Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

Daniel Lobell: (00:22)
Hello, and welcome to the Doctorpedia podcast. I am your host, Daniel Lobell, and I am honored to be joined on the line today by Dr. Ruchi Garg. How are you?

Dr. Ruchi Garg: (00:33)
Doing well, how are you doing?

Daniel Lobell: (00:34)
Good, good. I know that you’re a founding medical partner with Doctorpedia, and I know that you’ve just started an exciting new job and there’s a lot to get into, but before we go into any of that, I’d love to hear a little bit about you, where you grew up, and what it was that was the impetus for you to become a doctor.

Dr. Ruchi Garg: (00:51)
Oh, wow. Okay. So I — it’s a long story, a 40 plus year old story —

Daniel Lobell: (00:58)
Well, we got the time, and we’re interested.

Dr. Ruchi Garg: (00:58)
I was actually born and partially raised in India. I was born in Delhi, but we were living in central India at that time. And my dad worked for the Indian government, and we moved to Delhi. I was there until seventh grade and I had probably changed about seven schools by then.

Daniel Lobell: (01:15)
Wow.

Dr. Ruchi Garg: (01:16)
Yeah. That’s what happens when your father belongs to a defense kind of position. So then we got a green card to come to America. And my uncle who had sponsored us actually lived in Puerto Rico at that time. And we moved to Miami because it was the closest mainland to Puerto Rico. We didn’t want to move to Puerto Rico. And when we moved there, we were the… Probably less than, there were probably less than a thousand Indian families in all of South Florida at that time. Say, it was a nice cultural shock.

Dr. Ruchi Garg: (01:47)
I was almost 12, I was very glad for that. Because we had the whole summer. I was able to watch TV and sort of brush up on my English and felt a little bit more cultured into American, into what American kids watch, and joined eighth grade. It was an interesting transition. There were quite a few funny moments that may or may not be okay to talk about.

Daniel Lobell: (02:09)
You got me interested now, but OK. [Both chuckle]

Dr. Ruchi Garg: (02:14)
I know, it’s just, I feel like there actually should be a book written for kids who transition from another country. And like some of the words in slang that are not okay to use.

Daniel Lobell: (02:30)
I think I know where you’re going with that. [Daniel chuckles]

Dr. Ruchi Garg: (02:30)
My name, Ruchi, rhymes with a lot of things. And then [Ruchi chuckles] yeah, it was just a big culture shock. We weren’t…. I still remember. So at that time, the dollar value was 17 rupees to a dollar. And so my dad would move — we moved here with family of four on $2,000 in his pocket, and I still remember when the porter at the airport, he had brought out eight suitcases, international suitcases, my dad gave him $2. And he wasn’t looking at my dad, but my dad was like, 1% of what I have, right? [Ruchi chuckles] Yeah, it was pretty interesting. But yeah, it’s a memory that we always keep in mind as a family. We were in a one bedroom apartment and my uncle had rented us a car. And then three days later, he, I mean he had to go back to his job and that’s what he had to do. It wasn’t as if he wanted to abandon us, but he was just, yeah. And we didn’t have a job. We just literally picked up and left and moved to this country. So my dad didn’t have a job. My mom didn’t have a job and they had a 15 year old and an almost 12 year old kid.

Daniel Lobell: (03:45)
Is that when they looked at you and said, “You better become a doctor because someone around here needs to have a job?” [Both chuckle]

Dr. Ruchi Garg: (03:52)
No, it’s pretty interesting, so my dad sort of went into a little bit of a culture shock and depression and didn’t know what to do. And we kept basically booking a ticket back to India every single day. And my mom and my brother were like, “We’re not going back as failures. We’re just not a failure family.” My mom basically went down and she was a teacher. She had a master’s in English from India, but she went out and basically got a job at Taco Bell and Dunkin Donuts. And that’s how we started. And I think a week or so, or two weeks into it, we decided it’s time to do something more. And we picked up the phone book. At that time, you had those big fat phone books that used to come to the house. And so we picked up the phone book and we started calling the Indians in South Florida. One of the Gargs that was in the phone book — the one and only other Garg — we called them. And he happened to be Dr. Erwin Garg who is a very nice dentist in India and very well known in their dental community. And his mom happened to be really good friends with one of my mom’s friends from high school. But when you talk about like six degrees of separation, we sort of actually learned that it’s only about two or three degrees actually.

Daniel Lobell: (05:06)
Wow. And India is not a small country either, so that’s impressive.

Dr. Ruchi Garg: (05:09)
Exactly. So she bade, immediately welcomed us into their house and befriended us and guided us. They really couldn’t do much more than that. But then the second family that we called was Dr. Gupta. And we were very fortunate. Dr. Gupta happened to be the vice provost of Florida International University at that time. And he also happened to be my aunt’s friend. So my aunt who’s married to my mom’s brother in India, she, before we were leaving, she’s like, “I have a friend who went to MBA with me, I just have to find his number.” Well, guess who that friend was. That was Dr. Gupta. [Ruchi chuckles] Dr. Gupta was the second family that we called, who the vice provost of FIU, Florida International University. And he immediately invited us to his house for dinner. And he realized what kind of family we were, my dad was well-established in India. And just sort of….

Daniel Lobell: (06:07)
Not a failure family. [Ruchi laughs] They know at least what kind of family you weren’t. I love that because I never heard of a family that claims they are a failure family. [Daniel chuckles]

Dr. Ruchi Garg: (06:18)
I know. We’re not going to go back failures. Nobody’s going back. So he invited us. And he got my mom a job in his office, right off the bat. He got my dad into the master’s program in Industrial Engineering at FIU. And he got him assistantship, got him paid tuition and things like that. Yeah. That’s a lifelong friendship, 30 years since that happened. And we basically took off from there. My brother worked for Winn-Dixie at 15, lost his first $50 paycheck that he got. He just told me the story literally an hour ago.

Daniel Lobell: (06:53)
About how he lost his first paycheck?

Dr. Ruchi Garg: (06:57)
He lost his paycheck. And he was really upset about that one. And then yeah, I started tutoring as soon as I could, basically, to earn money. And then, yeah, I’ve always just worked.

Daniel Lobell: (07:13)
What were you tutoring? What subject?

Dr. Ruchi Garg: (07:13)
Math and science.

Daniel Lobell: (07:13)
Amazing. And English was your second language, I’m led to believe?

Dr. Ruchi Garg: (07:18)
Right, but everything in India is really sort of done in English. And my mom had, because she was a non-citizen, she had her master’s in English. She, in India, you could take your sciences and your social studies in English or Hindi in schools. And my mom had always had us take them in English. So…

Daniel Lobell: (07:34)
I guess because it was a British colony, right?

Dr. Ruchi Garg: (07:37)
Exactly. Back in the forties. Yeah.

Daniel Lobell: (07:39)
What I’ve heard from India comes from my dad who — he’s retired now, but worked for many years as a photojournalist and he would go out to India and he told me like, you would see people starving on the street and kids with flies all around them. And he also said it was an incredible country, an amazing country with just eyeopening buildings and beautiful landscapes. But he said the level of poverty that he saw in the streets changed him forever. And it made him a much more cynical person. I would love to hear from you, what was that like growing up around there?

Dr. Ruchi Garg: (08:10)
Everybody sort of has a different viewpoint in what they take away. And I guess as a photojournalist, he may have… he saw that. I mean, I didn’t see — yes, it exists in India. It exists in every developing country and unfortunately even exists here in the United States, right? I mean, you see homeless people living under the bridges, exactly. So I think it’s just a viewpoint that he saw. India has the largest middle class community who really believe in education and have gotten themselves out of any sort of…. Many people have gotten themselves out of that poverty. But just like any other country, it has that extreme… There are really wealthy people. Yeah, I mean, so I think that’s just one viewpoint. I still remember actually in eighth grade, some kid asked me — people always used to sort of assume because this was in Miami and they always assumed that I was Hispanic and they would always start talking to me in Spanish first and I’d be like, “No hablo Español,” and they’re like “But you’re speaking Spanish.”

Dr. Ruchi Garg: (09:11)
I’m like, “Yes, that’s all I know.” And they would be like, “Oh, so then where are you from? What are you?” And I learned very soon that I was mistakenly calling myself an Indian, and I had a kid who basically started making noises and dancing around me. [Ruchi chuckles] And then I had one person ask me, “Oh, do they have homes in India and houses?” And I was like, “No, I lived in a tree and we had no roads. I swam across the ocean to come here.” I think that’s the point, you know? And unfortunately, yes, it does exist. And I guess maybe as a photojournalist, your dad saw that, but I don’t think I saw as much of it because I was a protected child in a upper middle class family.

Daniel Lobell: (10:01)
Right. Not a failure family. [Daniel chuckles]

Daniel Lobell: (10:07)
I love it though. I think it’s funny. I always think of my friend’s kid when she was really little, we went over for dinner and my wife asked if there was ketchup, and the kid said, “We are not a ketchup family!”

Daniel Lobell: (10:21)
[Both chuckle] It’s funny how people identify their family. What kind of family are we?

Dr. Ruchi Garg: (10:26)
I definitely was a ketchup family. I eat ketchup on everything, or I did at least, as a kid.

Daniel Lobell: (10:31)
We’re a ketchup family. We like ketchup.

Dr. Ruchi Garg: (10:35)
Yeah. So I did all my schooling down in Miami, I still remember — so my brother was applying for colleges. He was in 11th grade when he came here to this country and obviously it was within a year, he was applying for colleges. And at that time, lots of Indian kids in the Miami community wanted to go to this honors program in medicine, which is a six year combined medical program at University of Miami. So that’s what he wanted to apply to because he wanted to be a doctor and he didn’t get into it, but he got into MIT and my mom didn’t quite know what MIT was, and she was just sort of talking about colleges and at her work and somebody asked, “Oh, where’s your son going?” And she’s like, “Well, he didn’t get into the six-year program, I guess he’ll have to go to MIT.” [Both chuckle] And the guy was like like, “Oh yeah, he’ll just have to go to MIT.”

Daniel Lobell: (11:39)
Did your mom get at that point that he was being sarcastic?

Dr. Ruchi Garg: (11:39)
Yes.

Daniel Lobell: (11:39)
But he could be like, a lot of Asian families are very serious about academia to some point where it could be taken seriously, like “have to go to MIT” could be the real response of an Indian mother. Like “Ugh, I guess he’ll have to go.”

Dr. Ruchi Garg: (11:52)
Exactly, because he didn’t get into the six-year program where he wanted. So of course.

Daniel Lobell: (11:55)
Right.

Dr. Ruchi Garg: (11:56)
But yeah, I did end up going to the six-year program in Miami years later.

Daniel Lobell: (12:02)
Congrats.

Dr. Ruchi Garg: (12:02)
Thanks. And then I moved — after medical school, I moved to Johns Hopkins and Baltimore for my Gynecology and Obstetrics residency and then went on to do gynecologic oncology fellowship at Hershey, Washington, Seattle.

Daniel Lobell: (12:18)
So what attracted you to gynecology of all the many fields? It’s a unique choice.

Dr. Ruchi Garg: (12:25)
Yeah, I actually never thought I would be a gynecologist, but apparently my father pegged me back in early med school and I hadn’t even gone through rotations. He was like, “Oh, she’s going to be a gynecologist.” I was like, “Okay.” I didn’t even know what that was yet. But when I did my third and fourth year of medical school rotation, that’s when you sort of get exposed to different fields. And I still remember my first rotation with family medicine and it was an outpatient clinic and there was a podiatrist who was taking out some patient’s hangnail. And just the amount of pain that the patient was in and seeing that blood, I almost passed out.

Daniel Lobell: (13:01)
I’ve been that patient. I’ve been that patient. It was horrible.

Dr. Ruchi Garg: (13:08)
It is painful!

Daniel Lobell: (13:08)
It’s so painful.

Dr. Ruchi Garg: (13:08)
Yeah, and just watching that was very painful that I almost fainted. So I, at that moment, really sort of got worried that, “Oh my God, if I faint at this, how am I going to get through my surgical rotations? But the next rotation was general surgery and I totally loved it. Like I knocked it out of the park. And I was like, “Oh my God, really, I can do surgery.” And then my, I think third or fourth rotation was gynecology and I was fortunate enough to be assigned. So you could either do general oncology or you could be assigned to a gynecologic oncology team as a medical student. And I was fortunate to be assigned to gynecologic oncology. And that pretty much paved my pathway. I loved every moment. I mean, we worked, we would be there from 4 in the morning till 10:00 PM every day. And I loved every minute of it.

Daniel Lobell: (13:56)
And the oncology part, that’s to do with cancer, correct?

Dr. Ruchi Garg: (13:59)
Correct. Yes.

Daniel Lobell: (14:01)
And what about the word obstetrics? What does that mean?

Dr. Ruchi Garg: (14:03)
Obstetrics means, care of the babies. So in short form it’s OBGYN, obstetrics / gynecology, but anybody who goes through the training, they can deliver babies and do C-sections and vaginal deliveries and all of that, they’re also trained to do gynecology, which is managing abnormal pap smears and abnormal masses. And they do hysterectomy, which is removal of the uterus and surgery. So anything to do with sort of below the belt, gynecology, female part, essentially. And then there are subspecialties in that field. So you can specialize to be a maternal fetal medicine specialist, meaning a high-risk OB. So people who have complicated pregnancies or who are medically complicated and are becoming pregnant or patients who, for those kinds of patients, they’re managed by a high risk OB specialist.

Dr. Ruchi Garg: (14:54)
And that’s a subspecialty training factor. You do four years of OBGYN you can choose to go into, that’s called the fellowship, you can do that. Another one is infertility. So reproductive endocrinology and infertility specialty. So those are the ones who create babies. So test tube babies and Petri dish babies. My son is a Petri dish baby.

Daniel Lobell: (15:15)
Oh really?

Dr. Ruchi Garg: (15:15)
Yeah. And then you can also do oncology, which is the cancer specialty. So any cancers that arise from these areas, we’re trained to do surgeries on them, but we’re also the unique — the unique part about that specialty, that we’re the only surgical oncologists who are trained to also do chemotherapy. So we give chemotherapy for our patients as well. So we basically take care of our patients from beginning to end through their whole treatment. So not just pass them on.

Daniel Lobell: (15:44)
That’s an intense workload, it sounds like.

Dr. Ruchi Garg: (15:47)
It is. It is actually. Definitely. But that’s what I loved about it. I mean, that rotation really sort of pinched the deal for me. And I loved taking care of such brave women who get diagnosed with these tough diagnoses and then they still care about their families and they still continue to do everything for their families and, or carry on their career with such great and such perfect presence. It’s really sort of, that’s what triggered me. So I actually did — there’s no direct pathway to gyn oncology, so you have to go through OBGYN, so I did OBGYN residency only to do gyn oncology.

Daniel Lobell: (16:23)
That’s amazing. I mean, you talk a little bit about these strong women and it kind of brings up for me, like, your mother. And when you guys — as I kept joking with you about, “we’re not a failure family,” your mother’s insistence that you guys don’t go back to India, it sounds like you have a very strong matriarch in your family and maybe that possibly had something to do with your decision to help other families with their matriarchs. I’m not going to try and play psychologist, but does that sort of resonate?

Dr. Ruchi Garg: (16:53)
Yeah. I mean, I guess I’ve never sort of sat down and thought about it, but probably, I mean, my mother has had a very strong influence in my life. And even to this day, I mean, I really rely on her. We have just become friends and we rely on each other for emotional support. So yes, more than likely, but I never sort of sat down and thought about it.

Daniel Lobell: (17:14)
Cool. Maybe I made a breakthrough for you. [Daniel chuckles]

Dr. Ruchi Garg: (17:18)
There you go. I know, but no, I mean, it’s just amazing. I mean, these women, the majority of these women are older when they get diagnosed, but there are many, many, many young women who get diagnosed and they have very young kids and you just wanna power through that for them. I still remember one of my patients who was diagnosed with stage four ovarian cancer, and she came into me and she was like, “I just want to see my daughter get married.” And her daughter’s marriage was still about six months away. So I was like, “Okay, well let’s do it. Let’s power through that.” So we got the daughter married and then like a year later she said, “I just want to see my first grandchild.” And then we got through that. And then, now, so this was a few years ago and now the granddaughter is two or three years old. And she was like, “I just want to get to my second grandchild.” [Both chuckle]

Daniel Lobell: (18:11)
It’s worked so far. “I just want to see my grandchild get married.”

Dr. Ruchi Garg: (18:19)
I mean, it wasn’t about her at any point. If I had the crystal ball, I would.

Daniel Lobell: (18:25)
I believe you would. What do you think are the most important facets of the doctor patient relationship?

Dr. Ruchi Garg: (18:32)
Trust. I’ve seen over the years, even as a person who’s making a fee is a doctor, right? And they can be phenomenal doctors. So you don’t have to be an “A” student to be a great doctor, and you don’t have to have all the knowledge. I think you just have to know what you know, and know what you don’t know how to look it up or how to guide the patient in the right direction and have the humility to admit that to the patient. Once you have that, and you actually admit that to the patient, then the patient actually does trust you. I’m pretty upfront and honest with my patients right off the bat. And they know that I’m going to be honest with them and I’m going to hold their hand throughout. But I’m also going to be honest with them and they’ll know when it’s time. I’m going to fight with them, but then when it’s time to not fight and just sort of let it go, I’m going to go on that path.

Daniel Lobell: (19:26)
That’s gotta be a very difficult time for you as well, I suppose. Am I right in assuming that?

Dr. Ruchi Garg: (19:31)
It is. There are many times that I’ve cried with my patients. You can’t go into the field and not have those emotions and hope for the patient and for their families. So it really affects us when the cancer progresses, there’s a part of us because we’re not a failure family, right? There’s a part of us that always feels like we failed, even though we could have done everything that we possibly could have done. And we did it. But cancer is that kind of disease, that kind of a beast, it can progress. But I don’t think many of my patients — well, maybe many do realize that we unfortunately see it as a failure for ourselves, but we really do feel the emotions for them, even though we can definitely empathize in those moments.

Daniel Lobell: (20:25)
Have there been any breakthroughs lately in your field that have changed the playing field in any way? Or are there any things that you’re very excited about that you feel might save a lot of lives?

Dr. Ruchi Garg: (20:37)
Quite a few, several, actually. I think some of the game changers — to give an example in our field, in the gyn oncology field. Well, genetics has had been a real game changer, sort of figuring out these hereditary genetic mutations that run in some families are sort of like a mixed blessing because many patients actually who have those cancers, yes, they have those mutations actually have a high risk of getting cancers, but at the same time, many of them actually, because of that mutation itself, actually respond much better to treatment. So it’s sort of a double edged thing, but those, just that kind of understanding and breakthrough of understanding how to treat those mutations in my patients, there’s a new drug called, a category of drugs called PARP inhibitors. And I can’t sort of spell out the names. It’s a huge scientific name for PARP inhibitors, but in short form it’s P A R P inhibitors.

Dr. Ruchi Garg: (21:44)
It’s a pill that’s we give after chemotherapy that is done for ovarian cancer patients. And it’s really sort of worked as a wonder drug for some of these patients and really keeping them alive for a long time. We have a lot that’s being done in — and these are called biologic therapies, these medications are acting upon certain mutations or certain aspects of the tumor. So we have therapies, biologic therapies that are acting against the blood vessels that the tumors need to grow. And then there’s a lot of immune therapies that really have become like wonder drugs for patients. We all have heard about Jimmy Carter and the melanoma, but really, truly. I mean, yes, some of these medications are working just like that for many of these patients. It’s pretty cool. I still remember taking a biomedical engineering course in college. And I had learned about something called vectors where, I mean, I was a 17 year old kid and had no understanding or nothing, but I was always a dreamer and… Vectors were basically like, you could put a cell, like you could put something and they could act as a carrier inside the cell and they can make changes within the cell body.

Dr. Ruchi Garg: (23:05)
And even at that time, I was like, “Oh, how cool would it be to use this?” Like, can’t I just go and fix like a mechanic, can’t I just go fix a disease like that? And that’s exactly what’s happening now. I mean, I’m not smart enough to sort of know the whole aspect and concept, but that’s exactly what’s happening. They’re bio medically modifying patients’ genetics or their cells basically to fight against cancer.

Daniel Lobell: (23:31)
That’s really, really interesting. As you’re saying that, I’m thinking about the COVID vaccine and how I’ve read that it changes your RNA. Is it working in a similar kind of respect?

Dr. Ruchi Garg: (23:41)
I mean, yes, but more so even than that, I mean… But yes, the concepts are similar. Yeah, I mean, as I said, I can’t even begin to, for me, understand and explain it. And I’m so far removed from those bench research and those brilliant minds that are going into this at this point. I sort of moved away from that basic science bench research now, and I’m really into the clinical world and I see the end results or the translational research where we’re actually testing those things out in patients.

Daniel Lobell: (24:16)
That’s gotta be exciting to see when it works and very sad when it doesn’t.

Dr. Ruchi Garg: (24:21)
Absolutely.

Daniel Lobell: (24:21)
Let’s shift gears for a second to talk a little bit about the online health space. Do you typically encourage or discourage patients to look for information online?

Dr. Ruchi Garg: (24:30)
So I just moved here from Northern Virginia, I’m in Georgia now, and I haven’t really had too much patient encounter here yet, but I mean, we had very intelligent patients and patients with a lot of access. So I actually didn’t mind patients coming in with having done their research and being a little savvy and asking intelligent questions. So yes, I like patients who do their research, but I don’t encourage them to come in with a closed mind or think that because they have Googled the topic that have all the answers. I actually just was shadowing because I’m at a new facility at a cancer treatment center, and I was chatting with a doctor recently, just to sort of see how the flow of work is here. And I heard her say to a patient, to a patient who was uncertain about how to go about her breast cancer treatment.

Dr. Ruchi Garg: (25:24)
And she really did. She was like, “Well, in my research, this is not what I found.” But the doctor said, “Just like you may have some knowledge about cars, but you go to a mechanic to fix your car. You don’t fix your car yourself.” Exactly that way, you have some knowledge about the body and you have Googled it, but you still go to a doctor to do the deed essentially. So that’s what I mean. I actually don’t mind patients doing the online research, but it’s coming with an open mind and realizing that that physician has put in four years of medical school, for example, in my scenario, four years of medical school after college, then four years of residency and four more years of subspecialty training, 12 years after college, and then there’s something to say about experience and years of patient experience in clinical care to be provided that you have to be willing and open minded.

Daniel Lobell: (26:21)
Well, I know that you provide some really great information online through Doctorpedia, plug plug, Doctorpedia.com. Everybody should check it out. And that you’ve become a founding medical partner with Doctorpedia. Can you tell us a little bit about the work that you guys are doing together and what we can expect and hope to see on the site?

Dr. Ruchi Garg: (26:40)
Absolutely. So I actually ran into Doctorpedia because a friend of mine who’s a GI specialist in Northern Virginia, I saw a video of hers on LinkedIn and it was through Doctorpedia. And I think, “Wait, what is this?” And I followed the breadcrumbs and didn’t find a contact number from there. And I just basically, in their contact us general email, said, “Hi doctor, I’m interested, we’d love to talk.” And that’s how I got ahold of the powers that be, I guess, at Doctorpedia, and really sort of got exposed to the world, this aspect of medical world. And it’s amazing. I mean, all of us physicians want just what I said, they come with an open mind. What great platform this is that the patients actually can get word of mouth or get the information directly from the doctor themselves.

Dr. Ruchi Garg: (27:34)
So yeah, I decided to join Doctorpedia and what he can expect from me is I always sort of write down working on just sort of basic knowledge. When the patients come to me, I start a conversation and then actually write pictures that I draw out, or I have printed where I actually identify anatomic parts that we’re talking about to the patients, just to give them that basic knowledge in whatever we’re talking about, sort of guide the pathway. So the first set of videos are just going to be basic knowledge dispensing about the gynecologic oncology world. So anatomy stuff, as well as ovarian cancer and uterine cancer, cervical cancer, vulvar cancer, vaginal cancer topics, just a broad overview. And then we’re going to get into the nitty gritty of each kind of cancers. But one of the other near and dear topics to me in the oncology world is fertility.

Dr. Ruchi Garg: (28:29)
So as I said before, most of these women we have tend to be older, but there are many who are younger and many who have never even had, or even had a chance to consider pregnancy. So just how to tie in that with the oncologic care and how to preserve it, or unfortunately, sometimes not preserve it and there’s conversations surrounding that. So we’re going to definitely anticipate some of those videos of oncofertility. I’m very interested in hereditary cancers and genetics. So there’s going to be a lot of aspects on that.

Daniel Lobell: (29:04)
What are some of the things going on with genetics that are interesting that the audience might not know about?

Dr. Ruchi Garg: (29:10)
Well, I mean, as I said, the mutation identification, and there’s more and more every day, there’s some broad groups of mutations that are already known. For example, they’re called BRCA or BRCA mutations or patients with something called Lynch syndrome.

Daniel Lobell: (29:29)
What is that?

Dr. Ruchi Garg: (29:29)
So BRCA mutations basically are mutations that increase the patient’s risk of breast cancer as well as ovarian cancer and in some scenarios, some other cancers. So there’s BRCA1 mutations and BRCA2 mutations that have been identified in really either high risk families, in fact, in certain communities, for example, an Ashkenazi Jewish family, Jewish heritage people, it’s 40% chance of having these mutations. So they have just higher risk of cancers in these certain cultures. I’m actually noticing that there’s some in Northern India, as well as sort of Pakistani area women who have high-risk mutations as well. I’ve just sort of seen that more in my practice.

Dr. Ruchi Garg: (30:15)
So just identifying these patients in these families and actually offering them preventative or prophylactic surgeries to decrease their risk of cancer. I mean, BRCA1 mutation patients can carry a risk of breast cancer as high as 85% in lifetime by age 70, and a risk of ovarian cancer in them can be as high as 60%. Now, just to compare that, general population risk of breast cancer is about 12% and general non-mutated patient population risk of ovarian cancer is only about 1.3 to 1.5%. The magnitude is just huge there. And average age of ovarian cancer is about 58 to 60, but average age in BRCA 1 mutation is 48. So here we go, right? Thinking about young women, fertility, hormones, we offer these patients surgeries. We tell them to get their things done and have babies, and we do their surgeries, their prophylactic surgeries, and we recommend that between age 37 to 40. So there’s a lot of counseling that goes into that, a lot of followup that goes into that, in prepping these patients and these women as well as their family members, because they’re a high-risk family and identifying those other high risk family members and managing them appropriately.

Daniel Lobell: (31:37)
What about with regards to fertility? What are some of the biggest misconceptions that people have with regards to what you do and fertility?

Dr. Ruchi Garg: (31:45)
I think a lot of times actually patients come to us thinking they’re diagnosed at the end and it isn’t. There are so many options that are out there. And honestly, I mean, we don’t always learn about all of these things in our training. Some of it actually comes from just practicing because not everything can be put down on paper and in textbooks and you won’t necessarily see every clinical scenario in training, but no, there’s so much that can be done. So I really sort of encourage patients to, again, come with an open mind and just ask the questions, write down your questions for the doctors to see, what are all of the options? Have you covered all your — if that is your desire, and you are not satisfied with the answer first time around, and it could be that there isn’t much more that can be done and the doctor’s not saying something wrong, if you’re not satisfied, then that trust factor comes in. I actually always tell my patients who I sense that hesitancy. I always tell them, “Go seek a second opinion. Maybe I’m missing something, but at the same time, if I’m not, at least then if you’re going to seek treatment out with me again, maybe you could come back in with full trust in me.” And I have no ego about it, that, yes, go get a second opinion.

Daniel Lobell: (33:06)
That’s what you’d want from your doctor, I think. You don’t want an ego. Again, it comes back to that trust and humility that you brought up before. You want to know that the person seems confident, but don’t think that they’re God. They’re making you comfortable enough to still exercise your own judgment and your own research.

Dr. Ruchi Garg: (33:24)
So yeah, I mean, there’s a lot of exciting stuff that’s happening.

Daniel Lobell: (33:28)
Yeah. I actually produced a podcast for somebody who runs an organization called Bonei Olam. I don’t know if you’ve ever heard of them, but they work in the Jewish community with people who have fertility issues. And it was a really fascinating interview. I’ll plug the other podcast for listeners. It’s called People with Purpose with Chaim Marcus. The founder of Bonei Olam talked about how he and his wife were unable to conceive a child and they have gone on to, I think they said over 800 or 8,000 babies, I don’t remember, but a tremendous amount of people they’ve helped because so many more options exist now and there’s so much research to fund and there’s so much that’s being uncovered all the time that are making, to your point, these diagnosies are — is that how you say it? Diagnoses? — That people have…

Dr. Ruchi Garg: (34:18)
Diagnoses, yeah. [Both chuckle]

Daniel Lobell: (34:18)
…That people have been getting, which used to be like, there’s no hope for you, it opens up those possibilities for people.

Dr. Ruchi Garg: (34:25)
Absolutely. I think there may be reverse titles on the other side, you know what I mean? Yes, definitely, as an oncologist, as another physician, I provide this comprehensive care and hope, but I definitely don’t want to fail to say that when it’s time to stop treatment or not to treat them, there are some unfortunate times like that, when we do have to be realistic and not actually put our patients through that difficult treatment phase with minimal to no gain. And just the comment that you said about we’re not playing God and that’s when I have a pang in my stomach. Whenever I’m having that discussion with the patient that I think it is time or that we shouldn’t, that’s when I feel like, “Are we playing God here?” And I always have a pain in my stomach when I’m having that conversation, even though intellectually, everything that I know and all my training and all my education tells me that that is the right conversation to be having.

Daniel Lobell: (35:31)
Putting myself in your shoes. That must be a very, very difficult thing to do.

Dr. Ruchi Garg: (35:35)
Yes. It’s a difficult one to carry. And it’s really interesting that we actually get, now the government or CMS, actually, we get quality metrics from physicians and we get dinged for being inaccurate in that aspect. We get dinged that if we give chemo too close to the end of life, or we don’t have that conversation with the patient soon enough. And yes, there are, I mean, some, unfortunately the bad apples who just continue, but most physicians do have that conversation or, those who mean well sometimes don’t, or aren’t able to, because it’s just such a difficult conversation to have. And it’s such a difficult thing to predict.

Daniel Lobell: (36:21)
And you must feel, “Maybe if we just did this one more thing, maybe there’s still hope,”

Dr. Ruchi Garg: (36:26)
Correct.

Daniel Lobell: (36:26)
Well, it’s heavy stuff. Let’s lighten it up for a second, and add some other questions. Let me throw this one your way. How is technology changing health and wellness? And do you think it’s for the better?

Dr. Ruchi Garg: (36:37)
Yes and no. So yes, the technology’s great. I mean, I am the robot child, I actually do — well, yeah. Let’s talk about this. And robotic surgery has been approved for gynecologic surgery in 2005, FDA approved in 2005. And I got trained in 2006 and I’ve done over 3000 robotic surgeries. I do about 80 to 90% of my oncologic surgeries robotically, which is fantastic and allows for quicker recovery for the patients. I mean, we’re doing these massive surgeries that for which patients used to get huge incisions all the way from, their bottom of their abdomen, all the way to the, right before their ribs. And now we do them through five tiny holes less than a thumbnail size. And patients are doing fantastic and getting quick recovery, getting back to their life. And even if they need more treatment, they’re getting to that quickly with minimal scars.

Dr. Ruchi Garg: (37:34)
So yes, the technology is great. I mean, I’m a huge fan of surgical technology and improvement. Another good aspect of technology is actually just electronic transitioning all our medical records to an electronic format. It’s fantastic. That’s a double edged sword.

Daniel Lobell: (37:51)
Right. Because it can be hacked into, right?

Dr. Ruchi Garg: (37:53)
It can be hacked into, but it also made some of our older physicians… I definitely know, I think it put one of my older partners into retirement. [Ruchi chuckles] Because he didn’t want to — people haven’t been trained. I mean, we were the computer generation, right? Like 1990s, late eighties and 1990s. I mean, that’s when it all started. And if anybody who trained before then now you’re asking them to do everything electronically and know that it’s hard. And I think that wasn’t sort of well thought out when there were like mandates that were put on medical practices by the government, that everything had to be electronic and they gained this much money in terms of that, even though you were providing good care, but I think now it’s for the better, but then there’s just no perfect program yet.

Dr. Ruchi Garg: (38:39)
And there’s no full-on Microsoft platform, a full on Apple platform. That really has been tweaked to the max. So there are a bunch of different programs that are out there, like for electronic medical records that don’t talk to each other. And so there’s still some headaches that need to be worked through, but no, I mean, it’s fascinating what’s coming out and even the best technology that’s actually coming out are physicians who are thinking in that term and actually working with companies who improve the day to day utilization and aspects of technology and care that we provide.

Daniel Lobell: (39:16)
Wow. That’s a interesting answer that I didn’t expect, very nuanced and very interesting. Thank you. I also wanted to bring up the fact that you’ve got this exciting new job at Cancer Treatment Centers of America and give you the opportunity to talk a little bit about that.

Dr. Ruchi Garg: (39:29)
Sure. Thank you. So after doing my fellowship in Gynecologic Oncology at University of Washington in Seattle, I joined a fantastic practice in Northern Virginia, which is a gynecologic oncology practice and really sort of grew there. I did my first set of surgeries there and really had transitioned into a more mature physician. And it allowed me to get to this stage of my career. So I just joined Cancer Treatment Centers of America. One of their main hospitals is in Atlanta, near Atlanta, Georgia, but they have other sister hospitals. So the flagship hospital is in Siren, Illinois, and then another hospital in Phoenix. I was just hired as their National Program Director for gynecologic oncology, which is really exciting for me. And I’m just here developing and growing the program across the nation for the system.

Daniel Lobell: (40:23)
Very cool. It sounds like you’re going to have your hands full, between that and Doctorpedia and the incredible workload that you have to begin with. I don’t know how you find the time to do it.

Dr. Ruchi Garg: (40:33)
And I have a two year old.

Daniel Lobell: (40:33)
And a two year old! [Both laugh]

Dr. Ruchi Garg: (40:37)
Who doesn’t like to sleep at night.

Daniel Lobell: (40:38)
I’ll say it again, you’re definitely not part of a failure family. [Both laugh] Doctor, it’s been such a pleasure to talk with you for the past hour. I want to round off the interview by asking you this question that I ask to all of my guests: what do you personally do to stay healthy?

Dr. Ruchi Garg: (40:54)
I think for me, and I did want to take the opportunity and I’m glad I’m able to say this at the end — for me, it’s being with my family. And that’s what keeps me sane and stable, grounded mind to allow me to do what I do every single day. So my parents who have been phenomenal in everything that they have done for our family and what they have sacrificed through the years just to raise their kids and give us all these opportunities. But beyond that, they didn’t just sort of let us — whenever we needed them, they were always there and we could always count on them. And really my mom and dad have just been such a strong shoulder for us. And then I have a wonderful older brother who, without his guidance, I wouldn’t be where I am. And I think just leaning on each other has allowed me to definitely get to this point. My whole family, my brother is married and has three kids, I just took the three kids and my son to the zoo today, which was interesting. Those are the kinds of things that keep me going. And that’s how I stay healthy.

Daniel Lobell: (42:04)
That’s a beautiful answer. Really, really sweet way to end the interview. Thank you so much for your time, for your knowledge and for sharing with us so beautifully and eloquently. I know I learned a lot and I hope the listeners take a lot away from this as well. Thank you so much, Dr. Garg.

Dr. Ruchi Garg: (42:20)
Thank you, Daniel. That’s so great, and thank you for giving me the opportunity to share this aspect of my life.

Daniel Lobell: (42:32)
This podcast, or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

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