So many different scenarios, so hard to make a blanket statement.
- [42:33]
Host
And I really appreciate that because we've moved into an era where we are very radiophobic and to frame that up for the listener, the viewer, other than my dad, who might be, I think he's the only one that watches YouTube, but hopefully we're changing that. Here's what I've heard. Okay, don't use ipods, those Apple ipods, because it's going to create radiation for your brain. Do not stand near the microwave. I've had patients who don't want to get mammograms because they are afraid of radiation. Other patients that are afraid to go through the security line and will request an opt out, especially if they are pregnant. Did I miss any more other additional common.
- [43:23]
Dr. Sanjay Mehta
I think as a child of the 70s and 80s, when I was growing up, it was always don't sit too close to the tv.
- [43:28]
Host
The tv, yeah.
- [43:29]
Dr. Sanjay Mehta
And so let's address one of those.
- [43:31]
Host
Don't put the computer. The computer on your lap. Don't put your cell phone in your pocket.
- [43:35]
Dr. Sanjay Mehta
That's right. And so all of these things are different. Some of them have more credibility than others. So the TV part, the microwave oven or the AirPods, the iPod, those are all non ionizing radio waves and microwaves. So going back to what we talked about previously, in terms of the electromagnetic spectrum, when you're on the non ionizing, low energy side, those are not harmful. So the, so the headphones, the, the AirPods, the microwave ovens, none of that stuff is going to damage your tissue.
- [44:05]
Host
And we know that those are strictly non ionizing, correct?
- [44:09]
Dr. Sanjay Mehta
Correct. Because ionizing radiation is much more tightly regulated. So like the, the mildest type of ionizing radiation would be ultraviolet. That's less, less of a strong energy than X rays and gamma rays, which is the farther end. But even like a tanning bed, for example, those are now regulated by the fda. You don't want to be in it. I mean, tanning salons are obviously big business, but those are ionizing and they can cause skin cancers and things like that. So but on the other hand, as you mentioned, the lady who's afraid of going through an airport scanner because she might be pregnant, that is ionizing radiation. It's a very low dose to get us like an X ray to security area. But that is an X ray. X rays by definition are ionizing. And if I had a chance of being pregnant, I wouldn't go through it either. I think that, I think that's a very reasonable thing.
- [44:54]
Host
Wait, wait, wait. This. Is this really important for the, the community?
- [44:59]
Dr. Sanjay Mehta
Yes.
- [45:00]
Host
Going through the. Is it the machine that you stand up that scans you or is it the. What. What is it?
- [45:06]
Dr. Sanjay Mehta
Yeah, so there's different types. There's like thing. There was one. I'm not an expert on this by means, but there's a millimeter scanner. But they all do use X rays. It's very low dose. It's probably not a big deal, but why take the chance? It's in theory it is low, low doses of ionizing radiation, like any X ray. And that if you have enough of them. Now, if I wasn't, if pregnancy was not an issue, I wouldn't think twice about it. But for a pregnant person, why take any chance? There's a principle we have called Alara A L A R A and that stands for as low as reasonably achievable, A L A R A. And that's one of the things, the tenets of radiation safety where no matter what we're doing, why not minimize things as low as reasonably achievable? Why, why put even, even if there's a 0.01% chance of damaging a fetus, why not make it zero and just not do it? But if it's not a pregnant person, these doses are so minimal. And that's where, getting back to what we talked about earlier, radiophobia is a real thing. And when you have high doses of radiation or whole body radiation, those effects are potentially lethal or at least very much damaging. But at very low doses, this is the point I wanted to make. At very low doses of radiation, it was always thought that even super low doses could cause DNA damage and therefore potentially cumulative effects over time. And I would agree with that. Like for someone with who's pregnant, that's a different scenario. But for a non pregnant and a non, like a child who still has multiplying cells and is still, you know, growing, we try to basically keep the radiation dose at zero. But for adults who are fully grown, it has now been shown that these super low doses, radiation are not only not damaging, there may actually be a hormetic, a hormesis effect, which you said.
- [46:47]
Host
Again, that I think we're not really thinking about in that way.
- [46:50]
Dr. Sanjay Mehta
So these super, super low doses, like the amount that they use for an airport Scanner is tiny. It's so little. If I was pregnant, I still wouldn't go through it. I don't blame her. But otherwise it's nothing for the average person to be concerned about.
- [47:02]
Host
Where else would we be exposed to radiation like that? Would that be the red light? Those red light beds, just also the red light panels, which by the way I use all the time, so you better tell me.
- [47:13]
Dr. Sanjay Mehta
Yeah, no red light is, is visible. If you can see the light, it's not ionizing.
- [47:17]
Host
But is there some light that we again that maybe is being produced that we're not seeing?
- [47:21]
Dr. Sanjay Mehta
My smart ass answer to you would be everywhere living on Earth is where we get exposed to radiation. That's because there's, there's radon gas in the atmosphere. Of course you have UV radiation from the sun, which is absolutely everywhere. And depending on where you are in, in the country or in the world, the elevation you're at makes a big difference. Difference. So people in Denver, mile high, get way more background radiation than we do here in Houston at sea level. But an interesting point about that. Even though they get far more radiation, the, the baseline level of cancer incidence, Colorado versus here, no difference, undetectable difference. Even though we get far less exposure than they do, it's still within that small amount to where it's not a problem. People who are either astronauts for one thing, get a ton of radiation. They're beyond the atmosphere. But even people in the airline industry, pilots and airlines, they do get a relatively high dose because you're up in the air all the time. But even in those populational studies, I haven't seen any data showing that they have a higher incidence of cancers than those of us that stay on the ground most of the time.
- [48:28]
Host
Is it the location of where someone is? So the higher they get up in the atmosphere, the higher the. Is that because it's closer to the sun?
- [48:34]
Dr. Sanjay Mehta
Yeah, you have, you have less shielding from the earth's magnetic field and, and.
- [48:38]
Host
Also from the atmosphere, from the earth's magnetic field. Even though you're in a plane where you're not really being exposed to, you're still, you're still.
- [48:45]
Dr. Sanjay Mehta
It's because it's not. It goes. The plane itself is made out of metal and that will shield a certain amount, but a lot of it still goes through. So.
- [48:52]
Host
Have you ever. Okay, don't make fun of me. We're friends, so don't make fun of me Sunday. But there. And again, I did this while I was pregnant. There were blankets that were EMF protector blankets. There were shields of placing my computer on an anti. You know they call it this anti emf anti radiation tablet. Talk to me about that.
- [49:14]
Dr. Sanjay Mehta
Yeah, so that's all, all the electromagnetic frequencies now that's all non ionizing so it's not of any danger.
- [49:21]
Host
So you're saying I wasted my.
- [49:22]
Dr. Sanjay Mehta
I, you know, again, there's a lot of things I'm not trying to say. Medicine, modern medicine knows everything and it's your own child you're talking about. Why not be a little extra cautious? I wouldn't, I would probably agree with everything you did as to whether it helped or not. It certainly didn't harm anything. Maybe harmed your pocketbook a little bit. But you know, electromagnetic EMF is not going to like you could, you could have a television and a radio and a microwave on all the time and it's not going to do anything.
- [49:50]
Host
It's a really important conversation because there's a lot of misinformation out there and frankly it's confusing for me as well, which is why I bought a EMF blanket and I use this tablet that I put my computer on. But if it's not accurate and it's not, then I think that we have to. The whole point is to have.
- [50:08]
Dr. Sanjay Mehta
Did you ever see that self that it was a viral video probably 15, 20 years ago when viral videos became a thing about the cell phone in the, in the bowl of unpopped popcorn and then someone would dial that number and the cell phone to ring and all the popcorn kernels started popping and becoming popcorn. That was that. Everyone used to ask me about that like oh my God, if this cell phone can pop popcorn. Of course it was. It was a joke. It was a hoax. It was completely fake. But even if it wasn't the popcorn kernels, what makes them pop? It's heat. It's just thermal energy. It's not radiation that does that. So there's a lot of that type of stuff that's out there that unfortunately is a multi billion dollar industry with misinformation. Same, same as we see with all these liver cleansers and all these, you know, it's. There's no end to this sort of stuff.
- [50:54]
Host
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- [52:38]
Dr. Sanjay Mehta
Yeah. Static electricity. That's actually important if you're putting gas in your car because a little spark can cause a big kaboom with the evaporating gas fumes. So that's why you don't want to be talking on your phone when you're putting fuel in your car. I didn't know that that's actually a real thing.
- [52:56]
Host
Okay, what you got to tell me, you should not talk on your phone. What if you're using an ipod?
- [53:01]
Dr. Sanjay Mehta
Yeah. So it's extremely rare, but there have been a few explosions at gas stations, and people are. An ipod is probably fine.
- [53:08]
Host
No, no, you gotta tell. I mean, listen, I do not want to.
- [53:11]
Dr. Sanjay Mehta
The only time I've heard it's blown up. Because think about what's happening when you're on your cell phone. It's basically like it's a walkie. It's a fancy walkie talkie. It's a radio. So there's radio waves that are going back and forth, but there's a little tiny amount of potentially static electricity, that which we generate just by touching the ground. You know, static electricity. You, you know, on a cold day with. Barefoot on the carpet, you zap yourself. And so that same sort of thing can happen with. With a electric electronic device. No big deal. But when you're putting gas in your car. Some of that gas is evaporating. And so the gas fumes are highly flammable. So that's a situation where if you. I'd get off the cell phone.
- [53:47]
Host
I don't think they taught. I don't think they teach us that.
- [53:50]
Dr. Sanjay Mehta
Yeah, and maybe some people don't agree with me on that, but that, that was an actual thing and I know that. Actually you'll see it some gas station stations, there'll be a sign saying turn off your cell phone. Another thing to say, turn off your car when you're filling it up, because the ignition source of your car, the actual spark plugs that are igniting your engine to keep it running, in theory could ignite some gas fumes. That's a whole. That's nothing to do with radiation.
- [54:10]
Host
Okay, but. Okay, we're going to go back to radiation.
- [54:13]
Dr. Sanjay Mehta
Don't let me start talking about cars.
- [54:14]
Host
But I will say that I actually got into a fight with my husband about turning off the car.
- [54:19]
Dr. Sanjay Mehta
Yeah.
- [54:19]
Host
While you're pumping gas.
- [54:20]
Dr. Sanjay Mehta
Yeah, yeah.
- [54:21]
Host
He told me. No, no, he was right. He said, you have to turn off your car. And I said, well, why on earth would you have to do that?
- [54:27]
Dr. Sanjay Mehta
And having said that, I know plenty of people who, when it's hot 100 degrees in the summer in Houston and your spouse is in the car, you don't want them to bake for 10 minutes.
- [54:36]
Host
Yes, you do. Yes, you do. Let's talk about how your treatment, what your low dose radiation treatment is, especially around musculoskeletal injuries.
- [54:49]
Dr. Sanjay Mehta
So this is really a new paradigm for America. This is a, the situation is that typically we always use radiation to kill cancer cells. It takes relatively higher doses to kill a cancer cell versus low doses of radiation, which it turns out will actually stop inflammation. So if there is inflammatory cells in the body, if there's a part of the body where you have a painful joint or something, that's essentially white blood cells, macrophages that, that have migrated to wherever the area of pain is and they secrete cytokines, interleukins and different cytokines that create the inflammatory cascade. It turns out that very small doses of radiation, not enough to affect the rest of the body, but very small doses can stop those white blood cells from living. It basically kills them and stops them from migrating to the area of pain. And so it's the same effect as a cortisone shot. Cortisone is an anti inflammatory drug. Radiation, the same radiation we've been talking about when given in very small doses is it wipes out the white blood cells that cause inflammation and therefore it actually can stop the pain in a joint. And this is something that the rest of the world has been onto for 125 years. Not just a couple of years, a decade. We're talking about since the late 1800s. And Americans also used to use this. So this was a very commonly done procedure to treat joints for arthritis, even in the US up till the 1960s or 70s. But since that time America decided not, it wasn't a formal decision, but America just gravitated towards using drugs, cortisone shots. Then of course, when ibuprofen became a thing, if it was a prescription, ulcers. Do you remember? There was a time, you may be too young to remember, when ibuprofen was a prescription. And so at that time it was a big deal. When that first came out, then you had all the other, the COX2 inhibitors, the Vioxx and the Celebrex, all of those drugs, they, they worked really well for pain. Now granted they had all kinds of other side effects, but Americans kind of gravitated away. Doctors stopped using radiation, they just used drugs for this. Whereas the Europeans and a lot of the rest of the world, Asian as well, but especially in Europe, the Germans and the British continue to publish studies and use low doses of radiation for various joints. And now they have very robust hundred year old data showing that it's safe and effective to stop joint pain, whether it's osteoarthritis, whether it's, whether it's tendinitis, whether it's bursitis, plantar fasciitis in the foot, any type of an inflammation, radiation can stop that inflammation chain reaction and let the body heal and really cause and really help the patient in terms of pain reduction.
- [57:22]
Host
Prior to the 1960s, when was this first utilized and who was delivering it? Was it, you know, was it the orthopods? Was it physical medicine and rehab?
- [57:33]
Dr. Sanjay Mehta
That's a great question. So in the earliest days. So this actually goes back, go back to. Let's maybe talk for a second about the history of radiation. Dr. Roentgen was the, was the doctor in 1895 in Germany that first described what an X ray, he gave it the name an X ray. And so when they were X rays were first discovered, that was 1895 when he first published. You've probably seen that iconic picture of the, of the hand with the bone showing and there's a big lesion on the fourth finger, which I Asked my med students, you know, what is that? And they're like, oh, is that an osteosarcoma? Like, no, it was his wife's wedding. Wedding ring. But that was the very first X ray that was ever done. That was 1895. By 1898, there were already publications in the scientific literature showing radiation being used for all kinds of things. For cancer, for one thing, but also for ankylosing spondylitis. It was given in the spine. And so that. Those were done by. Those are. Essentially. There weren't even any radiologists yet because it wasn't even a discipline yet. So this was just a general practitioner that had access to an X ray machine. Machine. But as the years went on then it was. There were no radiation oncologists. We weren't a thing. That my discipline is relatively new. It's only the last 50 years, roughly. That's exactly right. And so in the earlier days, it would have been done either by an interventional radiologist who had done some kind of fellowship or just. There was no. Really no regulation. So, you know, dermatologists were using them for skin lesions. But you didn't have a linac. Remember the term linear accelerator? Those are all highly regulated, very complicated, expensive machines. Machines that are really part of the modern era. But back then they had superficial radiation machines or even an actual radioactive isotope. Like, for example, you could have a tiny little piece of a radioactive chemical called strontium. Oh, yeah, that could be applied directly to the cornea for a pterygium, and it would make the pterygium go away.
- [59:15]
Host
You know, you can take that orally, right? Did you know that?
- [59:18]
Dr. Sanjay Mehta
Yeah, I've heard of that. You probably know more about it than I do, but I've heard of it. I mean, I don't know what you'd use it for, but it is used like there's liquid forms that can be instilled in various parts of the body, like to try to cauterize, like a hemangioma maybe, or something like that.
- [59:32]
Host
Radiation was given, but it wasn't utilizing a Linux machine that is able to target. That's right where it's going.
- [59:40]
Dr. Sanjay Mehta
It was very crude. Crude, but it worked.
- [59:42]
Host
But did it cause damage? One of the things that I want to really offer people is a solution. Right now in the US Someone has. Has plantar fasciitis or, you know, I've had. God knows I've had a ton of bursitis. What you will be recommended to do is take an ibuprofen or take Something else. Lay off of it. And you can't do any work for.
- [60:04]
Dr. Sanjay Mehta
A while or go get a cortisone injection.
- [60:06]
Host
Yes, yep. What about living next to an electrical.
- [60:09]
Dr. Sanjay Mehta
Tower or that's, that's EMF again. And so that's electromagnetic frequencies that are not able to, Able to damage your DNA. No, but.
- [60:18]
Host
Is that radiation?
- [60:19]
Dr. Sanjay Mehta
No, but.
- [60:20]
Host
Radiation.
- [60:21]
Dr. Sanjay Mehta
Okay, so the, this is like a whole. I'm not a physicist. I could probably explain to you better if I got a physicist to back me up. But the electromagnetic spectrum does include electricity and waves. Like things that. There's electric, there's electricity and there's magnetism and the two combined. Electromagnetism is what powers everything in here. But those are not, not waves that are able to eject an electron off of a nucleus because it's.
- [60:46]
Host
The radiation is that it disrupts atoms.
- [60:49]
Dr. Sanjay Mehta
So when you have just, let's say a water molecule, H2O, you got two hydrogen atoms and an oxygen atom when ionizing radius. And most of we're mostly water. We're just bags of water. Right. With a little bit of salt. Yeah. Well, you're, you're more water than the rest was because you're more muscle. The more muscle you have, the more water you are, as opposed to fat. And so when you hit, when it, when a little X ray comes and hits a water molecule, it will eject a hydroxyl ion, an HO ion and a free radical. You know all about free radicals. And so that creates an ion. So where you had a stable H2O molecule, now you have an oh, hydroxyl group and a proton that comes off of it. And so when that happens, the ion can zip around and hit a double helix DNA molecule and damage it. And that's DNA damage, which is what you're trying to do in the case of cancer. And what I didn't mention, I probably should have. When you're treating cancer cells, their DNA, the cancerous DNA is fragile to start with. It doesn't have the ability to re anneal and form the double helix back when you damage it. So that's the beauty of. When I radiate someone's tumor. The cancerous part will fall apart more readily than the normal cells that still have the repair mechanisms in place. But non ionizing radiation can't do any of these. Of that.
- [62:04]
Host
Is there any positive benefit of non ionizing radiation?
- [62:07]
Dr. Sanjay Mehta
You know, I think like in the psychiatric realm, they're doing tests with like, they're using. Have you heard of like, what's it called?
- [62:14]
Host
TMB or what's like ECT or trans magnetic stimulation.
- [62:17]
Dr. Sanjay Mehta
Trans magnetic stim. So I think with the magnetic fields they've seen changes in brain activity. That's not my area.
- [62:22]
Host
But is that for the military operators?
- [62:24]
Dr. Sanjay Mehta
Yeah, yeah, that sounds amazing, but I know nothing, I'm an ignorant person about that. But in that situation.
- [62:29]
Host
Situation, yes, I can just treat cancer, but whatever.
- [62:31]
Dr. Sanjay Mehta
Yeah.
- [62:33]
Host
But there again, this is, this is something that a little bit of knowledge seems to really affect people, including me, because I bought all that stuff.
- [62:41]
Dr. Sanjay Mehta
Yeah, yeah. But someone made good money off of those EMF blankets. It's kind of like those people that sell the copper bracelets and all that stuff.
- [62:48]
Host
Why are they selling that? Is that for arthritis or inflammation?
- [62:51]
Dr. Sanjay Mehta
Why, why do people. Why, why do actual professional athletes pan to like new genics or what are those? When you watch tv, you see all these ads for these medicines that make you think more sharply and all that. They're not even FDA approved, They're completely untested and they're all over actual tv, not just social media. And there's zero data. Walgreens will sell you all this junk.
- [63:14]
Host
For the copper bracelets. Let's talk about what works for arthritis. Yeah, not those, but arthritis is definitely, definitely something that can really impair someone's ability to live. Right, Right.
- [63:27]
Dr. Sanjay Mehta
Big time. And especially you're, I mean, as you've been a huge proponent of exercise and muscle building and all that. If you're sitting around and you can't do anything because you're in pain, it affects your whole body because you're going to lose muscle mass, you're probably going to develop type 2 diabetes, you're going to gain weight, hypertension, you know, the whole cascade. If you can't do all the things that you're such a huge proponent of, and rightly so, your joints can stop all of that. So it's a huge quality of life issue. And traditionally you would either have physical therapy, which again is the best thing. You exercise, you do this sort of thing. But when you have a chronic joint inflammation that's not going to get better with just that it requires an intervention, which is most commonly going to be a steroid shot, or just being on NSAIDs.
- [64:06]
Host
Can we talk about the trajectory of arthritis?
- [64:08]
Dr. Sanjay Mehta
Sure.
- [64:09]
Host
It doesn't just happen. You don't all of a sudden wake up one day and have arthritis. If it's low grade inflammation, does that happen in stages?
- [64:18]
Dr. Sanjay Mehta
And so I think let's. Arthritis is a very broad term. Let's maybe focus on osteoarthritis because rheumatoid arthritis is an autoimmune disease and osteoarthritis is just essentially friction in the joint from a lot of use, whether it's an athlete who's really used it up or just an older person that's been using their joints than living their life. You have basically two articular surgeries, surface of two bones that are protected by a layer of cartilage. And as time goes on, maybe it's an injury related thing or just from chronic use, the cartilage wears away, it compresses, and eventually it can be completely reabsorbed and it's bone on bone. So that's like grade four osteoarthritis, but in the earlier stages, when it hasn't gotten that bad yet, when you have this inflammation and this, this irritation of maybe a rough bone surface and the friction, the body's own immune system will come to the rescue. Rescue, as it always does for any injury. And the macrophages, the white blood cells will, will be sequestered to that area. They'll come through the capillaries and they'll sit there and they'll release cytokines and interleukins. And that's what leads to the, the redness and the warmth and the, and the pain, which is what we know is inflammation. But radiation in very low doses will selectively kill the weakest cells that you aim it at. And the weakest, most fragile cells, cells are going to be the white blood cells. So by giving tiny amounts of radiation, you're not hurting your normal tissue at all, but the white blood cells go away. They basically die off. And that's what stops the inflammation without having to. Excuse me. Without having to deal with a cortisone injection and the potential. Either you're going to have side effects from the steroids itself or the actual physical injection. All those sorts of things can cause problems. I was my own first patient. I think I may have told you that story. Story. My Achilles tendon was killing me. Cortisone worked a little bit, but you do too many of those. And as you know, you can rupture a tendon if you get too many shots. Plus, it was really not pleasant to have an injection in my Achilles tendon. So I decided to use the radiation like they do in Germany. And I did it.
- [66:11]
Host
And you just went into the office one day, I was like, you know.
- [66:14]
Dr. Sanjay Mehta
What, I'm just gonna try. Actually, I should, I should give proper due credit. There's a buddy of mine who's a radon in Florida who tweeted about doing it on his Achilles. And I'm like, I have one of these machines. Why am I only treating cancer when I can? I'm limping around like an old man when I could be treating myself. I said, let me try it. I knew based on I'd never treated anyone. But I've been treating cancer for 25 years. I know what the physics and the. And the physiology is. And so it made sense. And the German data was quite compelling. So let's just give it a shot.
- [66:40]
Host
Were there protocols in place? The gray number, what?
- [66:42]
Dr. Sanjay Mehta
Exactly. So we use half a gray. So just to give you that, that we talked about earlier, in case you may have missed the earlier part part, or your listeners might have missed it, high doses, like, say, 81 gray, you're very good. Exactly. Good memory. 81 gray is for a prostate. A breast might be 50 gray or 40 gray. A brain tumor could be 20 to 60, just depending what we're treating. So high doses in the double digits treat cancer because you need a higher dose to damage cancer cells. But these inflammatory cells, the white blood cells, you need half a gray. So 0.5 gray. And the typical protocol is usually six straight treatments. So, like Monday, Wednesday, Friday, every other day for two weeks. So half a gray times six is a total of only three gray. And it's to a peripheral part of the body, meaning there's no vital organs. You're not treating centrally. So whether it's a hand or a leg or a hip or whatever, you.
- [67:30]
Host
Wouldn'T treat, say, a costochondritis.
- [67:33]
Dr. Sanjay Mehta
You could. Absolutely you could, and it would work just fine. And half a gray, even to the thorax, is not going to hurt anything. That's an unusual situation, but there's no reason you couldn't. And in the last year and a half, almost two years since I treated myself, now I'm getting this deluge of all different types of things. So even spine spinal degenerative diseases. I have people with low back pain that have gotten better. So you can treat any articular joint in the body.
- [67:57]
Host
Does it have to be inflammation? Now, when I think about inflammation and I think about, say, plaque and arteries, there's a reason why that plaque builds up.
- [68:07]
Dr. Sanjay Mehta
It's a physiological response. Yeah, absolutely it is.
- [68:10]
Host
Are you. When you're using lotus radiation, do we want a little bit of inflammation early on? For example, as I think about my hamstring, we put PRP in there to increase the white blood cells, increase inflammation, to hope for Some kind of healing.
- [68:27]
Dr. Sanjay Mehta
Right, Right. And that's a good point because every little trauma you have, your body's going to heal it that way through the inflammatory pathway. And then normally the inflammation will pass once the tissue is healed. Healed. But what I deal with is chronic inflammation. So when it's someone that's had this, you know, you have a. I actually had a knuckle that was bugging me. I just, I don't know what I did to it. It was hurting when I knocked on the door, cars probably. And it was three or four months and it was getting to the point I was like, this is going on for quite a while. But then it got better on its own. But for the people who are dealing with this for years, and then you do an X ray and you can see in the joint articular surfaces where there's actually evidence of what they. The radiologist will actually have criteria that this is arthritis. That means it's not just a short term inflammation due to an insult, that normally most of these things heal themselves. This is for the long term, arthritis, tendinitis, fasciitis, where it's just, it's not healing. Other, other modalities haven't worked and at some point the inflammation is no longer a good thing. It's certainly without inflammation, we wouldn't be alive. It's part of the healing process. But when it goes out of whack, and especially when you have a lot of joints or a lot of tendons. In the case of my Achilles, Achilles, there's a very poor perfusion. You don't get blood flow to your tendons. That's where PRP comes in. In theory, that will give you all the healing factors, but even that seems to be only somewhat effective. It's not like it's a, you know, 100% effective, but with the radiation that will allow the actual energy of the X rays will stop all the inflammation without having to resort to injecting a drug into it, like cortisone, which is more effective?
- [69:58]
Host
Cortisone or. You know, I think about Don, my best friend, Don Lehman, he's a, a world class PhD protein researcher. He doesn't listen to this podcast, so I can talk about him. He loves tennis.
- [70:10]
Dr. Sanjay Mehta
Okay.
- [70:11]
Host
His knees bother him. And I was telling him about you. I said, you know Don, because he comes quarterly and we record the podcast. I said, well, you gotta see Sunday. And he's been doing cortisone treatments.
- [70:23]
Dr. Sanjay Mehta
Sure.
- [70:24]
Host
Which if someone is early on or like, if we were to take two scenarios, my dad has terrible hips, he will go to get a cortisone shot, probably needs a hip replacement. But that is late stage challenges someone who is maybe early on and they're getting arthritis or it's kind of early on in their disease process. Could they come in and pre treat early with the radiation?
- [70:56]
Dr. Sanjay Mehta
They could. So there's two different scenarios there. One was, I guess the first question is, is it better than cortisone? And you know, whenever I, as a physician, especially as an oncologist, when you're trying to compare two modalities, you want to nerd out and have randomized clinical trials, prospective data that really shows that X is better than Y. It's been thoroughly tested and we don't have that level of like a direct cortisone versus radiation comparison. The few randomized trials that have been done were not particularly, they were done in Europe and they weren't particularly well designed and well powered.
- [71:28]
Host
So I don't probably they have different machines.
- [71:30]
Dr. Sanjay Mehta
They do and so, but what we do have is a lot of observational data. And so what I can tell you from what, and I've seen this mirrored now in my own couple of years of doing this, I'm still relatively new at it, but even doing a couple of hundred patients you start to see trends pretty easily. And me myself being the first one, the cortisone usually works faster because you get that instant anti inflammatory. And also a lot of times I think the pain docs, when they do the injection, they have a cocktail, they'll put a little lidocaine or something else in there which gives you that instant, instant relief as well. And I had that done as well. So the radiation typically doesn't work as quickly, but it seems that it has a more durable response where the cortisone might wear off in a few weeks or a few months. What seems to happen more often with radiation and this, it seems to be more durable. And the reason seems to be what.
- [72:15]
Host
Do you mean by durable?
- [72:16]
Dr. Sanjay Mehta
Durable meaning that the pain doesn't recur as quickly or, or necessarily at all. And what we've seen based on the European data is five years out, half the patients who've had radiation are still pain free or nearly pain free.
- [72:29]
Host
That's extraordinary.
- [72:30]
Dr. Sanjay Mehta
And I don't think cortisone shots ever last even, you know, a year, much less five years. And what it seems to be happening is that both the radiation or the cortisone might stop the initial inflammation, but the cortisone is very short acting and the Inflammatory cells will come right back in many cases. Whereas what happens with the radiation on a microscopic level, the way these macrophages get into the area in the first place is through the capillaries. You have microvasculature that delivers the white blood cells to the joint. But with the radiation, it seems to reduce the permeability of the microvasculature. So you don't get the next round of macrophages sequestering there. Again, it seems to inhibit them from coming back and therefore you get more of a durable response. And that's what I'm seeing. In my case. I treated my Achilles almost two years ago now and I'm still. And so the way the protocol works is the German protocol, which we follow. You do six treatments, as I mentioned earlier, half a grade times six, then you actually wait 12 weeks and if necessary, if there's any residual pain in.
- [73:30]
Host
The first six treatments, two weeks in a row.
- [73:32]
Dr. Sanjay Mehta
So Monday, Wednesday, Friday, two weeks straight, six days over two weeks, wait 12 weeks and reassess. And in Germany at that point they have, they would say, I think roughly a third to maybe almost a half of the patients decide to go for a second course. And that sometimes gets your results even closer to a 100% in terms of pain reduction. In my case, I just did the first course, I never had to do it again. And out of my 200ish patients we've treated, I'd say maybe 10 to 12 of them have even come back for the second course. And those that do have, most of them have been happy. The only people I've seen who don't respond well when it gets really bad, as you mentioned, a really severe, like a grade four osteoarthritis, where there's bone on bone, they still seem to see some benefit. Like they still feel good that they did it, but it's not, it's not a replacement for a joint replacement or something like that. But you mentioned that. I'm sorry, were you going to say something?
- [74:21]
Host
I was just going to ask about is there any possibility of disease reversal?
- [74:25]
Dr. Sanjay Mehta
So it depends on what the disease process is. So for an earlier stage, when, like you mentioned earlier, you're asking, can this be prophylactic? Not truly. Like I wouldn't radiate it in absence of any symptoms. But if you have this low grade kind of festering thing, that's like a, they grade osteoarthritis on a scale of, of 1 through 4. So 4 being like bone on bone, really end stage, 01 being very minor stuff Typically, this is offered to people who have grade two, grade three. If it's just chronic, and maybe it's not really debilitating, but it's just annoying for long periods of time, this works. And again, whenever I offer a patient a treatment, whether it's a cancer patient or an arthritis patient or no matter what any physician does, obviously you want to weigh out the risks and the benefits. And if there's not a favorable risk, benefit, benefit ratio, you're not going to do it. So although the radiation works extremely well for most people, even in some of these fringe cases where maybe it works, maybe it doesn't, the benefit may not be as clear, but the risk is also essentially zero. So when there is no risk or very low risk, I'm more apt to offer the treatment because it's not like you're going to be injecting a medication or doing something that's going to have systemic effects. The low dose of radiation can, like for increased example, for a hand or a foot or an ankle, it can take 100 times more radiation than what we're using. And that's within safe limits. So even if you use six gray and you do it, or three gray and you do it every year, you know, 0.5 times six, which is three gray, you could do it every couple of years and still be well within the tolerance of that joint. So, you know, you're not going to cause problems. So that's why we do that.
- [75:54]
Host
Is there any application for muscle muscle law? I mean, obviously it wouldn't affect hypertrophy, but you see a lot of these machines doing various things.
- [76:05]
Dr. Sanjay Mehta
Yeah, I think, you know, typically when you have, for an athletic person, the muscle, you know, as you're rebuilding your muscle after working out, that's all more of a temporary thing. But the tendons and the ligaments that are nearby, it's sometimes hard to differentiate. Like a bicep tendonitis. It's not really the bicep, it's the tendon. And. But it. The whole area hurts. And so I've treated people like that where I'll maybe treat the. The AC joint on halfway down their arm, just as it radiates down there. And it does tend to work. But, you know, someone who's just sore after a really heavy workout session, you're not going to use it for that. Yeah, that would be. That would be overkill. Because, first of all, yeah, it probably would make them feel better, but so would a few days of not doing anything, and you don't want to overdo this sort of thing. But one quick thing you mentioned earlier, which I wanted to touch on. You asked a question about, I think it was your dad's hip. You said one thing that I've suddenly, that I've noticed now that I was not paying attention to for all these years. But now that I'm so tuned into it, I treat so much prostate cancer. The prostate is in the middle of the pelvis. The different beams we use, they actually go through the hip to get there. I've had multiple people over the years that I didn't really pay attention to who told me their hip pain got better, which was an unexpected, inadvertent side effect. But it truly was a big thing. And one of the guys I just treated recently told me that. And now that I'm doing all this arthritis, I was like, I'm looking back and I'm sorry, saying, you know, I've seen a lot of that actually for people's hip pain got better. Now we know why. But as radiation oncologist, our title is oncologist. We just were never focused on this in America, but the Europeans knew about that.
- [77:32]
Host
And it seems as if they're still doing it. And it's quite frequently used if you look in the literature.
- [77:36]
Dr. Sanjay Mehta
Yes.
- [77:36]
Host
Seems as if it's, oh, yeah, in.
- [77:37]
Dr. Sanjay Mehta
Germany, in the uk, Spain, like most of the big. The, the leading minds in this who've done it for a while are all European. And the data is very robust. So. So there's really no downside. One of the big things people are always afraid of is secondary cancers, or I shouldn't say secondary because there is no primary cancer. This is just cancer from radiation induced malignancy. But at these very low doses, unlike with high doses, there is no evidence that cancer is even caused decades later because we have decades of information now. I wouldn't treat a child, obviously.
- [78:08]
Host
Makes sense.
- [78:08]
Dr. Sanjay Mehta
You don't. It's just common sense. But even someone in their 20s or 30s, we've treated teenagers with keloid scars forever and we've never seen an incidence of secondary cancers from that.
- [78:18]
Host
And no damage to the surrounding tissue.
- [78:20]
Dr. Sanjay Mehta
Yeah, or very. Or when you say no damage, maybe a transient redness like a little erythema for a few weeks, but no permanent damage.
- [78:27]
Host
And I know that we're talking about osteoarthritis specifically, but Rheumatoid arthritis.
- [78:31]
Dr. Sanjay Mehta
Yes, yes.
- [78:32]
Host
Can we just touch on that?
- [78:34]
Dr. Sanjay Mehta
Sure, sure. And so this is one area where I probably differ a little bit from some of the European doctors that I've talked To about this where they, they typically don't treat any other type of arthritis on a routine basis. They save this just for osteoarthritis. But what, what I've seen and what a few of my colleagues in the US who I've chatted with have seen is that with a. The difference is osteoarthritis is a local disease, whereas rheumatoid or psoriatic arthritis, those are, those are systemic diseases. So you're meaning for the non medical people, that means the whole body is affected because your immune system, in the case of osteo, in the case of rheumatoid arthritis, arthritis, your immune system is attacking the joints. So radiation won't be able to stop that. We cannot stop the whole body effect. But what's more important is from a quality of life standpoint, many folks that have systemic, you know, have rheumatoid or psoriatic arthritis. They may have one particular area of the body that's really bothering them and the radiation to that local area, it's a local effect, it's not a full body effect. They may still need to be seeing their rheumatologist for regular doses of. There's all kinds of, of different drugs now with immunotherapy, that sort of thing. But the radiation could be a great adjunct to just get that one painful spot and it improves their quality of life.
- [79:41]
Host
I mean, I have to say I think that that sounds really, really innovative and important because you get these patients that they're suffering with rheumatoid arthritis. And even if it's a systemic disease, if you're able to treat these joints and you're limiting pain, because again, I care about my muscle, right? And I don't care about muscle in isolation. I care about it from a metabolic perspective. Quality of life, all things point back to muscle.
- [80:07]
Dr. Sanjay Mehta
That's right. I mean, muscle centric, right?
- [80:10]
Host
That's right, sir. Muscle centric. And if we limit someone's ability to move in a meaningful way, then maybe not immediately we change their aging capacity and make it very poor. But it's gonna happen, right? What about post operatively?
- [80:30]
Dr. Sanjay Mehta
Okay, like what type of surgery?
- [80:32]
Host
I don't know. I'm just thinking post surgical, post hip replacement, post shoulder replacement, any of those.
- [80:38]
Dr. Sanjay Mehta
You bring up a great point, which is on a slight tangent. So I won't go too far off on it, but my first exposure and most radiation oncologists like me, who do cancer for a living in residency training, this is something that we did see A fair bit of which we don't see in the private practice setting, but, but post traumatic. So if someone has had a motorcycle accident with a hip like a broken hip or even a shattered pelvis that's been reconstructed, one of the common problems that they get once they are reconstructed and they get back to normal life is heterotopic ossification, or ho. And that's basically where you've got this chronic inflammation, like for example, in the hip, in the acetabular area where the body will lay down calcium. That's part of the inflammatory process, is laying down of calcium. And it can literally lock up that hip joint when you have a calcium like a bone bridge that forms between the pelvic bone, the iliac bone and the greater trochanter, for example, and it can lock it up. So early data, this data goes back to probably as old as the arthritis data from 100 years ago. They found that if you give a low dose of radiation just after the surgical intervention, that you will prevent that inflammation from occurring and therefore the heterotopic ossification won't lock up their, their hip. So I was actually doing that way back, you know, 20 years ago. But that's only in a post traumatic setting. It wouldn't be for like a, you know, a C section or something like that. But when there's an actual bone trauma, if you radiate that area, it will prevent heterotopic ossification.
- [82:05]
Host
That reminds me of we were talking earlier about keloids and we're talking about scarring. And again, I joke and say that we have the number one men's health podcast and a man can essentially, I don't want to say fracture his penis, but over time, if an individual gets scar tissue that creates curvature, which is known as Peyronie's disease, can be really painful and uncomfortable for men, for sure. Can you use low dose radiation to potentially treat that?
- [82:39]
Dr. Sanjay Mehta
It has been done. There are publications on it. I haven't done it personally, but when you think about the physiology of it, it's the same thing. Fibroblasts lay down scar tissue and normally the body regulates that and stops the scar tissue from overgrowing and things like that. But the same way that a keloid forms or the same way you get a pterygium in your eye, Peyronie's disease response to a penile trauma will cause scar tissue to form and radiation can help stop that. That it can help to soften existing scars and keep them from getting worse because the Problem is it's a self propagating thing where it keeps continuing to get worse. The most common scenario I'm actually seeing it in now is dupuytren's contractures of the hand, which is essentially scar tissue forming just under the skin, not in the tendon itself, but near the, the tendons for your hand. And these, these contractors develop to the point where they can cause, you know, irreversible bends of the fingers. And some people even get amputations from that because it's gotten so bad where they've tried to fix it. And when they do what they call a needle aponeurotomy, that's a common hand procedure where they release the scar tissue and straighten it out. Unfortunately, the actual surgery stimulates more scarring. So by radiating those areas after they've been operated on, that allows the scar tissue, keeps the scar tissue from forming again. And so dupuytrens, and then there's actually a foot equivalent of dupuytrens, which I wasn't even aware of until I started reading, talking about, it's called leader hose disease. So you can get plantar fibromatosis, which can be very painful if you're trying to walk on these things. And it's not plantar fasciitis, it's actually just scarring. You get these big thick nodules on the bottom of your foot, which would be, you know, terrible for trying to be agile. And so the radiation is an alternative to surgery for that as well because it'll soften up those areas. Now if you have a really bad one where you got a finger contracture, you got to have surgery.
- [84:23]
Host
You have to have surgery.
- [84:24]
Dr. Sanjay Mehta
But in these earlier cases, cases it's used a lot and peyronie is a similar type of disease, so it should work similarly. And I have seen some data, I was talking with some of our urology colleagues about it, but we haven't done it yet.
- [84:34]
Host
Not yet. But you never know this area, you could be one of the first in the area. The data is there, the data is there. But what's holding back the US from adopting more of these practices and how many physicians are doing and using radiation to treat these itises?
- [84:52]
Dr. Sanjay Mehta
Sure. So, you know, about 50 years ago or so when this was a new field, it was actually referred to as radiotherapy. And as a profession, a lot of the early, what we now call radiation oncologists, they actually really lobbied to be called radiation oncologist. So oncology is in our name and therefore everyone is so focused on Oncology, which is the study of cancer, that all these benign diseases for the most part got left by the wayside. In the US now, many other, basically any other country you go to, there is a much higher utilization of these sorts of things for benign diseases, whether it's keloids or arthritis or any of these things. But in the US it's been highly, highly underutilized. But I think we're at the very precipice of this changing. You're starting to see I was, I was really not even. It wasn't that I was a non believer, we just didn't, just didn't focus on it. But now that I treated myself, I became a believer instantly. I'm still not limping two years later. And now that we've seen a couple hundred patients, I'm seeing the true trends of how well it works. I think a lot of other doctors like myself are starting to maybe start to pick up on it. When I talk to my colleagues all the time, I'll tell them what to do and I'll get emails from people all over the country and say, you have somebody in Montana or somebody in North Dakota. So I'll talk to the local doctors and explain to them. Most of them are still not doing it it. But I think we're getting to a point where that's really going to change.
- [86:14]
Host
And to be clear, it should be a radiation oncologist.
- [86:20]
Dr. Sanjay Mehta
It has to be. No other, no other doctor is trained with the radiation safety techniques and you know, knowing exactly what to do. Even in the situation where you, you may have like a, a dermatologist that only treats skin cancer, they may have a machine in their office, they can just treat superficial skin lesions. They still have to have radiation oncology supervision to do that.
- [86:42]
Host
I think that you're really innovating and I'm grateful for you. And I know that many of our mutual friends are, you are providing a solution that is critical because we have to be able to treat these challenges for people so that they can go on with their life.
- [86:58]
Dr. Sanjay Mehta
And it's exciting. It really works. And they, people, people think you're a hero because you've eliminated their pain almost instantly with no side effects. It excites me. It's just fun. Like I have a good time going to work every day.
- [87:09]
Host
I mean, there's nothing better than being able to positively impact someone's life, right?
- [87:14]
Dr. Sanjay Mehta
It's for all these years, my, the, the, the dopamine came from telling people they were now cancer free, that they're cancerous. Which is also a huge thing, obviously. But now we're seeing the same thing in the pain space where you're. You're pain free. And that usually happens even faster. So instant gratification.
- [87:28]
Host
And if people want to come see you, obviously we'll include the link. Where can they. Where can they go?
- [87:32]
Dr. Sanjay Mehta
Yeah. So my website is drsunjaymahta.org D R S a N J A Y M E H T a dot org and on there I have a phone number and an email you can reach me on. But my clinic is right behind us here on south main. So it's 9150 South Main street, right across from NRG Stadium. And they can call anytime. 713-630-8181.
- [87:57]
Host
And your practice takes insurance?
- [87:58]
Dr. Sanjay Mehta
All insurance. Basically all insurances. And of course, most patients are medicare age, so that's the typically what we see the most of. But yeah, most insurances.
- [88:06]
Host
Well, Dr. Sanjay, I'm excited to be a patient of yours and looking forward to it.
- [88:11]
Dr. Sanjay Mehta
I think we can help you.
- [88:12]
Host
Gonna be great. I will report back.
- [88:15]
Dr. Sanjay Mehta
Thank you so much.