A Wellness-Centered Approach to Surgery Addressing Gaps in Cancer Care

Summary
Dr. Monique Gary, a breast surgeon, educator, and advocate for wellness, discusses the connection between mind, body, and spirit in promoting overall wellness. Dr. Gary emphasizes the importance of a wellness-centered approach to surgery, focusing not only on removing the tumor but also addressing other factors that contribute to disease. She advises patients to prepare for surgery by incorporating movement, sleep, and nutrition into their daily routines. She highlights the significance of effective communication and partnership between surgeons and patients, as well as the importance of a multidisciplinary team in providing comprehensive care. She shares her experiences in educating medical students and patients, as well as her work in creating a wellness community for cancer patients at Still Rise Farm.

Takeaways

• The connection between mind, body, and spirit is crucial in promoting overall wellness and healing.
• A wellness-centered approach to surgery involves addressing not only the tumor but also other factors that contribute to disease.
• Patients can prepare for surgery by incorporating movement, sleep, and nutrition into their daily routines.
• Effective communication and partnership between surgeons and patients are essential for providing comprehensive care.
• A multidisciplinary team, including nurses, navigators, social workers, and therapists, can provide 360-degree support for patients.
• Educating medical students and patients about holistic approaches to wellness and healing is crucial for promoting overall wellbeing.
• Creating a wellness community for cancer patients, like Still Rise Farm, can provide support, education, and a sense of community for those going through treatment.

Chapters
00:00 Introduction and Background of Dr. Monique Gary
02:26 The Connection Between Surgery and Whole Person Care
04:04 Preparing for Surgery: Incorporating Movement, Sleep, and Nutrition
06:05 Complementary Modalities for Healing
08:32 Effective Communication and Partnership in Surgical Care
12:40 The Importance of a Multidisciplinary Team in Comprehensive Care
23:07 Exploring Innovative Approaches in Cancer Care
28:32 Addressing Gaps in Cancer Care
29:38 Educating Medical Students and Patients in Holistic Approaches
31:14 Creating a Wellness Community for Cancer Patients

Resources

• Still Rise Farms

Check out the book: "Healing and Cancer: A Guide to Whole Person Care"
Visit https://www.healingandcancerbook.com/ for more information.

Connect:
Twitter: @DrWayneJonas
Facebook: Dr. Wayne Jonas
Instagram: @drwaynejonas
LinkedIn: Dr. Wayne Jonas
LinkedIn: Alyssa McManamon

Visit Healing Works Foundation www.healingworksfoundation.org for more information.

Dr. Wayne Jonas is a board-certified physician and Dr. Alyssa McManamon is a triple-board certified hematologist/oncologist. The opinions expressed on this show are those of the hosts and guests and do not necessarily represent the views and opinions of their places of employment, the Department of Veterans Affairs, or the United States government. The opinions expressed on this podcast are meant for entertainment and education and should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Wayne Jonas and Dr. Alyssa McManamon have no relevant financial disclosures.

Transcript

Please note that this transcript is produced electronically and may not be an accurate representation of what was said. It may not be reproduced, edited, altered or modified in any way without prior written permission. Any use of quotes or excerpts from this interview requires explicit permission from Healing Works Foundation. Please contact us at healing@healingworksfoundation.org if you would like to use any part of this transcript for quotes or other purposes.

“How Healing Works with Dr. Wayne Jonas & Dr. Alyssa McManamon"

A Wellness-Centered Approach to Surgery Addressing Gaps in Cancer Care

Alyssa McManamon (00:05.941)

Welcome to How Healing Works. I'm Dr. Alyssa McManamon, and my guest today is Dr. Monique Gary, a breast surgeon educator and advocate for wellness. I hear you go by Dr. Mo, is that correct?

Dr. Monique Gary (00:17.878)

That's absolutely correct. How are you?

Alyssa McManamon (00:20.429)

Great, how are you doing today? Yes, we're so excited to speak. So Dr. Mo believes in the power of the connection between mind, body, and spirit to promote overall wellness and is passionate about addressing the disparities in health outcomes for marginalized people. In addition to her work as a surgeon, Dr. Mo is the founder of Still Rise Farms, a wellness retreat located in Bucks County, Pennsylvania, which connects cancer patients and under-resourced marginalized communities with nature. 

Dr. Monique Gary (00:22.038)

I’m well, thanks for having me.

Dr. Monique Gary (00:54.42)

Thank you again. I really, I appreciate it. I love the show. I love the podcast and I love the work that you're doing in this space.

Alyssa McManamon (01:01.345)

Oh, thank you. Yeah, it's so great to start to have it get some audience, you know and to hear back on this podcast. We certainly do like to hear from our guests about their origin story and if you could please share with us how you got to where you are today.

Dr. Monique Gary (01:16.27)

Sure, oh boy, I think it's a long and circuitous route, but suffice it to say that growing up and watching loved ones battle cancer, breast and ovarian cancer, it certainly leaves an imprint on you. So I watched my mother who was diagnosed with ovarian cancer at 29, and she was a nurse. My grandmother was a nurse. I come from a family of healthcare professionals, so I knew that I would go into healthcare, but watching her die at 29 of ovarian cancer, and not fully understanding, but

seeing the impact that cancer has on women and their entire family really just placed in my heart that I would go into something where I could every single day make a difference for cancer patients. My grandmother was diagnosed with breast cancer, bilateral breast cancer, invasive lobular, the sneaky one, you know, that doesn't always show up on the imaging. And watching her advocate for herself made me learn how to be a fierce advocate, not just for myself, but...

for my patients as well. And so every chance I get to give a woman back a little bit of time or give a family their loved one for a bit longer and maybe change the trajectory of how cancer impacts people's lives for the better is a good day for me.

Alyssa McManamon (02:26.185)

I really appreciate you sharing that and how it really came from the personal to the professional. There's such a connection there for you and how it impacts your patients is just so beautiful. So in your perspective as a surgeon, how do you believe that surgery connects and can be applied to whole person care when it comes to cancer?

Dr. Monique Gary (02:49.222)

Oh, I love this question because it is so connected. And I think it's more connected than even surgeons appreciate and certainly more than we train. You know, the founder of osteopathic medicine, Andrew Taylor Still, was a surgeon. And he said, find it and fix it and leave it alone. And part of that mantra has to do with, I think, finding what's impeding us from wellness, removing that thing and then getting back on track to wellness. 

And so if we don't have that wellness centered approach, the surgery removes the tumor, hopefully gives people you know, a better chance at healing, but are they really living? Are they really connected? Are they experiencing wellness in a way that feels whole to them and that helps them to have a better quality of life? And I don't think they do unless we're able to really focus on not only removing the tumor as a surgeon, but what are the other cancers in your life? What are the other behaviors we need to modify? What are the things that are contributing to disease in your body and in your life? 

And how can we begin to chisel away at those as well? And that way the surgery becomes part of an entire package of life-changing treatments and philosophy and not just the sole contribution and the sole focus. The surgery's kind of the victory lap, I tell my patients.

Alyssa McManamon (04:04.002)

So kind of looking at the whole picture where there's an aspect, what you're saying is that something happened here and we're gonna try and have it not happen again and what do we need to maybe look at doing differently so that this doesn't happen again, as best we can, the prevention aspect.

Dr. Monique Gary (04:19.694)

And it's hard because, you know, cancer can happen to anyone. Sometimes I have patients who are very fit. They exercise six days a week. They drink alkaline water and they're vegan. They're plant-based. They meditate. All the things. And cancer still happens. And so I want to be careful not to sort of put that blame on folks. Like, we could have prevented this. But how can we optimize our bodies for wellness?

How can we fight disease, right? And how can we keep moving with a philosophy that helps us to, no matter what life throws at us, to be able to stay in a mindset of wellness and committed to that journey, because none of us can predict what will happen to us in that regard.

Alyssa McManamon (04:55.865)

Yeah, yeah, and I think what you're saying too is so inspiring because it's really, instead of just moving away from something which is preventing or avoiding something bad, it's really moving towards something that is inspiring and good, such as your health and wellbeing. Like, what a novel concept.

Dr. Monique Gary (05:11.526)

I love that. So much of the cancer journey is caught up in this fight language and this struggle language, you know? And sometimes there's a surrender, right? Sometimes there's an allowance to, okay, this is the journey that I'm on. What are the lessons that I need to learn? What are the behaviors I can modify? Can I get better sleep? Can I focus more on spending time with my family and get rid of negative thoughts? Or what are the things that we can do that will help to make this journey mean something? And that can be a surrender and not always a fight.

Alyssa McManamon (05:38.357)

Yeah, no, helping people orient toward, yeah, what they actually want and what matters to them, I think is so key to what you're saying. That's great. Just staying in the surgical realm for a second. When a patient is scheduled for surgery, typically there's not a lot of time, this is typical, spent between the patient and surgeon in that right prior to and then after in the post-op period.

So how do you advise patients to prepare for surgery with consideration of the mind-body-spirit that you were just mentioning? And what modalities, if any, that you would consider complementary do you actually advise people to use? I'd just be curious.

Dr. Monique Gary (06:19.374)

Okay, so the first thing that I do when I diagnose someone and I tell them, you know, this is what we have, here's our stage, here are our treatment options. And after that I say, now let's start to talk about how to get you ready for surgery. What does that look like for you? And for some people it looks like a little bit of prehab. It's gonna be some exercising. It's gonna be some stretching. It might be arm circles with water bottles because weights might be too heavy and you might not be used to lifting weights just yet. So I say, okay, if you can give me

an hour of TV a night, Family Feud, whatever your show is, American Idol, during the commercials, I want you doing some arm exercises, I want you out of breath, I want you stretching that chest muscle, I want you taking deep breaths. Are you sleeping? Let's talk about sleep. How much sleep per night are you getting? Having trouble getting to sleep or staying asleep? And then we go down a path of what tools do we have that are available to help you, whether it's something holistic, whether it's something pharmacologic or prescription, you know, whether it's just dietary changes or sleep hygiene.

And then I go into, talk to me about your diet. What's a typical meal? What's a typical day look like for you? What are we feeding ourselves? And then I say to them, something that sounds a little bit like this, everything that we in these white coats do, everything that we do makes you feel tired, because surgery is cell damage, right? I'm gonna make a cut. I'm gonna damage cells to take out a tumor and then put you back together and then your body's gonna have to heal and recover.

Dr. Monique Gary (07:46.818)

That's gonna take time and energy and effort. You're gonna take a medicine. That medicine may make you feel sluggish or tired. It may cause some side effects in your body that you now have to adjust to. You might need radiation. Radiation is therapeutic cell damage to get rid of cancerous cells and abnormal cells that don't become cancers in the future. And that too is gonna make you feel tired. So how can we give you more energy and what foods should you be thinking of? And I give them a bit of a prescription that looks like eating good food and getting good rest

and spelling out what that looks like up until the surgery, and then for after the surgery, once they see me and we're clear to do those exercises again, okay, let's get you back on track. Let's start talking about movement, mindfulness, and meals, and really focus on those things.

Alyssa McManamon (08:32.461)

So that's great, like really focusing on that you're giving them, as you said, a prescription or kind of a what to do, right? And that the pillars just you mentioned movement, you mentioned sleep and you mentioned nutrition and just the pillars that maybe we all struggle with anyway, right? But at a time of surgery prepping for that and getting those in the right spot to start with makes a ton of sense.

Are there any particular modalities that you find your patients gravitate to that either, you know, that you also recommend or just, you know, just in the breast cancer world in particular.

Dr. Monique Gary (09:02.378)

Sure.

I think there's been some benefit shown to modalities like Reiki and meditation. And I ask my patients, do you meditate? Do you have any practices that help you to either be more mindful or to be at ease? Because as you can imagine, every cancer diagnosis comes with its own set of anxiety surrounding the treatment, the outcomes, the future, the recurrence, all of those things. And so in recommending things, it usually looks a lot like breathing and breath work.

It looks like meditation and mindfulness. I recommend a therapist in some cognitive behavioral therapy where we can and we try to provide people with resources which are sometimes scarce in the oncologic world. Finding an oncology centered therapist can be really challenging, but I ask them what resonates with them and with their beliefs. And then I try to go from there. That way it feels natural to them or something like they've been wanting to do or try.

Dr. Monique Gary (10:00.458)

The other thing I'll say is that, you know, postoperatively, I do recommend acupuncture, acupressure for my patients. And I find that the rising tide floats all boats. So, you know, if you go for neuropathy or you're going for, you know, post mastectomy pain, it may also help you sleep better, might also help you stop smoking, might also give you a little bit more energy. And so those, those therapies, I think are really beneficial where, where we can get them and, and we find support groups to help provide them.

Alyssa McManamon (10:27.585)

Mm-hmm. Yeah. And I think where you're saying, you know, finding their interests and really you're asking them a lot of questions. Like what I hear out of the kind of care you provide is that you're, yes, you're telling them what to do, but you're also really asking them a lot of questions and being willing to listen at the outset to kind of get them to what can help. And I mean, some people use different terms for that, like culturally sensitive care or other terms, you know, but it's something that maybe we weren't taught as well. And so it's a-

I guess that's part of your origin story. Besides watching this in your family, maybe go in different ways, sideways or upside down, you also somehow learn to do this. And so I wonder, did you have a mentor in particular in this world or do you feel like you learn from what not to do?

Dr. Monique Gary (11:13.326)

Gosh, you know, I've had so many great mentors and one mentor particularly in the complementary medicine realm and integrative oncology, Beth DuPree, she's a surgeon, she's a friend, she's a gem of a human being who is always pushing the envelope to figure out how to bring the mind, the body and the spirit together. Beth is just a huge influence on me. But you know, it comes from recognizing that what we say and what patients hear are usually two different things.

And you don't realize until a few years in practice, or even as a student, I noticed this. The surgeon would come and say something and then the surgeon would leave. And I'd ask that patient, okay, what did the surgeon say? What do you understand? And they're two different understandings. And so my first question when I go into a room and I meet someone, I give them a hug, and I sit down eye to eye and I say, okay, you go first. Tell me what you understand about what's going on. Because if I can start from there and clear up the misunderstanding and course correct

then I know we're gonna end up on the same page and you're gonna feel good about whatever's happening here because you're gonna feel partnered with. But yes to mentors, yes to some mentors who maybe didn't do all the right things and say all the right things. And we learn from those mentors as well. Surgeons are an interesting bunch. And I think as there are more women in surgery, we find the outcomes are better, right? People are living longer, right? There's less surgical complications. There's more communication and teams feel better. So it's a great time to be a woman in surgery.

Alyssa McManamon (12:40.013)

Mm-hmm. Yeah. Plug for that. Well, thanks for the shout out to your particular mentors. And, you know, we all are learning from each other is kind of the way I hear it, too. And really, we're learning from our patients. At least I am. And I know you're saying the same thing. And that is what's just, you know, having these conversations. It doesn't just benefit the patient in front of me when I ask questions. Then I actually learn things that then go on to benefit other patients that they don't even know. And that's that link between all of us

that is just so beautiful when we can have a listening stance and not just be talking at people. Because I know there's just a lot of talking at when it comes to health care, because there's a lot of advice that goes on, right? But I learned a lot.

Dr. Monique Gary (13:23.694)

And a lot of innovation, right? A lot of innovation, a lot of new technology. And so we're the experts, but if we can't convey it to patients and they can't leave with an understanding of it, then all of our knowledge and all of our expertise, kind of goes out the window, but you're right. I do listen and learn from, and it has, I think, to do with also being willing to be a bit vulnerable in knowing what we don't know and accepting those things.

Alyssa McManamon (13:48.497)

Yeah, I 100% agree with that. And we talk about being a whole person. I think you bring a lot, just in meeting you today, I can tell you bring a lot of who you are as a whole person, even sharing your origin story about what happened in your family, right? You might not do that with every patient, but that does inform your care and you're bringing that here. That's part of who you are. And the wholeness of who you are or who I am and how I can then, or you can then interact with the patient who's in a vulnerable position it just levels the playing field. That's just part of what I think your care sounds like. And I can see why patients would gravitate to that for sure. The other thing I wanna say about something that you commented on early on was just the way that you kind of languaged around the treatments that can be offered at the time of cancer. You mentioned some of the different treatments and really did not...

you know, hide behind the only the positives, right? So giving that informed consent in a way that someone can understand and really taking responsibility almost. I know you're not the radiation doctor, but you know, we took some responsibility for that radiation can make you tired. Surgery can make you tired. You're gonna be healing. That kind of responsibility taking is part of what you do as a healer because especially as a surgeon, right? You cut to cure. I mean, it's a really unusual thing. First, do no harm, but in surgery, right? You must do harm.

It's just so interesting as a layperson to surgery.

Dr. Monique Gary (15:14.918)

And I think, you know, I'm the first person that a patient may encounter many times after their biopsy, the next person they see if they have early stage breast cancer might be a surgical oncologist. And so if I don't explain what to expect, if I don't preface it for my colleagues to come, you know, it's nothing worse as you know, as a medical oncologist, right? To have a patient come to you and say, well, no one told me about this, or I wasn't expecting to hear this today, or feeling unprepared and they don't know what questions to ask and they feel blindsided.

Alyssa McManamon (15:44.94)

Yeah.

Dr. Monique Gary (15:45.098)

And so I really try to prepare patients for, you know, understanding the totality of what's to come and to feel prepared that whatever is coming, you've got a team, you've got a support and we all work together and we all sort of understand. We don't prescribe each other's, you know, regimens, but we understand how it all works together so that they could then feel more supported. And I think that conversation needs to happen more with surgeons because the studies show when a surgeon just says, I'm going to do this, this and this, and they walk out of the room, patients don't feel partnered with, they're less likely to do aggressive therapies and things, you know, like chemotherapy if they have to. Yeah.

Alyssa McManamon (16:21.269)

Yeah, yeah, yeah. I'd love to do a study about “we got it all.” You know, when the surgeon tells the patient, we got it all, and then they come to the medical oncologist and they're like, I'm not doing chemo, they got it all. And I'm like, oh, no, we got to step back. We have to go back to what does that mean we got it all? And how does breast cancer really get you, you know, if we don't do the adjuvant or so-called after you know, after surgery therapy. 

Alyssa McManamon (16:44.745)

So there is so much in the languaging of how we talk to people. So I just really appreciate you being a stan within surgery for, you know, that it's important to ask questions and to explain things in a way that people can hear. And I just, thank you. You know, you mentioned team really

in your practice, how does that team aspect come out, you know, in the surgical clinic, would be an example. I just be curious because some, you know, many of us have worked in community-based hospitals and I'm not sure if that's your situation, but the team may not be real, real deep, you know, in terms of numbers, but how does it look in terms of your team in the clinic center?

Dr. Monique Gary (17:21.578)

Oh gosh, yeah, our team isn't deep. I do, I practice in a community hospital in rural Pennsylvania, and so some of the limitations for folks could be things like transportation. Sometimes it's language barriers, sometimes it's financial barriers. And I have a team of nurses, navigators, social workers, folks who are really committed to making sure that patient feels supported, you know, 360 wraparound support.

And so I'm fortunate in my program to have not only a nurse navigator, we have a nurse practitioner who does genetics and high-risk counseling and programs. I have at our institution a financial navigator. And this is something that's really amazing. And I'm going to call out her name. Her name is Aimee Hoch. And Aimee is incredible because she took the time as an oncology social worker to take additional training in the finances of cancer.

Alyssa McManamon (18:17.254)

Mmm. That's amazing.

Dr. Monique Gary (18:17.778)

And that's all she does is she meets with patients. Yeah, she goes over the copays and what plans do you have? It's enrollment time and are you on the right plan for what's to come? And it's such a load off for patients to know that if they've got questions about how much is this gonna cost me, that there's a person who's dedicated to that. During COVID, we were able to, I think, really establish the surgical team as a support because patients can't bring their families in.

Alyssa McManamon (18:36.31)

Mm-hmm.

Dr. Monique Gary (18:47.442)

And there's nothing like being in that pre-op holding area where you usually, you know, sometimes my families are five, six, eight people deep. They got shirts on that say Hooters, I'm here for her. It's my job, you too. You name it, right? Like I get all the things, but when you can't bring somebody with you, right? We're all masked up and you can't see anybody's faces. You know, and so I invited my surgical team to come out of the OR, come meet this patient, come sit by the side. We're gonna be the family here.

Dr. Monique Gary (19:14.922)

And so I'll stand at the foot of the bed and I'll be talking and I might even just kind of massage the feet a little bit and start talking about what to expect post-op and okay, do any of your family members have any questions? And we really, we learned what it was and what it meant to be that support for patients because COVID forced us to do it. And so my whole team, even in the operating room, there's so much more sensitive and thoughtful now than before. And it was a good thing that came out of COVID.

Alyssa McManamon (19:40.265)

That is a beautiful story. I mean, just even the play acting of them as family and the empathy that comes from being in those chairs next to the side rails, you know, that is just a beautiful example. Thank you for sharing that particular. And so, you know, we are happy to interview you thinking you're unique as a surgeon, you know, and there's many other surgeons probably doing this, but when we talk about, you know, a focus on the whole person care and healing the whole person

you know, for many, again, their contact with their surgeon is that limited time in pre-op, then surgery, and then post-op, and typically with cancer, you know, patients, the surgeon's focus is gonna be on that good surgical outcome. I mean, really, that's what they train to provide in most people's understanding, that's the goal. But you're describing, and I think there is an opportunity for surgeons to invest more time in, you know, supporting and treating the whole person, not just the cancer, and surgeons know that's how you get a good outcome too, is to actually support the whole person

but where did your interest in whole person healing really originate and how does it, outside of what we talked about, is there anything else you'd like to share about how it informs your work as a surgeon? Because you went through the surgical training, everybody goes through, and then somehow you ended up here.

Dr. Monique Gary (20:52.858)

And, you know, I love that because I remember being the only woman in my surgical residency program after a few years of, you know, a couple women came and they left. And it was such a militaristic experience. You know, the chairman of our department is a colonel in the army. And so it felt very regimented and very military, if you will. And the training itself doesn't lend itself to this

sort of philosophy or this approach, right? It's all about precision and steel and cutting and doing the thing that must be done and saving the day. And that has its place. And I think it's an important part for us to remember at the end of the day, but what patients really want and what prompted me to take this sort of stance is the fact that patients wanna be partnered with. They wanna be listened to.

And when I hear the stories of earned medical mistrust, especially in the black and brown communities, it comes from paternalistic doctors who are telling people what they're gonna do, what they're gonna get, and not really asking, what do you believe? How do you feel? What questions do you have? What are you afraid of? And making sure that we're addressing those things. So my patients, I think, and my lived experience, caused me to become the type of surgeon that's not afraid to ask those questions

and to listen for those answers and to be honest about the things I don't know because that's the other part of this is we talk about nutrition and all these other sort of integrated approaches. If we didn't learn it, it doesn't exist, right? That's how it is in medical school. It wasn't in our textbooks and we didn't publish it, then we tend to somehow downplay it as not real. And I didn't wanna be that doctor because I found and I saw surgeon after surgeon and clinic after clinic, we lose patients, especially in cancer.

Dr. Monique Gary (22:41.47)

We lose it because they want to believe that food is medicine. They want to believe their body has healing capacity. They want to believe that there's something else besides, I have a tumor and it has to get cut out and I have to get toxic treatments and then I'm back out into the world without a clue and without a tool and feeling on my own about why it happened and what to do in the future. And so I just figured there had to be a more integrative way and I wasn't afraid to look into what that meant and teach myself a lot of it.

Alyssa McManamon (23:07.173)

Yeah, yeah. And really, what I hear too is like I'm making friends with uncertainty. Like we all in medicine experience uncertainty and anybody with cancer is going to experience uncertainty. But as the provider, you know, rather than running from uncertainty with certainty, that's maybe not we can't prove everything, but you know, we do our best.

We can also make friends with uncertainty and live in that with the person. And just, you know, and that's that, you know, living in the question, kind of being with, and things can still be uncertain. And it's, you know, you can be with that. And I appreciate kind of that's how you got to, got to where you are, so to speak, with living in that. I do wanna say one thing, cause I...

I'm a military retired colonel. And there's a lot of kinds of colonels. So there's a lot of kinds of people. It's interesting because Wayne and I both come from a military background. And I thought of the military as one thing before I was in the military. But actually, when I went to go interview at Uniform Services University, the reason I actually went there, besides they had a motivational speaker that hooked me, was that they had flyers about integrative medicine. This was back in the 90s.

Dr. Monique Gary (24:20.206)

I love that.

Alyssa McManamon (24:21.277)

I couldn't believe it because I had a certain view of the military as very regimented XYZ. And yes, parts of the military have to be and are that way. But within the medical field, it was so interesting to me how open-minded they were. And so I ended up in the military. So I just want to share that because when you haven't been in the military, sometimes you see it from the outside one way. But it's a lot of these studies on the modalities and things for patients with traumatic brain injuries and others.

A lot of these complementary modalities actually have been studied in the military population because there are researchers who are military physicians who have been interested. So I just wanted to share that just as a plug, not to shy away from the military.

Dr. Monique Gary (25:00.659)

I love that. No, no, not at all. And you know what I learned from my mentors who were military? I learned such a sense of confidence, right? Of a willingness to explore something and to figure it out, right? There's this attitude of, you know, how does innovation support, especially in surgery? You know, my mentors were surgical innovators. And if there was something new to try to figure out how to make it better for people, they were all about it. And it just, my mentor and, you know, my chairman at the time, Tim Punahan, taught me that there wasn't anything that I couldn't do.

And he made me feel so empowered and so well prepared that there, I agree with you. I think that, you know, when you look at the funding and the innovation that comes from the military space and from the research, you know, it's cutting edge. It's real time, it's saving lives, and there's a gravity to it and an urgency to it that I wish we saw more of in medicine. It's like, well, let's try it and let's fail fast and let's figure it out because we gotta save lives.

Alyssa McManamon (25:55.837)

Yeah, I hear you. I hear you. Yeah, yeah. Fail to get to the next thing. I mean, I think that, you know, unfortunately, we don't want war to be the source of innovation, but it oftentimes is. And I think that's part of that history that you share, you know. But thank you for letting me take that segue because I just, I couldn't, I didn't, I didn't, I didn't know what to do except for dimension, you know, my own personal experience. I am, I think that out of what you've said, I mean, you're somebody who is

probably willing to fail because you're willing to try different things and you see gaps that you are trying to fill. And I wouldn't mind if you just say a little bit about what gaps you see besides what we've talked about. What other gaps are you seeing that you're trying to fill in your work?

Dr. Monique Gary (26:38.11)

Oh gosh, yes. And it's so interesting and timely because the US Preventive Task Force, the US Preventive Services Task Force just put out new recommendations about, you know, screening guidelines for women. And this is in response to the previous guidelines that they had put out that said women should start screening at 50 and go every other year. And so they've now backtracked a bit and they've said women should start screening at 40 for women at average risk and still go every other year.

And there's still insufficient evidence to suggest that women who have increased breast density should get supplemental imaging. There's still insufficient evidence to suggest that, you know, Black women who get cancer at a higher, later stage, earlier age, that they should start screening sooner. And so there are these gaps. There's gaps in clinical trials as well. So a lot of the work that I do outside of the operating room focuses on building trust in communities to encourage them to consider clinical trials.

It centers on looking at different and innovative modalities that can overcome breast density for screening, right? Can we look at those gaps in early detection? Because my youngest patient, 17 years old, you know, I'm seeing patients and women in their 20s, 30s diagnosed with stage four cancer before they could even get their first mammogram. And so there's some gaps there in our understanding, but I think that we can't afford to continue to let...

Dr. Monique Gary (28:04.45)

those gaps go unnoticed and unattended to, even as we put out recommendations for the general population. So I focus on those sort of special populations and figuring out what can we do, what's innovative that we can offer in those spaces and how can we approach it so that folks who are at the highest level of need and impact can have access to life-saving early detection earlier. What are the tools? What is the research? And then what's the communication look like? Because that's...one of my strengths as a doctor is to be able to talk to these communities and be on these advocacy boards and meet women where they are and start to educate them about advocating for themselves.

Alyssa McManamon (28:42.885)

Mm-hmm. Yeah, bringing it full circle from educating yourself, which is where you started, to now educating your patients and being in a position of influence, which is what I'm hearing. I mean, I think all the things you mentioned are so important, and really, the clinical trial part is the biggest part, if you can get people who actually trust that their information is secure and will be put to good use and will help other people and they trust you enough to consider enrolling in a trial. That is something that we should never overstep because it’s 

quite a bit to get somebody to actually go down that route. But for the good of themselves, hopefully and someone else too. You know, to shift gears just a bit, how does your outlook on wellness and healing inform the way that you approach the training then of those below you? So we talked about educating yourself, educating patients, and then how about educating people who are in the training pipeline? How does that look? Or is that part of your work now in the community hospital?

Dr. Monique Gary (29:38.63)

So it is, we have PA students, we have medical students who rotate with us. I'm also an adjunct associate professor for health equity at Dartmouth Geisel School of Medicine. So I teach courses and audit curriculum to make sure that health equity is focused on throughout the curriculum and not just sort of the last two-week block of the year where we talk about issues of equity. It's like, no, we can talk about this in maternal medicine, right, in endocrinology, in cancer. And so that work

is so meaningful because outside of the operating room, you know, when I talk about cancer, I talk about it from the lived experience of watching my family members go through it. I will invite patients to come up with me and I started a program called the “Patient As Visiting Professor.” And they now teach not only from their lived experience and many of them have, you know, sometimes they have negative experiences with the health system and there's something to be gleaned, but oftentimes they were in a clinical trial

or they have a great relationship with their healthcare team. And we talk about what does repair look like? What does a good relationship look like? What are the, right? How do we become this? If we're only ever talking about what the doctor didn't offer and didn't do and the disenfranchisement that people feel, we never get to the point of having the model for making medicine better. And so a lot of the work that I do in academia is centered around that. And for me, I think it's just...

We need more Dr. Mo's. It's great that I can do this work and that I can be recognized, you know, by Everyday Health as one of the five oncologists on social media to follow. But I want a whole generation of young folks and doctors who are not afraid to jump on Instagram and answer questions to a community who's getting misinformation online. Like we gotta be that trusted voice. So I love doing that work.

Alyssa McManamon (31:26.701)

Mm-hmm. Oh, that's great. Yeah, I just that makes a ton of sense. It's like, we need you to be a force multiplier and that's what you're doing through your work at Geisel and that's important work. Thank you. In addition to everything and your work as a surgeon You're also interested my goodness and wellness and healing for people going through cancer treatment and you formed a wellness community for goodness sakes called Still Rise Farms in a rural setting as we mentioned in Bucks County, Pennsylvania This is about an hour north of Philly

and it's for cancer patients in under-resourced, marginalized communities. So we have to first ask, you know, any special meaning behind the name, Still Rise.

Dr. Monique Gary (32:03.814)

Okay, yes. So the name comes from a couple things. It's a play on words. One, the sunrise here, my very first night, was incredible. And it was the most serene and most amazing sunrise I think I'd ever seen. And that was, it was imprinted upon me. Secondarily, I wanted to build a place and a community where people could learn to be still, to sit with themselves and to really center themselves and that

as a prerequisite for healing and for rising and for getting back up again. And so being able to be still so that you can then rise in power, rise in energy, rise in motivation to do whatever it is that your life requires is the second sort of play on words. And the third part of it is that it's 40 acres. And in the black community, there was this promise of having 40 acres and a mule as embedded in part of

the legislative decision-making as we became acknowledged as, you know, five-fifths of a human. And so this concept of having 40 acres and a mule, and people say, oh, you've arrived. This is great. And I say, no, we're still rising. There's more to come. There are better things ahead. So all of those things kind of came into play, and that's how we ended up with the name Still Rise.

Alyssa McManamon (33:19.085)

Mm-hmm. So many meanings and so many layers to that. And thank you for connecting all those dots for us, too. So I know I can hear so much already in where your inspiration and mission comes from. So I don't know that we need to ask that again. But when people consider coming, what do you hope that they'll see as the mission of the place? And besides having stillness, I hear that. But then also, what are you offering as services to those who do feel interested in coming into a retreat setting?

Dr. Monique Gary (33:53.366)

Sure. So I'll tell you a funny story. Our tagline is “Our main crop is wellness.” And it's a funny story because I moved here during the pandemic, during the election season, and I didn't know what I would do with this space in terms of actual physical land development. And I had no crops. And everyone kept saying, what are you growing? What are your crops? And are you having corn? And there's, well, our main crop is wellness. That's what we're planting. And it got to the point where if that's the only seed we ever plant,

then if that's what grows, we're very happy with that harvest. But patients would ask me three questions. Am I going to die? Do I need chemotherapy? And then what should I eat? What should I do? How should I live? How can my body heal itself? And what can you tell me about anything holistic that I could take with me and hold on to? And I didn't have the answers. And so.

10 years ago I started to do some research in integrative oncology, was young back then. There were some classes and there were some programs in it, some textbooks, and it has really matured. And what we offer here is we call it a living learning laboratory. And it's an incubator farm with space for people to try different modalities, figure out what works for you and what you can extrapolate to take back home with you. So on the side of movement and mindfulness, there's yoga, there's meditation, there's Reiki, there's sound bowls.

Dr. Monique Gary (35:14.79)

We're working on hopefully getting some goats and we might do some goat yoga, but maybe it's goat yoga for you and it's hot yoga for me and it's no yoga for someone else and you know, I feel like wellness is not so prescriptive and they there needed to be a space for folks to try these different modalities so that they could see and in a way that they could afford and to democratize it. So we have the movement piece and the mindfulness piece. We have a community garden where we teach, you know, food is medicine principle.

Okay, you're growing kale. What's in that kale? What makes it medicine for you? How should we prepare that? When do you plant that? Is this something you can do at home in your patio garden or in your backyard? So we cover sort of the meals aspect of it and the food as medicine component. And then we invite women and men now to come out for the community part of it as well. And we infuse all of that with education about this. So we love what we do here because it's mind, it's body, it's spirit.

And hopefully it's something that people can fit back into their lifestyle and teach their families and communities.

Alyssa McManamon (36:18.277)

Mm-hmm. I love that, you know, visual of a learning lab that's on a farm, you know, and really this, again, this idea of like just trying and maybe something doesn't fit, you know, like you try this. I mean, I've tried goat yoga. It doesn't fit for me, you know, but like for somebody else, they might love it, right? So.

Alyssa McManamon (36:36.741)

I think, yeah, giving people, it's like that menu of choices and really having it all in one place. How is it sustainable in terms of, I guess, accessible? How is it accessible financially for people? Or how does that work? Who gets to come?

Dr. Monique Gary (36:49.802)

Sure, so anyone can come in the sense that we sponsor integrative wellness days. So this Saturday coming up, for example, we're having our first one of the year. We've got 75 women with breast and ovarian cancer who will come out all stages, all ages, and they will spend the morning rotating through eco-therapy and nature walks, yoga, they'll do fishing, we'll have a cooking demonstration, and then we'll have a series of workshops that cover things like chemo brain and neuropathy, 

ask the experts on breast and ovarian cancer, sex and intimacy, and reclaiming that for you. And we'll have a massage therapist and we'll have some vendors. And we make it all free. So we get some sponsorships and we're always looking for more partners and sponsors. There is a wonderful organization called Unite for Her with whom I partner. Sue Weldon is a dear friend of mine. And so she brings her instructors and they bring produce boxes.

Every woman will leave with a giant box of fresh vegetables in a cookbook to teach them how to cook it. And then they can enroll in the programs and do online cooking classes. So it's through partnerships. And it really is in the sense democratizing wellness because it's not relative to your race or your ethnicity or even your income level. Because when you got cancer, as you know, nobody budgets for cancer. I don't care how much money we all make and how many vacations we all miss during COVID. This wasn't in our...

in our budget. And cancer treatment can be expensive and the integrative components of cancer wellness are equally as expensive. So when I say democratizing and we talk about equity, it takes that form as well.

Alyssa McManamon (38:29.933)

Mm-hmm. Yeah, it's such a jump start to be able to come out there. It sounds really enticing, you know, to just, and to leave with food. That's never a bad thing.

Dr. Monique Gary (38:38.006)

I can't wait to have you. You got to come out and meet some patients and do some talks and share. I'd love you to have a book signing with us. That'd be amazing.

Alyssa McManamon (38:45.549)

See the sunrise. Hey, I get to see the sunrise. I'm a big sun person. So living in Ohio, we don't have enough sun. I'd love to see your sun. Yeah.

Dr. Monique Gary (38:53.666)

We're neighbors. I think that would be great. And you know, yeah, absolutely. It's just that we started out for cancer patients and what we found was that folks who are facing chronic illness are all looking for the same thing. They're looking for meals, movement and mindfulness. How can I, you know...

Dr. Monique Gary (39:14.662)

transition off of my Metformin and change my life? How can I manage my hypertension better, my child with ADHD? And so what started out as a mission for cancer has really opened up now into wellness for various interest groups. And so our calendar is getting pretty booked with folks who, you know, grandparents who are raising children with ADHD and folks facing ovarian cancer and men with prostate and colon cancer. And it's wellness for everybody.

Alyssa McManamon (39:38.313)

Yeah, yeah. So you grow wellness and just not even knowing that this is how it would go. You know, you start with cancer. And the other way, you know, my co-author for the Healing and Cancer book, Wayne Jonas starts with family medicine and primary care. And then we're, you know, but there's a marriage between these things, right? Then the cancer part comes into play. And then, you know, there's like.

It's just because it's about what makes people well in general. And why do we have to silo into these separate things to get anything done? We actually get less done when we're siloed. The other thing that people are getting that they maybe know that they're craving or they don't know it till they get there is you're giving people community, right? You're giving people, you know, 

vitamin N if you want to call nature, right? And then there's vitamin M for movement. People talk about that. You're giving all those things that sometimes you don't know you don't have it until you get into the environment where it's provided. And that community aspect is so, I can't imagine that part except being wonderful.

Dr. Monique Gary (40:42.074)

Wow, I think so. And that's the feedback that we get when women come here. And I mean, anyone they come and they step on the land, the land itself is healing. Even if you never did an activity and some people come in there, you know, not in a either frame of mind or physical state to really participate in all of the events, even though we'll modify, we'll do chair yoga. Some people just want to come and sit in Adirondack chair and breathe and stare at the sky, walk barefoot in the grass.

Dr. Monique Gary (41:07.646)

And that's wellness for them, you know, and one of the joys that I really have enjoyed is bringing young people out here. We have a couple summer camps and schools because we have to start these philosophies and this ties in certainly to Dr. Jonas, you know, is that we have to start younger and earlier teaching wellness and not that it's for when you get sick and now we're gonna focus on, you know, course correcting our lives, but how do we start out with a healthy mindset and keep a body healthy and keep a spirit healthy?

And so bringing the kids out, you know, from inner city Philadelphia, before we can get all the yoga mats down, the kids are like this [showing corpse/savasana]. They don't even know what the pose means, but they're feeling it and they are just, you know, we talk about de-escalating violence and preparing ourselves for exams and, you know, making our own cold press juices and I let the kids make their own and tell me what's in it and what does it do for the body. And so it's just such a fun thing.

Alyssa McManamon (41:58.601)

Oh, that's awesome. Yeah, I mean, that part of what's not taught in schools, you know, that you can provide that can be just so soul nourishing and body nourishing is just, I can just hear how much you're getting back from this endeavor, you know, and that's what I always try and also let people know, like when you do these things that seem kind of like good, but you don't know if it's worth it, guess what you get a ton back. You get a ton back. That's awesome.

You know, for the actual stories, I don't know if you wanna highlight any cancer survivor stories. I know a lot of people are coming there for a lot of different reasons now, but can you give us a story of somebody who spent some time at Still Rise Farm who had a cancer diagnosis and how maybe you saw their recovery and healing unfold or how it might've been different if they hadn't had that experience.

Dr. Monique Gary (42:47.57)

Oh, sure. I can think of two in particular. And one is a very young patient who said, you know, I typically shy away from support groups because they never really look like me. They don't feel like they're for me. I feel like they're full of folks who are

angry and resigned and ready to die. And I just want to figure out how to get my life back. And so she came out and she was able to connect with, you know, probably 10 other women who were all under the age of 40 and diagnosed. And they got mini makeovers and they talked about skincare and, you know, using clean products. And they were able to move their bodies and figure out how to get a walking group near where they live. So I see something for young individuals. And I can remember one other patient who was going through a really tough time with her treatment.

She was on an immunotherapy that caused an adrenal crisis and then she was in the ICU and she ended up, you know Just wanting to resign herself to not continuing treatment and she'd actually discontinued treatment And she came out and she said, “I didn't think anybody cared.” She said, “but being here today has shown me one

that my doctors do care, all that there were other doctors here” and you know, we were participating in doing yoga and walking around and feeding people and making sure everybody was okay. And she said, I feel like one, my doctors care, two, there's other people who made it through. And if I can see them and they're five years and 10 years and 20 years out in survivorship, that gives me hope. And three, if I can manage some of these side effects, I feel like I could go back on treatment and now I feel like I can.

Dr. Monique Gary (44:21.502)

I know what to do for nausea and for neuropathy and for diarrhea. I got some tools. And so I'm going to talk to my doctor Monday and I'm going to maybe give it another try.

Alyssa McManamon (44:32.453)

That's called hope. Yeah. That's amazing. Well, you know, for all of us today, I mean, I think we have seen, you know, the opportunity and the power of a surgeon who's engaged in whole person care and the connections that you have with your patients as whole people really help them to achieve their health and wellness.

And for some people, surgery is the curative line, right? For a majority of cancer cures, they really do come from surgery. And we know just in speaking with you that there's a lot of impact on the body, the mind and the spirit, all things. And so really appreciate you sharing your take on this. And I wanna invite any last comments that you have really that haven't been covered today before we close.

Dr. Monique Gary (45:21.41)

Sure. I think I just want people to feel hopeful that there are doctors like you and I and Dr. Jonas who are really committed to meeting people where they are and helping them to understand how bodies can heal, how food can be medicine, how everything can work together. And it doesn't have to be CMOS or chemotherapy. We can use every tool and every innovation and even ancient medicine to help us to heal

ourselves and live better lives. So I want people to feel hopeful that in the cancer community there are those of us who feel that way and we live that way and we teach that way. And the second thing is people can certainly follow us on social media. We got a little Instagram, it's Still Rise Farms. We have our website and if they have groups that want to come out or they want to be engaged with us, we're here in Pennsylvania and they're certainly more than welcome. But I just

I think that I'm just grateful. Yeah, grateful to be here and to be a part of this movement with you and excited to meet you in real life. I'm gonna take you up on that offer to close.

Alyssa McManamon (46:27.681)

I love it. Well, I have to, if there's a mule, I have to ride it or take it or wash it or something. So you have to tell me.

Dr. Monique Gary (46:32.994)

There's no mule. There was one goat. And someone said, you should have named the goat mule. And that's right.

Alyssa McManamon (46:38.318)

Get it done, get it done that way. Yeah, thank you, thank you so much, Dr. Mo. It's really been a pleasure to learn about what you're up to and what you're getting done and what you're offering. And just, I'm grateful along with you and thank you again, just so much. And we thank everyone for listening to How Healing Works and please stay tuned for the next episode.