This week, Dr. Daniel Correa sits down with Dr. Katy Peters, a neuro-oncologist and associate professor and director of supportive care at the Preston Robert Tisch Brain Tumor Center (PRTBTC) at the Duke Cancer Institute. Drs. Correa and Peters talk about neurologic conditions and how they are depicted on TV as well as the importance of speaking with your doctor when you have questions about how certain medical conditions and brain marvels are portrayed in your favorite shows.

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Episode Transcript

Dr. Daniel Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa. This is the Brain & Life podcast.
This week we're going to talk about some of what we see on TV in terms of our brains and neurology. I'm overjoyed to be joined by a guest co-host today, Dr. Katy Peters. She's a neuro-oncologist and cognitive neurology specialist at Preston Robert Tisch Brain Tumor Center at Duke University, where she's not only supporting the care of people in her community living with brain and nerve disorders, but she also works to improve their day-to-day quality of life.
We met as a part of the Brain & Life editorial team and she has been the origin of some of the great stories that we have helped bring to you on the podcast. We're both committed to improving the community understanding of neurologic conditions and brain health literacy. And one of the things that we've geeked out a bit about is how TV shows and movies incorporate brain conditions, brain hacks per se, and the future of neurology and neurosciences in their storylines. We're looking forward to including you in this conversation to see what shows get it right and some examples of wild ideas about how the brain works. Katie, thank you so much for joining us.

Dr. Katy Peters:
And Daniel, thank you so much for that great introduction and delighted to be chatting with you and your listeners today.

Dr. Daniel Correa:
So Katie, I'm getting from the presentation that you did to our fellow neurologist at the American Academy of Neurology meeting of how neurology is seen on TV that you're not shy about spending a little bit of time catching up on the latest shows. So I've gotten really into watching some of the different Apple TV shows, and one of those is Severance. Did you and your husband get a chance to catch the whole series of Severance?

Dr. Katy Peters:
Well, we've only seen a little bit of that, but just the beginning and just the concept of it that you would be able to split essentially your work life and your home life and that it's involved in a neurologic procedure is fascinating to me. And I think it borders with the psychiatry and talk even about having a work-life balance. Isn't that if you totally separated them, could that be some representation of that that sort of permeated through sort of the popular culture?
I don't know if we're there yet, but if you think about how we now put ourselves in different situations like in regards to alternate virtual universes with gaming, people can have different parts of their life and maybe even utilize different parts of their brain. So yes, I think it's definitely compelling. It's not something that we're doing normally in clinic.

Dr. Daniel Correa:
Yes, thankfully. I found the show incredibly engaging and interesting. Yes, having this whole discussion about literally work and life balance and whether or not it can actually be completely and totally separated. Fascinating, also incredibly scary, but I think very reassuring that anywhere or anyone, any experimental place in the world is at a place of playing around with that. There isn't actually a part of the brain where you could somehow disconnect memory from one experience from another. There is an amazing area of the brain that records your short-term memory, and there are experiences in the past of people who've had injuries to that where they just can't establish short-term memory into long-term memory and they just keep having to repeat things around them.
But it's not like that TV show and thankfully, and I would reassure everyone that if someone is talking to you about an implantable device into your brain for medical treatment, it's not going to be anything that's recording your thoughts. It's not going to be recording your memories, it's not going to separate context. None of these things are capable or anyone's even exploring at all in medicine. There are amazing devices out there for treatments in certain medical conditions where you might get something implanted, but there is not a memory chip to disconnect you as you enter the purgatory of work.

Dr. Katy Peters:
I agree with that, but I do think the lesson of having a good work-life balance is important and so maybe if we can take that little grain of salt there and bring it to us and maybe practice it in a different way. I do think that during the pandemic that we learned how to work in our homes, that we sort of smashed work and our home life together way too much. So maybe that's what inspired Severance, the desire to actually have them be separated again.

Dr. Daniel Correa:
I could see that. I'm looking forward to the second season. You'll have to tell me what you think as you finish the first season.

Dr. Katy Peters:
Absolutely. I'm actually into Succession now. The patient has a stroke at the beginning.

Dr. Daniel Correa:
Do you think their depiction of what a stroke was and some of the outcomes from it made sense?

Dr. Katy Peters:
Spoiler alert if you haven't watched, I think it was a brain bleed initially. It was depicted well.

Dr. Daniel Correa:
I think that's important for people to understand from some of these shows. There's different types of strokes. Some of them come with bleeding, some of them don't have bleeding, and it's actually that you're just not getting enough blood to certain parts of your brain. What's important, and it's depicted I think more consistently now and shows when they depict stroke is that time is essence. Time is brain as we say often as neurologists and getting to the hospital as soon as possible just like initiatives were made for heart attacks and the importance of getting there quickly. Over the years, many of us in the community now have made clear and people have learned when you have any of the stroke-like symptoms to get to the hospital because there are various treatments that are very time-dependent.

Dr. Katy Peters:
Absolutely. Absolutely. And I think the media does a fine job depicting that in several shows.

Dr. Daniel Correa:
I think what's important for us to reemphasize though is that most of the time what's depicted with a stroke on TV are the things that are very easy to see. And so yes, if you have sudden onset weakness or you have suddenly can't walk, you suddenly can't talk or you can't see, those are immediate things that get evaluated for possible stroke or a variety of other medical conditions, but they're all time sensitive. But we want you all to be aware of if you suddenly can't walk because of a balance issue or you have severe onset of new dizziness or really if all of a sudden normal functions that you could do before, you can't do a and that's a sudden onset, there are other ways strokes can happen and we don't want people to think they're just limited to, oh, I'm not having weakness, so I'm not having a stroke.

Dr. Katy Peters:
Absolutely. And I always say for patients, especially because I treat patients with brain tumors, they often say, well, what would be the symptoms if it was going to come back? And I essentially say, if anything happens abnormal, it is better for you to be seen and to call us and gauge us than to wait. It's better to be open-ended rather than for me to say, well, if you start having that speech problem again, that's probably what we're seeing. I'd rather have you come in and tell me for any symptom. It's better for us to dial it back rather than to just blow something off. And so I think that's an important lesson for so many different patients.

Dr. Daniel Correa:
And Katy, you bring up your patients living with brain tumors and talking about those symptoms. I'm wondering, have they ever brought in or asked you examples about, Hey, I saw this on TV related to a type of brain tumor and you have to explain how really it's a little bit different when it comes to the day-to-day of your practice.

Dr. Katy Peters:
Absolutely, especially in regards to treatment. So patients are often very ... either they think that the tumor can be easily eradicated with a simple surgery that can go through just their nose, like every tumor can be fixed like that to the other end of the spectrum. That treatment is going to be absolutely horrific. The treatment is going to be horrible chemo where you're on IVs and your hair is all falling out and you're constantly sick. And really in all actuality, it's more in the middle and deserves to be tempered. I have a really good colleague here at Duke who actually writes for one of the medical shows, he's a neurosurgeon and he's a very good colleague. And he came to me and he's like, "Katy, we have this patient. They're on the show and they're going to have a brain tumor and we want to give him chemotherapy."
And I said, "Okay, it's going to be a pill." He's like, "Well, that's not exciting enough, so we're going to have to do IV.| And I was like, "well, we don't really do IV. And I was like, we really do oral chemo for this and it's pretty well tolerated." And he's like, "But no, we have to have him on the IV and all the lines in and he's vomiting and it's all this horribleness." And I was like, "But that's not really what happens. I'm trying to convince him to do it the way that it should be depicted." But I guess there always has to be a little bit of drama. But I think one of our jobs, Daniel, and this is what's great about this podcast, is educating our patients. So it's okay to be your own MythBuster, right?

Dr. Daniel Correa:
And I would encourage people in the community. Maybe if you see these things, they make you a little more concerned or you're just wondering if it's possible or if it's related at all to an experience you are having with a condition or someone in your family, let that be part of the beginning of a conversation with your care team. We enjoy it. We'll enjoy that conversation together and it can help you understand. Okay, a little bit more about what fits into our reality and your reality and what might just have been an interesting and exciting thing for television.
The reality is on TV and story writing and show writing, things tend to be on the extremes, and they have to be very visual because TV and movies are visual medium, and so we don't always see that sitting down and having a great conversation and handing someone a pill is the highlight of a TV show. But sometimes.

Dr. Katy Peters:
Yeah, I mean they'd have to have drama. And again, with this depiction with my colleague, he said, "We want to put the tumor in the brainstem," which is of course, that deep part of our brain that controls all so many nervous functions, including our eye movements, our ability to swallow. And I was like, "Well, that kind of tumor doesn't really start in the brainstem. Usually it's someplace else." He's like, "But we need it in the brainstem." I was like, "Well, okay, it's fine." So again, it's okay to have a dramatic license, and I guess that actors or character story happened, but I think it's a good opportunity to at least have a dialogue with your patients.

Dr. Daniel Correa:
Speaking of dramatic, at least from my perspective, it was a TV show that looked at using tapeworms for multiple sclerosis, and there's actually been some discussion about that and some science behind it. Where are we with tapeworms for MS?

Dr. Katy Peters:
Well, it's not going to be standard therapy, but there were at least I believe three clinical trials that actually looked at giving patients tapeworms because it prompted the immune system to react in a certain way. And so I think that this is definitely an interesting paradigm-- brings together sort of what can we use in sort of the microbe field to treat neurological illness because even in our brain tumor populations, we've had modified both the poliovirus, the adenovirus, and even the Zika virus to treat brain tumors. So it's not unheard of that we're using some kind of infectious organism in the treatment of neurologic disease. The next is it just shows that if patients also see something, they might just go out and do it by themselves.
And I think that's another one of the lessons from that particular clip because the patient actually wasn't in a clinical trial but decided to go get their own personal taper, which brings me the fact that it's better to do some kind of therapy within the confines of a clinical trial or at least with the help of your physician. And the way I bridge that is I just say, tell me everything. I want to know what you're up to. I don't want there to be any kind of untowards interactions. And building that trust relationship is just so important. And I really think that it will definitely benefit the patients and it'll benefit that relationship too.

Dr. Daniel Correa:
Yeah, I mean, whether it's a new supplement or any other newer treatment, and there can be potential benefits that we don't still yet understand about lots of other natural treatments and processes that have been out there in the community but just haven't been studied. But I think having the conversation so that we know are there risk factors that we need to follow, and even if we don't know that there's a benefit, if you're really committed to trying it, then we can follow how you're doing afterwards and monitor for things that we might be concerned with or just double-checking.
Now I'm wondering on TV, what have you been thinking about the depictions of people living with a neurologic condition?

Dr. Katy Peters:
Well, I think it's pretty good if they can show that they're going through sort of the challenges maybe that you would see with the stroke patient, maybe navigating their speech issues and communication with their loved ones if they have difficulties with walking upstairs or holding groceries because of a neurologic injury, like a stroke. I think that's good because it humanizes the struggles that people have. But then I think that if we could even have good stewards in our community, I would love to see those characters going to PT, going to OT, going to speech therapy and building a community and seeing also the caregiver role.

Dr. Daniel Correa:
I'm thinking of the show, This Is Us. There in that show, we saw not only a whole family dealing with an individual and their family progressing along with Alzheimer's dementia, but there was also the actor Timothy Omundson depicting a neighbor who had Hemiparesis this or weakness on one side limiting some of his mobility in action, but it's actually because they wrote that in to fit with his own story. We did a previous episode, we interviewed Timothy Omundson and learned he had had a dissection, an injury to his carotid artery that led to stroke and pulled him off from his acting until he was able to work through a long course of recovery and got back on the stage through advocacy and work that they helped him not only get around and have access on the stage set for the TV show. We need more examples of people living with neurologic conditions and the steps of recovery. But I think we also need more examples on TV of just centering people from various different abilities and neurodiversity as just key characters of our lives and our communities.

Dr. Katy Peters:
And I think that the depiction in film, particularly with some of the recent Academy award-winning movies with Marley Matlin and with hearing dysfunction and deafness has been greatly portrayed. And I think that because we now have all these streaming stations, you can watch programs galore and I feel like on Netflix I can make a movie just about everything. I think there's an opportunity to have sort of this functional diversity within characters and within actors and also an opportunity to even see it in things such as documentaries. So even beyond sort of a fictional representation, something that truly is happening, whether it's an actor that is contending with a neurologic illness or even those characters, I agree that there's an opportunity. And I think it will only help us talk more about the challenges of neurologic disorders, but I like to say challenge because challenge is something you can overcome or manage rather than saying a problem.
And I use challenge very particularly with my patients because I think that they can overcome, they can also manage throughout the whole trajectory of their illness. And I am the lucky one that gets to be a partner with them.\.

Dr. Daniel Correa:
Whether it was ER, House, Grey's Anatomy. Do you recall some misconceptions about what neurologists do and R between those shows and people should have a little bit better understanding of?

Dr. Katy Peters:
Absolutely. I think the main thing was seizure management. They love to stick things in people's mouths for seizure management. And we do not want you to stick objects in your patient's mouth.

Dr. Daniel Correa:
There's people who are the character and that they're supposed to be a neurologist, but then they sometimes end up doing things that look much more like neurosurgery or look much more like a catheterization of the brain, which is something more a surgeon or a special radiologist might do. So sometimes I think that it's important for people to understand is just because on TV, a neurologist does one thing, it doesn't necessarily mean that's the typical activities, skill sets and things you should expect from them in the hospital. And oftentimes we're working with the team of lots of different specialties to get the types of things done that one person in house might do.

Dr. Katy Peters:
Absolutely. And I think my favorite show is definitely Chicago Med because everything happens in the ER. The neurologist is in the ER, the outpatient neurologist, the psychiatrist, the surgeon, the neurosurgeon, everybody's in there and sometimes they do tasks that are not necessarily in there subspecialty, and sometimes they have very magical tools. I remember recently there was one where a patient came in with some nausea and vomiting and lethargy and it was a child, and somehow they got the idea that it could be a genetic disorder, that could be an error of metabolism. And they took his blood sample and five minutes later they had the genetic code.
And they said, "Put it in the computer, and this is what came down and all you now have to do is take a vitamin." And it was like, ta-da. And I was like, I don't have that tool. I'd love to have that tool, but things actually do take time. You do have to see people as an outpatient and going to the ER is not necessarily the best way to get care. So yes, I do think there's some education on what a neurologist is and that we can communicate that. And I'm sure in your day-to-day practice, you tell your patients what your role is, and I have to do that so much as a neuro oncologist because we function in a interprofessional, multidisciplinary team with neurosurgeons and radiation oncologists, other neurologists, other oncologists and psychiatrists.

Dr. Daniel Correa:
Yeah, I think what's important always is for everyone to remember. We're part of a big team, which includes you, the individual, your family, and all the other caretakers on the team, and we all bring a level of expertise, perspective, and specialty. Also, you as the individual and your family bring to make everything move forward. We have to work together. It really isn't going to be one person that's somehow going to do it all.

Dr. Katy Peters:
And Daniel, I like to say I'm special teams. I bring in the sports influence. I practice in North Carolina and there's definitely grudge matches in basketball here between Duke and UNC and NC State. We're very proud of our ACC basketball. But I like to say even if my patients are from different groups, I say I'm special teams and we'll be part of your team.

Dr. Daniel Correa:
So tonight and tomorrow, what's next on your TV or movie-watching list?

Dr. Katy Peters:
We're really into Succession right now. My husband and I are really enjoying it. We love watching those shows. It's a good brain break-- time to hang with my family, my husband and my cats, and relax after a long day's work

Dr. Daniel Correa:
For the episode and interview we did with BJ Miller, we did some work taking a look at the show Limitless with Chris Hemsworth and exploring body and brain health and initiatives and ways to try to, like we said, hack the body and brain and see how we can push the limit on health optimization. So it's been a fun exercise to watch some of those episodes about exercise or about challenging your body to do new and hard things and where the science might be and how that contributes to improving our stress responses and our body.
So I'm looking forward to finishing up those episodes and doing a little bit of more background reading so I can be prepared when someone in the community brings a question about it and see, okay, what do we know actually about that? And we look forward in the future to be doing some more brain health episode and discussions here about those exact situations, exercise and otherwise, and what we know and putting it into practical terms for you, our listeners.

Dr. Katy Peters:
I agree with all of those things. It sounds like a great show. It's going to be in my list also to watch. It sounds like a lot of fun. Now, Daniel, are you a watcher or a doer? This is mostly done in the context of cooking shows that they're the people that watch them and the people that actually cook the recipes, but I wonder if you're going to be doing some of those limitless activities.

Dr. Daniel Correa:
Well, I am training for a marathon, so I guess I'm a little bit on the doer side of some of those Limitless activities, and I'm definitely the one who watches the cooking show while cooking.

Dr. Katy Peters:
That's awesome. The secret's out. Daniel is a doer and that's just great. I like it. I guess you walk the talk.

Dr. Daniel Correa:
Oh, I enjoyed our discussion so much, and I'll look forward to catching up on some of these TV shows. We ask our listeners to submit or ask any questions about things you find on TV, online, in a movie, or any suggestions that you have about future topics.

Dr. Katy Peters:
Thank you so much. Go pick up a copy of Brain & Life, and thank you for having me on this podcast.

Dr. Daniel Correa:
Thank you again for joining us today on the Brain & Life podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain & Life magazine for free at brainandlife.org and even get the Espanol version for each episode. You can find out how to connect with our team and our guests along with great resources and our show notes. We love it when we hear your ideas or questions. You can send these in by email to blpodcast@brainandlife.org and leave us a message at 612-928-206. You can also follow the Brain & Life magazine and me on any of your preferred social media channels. These episodes would not be possible without the Brain & Life podcast team, including Nicole Lucier, our public engagement program manager, Rachel Coleman, our public engagement coordinator and Twin City Sound, our audio editing partner.
I'm your host, Dr. Daniel Correa, connecting with you from New York City and online @NeuroDrCorrea. Most importantly, thanks to our community members that trust us with their health and everyone living with neurologic conditions. We hope together we can take steps to better brain health and each thrive with our own abilities every day. Before you start the next step episode, we would appreciate it if you could give us five stars and leave a review. This helps others find The Brain & Life Podcast. See you next week.

 

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