E 184 Cytopathologist and FNA Specialist Celina Nadelman MD

Time to learn about fine needle aspiration and cytopathology with Dr Celina Nadelman. She has a private practice and that is a rate situation. Get inspired and enjoy her episode.

a doctors perspective 184 FNA nadelman trosclair sq
Dr. Celine Nadelman, MD talks to Dr. Justin Trosclair, DC on A Doctor's Perspective Podcast

How does one go from psychology (neuroscience), art and then switch it up and go into medicine? Dr. Nadelman even spent multiple years in Italy developing her artist vibes but ultimately the practice of medicine is an art as well as a science so the two melded nicely.

Some people know they want to not only do medicine but which specialty from high school age, but she was a bit unsure and had to try out a few things to figure out that Fine Needle Aspiration (FNA) pathology was her best fit.

When she was in the process of residency, the big push was primary care but through a series of events and personal contact she found that pathology was her path. She was also a talented surgeon but with her desire to have a family and balance family with the surgery responsibilities, Dr. Celina decided that wasn’t her path.

Fine Needle Aspiration Biopsy

Smallest needle possible, getting a smear of tissue, looking at in the microscope and determining what it is you have. It’s the smallest amount of tissue needed to make a diagnosis.

Pathologist is the Doctor’s Doctor

A lot of anatomical pathology is pattern recognition. You know what it is supposed to look like and in what location and then you start to recognize what’s wrong and what patterns wrong have.

Her specialty is cytology aka thyroids and head and neck tumors.

She has her own private clinic doing FNA biopsy but it’s a pretty rare thing and Dr. Nadelman is hoping a platform like A Doctor’s Perspective Podcast will help others to do the same thing. It is a little hard to be private because you compete against the hospital pathologists.

A problem is that any MD can do a fine needle aspiration but many many times they don’t get enough readable material, or it’s full of blood (bad) and both make it difficult to make a correct and confident diagnosis.

Having to get more than one biopsy is not a pleasant experience for the patient and in her private practice, she can get the sample, smear it on a slide immediately and put it in under the microscope she has in the room to make sure it’s readable. (Rapid On Site Evaluation).

She gives a great story around minute 18 about a case that she did that required a second FNA because what she saq bedside would require extra tissue for further testing. This also saved the patient from having to come back to the office and from another pathologist reading it as, need more tissue for evaulation. Especially in this case it could have been a 1 year terminal diagnosis or not.

Diagnosing normal and cancer is easy she says. The tough stuff are the tissues that are irregular and make you need to send out the sample to molecular specialist and beyond.

Who is a good referral source for a private practice pathologist? Would it surprise you that she has to meet face to face with doctors, just like you do, so they refer to her instead of the hospital?

Dr. Nadelman has been married for 24 years and this was during both of their professional school years and have 3 kids. Listen at the end for her marriage tips. A top tip is to not be in cruise control on your marriage. You have to engage each other in partnership. Also, don’t be afraid to go to a counselor.

www.drnadelman.com IG:drcanceranswer
Show notes and the transcript can be found at https://adoctorsperspective.net/184

a doctors perspective 184 FNA nadelman trosclair
Dr. Celine Nadelman, MD talks to Dr. Justin Trosclair, DC on A Doctor's Perspective Podcast
Full Transcript of the Interview (it will have grammatical errors and mistakes). Just Click to expand. Thanks descript!
Episode 184 cytopathologist and FNA specialist. I'm your host, Dr. Justin TRS, Claire. And today we're Dr. Selena Nadel man's perspective. Award-winning podcast host and bestselling author. Dr. Justin TRS, Claire, as we go behind the curtain and talk to doctors and experts about their specialty marketing and home life balance.

Let's. A doctor's perspective.

Hey, welcome back to the show. Today is fun because it's one of those interviews where you're not exactly sure where it's gonna go when you book the person, and then you learn about a whole new field of medicine that you kind of know about, but not really. And then you find out there's all these complex layers involved with.

And so that's this one, she's a pathologist, but really she's a cytopathologist she does fine needle aspirations. And she has a private practice, which apparently was super rare. It was maybe like a dozen in the entire nation. So I hope this will be a fun episode while you drive while you work out, whatever it is that you're doing as always, if you go to a doctor's perspective.net/all links.

You can get everything you need from the multiple series that we've done, like on acupuncture, financial podiatry, best episodes of each year, et cetera. And if you'd be so kind to buy some swag or even tip me a cup of coffee, that grows a long way to kind of just feel the love, keep making these episodes.

And I really appreciate you listening, of course, and writing these five star review. Which I don't have enough of. So if you find it in your heart to do it, go for it, but look, the transcript and all the show notes can be found at a doctor's perspective.net/ 180 4. Let's go hashtag behind the curtain

live from Beverly Hills and Louisiana today on the show, we have got a unique specialty that I had actually never really heard of. And, uh, there's a good chance that you don't either. So. She graduated from the USC Kirk school of medicine. All right. She lived in Italy for three years. She was an art student.

Can you believe that? And studied it for like three years and then, you know, we'll figure out what happened there because that's a completely different, uh, ball of wax, if you will. But, uh, her, her expertise is fine. Needle aspiration. It's called FNA. It's. It's a whole thing. So it is gonna be fun to dive into what this means.

Uh, I don't wanna jump too much into it, but she wants to be a compassionate patient-centered environment while gauging in open and immediate communication with referring doctor and actually be there when we do the biopsy to get the most complete picture. So please welcome to the show Dr. Salina Nadelman.

Thank you. Thank you for having me.

Absolutely. Well, thank you for being on the show. And I hope I didn't butcher that too much in there, but, uh, what's the background because I thought, I mean, that's really cool, like an art and then studying and then somehow switched into medicine. So how'd that play out?

I actually started out in psychology. Um, I went to, I mean, I went to Clark university, which was like, it's. Very very big on studying psychology. In fact, it's the only university that, that Freud, uh, came to when he came to the United States and lectured at Freud and young, it has a very long history of psychology and I assumed got interested in like psycho bio, uh, neuroscience.

And I was always interested in art. I'm a very like creative, artistic person. And I, I took a couple of classes and then I decided to go for my junior year abroad to, to Florence, Italy. And there, I took Italian as well as art and art history classes. And when I came back, I realized that I had actually turned it into a double major.

So I was actually a D double major in psychology and studio art with a minor in biology. I fell in love with the country. I didn't really know if I wanted to go into the artistic field or into the scientific field. You know, a lot of people find that medicine is an art and a science. So I guess it kind of Mels together that I eventually did become an MD, a physician, but while I was in, uh, I, I went back to live in.

I went to an academy of decorative and restorative arts. I thought that maybe I would go into that. Um, you know, it was a big thing, you know, fake marbling and restoration. And, but in the meantime, I was still interested in neuroscience. So I was matriculated through the university of realm, Las PZA and I did an internship, a research internship with two professors there who were doing neuro.

Uh, research on, you know, stroke victims as well as dementia patients. And then I decided to come back and, and go

into medical school. Well, it really could have went either way, cuz I'm thinking a restorative art would've kinda taken you on a life, a life path with a lot of adventure and seeing amazing things.

But ultimately I guess, you know, that could be always a, uh, retirement plan or a second career. I wanna get back into this. Okay. So there's lots of specialties out there. You could have just been Jomo pathologist, but then you took it to the next level. Well,

yeah, actually, you know, my life kind of always had like a circuitous route.

Like I didn't, and I tell this to even when I go and speak at like high schools or colleges, I, I, I try and. Uh, the young, uh, people that, that nothing is written in stone. Like I thought, you know, all my friends who went into medicine, they had wanted to be, you know, go to medical school since they were like in kindergarten.

Well, I didn't, um, they knew exactly within their first or second year, what specialty they wanted to go into. And I didn't, I wanted one specialty and then I actually went into internal medicine. I did a year of internal medicine at the VA, um, UCLA program and discovered that, although I. You know, patient dealing with patients?

I, it was not, for me. It was not my, I didn't feel like this was my home and did actually research in dermatology and wound healing. And then I had always liked pathology. Uh, in medical school. It was. Taught fantastically. Well at USC pathologists were all really nice and very knowledgeable. But when I was going to medical school, the great push was to go into primary care.

I mean, everybody was supposed to go into primary care, which was, you know, internal medicine or family practice and, you know, pediatrics gynecology, um, some general surgery, but no sub-specialties and I did a Subi. Is that what they needed back then? Yeah. You know, it was very, it was all primary care. And when I had done a sub I in pathology, I enjoyed it, but everybody was like, don't go into it.

There are no jobs. So after my research fellowship, uh, after my internship, I kind of fell into pathology. I, I didn't really know what I wanted to do. My husband at the time had decided to go back to school. He had gone to medical school in the Soviet union and decided to go back and get a Chinese medical degree.

So he. Getting his O MDs, you know, masters in Oriental medicine. And so I had to choose a program that was in Los Angeles and there were openings in specific areas and one of them was pathology. And one of my mom's friends was a pathologist. He was like the chief pathology at one of the major hospitals here in Los Angeles.

He was like the president of the, you know, college of American pathology. He was very, very involved and he said, why don't you just try it? You know, I it's like, I love it. It's a great career. So I went and interviewed not expecting to get accepted, uh, because it was kind of last minute. Uh, and I figured, and they said at the end of the interviews, they said, when can you come?

I said, I'm gonna just take it as a, as a year just to learn about the profession. Because you know, when you learn about pathology in medical school, it's very different than how you practice as a pathologist. Yeah, I can imagine. So I. I kind of sat back and just enjoyed the learning rather than really being, um, stressed out about it.

You know, a lot of people get stressed out about the learning. And so that first year residency in pathology was just to introduce me to the world of. Pathology as, as a profession thereafter, I did a, a fine needle aspiration clinic. It's just part of, one of the rotations inside of pathology, which is kind of cells in space.

It's like what you see in pap smears or urines or fluids. And one of the thing was fine. Needle aspirations, which is actually doing a small needle biopsy. Uh, and then you smear it on a slide and you look under the microscope and you determine what the person has. So it's the smallest amount of tissue that you can get.

It's gonna be comfortable

for the patient.

It's well, it's, it's much more comfortable than having to have a surgery. I mean, you know, um, so at first, when I first looked at it, I thought, what is this cells in space? I can't understand it, but when it clicked, I was like, wow, this is really cool. And I really, I always liked doing procedures.

Uh, during medical school, I was very good at surgery, but I didn't see myself as a surgeon because I didn't like the, the work life balance. In fact, they, I did, you know, those people who did well in surgery had at the end of the year, uh, a dinner. And so if you, if you did well, you were invited to this dinner and I was sat, I was one of the only women at the dinner and I was sat with all the female surgeons there and they said, so are you going into surgery?

And I said, well, I kind of wanna have a family. And, and one of them jokes, like what about surrogacy? And I was like, oh my God, this is not for me. Come on. No, I mean, obviously this is different now, but back then, you know, this is what, you know, they were. Not there were, there were surgeons who had many kids, but I'm just saying that, you know, there's surgery is a certain way and you kind of have to devote your life to the hospital and, and that, and it, it kind of, I think having a family until you're established as a surgeon, kind of, it takes a long time and, and it, it goes by the wayside.

So I wanted to make sure that I had, I wa that was very important to me. I wanted to have a family and I wanted to have. Something that I really enjoyed doing and waking up.

I mean, how many people don't even have that realization and then wake up 15 years later and they're like, wow, I really missed out on something.

And I didn't even listen to my heart during that time. And also kudos for you to realize really fast. I don't like this whole patient interaction, managing diabetes and all these different things all the time. What a great thing to figure out now

versus me. Yeah. You know what? It wasn't the patient interaction per se.

Cuz I like that part mm-hmm it was, you know, internal medicine. It's a different way of thinking of things. I'm I'm a visual person like as an artist mm-hmm uh, so pathology was, I mean, knowing pathology is basically the study of human disease. So as a pathologist, pathologists are considered the doctor's doctor.

So all the doctors come to. For the answers, you absolutely send off blood samples to the lab. We're the laboratorians. We tell you whether you have high cholesterol or we tell you if you, if your CBC's off or if you have leukemia

or you have the most stressful part, we take the biopsy and they were like, all pass the buck on somebody else to tell me what is kind of yes, like a chiropractor.

Hey, we got something on an MRI. I don't know what. Send it to the radiologist and now it's on di tell me what it is so we can refer it around. It's like that

has a lot of pressure. It is. It can be, it can be, there's a lot of learning, but it's very interesting that I also, I, I it's anatomic pathology is very visual, so it's all about pattern recognition.

When I was in medical school, achieve of pathology, used to back then there were slide carousel. So they would put up the slides of different things and he would inter. Like the picture of the Eiffel tower or the Tama hall Mount Fuji. And you would, he would say, okay, where is this? And we'd say Paris or India, or, you know, uh, Japan.

He's like, yes, because you can recognize that this is a pattern like this is the Eiffel tower and that belongs in Paris. So anatomic pathology is very similar to that. You know, all the things have a pattern. And from that pattern recognition, you can make a, a certain di diagnosis.

When you see it enough, you see it.

Right? Exactly. So if you don't have a good eye or then a lot of pathologists and atomic pathologists are artistic, they have a, because they it's, they're just drawn to that and they're drawn to

that kind of it's really, you fit right in. It's kind of like that hidden calling that you didn't even know was there like, oh yeah.

Where's that on the, uh, professional match.

When I was in my second year of, of residency, a, a guy came and he said, oh, I have a standalone fine needle aspiration clinic. And I thought, wow, I love that. And that's what I'm going to do. So that's what I, that's what I did. I, I went and pursued having a private practice as a pathologist.

And when I first started out and I would go and do networking with other local. Clinicians in the area, they would say what your pathologist and you have your own clinic. Like you see patients cause most, you know, yeah. Most pathologists only see thought of as like looking at parts or autopsies.

So, right.

So lemme ask you this, I pre-talk, you had mentioned there's only like 12 private practices, so I'm curious as to,

I don't know how many exactly, but about a dozen.

But definitely not enough to, to serve the amount of people that probably need it. So are you able to cross state lines or just have multiple licenses or is it just like, so out there to have your own clinic?

I mean, do you take insurance? Is it a cash thing or so many questions about that? What do you think? Because it sounds like a great business

idea too, because there aren't, but the issue is I'm in Los Angeles. And in west Los Angeles, there are at least three large hospitals that profess excellent care, just within 10 miles.

So like Houston might

be one of those places then

I'm just saying like Los Angeles there's, you know, St. John's there's UCLA, and there's Cedars all within 10 miles of my clinic.

Oh,

okay.

I'm, I'm competing with them and they're competing with me. People can go and have a fine needle aspiration biopsy by anybody who can, it has an MD by their name.

Oh. Whether they get diagnosed with material, that's a different story. So when I first started out, you know, I worked at the VA, I ran the FNA clinic there, but I also was a staff pathologist. And so we would get FNA smears from endocrinologists, from ENTs, from surgeons, and most of them were barely readable.

We would try our hardest because the clinicians would get upset. Like what? You don't have enough material or you can't lead it. Or when I first started out in private practice, I would have endocrinologists send me their biopsies. Like they would do the biopsy. They would see the patient, they would do the biopsy and then they would send me their slides.

And I would have to look through 40 bloody slides to get like a couple of cells. And that would take a lot of time. Yeah. They don't realize if you're not a cytopathologist or even a pathologist. Most other doctors don't quite understand or realize what it takes to get a good sample. They think, oh, if I have a syringe and I pull my syringe and I get blood, that means it's gonna be a good sample.

But in actuality, blood is obscuring, especially for thyroid biopsies. I wanna get as little blood as possible. With as much cells and make sure that it's fixed immediately and that the smear is correct. And the other thing that they cannot do, which is, I mean, like I can't do surgery. I mean, I learned it, you know, in medical school, but I'm a pathologist and I read these all the time is I have a microscope right.

In the same room with the patient. So when I do the biopsy, I smear it and I sing one of the slides immediately. The rest I. And I look at it right there, the patient's on the table and I'm looking at the slide and I can say, oh, I need more material because later on, I need to make a better diagnosis or I need more material because I know I need to send it for another type of test.

I had a patient once he was referred to me because he had a, uh, rapidly growing thyroid mass. And of course he was of that age. He was over 70. Clinicians immediately think it's the worst kind of cancer. Most thyroid cancers are not bad. Most people do not die of them, but there's one type that's usually in the elderly and it grows like literally overnight.

And it kills people within a year. Like there's nothing to be done. It's called anaplastic thyroid cancer. And so the patient was immediately sent to. And when I looked at it, it's called onsite evaluation of the slide or rose rapid onsite evaluation. I saw that it wasn't made up of thyroid cells, but rather made up of lymphocytes, the same kind of cells that are seen in your lymph nodes or in the bloodstream.

And so I, it dawned on me. I said, I thought maybe this could be, uh, I mean, there are inflammatory situations in the thyroid, but this looks more like it could be a lymphoma. So at that point, I took more material. I went back and I put it in this special median that could be sent for another test for Flo cytometry, which is to rule in or rule out lymphoma.

And what lo behold, the patient had lymphoma and not aplastic thyroid cancer. So the patient, if he had gone to either a radiologist or an endocrinologist or an ENT that sample would've been sent to the lab in, let's say a hospital or quest or lab core, they would've said atypical cells or lymphocytes present, go back.

So they've said it anyway. They would've not, they would've not been able to make a diagnosis immediately. And the patient would have to go back for a second biopsy or they could have missed it all altogether. But this way, it was like a one it's a OneStop shop. The patient is able to go only once get a biopsy only once get the answer and the patient never had to have surgery.

The patient went directly for chemotherapy. Right. And it was fine. Yes. So in that way, as a pathologist cytopathologist I am able look at the material immediately. You know, in real life, right. To ensure not only that I have a diagnostic sample so that the patient doesn't have to come back. Cause oftentimes it's missed there's too much blood.

Or if I do need to send the sample for something. Like I could send it for molecular studies. I could send it for post cytometry. I could send it from, let's say microbiology. Let's say I look at it. And it looks, someone comes in with a lymph node. I do a biopsy of a swollen lymph node and it looks like there's an infection.

I can send it for culture. I've diagnosed TB. Twice when they patients have come to me, they, the doctor said, oh, I think it's a lymphoma. And actually they had

TV that's wild. So I guess would one of the take home messages for today be if you're a doctor that can actually do these things, obviously I'm a chiropractor and whatnot.

So obviously I'm not, I don't do that, but the audience is bigger than me. When we're looking for a pathologist, can we request a cytopathologist versus just a regular pathologist? So you just get who you

get generally, uh, out there. Let's say, let's say you find a lump on your body. You go to your, your primary care doctor.

He's like, okay, well I know this great. Let's say endocrinologist. Let's say they find a thyroid. No. The endocrinologist may or may not have had experience in doing thyroid ultrasounds, most likely had and doing FNAs. The problem is, is they may be a brilliant endocrinologist. Like don't ask me how to manage your diabetes or, you know, I don't know how to like, deal with hormones.

I know of it, but I don't know how to like treat you. And they try and do the biopsy themselves because the referring the, your primary care physician knows them as a person and thinks they're a smart person, but the fact that they can't look at the microscope themselves and they don't know what really entails.

To make a perfect smear. Uh, it makes my job harder if I'm on the receiving end, you know, um, in the laboratory, I mean, I've been actually an expert witness for, for cases, you know, that have gone to court, you know, right. Patients have sued and, you know, sued pathologists and, and, and it's not necessarily the pathologist fault.

It's the pathologist. Doesn't. Like what, like I said, good sample,

it's too much blood or whatever.

Well, sometimes, you know, the person who's performing the biopsy, I can teach anybody to perform a biopsy. You just stick a needle into something. I mean, that's all it is it really right? The skill is being able to get diagnostic material.

And the only way that, you know, aside from the feel and having like expertise. Knowing how to do a biopsy well is also being able to look at it and make sure that you've done a good sample and how to fix it. Well,

could they do a CE to, I mean, we gotta take continuing education. Are they able to do some sort of biopsy refresher course?

Well,

they don't know what they're, they're not pathologists. They don't look under the microscope. They, I mean, let's say endocrinologists, they, they look at thyroid samples. Sure. They do that in their, in their fellowship. They do. There's some endocrinologists that profess that they're just as good as any pathologist, but this is not what they do.

I mean, this, this is so

the ego probably wouldn't allow them to some, some

of them I'm just saying, you know, and, and, and part of, let's say EENT like when I was at UCLA and training at UCLA, we used to do conferences, pathol pathology, otolaryngology conferences, and they learned how to read. Recognize what certain things look like, but it's like a tiny bit of their education, most of their education and most of their training.

And, and then years later on based on their specialty mm-hmm and, and as you go on, I mean, I'm not doing general pathology. I mean, yes, it can go back and probably read GI, you know, biopsies, but that's not my specialty anymore, you know, like I, right. It's there, but now I'm doing cytology mostly. And so that's my expertise.

Like I can. I see a gajillion thyroids. I do a lot of thyroid FNAs. I do a lot of head and neck tumors. I know how to, I know, you know, like this is like my bread and butter and so you get better and better at it. And it's not just, it's not just being able to know how to make the sample and how to read the sample at the side, the PA you know, the microscope, you know, using the microscope in a certain way and knowing that it's everything else.

It's it's. You know, I'm a hybrid between the clinician, like the surgeon and the internist and the endocrinologist and a pathologist. So my background in internal medicine has helped me. And being able to be with patients and look at them as holistic, you know, their problems in a holistic way. I have the advantage over my pathology colleagues in that I get to see the patients and I actually get to feel them.

You know what I mean? When you're in the laboratory and you're just receiving the slides, you may get on a requisition form, like 35 year old, you know, Caucasian male with a two year history of a one centimeter thyroid nodule. And that's. Right. But when I see patients, I get to talk to them and I give, I get a focused history and physical, I, I ask how long it's been there.

Does it bother them? Are they ho do they have a family history? Oh yeah. My mom had ER, and my, you know, late cousin had died of capillary carcinoma, the thyroid, or, oh, I'm I, you know, yes. I survived Cher, noble, you know, you know,

there are things that, those mild details, like, what am I looking

at and why am I looking at this?

Yeah. I mean, I've. Interesting cases. I had a man who had a thyroid nodule for many, many years and in his remote history, 20 years prior, he had, uh, kidney cancer, renal cell carcinoma. So when I did the biopsy, it looked strange. And so there's a nomenclature that set a pathology and pathologist use. And so part of that nomenclature was, you know, Atia.

And so I sent it out and it came back and I sent it out for molecular studies and the molecular studies came back that it. Metastatic kidney cancer. Wow. Referring doctor couldn't believe it. So that nodule's been there for so long. I can't imagine it's not filing avoider or thyroid nodule. And so he asked me to do it again.

So I did the biopsy again, and this time I, I took more material, so I could actually. Stain the material in a certain way to prove whether it's thyroid origin or whether it's kidney origin. And it turned out again to be kidney.

I see in my head, he goes the fact that there's that many tests and that many stains that you can do that is pretty cool to me.

That's really cool. You know, obviously there is there's different

materials and, and, and things are getting much more like granular as, as medicine is going forward, you know, we're able. Diagnose things on smaller and smaller samples, which is why as a cytopathologist, it's very exciting. I can do fine needle aspirations and it's is minimally harmful to the patient.

It's a tiny needle. It's like a smaller than the, kind of the used to draw blood with. It's like mm-hmm between that and a Botox needle. And instead of going in, in the old days, it used to cut everybody out, they cut out things and we're finding things that are smaller and smaller. Our imaging modalities are better.

We, our ultrasounds are getting better. People are getting MRIs, you know, it's getting much clearer. And the other thing is we're able to do things with small samples and small cell cell samples, because we have like molecular techniques. These are like more and more molecular techniques. Like one of the things that I use, um, quite often is if I can't tell sometimes.

Diagnosing something that's benign is easy, diagnosing something that's cancer is easy. The things that are in between is what makes me sweat. You know, I like makes me like, you know, like I sit there and I ponder it forever and ever, and I'm lucky that in let's say thyroid, I could send it off for molecular studies.

And now they're looking at all the different permutations and, and promo Somal aberrations, genetic problem. That could lead to cancer. Yes. And it's expand. I mean, it's constantly expanding. It

makes you wonder what we were doing 30 years

ago. It used to be that people would come, you know, let's say thyroid cancer you'd have to have a big, huge squatter.

And they would say, oh, I see that. Let's cut it out. And, and the problem is, is that most of them

are benign. Well, and the treatment's probably better now, too. If you can get to that granular level of what exactly it is, you can probably tailor the treatment to exactly what that is instead of guessing and hoping

things are, are going that way.

It's called immune therapy, like in, in lung cancer. I mean, I'm sure you've heard of things like Keytruda and things that are advertised on TV. Those are cancer diagnostics and which is my bread and butter, but therapeutic. Are getting better and better and less harmful to entire body. So, you know, they're looking at ways to kind of, instead of destroying everything, like with just a big shotgun, you know, getting a, like a, you know, sharp shooter in

there.

We had a couple patients this week who were talking about their spouses and they were doing chemo and they had the chemo fog afterwards. They're like, my husband was completely useless. Like , couldn't remember anything. And I was like, well, I heard it fades over time, but they're like, yeah, but during the timeframe, it was bad.

But, um, switching gears a little. So if you're doing private practice, what are you doing to market? Like maybe you don't have to do it as much. Now you got a name for yourself, but no, I still have to. And you're kind of starting out. You still have to do it. What are you doing? What's working. I

don't know. I wish you to the doctor.

I wish. Yeah. I, you know what the best, the best way I I've tried all different kinds of ways at first going doctor to doctor. I mean, I, I do have a reputation. I'd say most ENTs and a lot of internists and endocrinologists know me know of me. Cause

you don't need everyone to refer to. But you do need a certain amount.

I do keep your schedule

full. Yeah. I'd like more okay. Yeah. Yeah. I'd say most of the, like a lot, you know, because I'm in this area, I'd say all of the concierge doctors know me and refer to me. So I see that's huge. You know, I also work for the county of Los Angeles and south central Los Angeles for the underserved.

I work at Martin Luther king Jr. Outpatient clinic. Doing exactly this. I was recruited by the chief of endocrin. And so I see all walks of life and some of those doctors also have private practices and they refer me patients when I'm training. My, like my assistant is like, you know, everybody, everybody gets anxious.

Everybody comes in thinking that they have cancer when most, most of the time they don't, but everybody has that thought. And so you, everybody has to be like sensitive to it and people react differently. You know, you have to, you have to be sensitive to it. So how do I market the best method is going as meeting the doctors up front.

I mean, going and introducing myself. Uh, I used to have someone who used a market for me. She was much more organized than I . She had all these Excel spreadsheets, um, helpful. Yeah, I did direct mail. It's very expensive. I don't know how much, although some, some doctors were like, oh yeah, I remember your postcard.

I'm trying to fax, uh, now I'm trying to get into like social media and Instagram. I don't know how much that's helping.

I don't know. Yeah. You got, you got a unique challenge. Uh, I would say

part of the challenge is educating other doctors, referring doctors that someone like me exists because they just don't.

I've never heard of someone like me and the other challenge. And that's the other thing that I wanna reach out to the public is I want to change the paradigm for now. You have to be referred to me by a doctor. Oh, there's a prescription, right? You can't want, I'm like a radi. You can't walk into a radiology suite, say like, Hey, I want an x-ray you have to get a prescription or a referral just like you can't walk into, um, pharmacy and say, I want an antibiotic.

You need to have a prescription, but, and, or, but I wanna change the paradigm, the kind of paradigm that's being changed already in the past 30 years, it used to. You never saw advertising for drugs in magazines or on TV, right? Mm-hmm . But now, because there's, you can't go in and say, I want Keytruda. You have to go to your doctor and the doctor has to write your prescription.

And that's what I wanna do. I wanna reach the public because I feel that nowadays. The public's much more skeptical and much more in control of their own healthcare and their health healthcare choices, or I think medicine was much more paternalistic and now people are much more questioning and I feel that, uh, they can have access to superior medicine and to someone like me, they just seem to know about me and be able to ask their.

So I have gotten people from the internet as well.

You know, I recorded an interview tomorrow with the author who describes sort of the downfall and the reason why everything is so expensive with healthcare in America. And they talk, he, he mentioned things like what you just said about, um, direct access and some of these prescriptions that we have to have, and just kind of the whole, there's lots of little rabbit holes that, you know, that interview might take because you look at it and you're like, we should be able to.

Go and get an MRI, especially if we're willing to pay for it outta pocket, but you still have to get that prescription and well,

because people don't understand. I think, yeah. I, I mean something as simple as I have a nodule, I, I know I have a nodule. I think it needs to be biopsy. And if your doctor saying, oh, you're gonna go to my friend endocrinologist to biopsy it.

You can say, he's already referring you for it's like saying you need to go and get a mammogram. Okay. I'm already writing your prescription to get a mammogram, but you can choose with that prescription where you go and get your mammogram. You don't have to go in the same office building as your doctor.

You can go to wherever

and people don't realize that. I don't think either,

uh, a lot of people here in Los Angeles, they choose where they wanna go and get their mammo. They're not no longer going just next door. They're like, I wanna go to an academic center. I wanna go to UCLA for my mammogram, or I wanna go to Cedars.

I wanna go to tower. Yes. They take their prescription. Or the prescription gets actually faxed to that radiology center or mammogram center and may choose the patients choose. So that's what I want. Eventually. I want patients to be able to say. This is a better way. And I wanna choose that way rather than just depending on where their doctor happens to be sending them.

You know,

it's kind of fun to be enlightened by. Every profession as a chiropractor, of course, we're like, Hey, you know, the, uh, case management actually recommends us and PT and doesn't recommend these drugs actually is really a better physical modality is the best option, yada, yada, yada. And then of course, when you've been doing it for a long time, you're like, um, headaches.

That's like my bread and butter. We should be one of the first choices that you pick. Oh, not that person, but me, you know, and like every profession, it seems to have that like a podiatrist, wait, send it to me. Don't send me, don't send 'em to the ortho. And like, it's, it's fun to see that like, even. Have to deal with some of that stuff as well in a different aspect.

But it's, I think, I think you're still

educating so much. Yeah. I think because there's so much overlap in your field for a very, very long time. There aren't very, I mean, a lot of doctors still, I'm still meeting doctors, even on the west side who are like, what I've never heard of, that I've never heard of a pathologist actually seeing patients and, and doing biopsies and you.

Yeah. Also having a laboratory, you know, in one under one roof, like one stop shop.

Well, here's my card. Here's my script path. Yeah. Yeah,

no, of course. I mean, that's just part of it, but I, I wanna be able to reach a broader audience, you know, I wanna be able to give good, excellent superior care. I believe that everybody deserves it regardless of where they are.

And do you have staff? I do. It's very small. okay.

Okay. Do they handle more? Um, Scheduling or like backend stuff. They,

everything they're, you know, Jack of all trade.

Ah, yes. Okay. Maximize their potential. Yes.

Yes. I have a, I have a sonographer. I have a, you know, an ultrasound tech who helps me with that because usually in a lot of settings, let's say people who do find needle aspirations, they have a nurse.

And let's say radiologist is doing the biopsy and they usually have a sonographer with them, even though they're a radiologist. And then they have someone else smear the slides. I'm the pathologist. I'm the laboratory professional. I wanna smear my own slides. I have control over that. I wanna have, I wanna have good clear slides because I know I need to read them later on.

Yeah. And I need to make a diagnosis out

of them. Indeed. Well, let's switch gears. Wanna respect your time and, and the audience and everything. One of my favorite questions is, uh, we talk about relationships and. You have a, a, a spouse and we always wanna keep the love alive and not end up divorced and have a happy marriage.

So do you have any tips or advice on what we can do for that? I

met my husband right before I started medical school. So it's been 28 years and we've been married for 24. We have three children.

This is the one that we did the Chinese medicine Uhhuh degree earlier. Okay. Wow.

He's a hospital administrator.

He didn't really pursue acupuncture and Ural. He does it kind of on the side, but doesn't really do

that. That's kind of a big deal too. You can't just, uh, get that job. Yeah. Earn that one.

Yeah. He's been working. Yeah. He's been working for a while. You know what? I think he can't be on cruise control. You know, I think a lot of men, you know, once they get married, they kind of get, get into who's control.

And I think women are kind of, you know, the prodders a little bit more. But, you know, we're real partners. I think we engage each other in partnership. And, you know, occasionally when there are issues, we go into, you know, group the family therapy. And I wanna hammer something out. I feel like I need a third person to present it.

So it doesn't sound like Lucy of the peanuts, you know, you know, like, you know,

yeah. It's a safe environment to really air out the grievances sometimes.

Well, I just think that women are a lot of times seen as you know, when they, when we have complaints we were seen as nagging and that, you know, it doesn't, you hit a wall with it.

It doesn't, it. You can't get anywhere with someone just pushes that aside. Something that's broader. , you know, we've gone through a lot together. I think we respect each other and you know, we wanna strive to be better for

each other two strong professionals, two careers that actually take up a lot of time.

You had, you had a couple kids, right? You said three, three. So how did it's always the sexist question? So how did that play out where, uh, the, the roles of childrearing typically fall on the women, especially a few years back there. And, uh, you had a demanding job. Oh,

let me tell you that's one of the reasons why, you know, like that's, that's like a, what do you do?

How does that work? How do you shuffle all

of these things? Women got the short end of the stick, at least in my generation. Okay. My generation gen X, you still

gotta do 95% of the childcare and go to work

gen X. We had to become professionals. If my mom was like, you have to become a profession. What if something happens?

Yeah. Well, it was, no, it was like all of my friends, half of all of my. That I grew up with from are professionals. Half of them are doctors. I have a lawyer, a businesswoman, uh, they all have masters, at least if not doctorates. These are friends I grew up with from elementary school and high school for me.

I always knew I wanted to have family and children. I, that was first and foremost and that my career was always secondary in my. You can't really go through medical school and residency without some sort of sacrifice. And I did have help. I mean, we had to pay for childcare mm-hmm uh, and I went into a profession knowing that I didn't wanna spend all my life doing, you know, my work and that I want to be present.

And which is one of the reasons why I work part. I, I carved this out. Like my way of working. I may not earn as much as my colleagues probably I earn like maybe a half what they do, but that's because I wanna be flexible, have a flexible schedule. I crafted it this way. I really, it was very, very important and life by design life by design.

You know, my kids don't get to go to Europe every summer and stay in hotels. Uh, and we stay at Airbnb. You know, instead, but you still get to experience life. I think it's really important. Um, I think, you know, travel and culture. I grew up traveling my family, half of my family lives in Europe. I, I believe in, in experiencing life and I, I never skimped on that.

These are the choices that I, I had to make. And I'm, and I'm actually very happy

about them. Yeah. I mean, I love that because I'm with you. I, even as a guy, I don't wanna spend all my time at work. I wanna spend time with my kid. I wanna not have to put in the hour, you know, 50 hours, 60, 70 hours a week. Cuz I was like, what's gonna happen next.

She's only gonna be this age at one time and pretty soon, yes, there'll be teenagers and not even wanna deal with me. And then I, okay, cool. Oh, let me tell you, Mike, I got other things I wanna do too.

Yeah. Two of my two oldest kids are actually, uh, moving out in, in the fall. I post, you know, my one is going into a master's program in New York and the other one is starting college.

And so he'll, and then my youngest one is still in middle school, but, you know, I can't believe it. They've been like a nuclear family for so long. And now all of a sudden they're, they're leaving the nest. It's gonna be kind of a shocker all at. Uh, but I also, it was really important for me to be doing something that I truly loved.

I love what I do, and I think I'm because of it. And just because of all the things together, like I'm good at what I do. I think I'm the best. I'm one of the best probably at least in California. Of of this, you know what I do?

That's great. That's what's cool is when you know you're good and then there's nobody that really can compete.

It's just like, I'm not being cocky. It's just, we have a small playing field and I I've worked so hard.

Yeah. But it's also an important, I think, uh, example to, to, to have to lead for your, for your children to know. So that they see a parent who feels their self worth in the world that you're giving back in some way.

And also they could be happy

that you're happy at a job. Yes. Because I may imagine that, you know, so many people don't even have the luxury of being happy at a job, much less. Uh, well, do you have a webpage or anything for people to con contact you? My

webpage is www. Dr. nadelman.com. So D R N a D E L M a n.com.

And my Instagram is at doctor cancer. Answer Dr.

Cancer answer. I just wanna thank you so much for, for being on the show and, and in lightness on what you do, because that is definitely a profession that needs more, like you said, it needs to be highlighted. It needs to be promoted. I hope the, we see that change over the next five to 10 years and of course, If you can get some more connections from this.

That's a great thing too, but check out her Instagram. I'm pretty sure she's gonna some amazing stuff there. I didn't get to check it out yet, but, uh, thank you so much again for being on

the show. Thank you. Thank you so much for having me have a good night.

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About the Author
Dr. Justin Trosclair, D.C., an expert in Chiropractic Care, has been focusing on back and neck pain relief for over 12 years and has delivered treatment to more than 6000 patients. With advanced training in treating disc derangement conditions, you can count on him to keep up to date with the latest research in physical medicine for spinal pain. He has 5 years of hospital experience in China, is currently working in Germany, and had a private practice in Colorado for 6 years. Dr. Trosclair hosts a doctor to doctor interview podcast called ‘A Doctor’s Perspective‘ with over 220 episodes. During his free time he wrote 3 books. Today’s Choices Tomorrow’s Health (rebooting health in 4 categories), a Do-It- Yourself acupressure book for 40 common conditions called Needle-less Acupuncture, and a step by step guide to look like a local for Chinese dinner culture called Chinese Business Dinner Culture. If you have kids, you may be interested in his 6 series tri-lingual animal coloring book series (english, spanish and chinese).