Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Empathy and Innovation in the Fight Against Cancer
Dr. Michael Ogawa joins us for a heartfelt conversation as we trace his compelling path from a childhood in Garland, Texas, to becoming a dedicated medical oncologist in St. Louis. His journey through the halls of Washington University and Texas A&M is more than just a career story; it's a testament to the power of passion and perseverance. Alongside reflections on his cherished partnership with Dr. Mira Rana and the joys of family life, Mike opens up about personal challenges, including a recent ankle injury, offering a window into how these experiences have deepened his empathy and approach to patient care.
The landscape of cancer treatment is ever-evolving, and this episode takes an insightful look at its promising advancements. We discuss the transformative potential of treating cancer as a chronic condition, akin to diabetes, and the groundbreaking role of immune therapies in modern oncology. With honesty and optimism, Mike and I explore the collaborative magic of tumor boards, where specialists unite to push the boundaries of patient care. Together, these collective efforts are leading to improved survival rates and a better quality of life for those living with cancer.
Success is redefined as we discuss family values and the enriching power of professional friendships. It's not just about individual accolades but about nurturing happiness and well-being within our families and communities. Parenting's journey is shared with an understanding of its challenges and rewards, painting a picture of true wealth found beyond material gains. The episode concludes with a tribute to the strength of professional bonds, as Mike and I express gratitude for a supportive work environment that has been a cornerstone of both our personal and professional growth.
Hello, my name is Jason Edwards and this is Doc Discussions. I'm excited to have a special guest. This is my good friend, dr Michael Ogawa. Mike is a medical oncologist, which means he treats patients with chemotherapy and immunotherapy and targeted therapy for cancer. And before we start, I just want to say Mike, when I think about him, he's he's such a a hard worker, a very smart guy, but a very kind and upbeat person, and I think all the people who work with you very much appreciate your personality, and I know our mutual patients do too. So, mike, welcome.
Speaker 2:Thank you, thanks for having me and thank you for the very generous and very flattering introduction. So thank you.
Speaker 1:Yeah, I try to flatter you, to kind of get you off balance, and then we can really hit you. It's okay, it works. And so, mike, you're from Texas originally, right?
Speaker 2:Yes, originally from Dallas. I grew up in one of the northeastern suburbs of Dallas called Garland, texas. Okay, kind of a small kind of an immigrant population there. So my parents are originally from, my dad was from Japan and my mom was from Vietnam and my dad actually moved to Texas for work, so that's kind of how they ended up there. But I grew up there and lived most of my life actually in Dallas.
Speaker 1:How about that? And that explains the big hair. Yeah, the big hair.
Speaker 2:You know, I don't have a cowboy hat, but I do have some cowboy boots, yeah.
Speaker 1:They always say the girls in Dallas have big hair. I don't know, that's probably changed since the 80s, but anyway.
Speaker 2:I know, maybe now more and more guys have perms yeah.
Speaker 1:And then you did your undergrad here in St Louis at Washington University. Is that right?
Speaker 2:That's correct. That's correct. So I did my undergrad here at Washington University and so I kind of had a good group of friends here. I ended up going back to Texas for medical school. I went to Texas A&M. It was actually one of the cheapest medical schools I could go to right around $20,000 a year. It was great. So I went there for four years and then I still had some friends here in St Louis and I did like St Louis a lot. So I came back up here for a residency, actually at St Louis University. My wife moved up from Texas to kind of be with me and she's a lawyer. So she took the Missouri bar and then she was like I'm not taking another bar exam. So we ended up staying here 10 years later. You know we have a daughter, we have a house here, and so I've been here ever since.
Speaker 1:Yeah, and then and you also did part of your training with Dr Mira Rana, who's our other medical oncologist- that's right.
Speaker 2:So she and I go back pretty far. So she and I met actually the first day of residency so we've known each other for eight, nine years now and so she went off to Wake Forest for a fellowship, but her husband and her family live here in St Louis, so we were very welcome to, very happy to have her back actually after that was done.
Speaker 1:Yeah, I think you helped recruit her here, and so we're also indebted to you for that.
Speaker 2:Oh no, she's definitely a welcome addition to the group.
Speaker 1:Yeah and so yeah. So you mentioned your wife and your new young daughter. Who is? Is she two now?
Speaker 2:Yeah, that's a good memory. She's two and a half years old and she's really coming into a fun age. It's exciting. There's a lot of fun new things that I get to experience every day, both her and myself so it's been kind of interesting to both kind of navigate that, but also it's been probably one of the most enjoyable times I've had in my life.
Speaker 1:That's beautiful, it's been good. Yeah, you learn a lot from your kids, you know you learn a lot about life through kind of living it on the other side of the lens, as a parent, for sure.
Speaker 2:Yeah, very much. So you know it's kind of interesting. I guess you can't see through the podcast, but you know I actually was recently injured, right, I broke my ankle and I had surgery, and so I think that the same thing, when it comes through with children, it kind of gives you a new perspective on kind of life. I think you kind of get into the grind and you get used to a certain routine and so kind of. When you see the novelty in the way your kids see things, it kind of brings excitement to your life. And the same thing, being on the other side of things, like being a patient, also kind of wakes you up to kind of the things that they have to deal with every day and it kind of gives you a new perspective on coming to the hospital and health care.
Speaker 1:I totally agree. My experience as being a patient was maybe five years ago. I was having heart palpitations and I called Craig Reese, our chief of cardiology, and he said well, you know, maybe come on in and get checked out and I was actually worried. You know it's your heart and I thought, you know I'm a pretty healthy guy. But you know you could tell he was a very competent physician and that and his kind of command of the situation very much put me at ease and I feel like I became a better doctor for that. What did you learn through your medical experience?
Speaker 2:You know, I think that I definitely have the same, I think, level of like fear, anxiety and almost helplessness I think that a lot of patients have when they come to see me, I think level of like fear, anxiety and almost helplessness I think that a lot of patients have when they come to see me. You know, I think as medical and radiation oncologists we never meet people on their best day, all right. So, you know, I think people coming to see me are always worried about things and even if they're not coming for a cancer diagnosis, when they walk in the doors and it says you know, blood and cancer center, that's something that is definitely at the forefront of their mind. It's something they're worried about. And the same thing with me too, you know, I think.
Speaker 2:You know, when I broke my ankle, I was really worried about kind of what would happen, not just in the in the short term as far as healing and the surgery, but long-term, like what would that look like for me? You know, moving forward and I actually had a had a very similar experience with you is when I came to the hospital here. Actually, I had my surgery here at St Luke's. You know I was not familiar with the surgical surgery department very, very much. But everyone was so nice. You know, it was a very kind of welcoming environment and they and actually people who I had shared patients with came by and kind of wished me good luck on the surgery. People I've actually never met before wanted to come by and just say hi, and it was really nice. It took my mind off of the upcoming surgery and it made me also feel confident that the patients that we sent to get procedures done are in really good hands.
Speaker 1:Yeah, I agree, when you're afraid, it's nice to see some friendly faces. It's nice to see some friendly faces. It's nice to see some people who are in control and they know what they're doing. And I agree with you as well it made me more confident in being a St Luke's physician. Now the Larry King question here is what kind of dance move were you trying to do when you broke your ankle?
Speaker 2:Obviously not a good dance move. You know, I think that I have a very Enthusiastic dancer. I probably Enjoy it. I guess my enthusiasm outweighs my skill, put it that way, right. And so I think my wife Not so kindly reminded me that I'm not as young as I used to be. Yeah, and I need to be more careful, but I don't particularly remember the dance move, but I do remember slipping, yeah, and so, although I did end up breaking my ankle, it was a very memorable and fun wedding. No regrets.
Speaker 1:Yeah, you know I don't like your wife's negativity and I think you still got it.
Speaker 2:So tell her. I said that I thank you. I do have a spare leg so I can still dance a little bit. It's pretty good though.
Speaker 1:Yeah, um, and you know there there's. This is another kind of tentative life is. There's always adversity. There's always. It's going to come in different forms. It's going to come at different times. I think sometimes, when it's through a fault of our own, whether it's um, break your ankle while dancing or or getting into a car wreck, it's it's sometimes harder to accept. But the the first step is really acceptance and saying, hey, this is where I'm at Like and I've got to objectively find a way to kind of move forward from here. Whether it's a broken bone or a cancer diagnosis, you've got to regroup and say, okay, how do we move forward objectively to optimize our situation?
Speaker 2:Yeah, I agree with that. I think that I definitely experienced some of that, you know, in the beginning, because it was something that was silly and possibly could have been prevented, right. And you know, the two weeks I was laying on the couch recovering from surgery, I definitely had time to mull that over and I kept going back and forth between being, you know, saying the same thing that you're saying, like, hey, you know it happens, you got to accept this, it is what it is and we and we can move forward from this, but also, like you know, how could this happen? This is, you know, never a good time for something like this to happen. And you know it's a busy time at work. It's tough, I'm out. It's a busy time for my family, it's hard for my wife, my daughter.
Speaker 2:But, you know, I think we kind of tell our patients the same thing, right, hey, like you know, this is something that's unexpected, this's something that we can definitely get you through, right, and so, you know, we allow them to process it, but definitely, after you know they've come to terms with the diagnosis, it's something that we would love to help push back on, right, it's time for us to fight back against the cancer.
Speaker 2:It's time for us to kind of get you back to do the things that you like to do, right, and I think that that's really the benefit of modern medicine, you know, even for diseases where we can't cure it, if we can get you back to doing the things that you like to do and getting back to a fairly normal life, I think that we've been successful in what we can do. And I tell my patients you know, there are lots of diseases where right now there isn't a cure, but every time that there's a conference that comes out or there's new data that comes out, I know it's a happy day for people, right? Because that just means that we just need to get you to the next good drug out there, the next good treatment, and then we start seeing cancer less as a terminal diagnosis but more of a diagnosis that we can manage long-term, like diabetes or high blood pressure, and I think that that takes some of the fear and some of the control away from the diagnosis itself some of the control away from the diagnosis itself.
Speaker 1:Yeah, so when somebody comes into our office my, whether it's mine or yours, you know the first rule is to always be completely honest. Or you could say, always tell the truth and never tell a lie, and those are two different things. And so we're honest with the patient. But part of being honest is to not say hey, the clinical trial that shows the best treatment for your disease, which is the treatment we're going to do, which we call the standard of care, shows that patients five year overall survival, meaning the amount of patients who are alive five years later, whether it was from a cancer or car wreck or whatever it may be is this number, say, 75%? But that's just the known knowns. So, like Nassim Nicholas Taleb would say, there are also unknown unknowns.
Speaker 1:And there are known unknowns, and the unknown unknown I guess it's a known unknown is that there has been continued advancements in each disease site and the cure rate of every cancer over time, and that will likely continue, and maybe even during the course of your treatment, and that itself may prolong your life life. And it's an exciting time because you have this not only new systemic therapies that you use with your patients, but there's like new classes of systemic therapies, so like whole new families of systemic therapies. Immune therapies were kind of the big thing maybe 10 years ago and continue to be a big deal, but that's been an exciting time to be a. An exciting but difficult time to be a medical oncologist, because the amount of drugs you need to know it has expanded exponentially.
Speaker 2:You know, and I definitely agree with that, I think that, like for a while, you know, the way we treat cancers hadn't changed for 30 to 40 years, and then now, really over the last five to 10 years, we're starting to see a lot of new drugs come to the market and a lot of new research coming to the forefront, which is really exciting. And I think that you know, as doctors, we never like to say we're wrong, but I do say that the thing that I'm happiest that I'm wrong about is sometimes when I meet patients and they always ask you know so, hey, doc, how long do I have? What does this look like? And I find that I'm becoming more and more wrong when I give them the answer based on the historical numbers that we've seen over the last 20, 30 years.
Speaker 2:Right, a lot of the survival data we have is based off this national SEER database and some of those outcomes that we see there are now being eclipsed by the new data. So when I tell someone, oh hey, on average people have nine months to live with this diagnosis, these patients are now pushing two, three years. And then it used to be that these were the outliers and now we're moving more toward where this is the median. This is what we see on average that people are living longer and longer. Not necessarily just because the cancer care is better, but our supportive care medicines are a lot better.
Speaker 2:People are able to tolerate treatments a lot better and the hospital care is a lot better when people do get into problems, you know yeah so, you know, I think that there's a lot of things that we do here at st luke's that uh make, uh, you know, kind of just kind of move us inches at a time but move us along toward getting people to have better outcomes and longer periods of cancer-free remission, like we do tumor board all the time, where you know, you myself, the other medical oncologists, the surgeons are there, the radiologists are there, the pathologists are there and, you know, we have 20 doctors in a room and just talking and kind of thinking about the case and looking at it under a new light, and I think that it gives patients opportunities to to have uh different opinions about their treatment and their care and it might open, you know, the door to something that even I hadn't thought of alone.
Speaker 1:Yeah, it's been good. Yeah, I agree. And specifically with oncology, one of the things I really like is that we have doctors at different stages in their career and I think having that diversity of age can be very beneficial, just because different people kind of have different viewpoints based off different experiences. And it's it's tumor board is nice and we get you know, I feel like it's very cordial and we get along well and take each other's recommendations, you know, um um, into account and, and I agree, I think it it's brick by brick, inch by inch, every bit of it, um, whether it be the supportive care with the nurses in the infusion area or in the hospital, all of it ultimately amounts to better outcomes. And it's nice to be in a state where we're not a steady state but things are continually improving and my hope and expectation is that, as time goes on, that continues to happen.
Speaker 2:Yeah, very much so, and I think that you made a good point.
Speaker 2:You know, in our group we have, I think, six people who are still practicing medical oncologists and I would say half of us in our group we have, I think you know, six people who are still practicing medical oncologists and I would say half of us are in our 30s to 40s and the other half of us are in our 70s.
Speaker 2:You know, I think I sit next to Dr Van Amburg and he's 77, still going strong, still sharp, and you know, while I bring, I think, optimism and maybe the new cutting edge treatments, he definitely brings a lot of experience to the table. Right, he kind of knows, you know, how hard to push and how hard not to, and I think that wisdom there is definitely something that you can only gain over years and years of direct patient care and just kind of seeing these things in real life. Also, you know, even at 77, he's still a pro using the computer. So I can't complain at all about using our medical record system or anything, and so he's, you know, he's an encouragement to what I could, you know, see myself doing one day. But definitely having a big mix in both experience, age and knowledge definitely helps our group a lot.
Speaker 1:You know, the other thing I like about St Luke's Oncology is that we're all busy. We're all not only busy, but very busy, and that means that if you see a lot of patients, it's just like anything else in life it's reps, and so patients aren't reps, but it's more experience. And so if you say you're a football player and you run a play and practice five times versus 100 times, you are going to understand the nuance of that play a lot better, and so anytime you do something a lot, you figure out how not to do it, and you figure out you know why you need to do it this way instead of that way. And I think being busy makes you a better doctor too, just getting in more reps, more experience, and so and I know you're you're a busy doctor, dr Rana and Dr Soken, and so but I think that makes people better too.
Speaker 2:I think so and I agree with that. You know, people always ask, people always say, like you know, you should choose the doctors that your doctors choose. Right, because, and in the same way, like the guy who did the surgery on my leg, he is an ankle guy so he does lots of ankle surgeries. I was his third ankle surgery of the day, right and so, and then I guess it's that sentiment where you know, if you kind of see a lot of different diseases and you see them often you kind of understand the nuances of how to treat things and it makes you as a practitioner more comfortable with any kind of issues whenever they come up.
Speaker 1:Yeah, same with tattoo artists too. If you're going to get a tattoo, um, you don't want them like, right, as they get the needle humming, to say, hey, this is my first one, hopefully it goes well. Right, you want somebody who's, like you know, done a couple of thousand maybe a couple more. Yeah, for sure, for sure, Mike. Um you're, um, you've told me before that your uh work ethic to some comes from your experience with your parents and seeing how hard they work. Can you talk about that a little bit?
Speaker 2:Yeah, so my parents, they were immigrants.
Speaker 2:My dad was born in Japan and my mom was born in Vietnam, and so coming to the United States, I think, was definitely a difficult transition for them, but I could definitely see that when they came here, almost everything they did was to help us succeed and help us make it in our lifetime.
Speaker 2:You know my mom when she was here she worked at Pizza Hut for a while, and my dad, he was a janitor, and so kind of seeing them come up from humble beginnings and even though they didn't have the same opportunities I had, they worked hard to make sure that I could pursue not only primary education but secondary education and to make sure that that was something that I found important in my life. I definitely learned from them that you just need to kind of have a goal in mind but also every day work hard and make sure that that's something that is always in the forefront of your mind, and it definitely kind of motivates me to know that my successes are not my own necessarily, but they come from generations of my own family and other people around me working hard to kind of put me in a good place where I have the opportunity to come and learn things that I would never have imagined and help people in ways that I would only dream of before.
Speaker 1:That's beautiful. And when I think of my own children, you know, I think it's a much better life to try to live your life for something bigger than yourself, and you have. You can look internally, and you can only do that for so long before you. You know, for most people it tends to get kind of ugly, but you have the whole universe that you can focus on instead of yourself, and that's actually a much better way to go. Are there problems?
Speaker 1:You know problems out there for sure, but living your life to sacrifice yourself for your family is, as I'm kind of learning over time is, um, you know, probably a better way to go, um, to try to live for ideas or things that are bigger than you. Um, and so when I think about your parents' life, you know they've, you know, worked hard with for you and your siblings to do well, and you know the same with my parents as well. And I used to be kind of like the wide receiver on a football team who would like, when he would catch a touchdown, he would like pound his chest and say, look how great I am. And I feel like I'm transitioning more to a running back where I'm thinking my offensive line and having a little bit more gratitude around the people who help you get to where you're going or who took the time when they didn't necessarily need to help you turn this way instead of that way, and sometimes that's just the grain of rice that tips the scale.
Speaker 2:Yeah, I agree with that. I think that you know, even talking about children, right, you know, I think that the way that sometimes we see success in the media is always portrayed as people who are famous or people who are wealthy, and I think financial success is something that people kind of put a lot of weight in. But I think that, you know, just seeing my parents and kind of reframing what they see as success, you know, I think that their joy doesn't necessarily come from having two or three cars. It comes from seeing their children successful and happy and comfortable and they can see that all their years of dedication to help us get where we need to be has paid off. And I think that, you know, I see that now as a goal for myself.
Speaker 2:I think, you know, people have career goals and career aspirations but, like I think, seeing the way my parents were with me, I put a lot, I guess I try to focus on the goals I have for my own daughter, not necessarily that she needs to have a certain job or be, you know, successful in whatever way she wants, but, you know, to make sure that she is well, you know, well adjusted and happy and ends up in a place in her life where she feels comfortable and and just enjoys that, you know, and I think that that's that's. That's something that maybe I don't ever see that much emphasize, see that emphasize on TV that often, but I think it's something that maybe I don't ever see that much emphasize on TV that often, but I think it's something that I know my parents have kind of shown me is a way to bring happiness even after I'm done working, even after I'm done with everything here.
Speaker 1:Yeah, yeah, your parents are incredibly wealthy and incredibly successful in that regard, and I think that's the best regard to to live life through um, and and you make a good point you know it's that is not emphasized enough um, and, and, and it's it's something that should be, um, venerated, it's something that should be respected and um, and that's that's what we want, right?
Speaker 2:our children um children and our community to live the longest life and the best life, the integral happiness curve right credit for when I was 18.
Speaker 1:For sure, but yeah, and so, and we will be imperfect parents, for sure, but the effort will be there, yeah.
Speaker 2:You know, and I think I actually look to you a lot whenever my daughter was born right, I think I as a new father it was very difficult, Like I wasn't sure, and I think your reassurance and your advice was just like you know, you take it one day at a time, right, and then when they're young, you just try to keep them alive and it'll be okay.
Speaker 1:Right.
Speaker 2:Everything will be all right. And I think that idea of just keep looking forward, you know, keep moving forward and do the best you can every day, I think that's probably sage advice for for every stage in life you know, yeah, and we're all winging it as parents, right, it's all our first go, so, like we're doing the best you can, um uh, the um.
Speaker 1:One of Mitch Albom's books says um uh, you know your, your children, are like crystal glasses. You will get fingerprints on them, but don't shatter them.
Speaker 2:So, yeah, I guess I'll tell you how it goes in 18 years. You know how good my parenting is. But uh, give me give me 35 years.
Speaker 1:Okay, that's fair, all right, mike. Well, mike, I um, uh, I appreciate working with you so much and I, um, and and and I think I think when I think of you, I think of somebody who's it's kind of weird, but you're an extremely hard worker but also have a very good and positive attitude, and you don't always see those two things kind of side by side, but I always love talking to you. You're a dear friend and I appreciate working with you.
Speaker 2:Thank you and I would definitely like to reciprocate that sentiment to you and that you know this is my first job out of training and I've been here now for for four years and you know, part of my success and part of who I am today, I think, is because of the people around me, and you guys have definitely helped shape the person I've become now and shown me kind of really what not only what I need, but what patients need when they come to us in a difficult time, right. So I definitely thank you so much for having me today, and then I do consider you a dear friend and I really kind of enjoy our both personal and working relationship and I'm looking forward to more years together.
Speaker 1:I couldn't agree more. Thanks so much, Mike.