Dr. Gabrielle Lyon 00:00
Do all cancers respond to radiation?

Dr. Sanjay Mehta 00:03
There is no cancer that cannot be destroyed by radiation. The limiting factor is the human being around
that cancer.

Dr. Gabrielle Lyon 00:10
One in eight men will get prostate cancer.

Dr. Sanjay Mehta 00:13
That’s right

Dr. Gabrielle Lyon 00:13
That is insane.

Dr. Sanjay Mehta 00:14
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 on 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.

Dr. Gabrielle Lyon 00:33
Gosh, that is unbelievable. What are some of the biggest myths surrounding radiation?

Dr. Sanjay Mehta 00:41
Radiation is part of the electromagnetic spectrum. Just essentially, light 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 tale about the cell phone giving you a brain tumor not going to happen.

Dr. Gabrielle Lyon 00:58
What about living next to an electrical tower.

Dr. Sanjay Mehta 01:01
That’s that’s EMF again, and so that’s electromagnetic frequencies that are not able to damage your
DNA. On the other hand, was 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

Dr. Gabrielle Lyon 01:23
it either. Wait, wait, wait, this is this really important?

Dr. Gabrielle Lyon 01:33
Dr Sanjay Mehta, welcome to the show. Thank you. Thanks for having me 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, osteoarthritis, rheumatoid
arthritis, you name it. You can treat it? Yes, ma’am, tell me a little bit about your treatment and your
experience of treatment with prostate cancer with low dose radiation therapy.

Dr. Sanjay Mehta 02:10
So for prostate cancer, it’s considered high dose we 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 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 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 painless. 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 stage and the grade of the disease and whatnot, the cure
rates are basically the same as a radical prostatectomy. So that’s a very popular procedure.

Dr. Gabrielle Lyon 03:41
and one in eight men will get prostate cancer. That’s right, that’s right. Very, very common. That is
insane. There is radiation, there is surgery, right? Is chemo, also utilized?

Dr. Sanjay Mehta 03:54
in metastatic disease, if you have bone meds, 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 leukemias 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,

Dr. Gabrielle Lyon 04:31
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, that’s right, is that

Dr. Sanjay Mehta 04:44
that’s correct, right? I’m kind of a tertiary specialist because of your typical patient will go to primary
care doctor. They’ll get an annual blood test, maybe their PSA is rising, or if it’s a lady, maybe the
they’ve had their annual mammogram or 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 or something’s unusual, to go to a breast
surgeon, and they will remove the lump, and then they’ll send it to me for radiate 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 or 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,

Dr. Gabrielle Lyon 05:36
there are those new full body MRI scans per novo. Yeah, and you, someone could come to you, for
example, I’m going to 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?

Dr. Sanjay Mehta 05:58
We start with the biopsy first. And so there’s a lot of things on these pernubo 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 prostate lesion, they’ll see a urologist. So after the biopsy is done, then they
can send to me, and I can help with the staging part, in terms of ordering PET scans, MRIs, whatever is
needed, and then depending on the stage, then we design the treatment plan

Dr. Gabrielle Lyon 06:27
and to set the stage for people. Radiation is the kind of medicine that you practice,

Dr. Sanjay Mehta 06:32
correct. Radiation Oncology is technically my specialty, right? 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 an 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 my patients
are like, Oh yeah, that’s Dr Mitchell. 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 with the medical oncologist.
Certain cancers need chemo and radiation combined modality treatment, or then the third type of
oncologist, of course, is surgical oncologist. So you got all

Dr. Gabrielle Lyon 07:33
three. And when we think about a physician that is prescribing a medication or chemotherapy, there’s a
dose, a treatment, length, right? All of those logistics, and you are delivering, right? 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. That’s right, we are radio phobic. You and
I, yes, you spoke about this. Yeah, 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 were your mom told

Dr. Sanjay Mehta 08:17
you don’t sit too close to the TV. Exactly. You’re gonna get a tumor. Yeah? So, like, 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, yeah, so that. So essentially, joules alone is just
energy, but joules per kilogram 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. It’s and there. 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 that 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 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 ability. 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. In the case of a
prostate cancer, I’ll treat the prostate gland. And 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.

Dr. Gabrielle Lyon 10:08
And when I think about radiation, is it fair to say that it is? Is it a laser delivering walk us through?

Dr. Sanjay Mehta 10:16
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. It’s probably more accurate. And so when you look
at the electromagnetic spectrum, human beings can 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 the
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. I mean,

Dr. Gabrielle Lyon 12:15
it makes sense. Also sounds like we’re exposed to various forms of radiation. If I’m hearing you
correctly, there’s non ionizing and then there’s ionizing radiation. That’s exactly right. You deliver non
ionizing.

Dr. Sanjay Mehta 12:31
No, it’s actually ionizing. So X rays and and you’ve heard 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.

Dr. Gabrielle Lyon 12:53
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 it Are there ways that we get non ionizing radiation naturally?

Dr. Sanjay Mehta 13:07
There are so non ionizing radiation is everything that’s that’s below the energy of visible stuff, and so
radio waves are naturally occurring. You know, you have astronomers who’ve got these big radar the
big satellites that are trying to detect extra extraterrestrial life. Here, come pick me up exactly. 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,
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 infrared camera 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 very, a very high
frequency, lower energy X ray that can actually, like, basically a microwave that could burn you if you,
or 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.

Dr. Gabrielle Lyon 15:02
The utility of it is just, it’s so interesting. Were you involved in physics? I mean, this seems

Dr. Sanjay Mehta 15:07
I just enjoyed, I’m like, I’m like, a mechanical type person. So I think if I wasn’t, I’m a rad on a 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 was 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 really great area of medicine, in my
opinion.

Dr. Gabrielle Lyon 15:38
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. And it’s a beautiful thing, and the side effects seem
to be very limited. Yes, when you are using low dose radiation, what are some of the biggest myths and
fallacies surrounding radiation?

Dr. Sanjay Mehta 16:04
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.
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 you’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 squamous cell,
lining of all your oral cavity, all the whole gi cavity, it just desquamates and goes away. So that’s a
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 1020, 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

Dr. Gabrielle Lyon 18:30
when 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

Dr. Sanjay Mehta 18:41
and high dose, high dose is lethal. But in some cases, that can be can actually be harnessed and be 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, the

Dr. Gabrielle Lyon 19:23
radiation. Is it fair to say that it’s the waves that change? What is it if we were to think about, how do we
understand in terms of if it was equivalent to medicine, sure, a an aspirin versus a Tylenol, they’re both
pills, but they have different mechanisms, different

Dr. Sanjay Mehta 19:40
different mechanisms 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 we’re
bombarding the tumor with. But if you have it, if I have 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 in that point, the different energies of X rays can be generated from different
machines, and you essentially can 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 you 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. Everybody’s
everyone’s been to the dentist. They 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 kilovolt is 1000 volts. Is enough to get a good image of a bone. You can see if there’s any
deterioration when you have a cavity or what, or a broken bone. If you go to the, you know, you go to
the, er, you get 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.

Dr. Gabrielle Lyon 21:37
But would you be able to use that tool for both when you go and

Dr. Sanjay Mehta 21:42
so actually, the machines that we use now that what’s really, really revolutionized what we do as
radiation oncologist is not only being able to give a high dose of radiation to a small area, but to be able
to aim it correctly, yeah. 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 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 we 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 a little Mickey Mouse ears sticking off one
side. I can, 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 you’re
radiating what needs to be radiated, but you’re not radiating and damaging the normal tissue.

Dr. Gabrielle Lyon 23:16
And do all, I mean, there’s various types of cancers. Do all cancers respond to radiation.

Dr. Sanjay Mehta 23:23
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 got to be cognizant of the
normal tissue. So if you took a tumor in a petri dish. Anything can be radiated, and it’s going to 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 that. 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 eye, things like that. So depending on which part of the body it’s in, then
the surrounding normal tissue will dictate how much radiation I can safely deliver,

Dr. Gabrielle Lyon 24:09
and it doesn’t affect the dermis. You can just go right through the skin.

Dr. Sanjay Mehta 24:13
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 a I’ve treated a 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 she can’t be off of her meds. So they couldn’t cut it out. So we just radiated it. But with with
with electron beam, the X rays stop a couple of 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.

Dr. Gabrielle Lyon 24:56
Gosh, that is unbelievable. Yeah, someone would not have to. Be opened, correct,

Dr. Sanjay Mehta 25:01
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 there 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

Dr. Gabrielle Lyon 25:49
energy. Everyone use a Linac. Almost

Dr. Sanjay Mehta 25:51
everyone. The other things you’ll hear that are alternatives. And being in Houston, we have MD
anderen up the street, they have proton therapy. So protons are different than 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 check, like a lung tumor, for example, and the surface of the skin will get a little
dose, be 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 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

Dr. Gabrielle Lyon 26:37
it, which they’re definitely not looking for in that area, right? Once you treat someone with radiation,
obviously, it’s a few treatments, a handful of treatments.

Dr. Sanjay Mehta 26:48
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. You have to be careful. The slower you give the radiation, if you have a tiny bit per day and you
stretch it out over many, many weeks, you have a lot less normal tissue toxicity in most

Dr. Gabrielle Lyon 27:34
cases. And is that all measured in grays? It is

Dr. Sanjay Mehta 27:37
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 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 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.

Dr. Gabrielle Lyon 28:13
It shrinks the cancer, but does it cure it?

Dr. Sanjay Mehta 28:16
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 for let’s, 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. In one case, your rates are the same, literally the same, even though, in one
case, you’re surgically removing the tumor on the other side that the can’t the prostate gland is never
removed from the body, but the energy from the X ray sterilizes the cells. So even though 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.

Dr. Gabrielle Lyon 29:10
What are the side effects of surgery or radical prostate?

Dr. Sanjay Mehta 29:15
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.

Dr. Gabrielle Lyon 29:35
That is the biggest one that I’ve seen, and

Dr. Sanjay Mehta 29:37
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

Dr. Gabrielle Lyon 29:53
you are the second person in all of my years of speaking with physicians. That have mentioned penile
shortening. It’s just not talked about much. Yeah, 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, yes, that you can
shorten your penis by a centimeter.

Dr. Sanjay Mehta 30:23
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

Dr. Gabrielle Lyon 30:33
point. If you have a radical prostatectomy, which is removing the prostate, you can reduce penile length
by how much?

Dr. Sanjay Mehta 30:44
Probably a couple of centimeters. Ah, 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 urethral length that’s inside of that is gone after that. Now that’s not to say, to be fair to the
urologist who may be listening and shaking their fist at us, 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 just to ruin the story, but fistula formation, you know, a Chola vesicular fistula from the scar tissue
causing the organs to stick together and fistulize. 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. That’s where radiation kind of got. Part of
its bad rap was because this is in the 70s and 80s, there were 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 hadn’t, 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 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.

Dr. Gabrielle Lyon 33:27
And I think it from talking to our mutual friend Dr Mohit Kara 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

Dr. Sanjay Mehta 33:40
another day. Yeah, I’m not in their league. They’re both the kings.

Dr. Gabrielle Lyon 33:43
Well, I don’t know you’ve got some day, 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.

Dr. Sanjay Mehta 34:04
Isn’t that interesting? And little hit 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 cancer. 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. 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 six 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 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 they eat
their spicy foods, maybe a little bit of bit of dysuria and everything, as you’re passing the spicy chemical
capsaicin around, out of the urethra, a little 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, 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 and go. My dad, I
actually treated my own 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

Dr. Gabrielle Lyon 35:52
that too. Is there anyone who would not be a candidate for radiation therapy? For example, prostate,
breast,

Dr. Sanjay Mehta 36:00
very few. There are rare situations like, there’s certain hereditary disorders of DNA repair, like
xeroderma pigmentosum and stuff that you probably haven’t heard about since med school. I don’t
even Yeah, 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, yes, and so zero Derma pigmentos. And these patients have no DNA repair, so if even
the minor amount of UV exposure, they’ll have horrible like sunburns and things like that. So in those
and again, 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 rheumatoid arthritis or
shogren’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, I have to make sure that my dose doesn’t
overlap with what was previously treated. And, you know, things like that.

Dr. Gabrielle Lyon 37:11
Is radiation the standard of care for all cancers.

Dr. Sanjay Mehta 37:15
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 a part of the multi disciplinary 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

Dr. Gabrielle Lyon 38:13
statement, and I really appreciate that, because we’ve moved into an era where we are very radio
phobic, 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, 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,

Dr. Sanjay Mehta 39:03
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, TV, yeah, and so let’s address one.

Dr. Gabrielle Lyon 39:11
Don’t put the computer, the computer on your lap. Don’t put your cell phone in your

Dr. Sanjay Mehta 39:15
pocket, 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 air pods, 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 air pods, the microwave ovens. None of that stuff is going to damage your

Dr. Gabrielle Lyon 39:45
tissues, and we know that those are strictly non ionizing Correct, correct

Dr. Sanjay Mehta 39:50
because ionizing radiation is much more tightly regulated. So like the mildest type of ionizing radiation
would be ultraviolet. That’s less 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

Dr. Gabrielle Lyon 40:34
reasonable thing. Wait, wait, this, is this really important for the community? Yes, going through the is it
the machine that you stand up that scans you, or is it the what? What is it?

Dr. Sanjay Mehta 40:46
Yeah, so there’s different types. There’s like thing, there’s one. I’m not an expert on this, 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 a Lara, 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 if there’s a 0.01% of 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
an that’s a different scenario. But for a non pregnant and a non like a child who has, 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

Dr. Gabrielle Lyon 42:26
effect, which he said, again, that I think we’re not really thinking about in that way.

Dr. Sanjay Mehta 42:31
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.

Dr. Gabrielle Lyon 42:42
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

Dr. Sanjay Mehta 42:53
me, yeah, no, red light is visible light, if you can see the light, it’s not ionizing.

Dr. Gabrielle Lyon 42:58
But is there some light that we again, that maybe is being produced.

Dr. Sanjay Mehta 43:02
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 the country
or in the world, the elevation you’re at makes a big 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 incidents 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 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.

Dr. Gabrielle Lyon 44:08
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, yeah, you have, you

Dr. Sanjay Mehta 44:15
have less shielding from the Earth’s magnetic field, and also from the shielding

Dr. Gabrielle Lyon 44:19
from the Earth’s magnetic field. Even though you’re in a plane where you’re not really being exposed

Dr. Sanjay Mehta 44:25
to you’re still 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 have

Dr. Gabrielle Lyon 44:33
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.

Dr. Sanjay Mehta 44:55
Yeah. So that’s all, all the electromagnetic frequencies and all that’s all non ionizing. So it’s not of any
danger.

Dr. Gabrielle Lyon 45:01
So you’re saying I was, I wasted my I, you know, again, there’s a lot of things. I’m not

Dr. Sanjay Mehta 45:05
trying to say medicine, modern medicine knows everything, and it’s your own child you’re talking about.
Why not be an extra 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 harm 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.

Dr. Gabrielle Lyon 45:30
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, yeah, 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,

Dr. Sanjay Mehta 45:48
did you ever see that self that it was a viral video, probably 1520, 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 in the cell phone to ring, and all the popcorn kernel 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.

Dr. Gabrielle Lyon 46:33
What about the idea of grounding, or this change in electrons? Have you heard about that? You go out,
you walk,

Dr. Sanjay Mehta 46:41
yeah, static electricity, that’s that. That’s actually important if you’re putting gas in your car, because a
little spark can cause a big kaboom with the with the evaporating gas fumes. So that actually, that’s
why you don’t want to be talking on your phone when you’re putting fuel in your car. I don’t know that
that’s actually a real

Dr. Gabrielle Lyon 46:59
thing. Okay, what you gotta tell me you should not talk on your phone. What if you’re using an iPod?
Yeah.

Dr. Sanjay Mehta 47:05
So it’s extremely rare, but they’ve been a few explosions at gas station. People are an iPod is probably

Dr. Gabrielle Lyon 47:11
fine. No, no. You gotta tell I mean, listen, I do not want to only time I’ve

Dr. Sanjay Mehta 47:15
heard it, 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 like you’ve, 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 an 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 I’d get off the

Dr. Gabrielle Lyon 47:50
cell phone, I don’t think they taught I don’t think they teach us that.

Dr. Sanjay Mehta 47:53
Yeah, and maybe some people don’t agree with me on that, but that was an actual thing, and I know
that actually you’ll see at some gas stations, there’ll be a sign saying, yes, turn off your cell phone.
Another thing is they 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 nothing to do with radiation.

Dr. Gabrielle Lyon 48:15
We’re gonna go back to radiation talking about cars. I will say that I actually got into a fight with my
husband about turning off the car, yeah, while you’re pumping gas, yeah, yeah. No, you told me, No,
no. He was right. He said, You have to turn off your car. I said, Well, why on earth would you have to do
that?

Dr. Sanjay Mehta 48:31
And having said that, I know plenty of people who, when it’s hot and 100 degrees in the summer in
Houston and your spouse is in the car, you don’t want them to bake for 10 minutes.

Dr. Gabrielle Lyon 48:39
Yes, you do. Yes, you do. Let’s talk about how your treatment, what your low dose radiation treatment
is, especially around musculoskeletal injuries.

Dr. Sanjay Mehta 48:52
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 have 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 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 shot. Cortisone is an anti
inflammatory drug radiation, the same radiation we’ve been talking about, when given in very small
doses, 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 on to for 125 Five 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 when, of course, when ibuprofen became a
thing, if it was a prescription, ulcers. Do you remember? There was a time you may be too younger,
when ibuprofen was a prescription. And so at that time, it was a big difference. When that first came
out, then you had all the other the Cox, two inhibitors, the Vioxx and the Celebrex, all of those drugs,
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, 100 year old data showing that it’s safe and effective to stop joint pain, whether it’s
osteoarthritis, 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,

Dr. Gabrielle Lyon 51:26
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?

Dr. Sanjay Mehta 51:37
That’s a great question. So in the earliest day. So this actually goes back to, let’s maybe talk for a
second about the history of radiation. History of radiation. Dr rientkin 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? They’re like, Oh, is that at osteo sarcome? Was like,
No, it was his wife’s 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 were. 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. 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 two 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 that are really part of the modern era. But back
then, they had superficial radiation machines, or even a an actual radioactive isotope. Like, for
example, you can have a tiny little piece of a radioactive chemical called strontium, and that that could
be applied directly to the cornea for a pterygium, and it would make the pterygium go

Dr. Gabrielle Lyon 53:19
away. You know? You can take that orally, right? You know that? Yeah, I’ve heard of that.

Dr. Sanjay Mehta 53:22
You probably know more about it than I do, but I’ve heard, I mean, I don’t know what you use it for, but
it is used like, there’s, there’s liquid forms that are that can be instilled in various parts of the body, like
to try to to cauterize a like a hemangioma, maybe, or something like

Dr. Gabrielle Lyon 53:36
that. Radiation was given, but it wasn’t utilizing a Linux machine that is able to target that’s right where
it’s going. It was very crude, crude, but it worked. But did it cause damage? One of the things that I
want to really offer people as a solution right now, in the US, someone 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 a while, or go get a
cortisone injection. Yes, yep. What about living next to an electrical tower?

Dr. Sanjay Mehta 54:13
Or that’s, that’s EMF again, and so that’s electromagnetic frequencies that are not able to damage your
DNA, no.

Dr. Gabrielle Lyon 54:21
But is that radiation? No, but really? Well, yeah, okay,

Dr. Sanjay Mehta 54:24
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 electricity, there’s electricity, and there’s magnetism, and the two combined electromagnetism is
what powers everything in here. But those are not waves that are able to eject an electron off

Dr. Gabrielle Lyon 54:49
of a nucleus, because it’s the radiation is that it disrupts atoms. So when

Dr. Sanjay Mehta 54:53
you have just, let’s say, a water molecule, H, 2o You got two hydrogen atoms and an oxygen atom.
When ionizing or. 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 and H O ion and a free radical. You know
all about free radicals. And so that creates an ion. So where you had a stable H, 2o molecule, now you
have an O, H hydroxyl group, and in a proton that comes off of it. And so when that happens, the ion
can 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 that.

Dr. Gabrielle Lyon 56:07
Is there any positive benefit of non ionizing radiation?

Dr. Sanjay Mehta 56:11
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 TMB, or what’s

Dr. Gabrielle Lyon 56:19
ECT, or trans magnetic stimulation,

Dr. Sanjay Mehta 56:21
trans magnetic stim. So I think with the magnetic fields, they’ve seen changes in brain activity. That’s
not my area, but I use that for the military operators. Yeah, that sounds amazing, but I know nothing.
I’m an ignorant person about that, but in that situation, yeah, I

Dr. Gabrielle Lyon 56:33
can just treat cancer, but whatever, yeah. 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. Yeah, yeah.

Dr. Sanjay Mehta 56:46
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.

Dr. Gabrielle Lyon 56:52
Why are they selling that? Is that for arthritis or inflammation? Why do people, why

Dr. Sanjay Mehta 56:56
do actual professional athletes pan to like nugenics 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

Dr. Gabrielle Lyon 57:17
for copper bracelets. Let’s talk about what works

Dr. Sanjay Mehta 57:19
for arthritis. Yeah, not those.

Dr. Gabrielle Lyon 57:23
But arthritis is, is definitely something that can really impair someone’s ability to live right,

Dr. Sanjay Mehta 57:30
right, 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 going to lose muscle mass, you’re
probably going to develop Type Two Diabetes, 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.

Dr. Gabrielle Lyon 58:09
Can we talk about the trajectory of arthritis? It doesn’t just happen, right, right? 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?

Dr. Sanjay Mehta 58:21
And so I think let’s arthritis is very broad term. Let’s, let’s maybe focus on osteoarthritis, because
rheumatoid arthritis isn’t is an autoimmune disease, and osteoarthritis is just essentially friction in the
joint. For you 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 surfaces of two bones
that are protected by 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 stage, 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, 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 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 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, 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

Dr. Gabrielle Lyon 1:00:14
did it. And you just went into the office one day. I was like, You know

Dr. Sanjay Mehta 1:00:17
what? I’m just gonna try actually, I should, I should give proper due credit. There’s a buddy of mine
who’s a radonk 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 like an old man when I
could be treating myself. I said, let me try it. I knew based on I had 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 and see what protocols in
place the gray number, what 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, 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 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

Dr. Gabrielle Lyon 1:01:33
whatever it is, treat, say, a costochondritis, you could,

Dr. Sanjay Mehta 1:01:37
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?

Dr. Gabrielle Lyon 1:02:01
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

Dr. Sanjay Mehta 1:02:11
up a physiological response. Yeah, absolutely,

Dr. Gabrielle Lyon 1:02:13
it is. 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, right,

Dr. Sanjay Mehta 1:02:31
right? And that’s a good point, because every little trauma you have, your body is going to heal it that
way through the inflammatory past pathway, and then normally, the inflammation will pass once the
tissue is healed. But what I deal with is chronic inflammation. So when it’s someone that’s had this, you
know, you have, I actually had a knuckle that was bugging me. I just might, I don’t know what I did to it.
It was hurting when I knocked on the cars, probably, and it was three or four months, and it was getting
to the point 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 call, 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 case of my Achilles, there’s 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.

Dr. Gabrielle Lyon 1:03:59
Which is more effective? Toward his own or, you know, I think about Don, my best friend, Don layman.
He’s a world class PhD protein researcher. He doesn’t listen to this podcast. So I can talk about him.
He loves tennis, okay? His knees bother him, yeah. 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 got to see Sanjay, and
he’s been doing cortisone treatments, 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, treat early
with the

Dr. Sanjay Mehta 1:04:58
they could so. There’s, 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. So probably they have different machines, 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 100 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 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 just seems to
be more durable. And the reason seems to be, what do you mean by durable? 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.
That’s extraordinary. 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. Now 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 great time, six, then you actually wait 12 weeks. And if
necessary, if there’s any any residual pain, first six treatments, two weeks in a row. 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 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
200 ish 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 gonna say something I was just

Dr. Gabrielle Lyon 1:08:25
gonna ask about, is there any possibility of disease reversal?

Dr. Sanjay Mehta 1:08:28
So it depends on what the disease process is. So for an earlier stage, 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 one
through four. So four 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. That’s 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 of 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 there’s not a favorable risk
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 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 point five 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.

Dr. Gabrielle Lyon 1:09:57
Is there any application? For muscle, muscle law. I mean, obviously wouldn’t affect hypertrophy, but
you see a lot of these machines doing various things.

Dr. Sanjay Mehta 1:10:09
Yeah, I think you know, typically when you have for, for an athletic person, the muscle, you know, as
you’re rebuilding your muscle, if you’re 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 differentiate, like a bicep
tendonitis, it’s not really the bicep, it’s the tendon, but the whole area hurts. And so I’ve treated people
like that, where I’ll maybe treat the ac joint on halfway down their arm, just as it radiates down there.
And it does tend to work, but if 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 about, I think, 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 beans 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 and now that I’m doing
all this arthritis, I was like, I’m looking back and I’m 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

Dr. Gabrielle Lyon 1:11:35
and it seems as if they’re still doing it, and it’s quite frequently used. If you look in the literature, yes,
seems as if it’s

Dr. Sanjay Mehta 1:11:40
oh yeah, in Germany, in the UK, Spain, like most of the big the leading minds in this who’ve done it for
a while are all European, and the data is very robust, 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. I wouldn’t treat a child. Obviously, we don’t make sense. You don’t 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

Dr. Gabrielle Lyon 1:12:21
from that, and no damage to the surrounding tissue, yeah, or very or when you

Dr. Sanjay Mehta 1:12:25
say no damage, maybe a transient redness, like a little erythema for a few weeks, but no permanent
damage.

Dr. Gabrielle Lyon 1:12:30
And I know that we’re talking about osteoarthritis specifically, but rheumatoid arthritis, yes, can we just
touch on that? Sure?

Dr. Sanjay Mehta 1:12:37
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 typically don’t treat any other type of arthritis on a routine basis.
They save this just for osteoarthritis. But 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, 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 different drugs now, with immunotherapy
and that sort of thing, but the radiation could be a great adjunct to just get that one painful spot and it
improves their quality

Dr. Gabrielle Lyon 1:13:44
of life. 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, yeah, with rheumatoid arthritis, 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
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. That’s right. I mean, muscle centric, right? 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 absolutely gonna happen?
What about post operatively? Okay, what type of surgery? I don’t know. I’m just thinking post surgical,
post hip replacement, post shoulder replacement. Any of those,

Dr. Sanjay Mehta 1:14:41
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 post
traumatic. So if someone is. 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. You know, 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 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 you, 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.

Dr. Gabrielle Lyon 1:16:09
That reminds me of we were talking earlier about keloids, and we’re talking about scarring, yep, 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 peronis disease, can be really painful and uncomfortable for men, for
sure, can you use low dose radiation to potentially treat that.

Dr. Sanjay Mehta 1:16:42
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 over growing and things like that. But the same way that a
keloid forms, or the same way you get a pterygium in your eye, pyrones disease, response to a penile
trauma will cause scar tissue to form. And radiation can help stop 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 duper trans
contractures of the hand, which is essentially scar tissue forming just under the skin, not in the tendon
itself, but near 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 can get amputations from
that, because it’s gotten so bad where they’ve tried to fix it. And when they do it, what they call a needle
aponeurotomy. That’s a common hand procedure, where they release the scar tissue and and
straighten it out. Unfortunately, the actual surgery stimulates more scarring. So by radiating those areas
after they’ve been operated on, that that allows the scar tissue, keeps the scar tissue from forming
again. And so duper trends, and then there’s actually a foot equivalent of dupertin, which I wasn’t even
aware of till I started. Aware of till I started reading, but 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 terrible for trying to be alcohol 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. You have to have surgery. But in these earlier cases, it’s used a
lot, and pyrones 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,

Dr. Gabrielle Lyon 1:18:38
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 why? 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, sure.

Dr. Sanjay Mehta 1:18:56
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 oncologists. 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 really not even it wasn’t that I was a non believer.
We 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 100 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, but I think we’re getting to a point
where that’s really going to change.

Dr. Gabrielle Lyon 1:20:18
And to be clear, it should be a radiation oncologist.

Dr. Sanjay Mehta 1:20:24
It has to be okay. 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 dermatologist
that only treats skin cancer, they may have a machine in their office that can just treat superficial skin
lesions, they still have to have radiation oncology supervision to do that.

Dr. Gabrielle Lyon 1:20:44
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

Dr. Sanjay Mehta 1:21:01
their life. And it’s exciting. It really works. And they fascinating. 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.

Dr. Gabrielle Lyon 1:21:12
I mean, there’s nothing better than being able to positively impact someone’s life, right?

Dr. Sanjay Mehta 1:21:17
It’s for all these years my the dopamine came from telling people they were now cancer free, that their
cancer was which is also a huge thing, obviously, but now we’re seeing the same thing in the pain
space, where you’re pain free, and that usually happens even faster. So instant gratification,

Dr. Gabrielle Lyon 1:21:32
and if people want to come see you, obviously we’ll include the link. Where can i Where can I go?

Dr. Sanjay Mehta 1:21:36
Yeah, so my website is Dr sunjai mehta.org, D, R, S, A, N, j, A, y, M, E, H, T, a.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,

Dr. Gabrielle Lyon 1:21:59
And your practice takes insurance

Dr. Gabrielle Lyon 1:22:02
All insurance, basically all insurances. And of course, most patients are Medicare age, so that’s the
typical, what we see the most of but yeah, most insurances.

Dr. Gabrielle Lyon 1:22:10
Well, Dr Sanjay, I’m excited to be a patient of yours.

Dr. Sanjay Mehta 1:22:13
I look forward to it and I think we can help you.

Dr. Gabrielle Lyon 1:22:16
Gonna be great. I will report back.

Dr. Sanjay Mehta 1:22:18
Thank you so much.