Dr. Isaac Yang-Neurosurgeon
Me: Can you explain what a neurosurgeon does? Say I’m a parent with a sick child, or a patient, how would you explain your role to me?
Dr. Yang: So a neurosurgeon is a doctor who does surgery. That means he opens people up and puts them back together. And a neurosurgeon is a surgeon who focuses on problems of the brain and spinal cord.
Me: I was doing a little research, can you explain to me a little bit about Gamma Knife Radiosurgery?
Dr. Yang: Gamma Knife Radiosurgery is a type of stereotactic radiosurgery. So it’s kind of like a brand, like Toyota, Honda; brands of a car. There’s Gamma Knife, there’s Linac, there’s Novalus; there’s different kinds of stereotactic radiosurgery. Overall, radiosurgery just needs highly focused, highly precise radiation. You get high doses of radiation focused on one spot while you leave all the normal tissue to lower doses of radiation.
Me: I know that in radiation, the surrounding tissue gets damaged. The Gamma Knife doesn’t do that?
Dr. Yang: It minimizes the damage.
My sister: You said before you work on the brain. Obviously the brain stem can’t be operated on. So how do you operate on that?
Dr. Yang: Very carefully. The deeper a legion is the harder it is to access it. So you do your best to weigh the pros and cons on how careful you ought to be based on how deep the tumor is.
Me: Are you going through any research right now? Is there anything you can tell us about your research?
Dr. Yang: We’re looking at using different kinds of therapy and technologies to attack brain tumors. We’re looking at stem cells, nanoparticles. We’re always looking at different ways at using that technology to attack brain tumors.
Me: You had worked on a vaccine for a glioblastoma, can you explain that a little bit?
Dr. Yang: Vaccines work by recognizing different proteins. So if you recognize a protein on a bacteria or a cell that’s wrong, the vaccine recognizes that and goes after it. So what we’re trying to do is use different kinds of therapies. Right now I’m trying to work on a nanoparticle vaccine in terms of trying to find different kinds of proteins that can help the immune system recognize the proteins on brain cancer. And then your body can fight brain cancer.
Me: Have you done any trials?
Dr. Yang: Clinical trials are going on right now at UCLA and UCSF.
Me: How are you involved with the family’s journey? Obviously, you operate in their brain. Are you involved with anything else with them?
Dr. Yang: I usually meet the patient’s before surgery. I talk with them, I let them know. I call it a journey. Brain tumor treatment is not In-n-Out. I like In-n-Out hamburgers, but it’s not “in and out”. It’s a journey. Once you get diagnosed with a brain tumor, you’re going to be fighting it for the rest of your life. Even if it’s quote-on-quote “cured”, you’re still going to get MRIs for the rest of your life. So I look at them and say, “You and I are going to be friends for pretty much the rest of your life. Maybe even the rest of my life. We’re going to be friends no matter what. It’s a journey.” So what I think about with my patients is it’s a journey we go on together. And if you want to go to go this way, we have to discuss so we can go together. And as long as we both agree to go we can move forward. And that’s what I think about with my patients. The brain tumor therapy is a journey that I go on with my patients.
My sister: What would be the biggest mistake a patient can make with their cancer? Or the biggest mistake a parent can make?
Dr. Yang: I think the biggest mistake I think I see patients make are doing something that A, they’re not comfortable with. So if you don’t know what’s going on, you have to ask. And I know it’s hard too, because doctors are kind of scary but you have to ask. On both of us. Patients have to have more voice to speak up and doctors need more of a voice to make it comfortable to speak up. So I think the biggest mistake is doing something they’re not comfortable with. And so you have to make sure that you’re comfortable and that you have everything explained to you.
Me: Misha had a brain stem glioma, what would be a treatment option be for her? She can’t have radiation anymore, and chemotherapy isn’t an option. Other than surgery, what could she do for treatment?
Dr. Yang: There are newer medications, versus twenty years ago. There is something called Avastin, which helps shrinks tumors. It’s experimental; it only works for a short time. If it came back, we’d be very desperate. You can’t keep shooting radiation so we’d trying something like Avastin. You could consider surgery, but if it’s deep and in the brain stem, it would be not a good idea to do surgery.
Me: Last question, I ask this to every doctor, what do you find the most rewarding about your job? Getting to save a life is always a great thing, but is there anything else?
Dr. Yang: The best thing about my job by far is connections. It’s the friendship, it’s the relationship. It’s the journey. Because I can’t always save their life. That’s the sad thing about it. Sometimes they have a really deep brain cancer, and there’s not much else we can do in terms of medical therapy, chemo, and radiation. But I refuse to believe that there is nothing else I can do. I can make them feel more comfortable. I try to make them smile. If they want to hug me, I let them hug me. It’s remarkable what a hug can do. What a warm smile, what that relationship can do. I have found out through my life and through my job, that death is not the worst thing. I know, death is horrible. I am not minimizing death. But it’s not the worst thing. The worst thing is not having those connections. Not having that opportunity to say goodbye, to say you love someone, to say you forgive someone and they forgive you. Being able to help families, to help patients through that process, they really like me for that. We have a super deep connection through this thing we’re going through. Because I am going with them on this journey. They feel very connected to me. And I have to say that is a very fulfilling, very rewarding, sometimes a little overwhelming experience. But that’s what I enjoy about my job.
Dr. Yang: So a neurosurgeon is a doctor who does surgery. That means he opens people up and puts them back together. And a neurosurgeon is a surgeon who focuses on problems of the brain and spinal cord.
Me: I was doing a little research, can you explain to me a little bit about Gamma Knife Radiosurgery?
Dr. Yang: Gamma Knife Radiosurgery is a type of stereotactic radiosurgery. So it’s kind of like a brand, like Toyota, Honda; brands of a car. There’s Gamma Knife, there’s Linac, there’s Novalus; there’s different kinds of stereotactic radiosurgery. Overall, radiosurgery just needs highly focused, highly precise radiation. You get high doses of radiation focused on one spot while you leave all the normal tissue to lower doses of radiation.
Me: I know that in radiation, the surrounding tissue gets damaged. The Gamma Knife doesn’t do that?
Dr. Yang: It minimizes the damage.
My sister: You said before you work on the brain. Obviously the brain stem can’t be operated on. So how do you operate on that?
Dr. Yang: Very carefully. The deeper a legion is the harder it is to access it. So you do your best to weigh the pros and cons on how careful you ought to be based on how deep the tumor is.
Me: Are you going through any research right now? Is there anything you can tell us about your research?
Dr. Yang: We’re looking at using different kinds of therapy and technologies to attack brain tumors. We’re looking at stem cells, nanoparticles. We’re always looking at different ways at using that technology to attack brain tumors.
Me: You had worked on a vaccine for a glioblastoma, can you explain that a little bit?
Dr. Yang: Vaccines work by recognizing different proteins. So if you recognize a protein on a bacteria or a cell that’s wrong, the vaccine recognizes that and goes after it. So what we’re trying to do is use different kinds of therapies. Right now I’m trying to work on a nanoparticle vaccine in terms of trying to find different kinds of proteins that can help the immune system recognize the proteins on brain cancer. And then your body can fight brain cancer.
Me: Have you done any trials?
Dr. Yang: Clinical trials are going on right now at UCLA and UCSF.
Me: How are you involved with the family’s journey? Obviously, you operate in their brain. Are you involved with anything else with them?
Dr. Yang: I usually meet the patient’s before surgery. I talk with them, I let them know. I call it a journey. Brain tumor treatment is not In-n-Out. I like In-n-Out hamburgers, but it’s not “in and out”. It’s a journey. Once you get diagnosed with a brain tumor, you’re going to be fighting it for the rest of your life. Even if it’s quote-on-quote “cured”, you’re still going to get MRIs for the rest of your life. So I look at them and say, “You and I are going to be friends for pretty much the rest of your life. Maybe even the rest of my life. We’re going to be friends no matter what. It’s a journey.” So what I think about with my patients is it’s a journey we go on together. And if you want to go to go this way, we have to discuss so we can go together. And as long as we both agree to go we can move forward. And that’s what I think about with my patients. The brain tumor therapy is a journey that I go on with my patients.
My sister: What would be the biggest mistake a patient can make with their cancer? Or the biggest mistake a parent can make?
Dr. Yang: I think the biggest mistake I think I see patients make are doing something that A, they’re not comfortable with. So if you don’t know what’s going on, you have to ask. And I know it’s hard too, because doctors are kind of scary but you have to ask. On both of us. Patients have to have more voice to speak up and doctors need more of a voice to make it comfortable to speak up. So I think the biggest mistake is doing something they’re not comfortable with. And so you have to make sure that you’re comfortable and that you have everything explained to you.
Me: Misha had a brain stem glioma, what would be a treatment option be for her? She can’t have radiation anymore, and chemotherapy isn’t an option. Other than surgery, what could she do for treatment?
Dr. Yang: There are newer medications, versus twenty years ago. There is something called Avastin, which helps shrinks tumors. It’s experimental; it only works for a short time. If it came back, we’d be very desperate. You can’t keep shooting radiation so we’d trying something like Avastin. You could consider surgery, but if it’s deep and in the brain stem, it would be not a good idea to do surgery.
Me: Last question, I ask this to every doctor, what do you find the most rewarding about your job? Getting to save a life is always a great thing, but is there anything else?
Dr. Yang: The best thing about my job by far is connections. It’s the friendship, it’s the relationship. It’s the journey. Because I can’t always save their life. That’s the sad thing about it. Sometimes they have a really deep brain cancer, and there’s not much else we can do in terms of medical therapy, chemo, and radiation. But I refuse to believe that there is nothing else I can do. I can make them feel more comfortable. I try to make them smile. If they want to hug me, I let them hug me. It’s remarkable what a hug can do. What a warm smile, what that relationship can do. I have found out through my life and through my job, that death is not the worst thing. I know, death is horrible. I am not minimizing death. But it’s not the worst thing. The worst thing is not having those connections. Not having that opportunity to say goodbye, to say you love someone, to say you forgive someone and they forgive you. Being able to help families, to help patients through that process, they really like me for that. We have a super deep connection through this thing we’re going through. Because I am going with them on this journey. They feel very connected to me. And I have to say that is a very fulfilling, very rewarding, sometimes a little overwhelming experience. But that’s what I enjoy about my job.