DR. DANIEL BUTTROS (MASTOLOGISTA) - PODPEOPLE #174

[Music] [Music] [Music] [Music] [Music] our guest today is a doctor specialized in gynecology and mastology who also works as a teacher and researcher focusing on the treatment of breast cancer Today we are going to talk about early signs of breast cancer the relationship with obesity, the development of the disease and the risks associated with breast implants, in addition, we will address the importance of regular monitoring after treatment and the role of the HPV vaccine in preventing cancer with you Dr Daniel butros [Music] [Music] Hello welcome everyone to another episode of pod piple a place where

we meet to see and hear people People who Do People who happen People who inspire our guest today is a breast specialist and came here to have a great chat for us everything good drout Daniel butros I said that right, perfect, what is the origin of butros, it's Arabic, perfect Arabic, I've never seen that last name, I loved it, Daniel, thank you so much, you're here, it's a pleasure to have you here, and it's different from what most people think doctors don't. We like doctors, we like good doctors and I have a premise that doctors

have to be good technically, but they have to be first and foremost a good human being and they have to like people. There are people who don't agree with me, but I didn't hit that button and you're a guy who's a good human being. At least I've been following you for a while now without being seen for a long time. I started to be seen following you in the last 3 months and I see that you do a lot affection and I wanted to thank you for medicine because medicine is always bigger than doctors I

always said that my medical students often said like this I'm going to give up because the professor is arrogant because I don't know who I said medicine is much bigger than that this professor this professor will pass the medicine will be Thank God so I wanted to congratulate you out of admiration before we start thank you very much from the bottom of my heart and I receive it from the bottom of my heart receive I wanted you to Tell us a little bit Daniel yours trajectory the choice of Medicine the choice of gynecology at olia

tell me a little bit I am the son of a doctor eh My father is my hero he is Alive your father is alive he works with me he operates on me how wonderful eh but maybe I didn't choose just because he is my hero until because he always forced me and my two brothers to study medicine he is so passionate about medicine that he always guided us on that path but I believe that if it wasn't for imposition it would be by choice or by vocation yes maybe I entered medical school to do Obstetrics

gynecology because my father is a gynecologist so I already got into it. My first book was a book on obstetrics gynecology and that was the case throughout college, I was always a good student, but I always took advantage of life and entered the medical residency in Obstetrics gynecology, but When I joined I discovered that I didn't want to take care of happy people because doing obstetrics means taking care of happy people almost 95 times, yes, you are bringing life, right? And that I would like to dedicate my life to taking care of people who suffer

and trying to bring In my daily life, combined with technique and science, I strongly advocate lightness, tranquility and a smile, happiness. I found Demi Mastology a few years ago to understand that it was possible to be happy and make my patients happy. Because for a long time I carried a lot of sadness I'm going home, but I never thought about giving up and today I'm telling you that I'm very happy in my profession and I think my patients are too, so that's my goal and what was your father's reaction when you said father? I'm going

to continue here, I'm going to Mastology, it was natural, he encouraged me, but he wanted me to do gynecology, obstetrics, Obstetrics in Mastology Uhum, he's also a mastologist . It's an area that needs an exclusive doctor for it. I actively defend this in the Brazilian Mastology Society because we only need to think about it 24 hours a day and not share time with other areas But that's a personal opinion. Maybe I'm wrong then. I deal with this I finished my residency in 2010 I have a good medical education a very complete medical education solid solid

School of Medicine a good college two medical residencies three specialist titles master's degree doctorate I am a teacher I am a researcher so Eh, I work in the technical part in a very peculiar way, like me, but I understood that treating my patients' breasts is not enough and that it is possible to try. Look at that patient who is behind and looks, oddly enough, I live with thousands of women who have perhaps discovered happiness after the diagnosis of breast cancer who suffered that they suffered so much during their lives and there are those who say

and I believe a little in this that this suffering has triggered At some point perhaps breast cancer so I work actively in rescuing Happiness based on scientific perspectives my scientific area that I research is about quality of life after breast cancer treatment I research the public there are my students with physical activity nutrition and motivation a lot of things everything that counts for you are talking about quality of life after eh treatment, everything that counts after treatment applies to pre, in fact, quality of life Yes, but I work with quality of life From the first

moment of the Cancer diagnosis, when I receive that patient, I already start with the quality of life line, now if we to talk about quality of life scientific activity the pillars of lifestyle Medicine physical activity nutrition toxic substances healthy relationships fatigue sleep all of this applies to pre because this prevents breast cancer and this also treats breast cancer These are the bases of Lifestyle medicine and when you're not only diagnosed with breast cancer, it 's the second most common cancer, that's not what I'm saying, that's what I'm saying, but you think it's the first, no.

I don't think it's the first one, it's that I have a lot of I have a huge refusal to hear bad news in relation to Oncology. Then Pink October arrives, I get scared because when we open the newspapers And this is the news that comes It is the second most prevalent cancer, but it is the disease that kills the most women and more and more women will have it and this makes women start to be afraid of the disease and afraid of the diagnosis and move away from prevention and even away from seeking treatment move

away from prevention as there are a lot of people who don't seek treatment because like, I won't look for it, I won't find it ex. There still still is this mentality, especially in the countryside, I'm not going to have a mammogram because if I find it, I'm going to do what, ISO, that's as if I didn't have anything to do, it's just that there is a problem in this situation that in public health, where I work with great pleasure, many women, no matter how much they want the post-mammogram diagnosis, won't get it quickly, so here

comes the second part, I even want to get the diagnosis But will I be able to get treatment in the SUS? Is that the end? I understand, so it would be a frustration, a greater stress because there are people who have a mammogram scheduled, I'm talking here about Rio de Janeiro, okay, I've seen patients who took 10 months to have the mammogram and I tell you that there are women who take 10 months to treat breast cancer after it is diagnosed, although we have to start treatment to start treatment. for patients I really like it

and in the line of taking care of those who suffer from me and those who need it most and those who need it most, that's both things. Those who suffer from the disease and those who need it most, which are the needy population, so I have a lot of love for this and work in public health actively, so in my city we have very different numbers from the ones you are citing for effective work, I am from Rio Claro, in the interior of the State of São Paulo, a city with 200,000 inhabitants R Claro uhum

and for over 15 years I have worked in partnership with public management is cool, unofficial uhum for my taste with other doctors guiding favorable and scientific logistics And today we have time Rio Claro is the Brazilian Switzerland of breast cancer SUS How cool, tell me a little more about this you 200,000 inhabitants What is the prevalence there eh prevalence of breast cancer in the State of São Paulo more or less 80 cases for every 100,000 inhabitants 80 cases for every 100,000 is much less than people imagine, right? People hear so much about breast cancer that

they think it's a problem everywhere like, there are 100,000, eh, it would be about 10,000 cases, right, but that's not the case, if we're going to talk about a prevalent disease, we're going to have to talk about cardiovascular disease, but that's not our agenda, you can't say whatever you want, my dear, eh But back to So, Rio Claro has 200,000 inhabitants, 80 cases per 100,000, I'll tell you today's numbers, not São Paulo, it's São Paulo, it's 80 cases per 100,000, it's actually because we do screening, right? There are mammograms in the north of the country,

30 cases for every 100,000 because there is no mammogram, there is no perfect diagnosis, it is under diagnosed, okay And today in Rio Claro I guarantee you that we have zero fil for mammography susum the woman does the mammogram we already have a navigation that goes in 15 days to biopsy if the biopsy is suspicious, already do the immunohistochemistry which is essential for starting the treatment to be able to know which treatment is best, exactly that and in another 15 days she is already starting in the oncological treatment with us queue zero for queue zero

for surgery Wow, maybe it will start treating in the south of Rio Claro is faster than treating in many agreements in Brazil, why private agreements and why because it has to be like this uhum that's not the case it was exactly like that it's called dignity Uhum So with this data I can say that there for our population They have dignity in diagnosis and treatment for breast cancer and that is why combined with all this this desire to make them happy because we have already done our homework so from now on we will mocher So,

I have a group today from a scientific group called Flor Azul, which is a group where we change our lifestyle for these women . everything is fine, biopsy, man, man, treatment, whoever entered the treatment now joins the blue flower group, she treats them when she finishes radiotherapy, we invite them to the blue flower group, ok, it's free if months of physical activity are with professionals with a master's degree and a doctorate so it's a comist line of ethics, everything months later we hold a graduation for these women, we give them a diploma so they feel

ready to get on with their lives and now we have a new project that we're going to take these women to teach classes in the municipality and they will earn money for this we are training people how did you achieve this let's go no I think that good experiences should be replicated and need to be publicized because what you are telling me is a gold reality, yes, it is a series of alignments first is to want to do it for sure first is not to worry about how much you will earn because otherwise you won't

do it if you want to deal with the SUS you will have to deal with idealism and affection if you are going to worry about how much you earn it stays in your office So, out of idealism, the SUS works that way there. First, I went to management and management helped me with logistics, city hall, city hall and the Municipal Health Department Municipal Health Department, basically like Look, when this woman has a mammogram, she cannot go back to the health center If it's a suspicious mammogram, she has to go straight to a biopsy, so I'm

saving at least a month. Okay, look, if this woman has something palpable in her suspicious breast, there at the health center, she doesn't need a mammogram, she'll go straight to a biopsy. Suspicion files this law already exists, you've been doing the archa, yes, like, if there's a palpable nodule with suspicious characteristics, there's no point in staying back here, back there, go for a biopsy, there's no ping, and do the exact chemical test, so first it was the Management and Logistics part, second part of the education, I started doing a lot of education because of Pink

Octobers there in my city with other doctors, so the population breathes breast cancer, breathes prevention, they seek mammography so it works uhum that said, I brought the science so I did my master's degree there in Botucatu, my doctorate at UNESP also, I did it with my patients uhum what I proved in my doctorate that women treated for breast cancer have an increased risk of cardiovascular disease I was just missing this one, have you ever treated breast cancer and have an oncological risk and it also adds a higher cardiovascular risk than a woman who has not

had breast cancer, you see, but due to the treatment and the perfect lifestyle adopted, so there is this relationship between cardiological heart disease and patients who have breast cancer, I'll tell you tell me something very very important please tell me for every 100 women who die from breast cancer every 100 women who have had breast cancer and who die uhum 60% will die of breast cancer 40% will almost die of cardiovascular disease women die of cardiovascular diseases, we are focused on the patient's breast, they have to take tamax feno, they have to take nastro zol,

that's not it, we need to worry that these women have a cardiovascular risk, as what matters most to me is my patient's life and not My patient's breast, I need to take care of her as a whole, perfectly with this data from my doctorate and with a lot of other research that we have, I said, oh my, we understand that they have cardiovascular risk, I can't keep this information because they were my patients who helped me do my doctorate how am I going to close the door blue flower group Why blue flower I'm in love

with flowers and the blue flowers in flower shops are beautiful But they are altered by man they are not real Of course they were not so beautiful flowers and the man blushed them and they what is the Blue Flower Project? I receive women who are not so beautiful due to the treatment and we transform them into the most beautiful flowers that they can offer intervention Humanity is man taking care of man, it's so many men killing men, but you propose it's man restoring man, it's man taking care of man, right? Eh, I love you as

I love myself, so exactly like that, eh, and then we created this group, so Hey, today this group already has an app We are already starting in Manaus now for a needy area and why is it going to grow Because we are creating methods so that these women can do physical activity every day for 12 minutes a day in a short time minutes and both aerobic and mass activities are carried out, building muscle mass No, this activity is guided by the teacher, so it is a fixed class, right, there are different classes, we deal with

a lot, it is an activity with kindness So people can talk but 12 minutes is very little for those who don't do anything, it's a long time, it's a lot if women get there on the project, they can't fasten their bra alone, in other words, they don't have autonomy, they depend on someone, not having autonomy, not having quality of life, so they When they arrive at the project, they can't get their slippers under the bed, they finish the project by doing push-ups, they don't fall anymore, they gain balance, falls harm the lives of osteoporotic elderly

women with fractures, so it's looking at the body as a whole and As I told you, months later we deliver a diploma, well, one day I deliver a breast cancer report, then I operate on this woman, then the next day I give a flower to this woman and six, and a while later I give a diploma for this woman I get to be part of the worst moment of her life and rebirth so it's really rebirth that's what it is and what is the relationship you put there I had already heard about it but I

don't know it's breast cancer and cardiological changes, you who are studying this study the oncological treatment itself, many chemotherapy treatments and radiotherapy, for example in the left breast in the heart field, it increases cardiovascular risk, I understood endocrine therapy Tamoxifen aromatase inhibitor to reduce the estrogen estrogen thing ISO the inhibitor generates a matase reduce estrogen, tomax hay, no, but Tom maxifen can increase triglycerides, early menopause due to chemotherapy, all the impact that the disease brings, making this woman no longer want to leave the house to do physical activity because She doesn't feel well, she doesn't

feel pretty, there's the issue of oncological fatigue that a diagnosis oncological fatigue is not a lack of will it's biological I understand ISO is part of the oncological syndrome oncological syndrome all of this together increases cardiovascular risk Uhmm I have a very emphatic story a very dear patient I was diagnosed with usual breast cancer usual SUS some time later she had bone pain but her bone scintigraphy was normal but the tomography was altered they said it was bone metastasis I said it's not because breast cancer metastasis appears In the scintigraphy technical issue I went there

and asked for a bone marrow biopsy I made a diagnosis of multiple myeloma I made this diagnosis I was euphoric Technically I called my father father I made a great diagnosis he damn Beautiful Vision three months later she died of an acute myocardial infarction she died of the disease most prevalent in post-menopausal women she died from the second most prevalent disease in women treated for breast cancer and I was concerned about making a diagnosis of multiple myeloma I celebrated that and she died I understood who lost her and I was wrong Uhum So This makes

me open my eyes a little and say: Take care of this woman and not this breast, I don't take care of the breast Uh, I take care of the woman who has breast cancer, yes, because the person is not the disease, right? She always existed before that disease it existed even before the breast, right, certainly before the breast, long before Everyone has already been drinking this Exactly, it's very interesting, what you're saying because, unfortunately, medicine was moving towards this issue of specialists, right? the specialists have a lot of this See your focus I'm saying this

that during the period whenever I attended I always asked for a lot of tests as a psychiatrist and I often saw there hormonal changes and then it indicated look, I'm looking for an endocrinologist and there are women who had very high FSH LH very loud Fi ah I look for the gynecologist everything was fine I asked for a lot of tests and a lot of times I would say something like this, recommend someone I said don't go to yours there's no problem go to your trusted doctor and a lot of times the trusted doctors would

say like that but Why is this psychiatrist getting involved in this, in her specialty, she said, people have to listen to this feeling that you get, like, change doctors, but you can't, right? Then the person said this, Doctor recommends someone because I, someone else there said, why? you asked for a serum catecholamine profile Why did you ask for a lipid profile if you are treating it if it only treats the breast if it only treats the uterus that is unbelievable, right the point we have reached we need subspecialists when someone arrives with when someone arrives

with unstable angina in the emergency room I don't, I don't want to know if he is obese, I want to take care of his heart, he will die, breast cancer provides a chronic situation, more and more women will live after breast cancer for many years at a time but we have earlier diagnoses and better treatments based on this I cannot focus my attention on this patient for a year which is the duration of the treatment I need to be by her side for all the decades that she will live by my side Uhum So the

mastologist First , the woman trusts him, there's no point in turning around and saying like that, oh, you have to do physical activity, look for it, no, no, Dona Maria, it's very important for you to do physical activity, you go with my physical educator, you go with my nutritionist, Doctor Can I do it, I'm sure you can do it? If the doctor doesn't give you this motivation, she won't, she won't, she won't cross the street, make this bridge, she'll take a walk at the end of the day, which doesn't serve any purpose uhum, this bridge

anyway, so the mastologist has this possibility of taking care of this woman for decades, this is very attractive And with this you can gain many stories and many things and that moment, for example, the renewal of technical treatment possibilities begins to give you new hope Because for a long time really the treatment , the diagnosis of breast cancer was almost a death sentence and then we saw that things were improving so much you said oh we have to do the hisop pathological exam yes we have to do it because this determines there are types of

breast cancer because we think it's all the same thing and that the right treatment for the type makes a huge difference of the right cell, when did you see that you said it like this, wow, there's a new dawn there, excellent, the question first, eh What most determines the cure is early diagnosis uhum it's not the drugs that's indisputable indisputable, okay, what most determines the cure is early diagnosis if you make a diagnosis in a tumor below 1 cm ok maybe you won't use it maybe not with great certainty you won't use most of the

new drugs that we have because they are not produced for small tumors uhm but there are larger tumors for these larger tumors there are drugs with targeted therapy so today we can first understand the name breast cancer it is simply a popular name there are thousands of possibilities and technical specifications for each type we have a different treatment uhum but we have to make one clear This is a very important thing, in the supplementary scenario of supplementary health in the SUS, it's not like that in the SUS, it's not like that and I don't say

that to scare people. Yes, I say that because we have to know the system we use. I work in the SUS. I defend the SUS but an advanced tumor in the SUS is not treated the same as an advanced tumor in supplementary health because the NS approves treatments that the apac, which is the one that manages SUS medications, does not approve but it is not because the apac is bad, it is not because there is a very high speed of approval in the INSS and for the SUS it takes time, especially because we live in

a poor country and you have to make a cost-benefit ratio not to waste time because like this, a new drug has an exact patent time, so after 10 years on average when the patent falls, then you start to see generics and everything and it becomes possible to do this, that's what happened in R2 positive disease, for example, for a long time there was only one drug that was impractical to purchase through the SUS after After a while the patent fell and then the R2 positive disease began to be treated, but it still doesn't happen that

the triple negative tumor is luminal tumor. Finally, the SUS patient needs to make an early diagnosis, which is why our role in the SUS is invested in precocity. of of of Diagnosis a lot of information and agility in this process of diagnosis and treatment education motivation technical agility is this tripod that works Uhum but that means that the SUS patient with an advanced tumor will harm herself, no, no, calm down, there are many other drugs that work very well and here comes a very important issue which is the change in lifestyle why Because an obese

woman with breast cancer may have more risk of being harmed by obesity than by breast cancer itself when I treat obesity I I'm treating breast cancer, very robust work demonstrates that making lifestyle changes in a professional way from the moment breast cancer is diagnosed onwards makes women live longer, it's a F Look how valuable it is that we live in a tropical country where anyone can going out and doing physical activity, women treated for breast cancer who do physical activity will benefit more from physical activity, perhaps than drugs that they were unable to use, so

we need to work in all these areas, both the issue of nutrition also fundamental nutrition and physical activity are two medicines that are not in the SUS or in other words they are available to everyone who decides or hip Hippocrates already said that your food is your medicine your medicine is your food Exactly that's it, that's not it bedpan talk No, it's a fact that what you eat determines your health and it's so difficult for people to understand because we live in a Fast Food society, right, and people think that this is the majority food

of the things that people eat and eat a lot today is not food, right? It is something that was once derived from something called food, I would like you to talk a little bit about the risk factors, right? Hey, we already know the issue of obesity, but talk in more detail these factors of risk for women in relation to breast cancer I'm not going to talk about breast cancer I'm going to talk about different diseases in one perfect way the base of the iceberg is called inflammation Uhum And there are thousands of other diseases that

will surface cardiovascular disease oncological diseases maybe autoimmune diseases and so on uhum What is inflammation is what you eat and what you don't train so it's a sedentary lifestyle plus an inadequate diet within lifestyle medicine there are criteria for food that are playful but wise peel more unpack less lifestyle the fridge is full your pantry is empty because a bagged bread that lasts 3S months in the fridge with the same taste and the same smell is not a bagged bread it is something packaged people need to understand that that sausage that She eats it because

it's cheap, I know there are a lot of people who can't afford it, they have absolutely nothing nutritious, it's not food, but it triggers a very serious process, which is an intestinal process, it completely alters the bacteria that live there in your intestine. called microbiota and from there good things that you had to absorb absorb you will not absorb bad things will be put into women this changes the production of estrogen called estroboloma look what a crazy thing what you eat triggers a series of chemical and biological issues that will cause losses in relation to

physical activity today gaining muscle mass is equal to living more fully in your area people who do not have muscle in the leg increases increase the prevalence of dementia in Look how we are doing the information we have So what people need they need to gain muscle mass with physical activity and eat more natural things, this basic thing already reduces general illness to a very large extent, there is no doubt, it is very simple, but it works . and they went to study these populations and these populations are populations that eat little red meat but

eat a lot of vegetable protein, almost nothing industrialized, they live a Healthy Life from the point of view of physical activity and that thing about moderation, right, there is also that because there are people who say so, ah, radicalism, neither radicalism is good, neither in ideas nor in practice, right, because there are people who say, no, I'm just going to eat meat, I'm just going to eat fruit, I'm just going, there's no moderation, what's interesting is that they're taking peaks, right? extremes now the fashion is her ketogenic diet begins to fall ketogenic now the moon

moon diet drink milk on the full moon I don't know there was a thing like that when I was a teenager that I tell people that doesn't make any sense but now some information is coming out very important, especially after the pandemic, people started consuming more alcohol, much more, this is a fact, much more, much more, this is statistical and the suicide rate increased because alcohol is a depressant, I actually heard a phrase this week that is very, very valid. alcohol Today it is seen as cigarettes 30 years ago 30 years ago people thought that

cigarettes would not cause anything and today those who smoke know the tragedy that alcohol is today it is still seen in a somewhat beneficial way not socially is is celebrated she she exactly she is not and in a few decades we will discover that it is not many jobs the recent Canadian Consensus 2023 says the ideal is not to drink at all but if you want up to two drinks per week are tolerable what tolerable what they are two doses Two glasses of vine or two 300 ml beers why Because up to two doses you

do not have a scientific increase in risk for diseases from two doses per week o increase in risk of diseases, including oncological, the higher the risk So the people need to understand that added to all this, alcohol is a villain for the increase in diseases, so people say Oh, but breast cancer is increasing in prevalence, of course, people eat poorly if they are sedentary and women are drinking more than ever drink, idealism begins to exist today, respect for the body, if I'm obese, give it to me and no one is disrespecting anyone, we are having

a scientific conversation. Women today who are obese in pre-menopause need to understand They have an oncological risk cardiovascular waist circumference is also that cardiovascular we have known for 40 years, yes, but even so, when we say it is not against the person, it is the doctor's and whoever likes and knows how to put this data, what the person will do with this data, we always respect and then comes an important question of how we inform you, we have to do it with affection, certainly there is no point in coming and saying like that, but look

at the your weight, not that, the person will only get angry with you now when you do it with affection, let me tell you something Let's take care of you, let's do this, let's do that, this affection I bring a lot to Oncology so Eh, people talk like that wow, but I deal with breast cancer, I deal with death, no, it doesn't, I deal with life, with a different life and this calm, assertive communication From the first moment of breast cancer diagnosis, it's possible for a woman to come into your consultation crying and leaving feeling

relieved, I'm not going to say she's going to leave happy, but she can leave feeling relieved. There are techniques for that, people first, in 10 minutes, you won't give a diagnosis of anything, forget it Ah, but I don't get much calm, one thing, one thing, another, something else thing in 10 minutes you won't diagnose anything in a breast cancer diagnosis you receive the patient and stay quiet let her talk definitely let her talk and she will talk and she will talk then at some point she will stop talking then You say that, what else will

she say like that, wow, but are you interested in me, I'm very interested in you? She's going to talk, then she's going to cry, she had the chance to say, maybe something she never said to PR, nobody ever said to PR, nobody exactly then. she will ease it, sometimes it's necessary to touch the hand, sometimes it's necessary to hug or take a tissue and say, don't worry, Sena wants to have a drink, calmly, she's here, ex, then she starts, then you can give the technical diagnosis at some point, welcome her. otherwise, a very recent story,

very beautiful, Mrs. Helena SUS arrives at my SUS office and the conversation was like this, let her talk, she was with her daughter-in-law and I, I'm very observant, I already look at my nails, I already look at my jewelry, I already look at everything, I look at everything and I stay quiet, I look at the best clothes she has on, she puts on the best clothes, then it's the doctor, beautiful, you have to treat this person well, that's deference, right? And then I looked at PR, her nails painted and her hair white, but a bit

judged uhum a certain moment arrived I said Dona Helena your hair doesn't match I know what was going through her head oh if I go to chemotherapy I'm going to go bald I'm going to lose my hair but that doesn't matter you have to look beautiful today I said Dona Helena We're going to have to dye this hair first appointment I'd never seen her before she said Choose the color I said red in 15 days she came back stunning red hair a pair of glasses Doctor what did you think I said I thought you look

wonderful hugged me I wanted to record a video in 15 days I operated on her I gave her a flower vase, all the women who undergo surgery, I give her a flower vase, I have a photo of her, the most beautiful thing in the world, it doesn't look like she had breast cancer surgery, red hair, she didn't have glasses, red hair, the flower vase and a smile maybe she had never dyed her hair, she had never received a vase of flowers and maybe she had never given that spontaneous smile or maybe no one had looked

at her with that look if that wasn't valuable if that wasn't there if the validity of that wasn't greater than what I receive So things are wrong that medicine is always about building good stories, right? And there's such a thing as generosity, right ? That's generosity, right? Generosity, scientifically, is good for those who practice it and for those who receive it, I always say this Some people say that, oh, but we have to choose who it's going to be for, at least it's doing you good if the other will recognize it, if the other won't,

if the other recognizes it, it was time for him to recognize it, it's a meeting of bones and what makes Double the action You know that in lifestyle medicine one of the pillars is called healthy relationships Uhm you say that but Wait that's scientific yes lifestyle medicine is scientific and it studies prevention and treatment of non-contagious diseases one of the pillars is called healthy relationships which means that living with good people makes you have less illness and treat and cure it easier than the ones you have so stay close to who you like who you

I don't like people, I don't have anger, I just stay distant, I'm sure I'm not angry with people I don't like, I don't even know if I don't like someone, but I just don't want to socialize, stay there, I stay here, I live with people I like and I try. like the Forgiveness thing, right? We talk about forgive, forgive or forget, but it's taking that thing out of your focus of attention, so it's essential that it's fundamental, right ? alcohol, right, it was done, I remember, correct me, please, the study on alcohol and breast cancer

was done a lot in England, where they drink a lot H years ago, if I'm not mistaken, about 8 years ago, something like that from a study I read and It had a direct direct connotation anyway, I didn't know that women drank so much in England, maybe they're drinking all over the world, right ? Now you saw this with the Olympics exactly, right? Then you talk about the Olympics of overcoming human limits of physical activities sponsored by alcoholic beverages, so just like you said, the drink today maybe it's alcohol or cigarettes from long ago and

when the doctor asks for the patient to do and not do because I think being a doctor has many bonuses, this respect, this affection that we receive, but there is a burden, right? You can't talk to a patient about all this and you don't practice it in some way, the doctor needs to take care of yourself before taking care of others I'm married I have two daughters and I have hundreds of patients the person I worry about most in the world is me more than my own wife uhum because if I 'm not well she

certainly won't be and so from now on you won't give her your best I don't need to have a good lifestyle to show my patient that I have a good lifestyle I need to have a good lifestyle so that I am healthy and happy and from then on so I can give back to society with my best performance if you don't have it you won't give back to the doctor today he wants to earn big amounts At the end of the month but he's not earning much per hour he's earning a lot per day because

he's working a lot so that's enough at the end of the month he got a fable that he never thought he would get at the expense of a lot of suffering this will add up and one day the bill comes and there comes a time when you don't get a medical illness it's too big and there comes a time when you can't do it anymore take care and do your best medicine Professor Celmo Porto My personal friend he says the doctor who works a lot at some point will no longer make sense of the medicine

he does and It is at that moment that he goes into Burnout uhum when he works at 10 minutes and at the end of the day he doesn't remember who he saw from three appointments ago, it's because that medicine no longer makes sense to him because the doctor who treats a patient badly often doesn't treat him, treating him because he wants to, the doctor is a good person he treats himself badly because he is treating himself badly, it is a reflection of what he does to himself and the search for this balance, I because I

agree that you said one of the highest rates of Burnout among doctors, doctors , nurses, healthcare personnel have not doubt you need it is like this, I will always return, I will always return to lifestyle medicine so that you can seek this balance, but not always or perhaps never the balance will be in science and then comes what I do a lot for myself, which is to seek my spirituality and my fundamental faith when I completely understand that there is someone much superior to me and that I love in a way Without Explanation, this puts

me in a situation exactly the same as you and Dona Maria and Dona Aparecida we are all equal because there is someone much superior and because of that he will like me more because I'm a doctor and less about that person who is younger. So this search for spirituality makes me understand in a way in a very calm way, hey, I'm a pilgrim, I've been on many pilgrimages, I wanted you to talk a little bit now about your spirituality, let's go, that was one of the things that caught my attention the most. One day I

decided to go on a pilgrimage to thank my 40th birthday and I went alone alone You didn't even tell Regina Regina Do you want to go with me I didn't even invite you my mother-in-law was sure I was going to come back a lot J Regina you found out after he was already on the road she knew I had gone my mother-in-law hugged me thinking I would never But they were going to hug me, my family was crying today, they don't even cry anymore, they laugh when I'm going on a pilgrimage, no, but like, you're

going to die, they thought I was going to die, uh, and the pilgrimage started to bring me situations and reflections. very intense and very great on top of the suffering you talked about, I'm going to start walking in your case to the Basilica of Our Lady, similar, that's not it, but at what point did this record drop, did a patient say something, did you see anything? I don't know, some report, I have one, I have a theory of my own and you will understand that the day you decide to go on a pilgrimage, it wasn't

you who decided . I've been doing these pilgrimages for years, I've done it just with my wife, I've done it alone, I do it with friends and every time I finish the pilgrimage, it's 300 km walking with a backpack on my back, simple but delicious inns, I say that we finish the journey with three steps in your spiritual life ahead when you return to the world you revolt Two Steps I understood so once a year I need to go to be able to keep that one step forward always the pilgrimage makes you so humble to

understand that you can walk 10 days with three changes of clothes that you live with that you don't need the best car because it is your leg that takes you forward that the people who are by your side can help you with a glass of water or with a word that is so valuable The next time in your life you start to look at the people around you in a very different way, within the framework of the pilgrimage, I developed a phrase of mine that I say to my patients, sometimes they arrive, I stay quiet,

then I say it like this I can tell you something, ma'am, I don't even know you, but I love you, Ma'am, I don't even know you, but I love you, this is from the bottom of my heart, it's possible to do this, it's not always because the other person isn't always capable of understanding or accepting you're not always prepared either Today I'm like this, tomorrow I'm ready like this, but I try to cza uhum and I discovered something about the Pilgrim that is very important, it was from my last pilgrimage in a very difficult time

with my pilgrim friends, all the tough men a Pilgrim in High Suffering had a very serious family loss and people were talking about it. I waited for the group to pass, I noticed it, then it was just me and I said, my friend, I don't have one for you, I have an arm to carry you forward, I don't have a shoulder to give you wings. Lamentations because what happened happened and I can't go back my role in your life is from now on and in a very direct way it's what I do in my medicine

My patient arrives at the worst moment of her life with breast cancer I I don't want you to cry on my shoulder because this tear won't work for me, from now on take your arm, let's go from now on, on the contrary, this tear can even, studies show that if you become depressed you open up the possibility of an immunological prognosis you also depress your immune system so exactly you don't depress the neuron you depress all the cells The Pilgrim doesn't have a shoulder for you to cry on The Pilgrim has an arm to carry

you forward in any degree of suffering be it at the moment of someone's death uhum can I tell you Tell me a story, please, I wasn't a Pilgrim, this is one of the most emphatic stories of my profession, I was a resident, a very dear patient who wasn't my patient, she had breast cancer 30 years ago, that was in 2009, she developed a serious metastatic condition, she Just trust me Daniel, I'm really bad, I didn't say anything I said nothing, we are together and so it was difficult months controlling it and one day she was

hospitalized, she was going to die, yes I put her in the best room in the SUS hospital there at the medical school in Botucatu, I put the family together and I went to do Resident things at the end of the day I passed, the son left her side I arrived right next to her, she was like this, lying down with her eyes closed, I bent down right in her ear, I said Edna, Who's here, she opened her eye like this, she looked at me, her eye was difficult, she opened it. with difficulty when she saw

me she gave a smile she gave a smile she put her hand on my face like that she let go of her hand she died and went and died uhum at that moment that 's me she was waiting at that moment it really hurt me at the height of my 29 years of age and then about 5 years later when it happened for the second time I understood how valuable that moment had been because she gave me the last smile of her life, I certainly won in the last initiative From her a smile and a

caress on her face as the last thing she did in her life was for me what did that mean in that moment of death I didn't go to hug her I went to say we are together from now on she smiled and was close I I think I was already a Pilgrim, I certainly wasn't setting foot on the road yet But you just don't know that you're a Pilgrim, you're a Pilgrim because I've been following you for a long time, that sparkle in your eyes is that of a Pilgrim, you You'll only find out when

you go on a pilgrimage, it's 300 km, it can't be one day, it can be 20 km, uhm, the pilgrimage is nothing more than a conjunction of energies to a place, you don't need to be Catholic, you don't need to be devout, just like we are, I don't think I even think that what we are talking about spirituality we are not talking about religiosity we are wrong Thank you very much we are talking about spirituality We all have a spiritual dimension You said a beautiful thing there is something much bigger than all of us and

from which we derive So when you say a patient I love you eh we came from the same dust from the same energy from the same whatever it is and it is so valuable to say ISS if you admit that you have a creator this creator created everything and when you Say that to a very poor person, it's very different, you know, because of course I have my patients in private practice. I love my patients anyway, but this private practice patient, if she doesn't like me, she'll find someone. I understand what you're saying. no she

has no option when you come to Dona Maria and Speak Dona Maria I love you there is a flower vase here you have had breast cancer surgery take this vase it's simple I paid 30 But take this vase from the bottom of mine heart, let's celebrate the lady's life They open a smile from here here I have Dona Francisca, a very dear SUS patient of mine I've had the operation three times the first time I gave her a flower the second time I gave her a flower the third time I gave her another flower She

only got a flower when she had surgery for breast cancer, this could be a trauma in her life, do you know what her WhatsApp photo is of me, her and the flower? sometimes breast cancer this is very valuable ex uhum medicine provides very valuable situations and the doctor needs to understand that he is he is fortunate to be in front of someone who even without knowing him puts on the best clothes she can puts on the few pieces of jewelry that she has and calls him Doctor out of deep respect and you need to transform

the journey of this very special patient and perhaps it is the best moment she will have in the consultation, I'm saying this to all doctors, when we have this vision when we have this vision than what is on the other side is a divine fraction as is on the other side what we joke that what separates one the doctor has a table because at some point he has to write because what is on the other side is the same as which is on this side I love getting over my desk I love getting off my

desk uhum recently I had a very very very special story in my private office with a patient courtesy she was susza and she went there with her two daughters, a very serious oncological condition, we already knew the prognosis and she at a certain point, the daughters left the room, the two of us were left and I said, tell me a little about yourself Doctor, my life is very hard, why Because my life with my husband is not easy I said but he and he hits no no I said that's not the problem Tell me more

I really miss my father my father died when I was 7 years old he committed suicide I said ok Let her talk, move across the table, I went to a cupboard that I have for rag dolls, I took it out, I said when she looked at the doll, she did it just like a child who will see her age when she goes to Disney, she was 53. Yes, at that time, at that moment, no. That was two three weeks ago uhum she looked I said choose she chose one and she hugged this doll with the

sensitivity that I have I already understood I just asked have you ever had a doll I never had a doll I told her what will it be called This Hope doll uhum ok three weeks later she was hospitalized when I went to visit her when she saw me she was smiling from ear to ear and whoever was on her lap the hope doll five days later she passed away but she passed away happily it makes it difficult I say that she was sick her whole life and died cured and perhaps that Hope formed the last

15 or three weeks of her life with relief She certainly left early but with hope if that is not valuable what is valuable in our life a doll of cloth but it's much more than a doll of much more it's crossing the table it's a lot it's crossing the tabler month and and I think that spirituality brings to us this energy or this sensitivity of understanding that my movement in relation to the other in the direction On the other hand, it's also the movement I make in relation to God, you have no doubt because God

calls you every day God calls you every day, you get very, very emotional, but I don't complain about that, not because there are people who say that, oh, I am tearful but my crying 90% of it is happiness you've always been tearful I've always been tearful Me too so I'm going to tell you something two weeks ago I heard a passage from the gospel that I listen to Sometimes I'm not as religious as people think that we are not even me but I heard a passage from the gospel that made a lot of sense to

me because I always asked myself Do I cry a lot or does he cry a little too Whoever cries a lot Whoever is crying I'm wrong because I cry a lot Uhum but always for happy moments I listen to a song I Cry uhum Jesus says like this God played the flute and you didn't dance God lamented and you didn't cry God provides very valuable moments in our lives every day and if you are not able to train Your sensitivity to look and understand you won't get emotional eyes to see if you can't look at

the world and only look at yourself you won't look you won't notice the absence of God nor the Lamentations of God then we who cry a lot maybe are people who we look little at ourselves and a lot at the world looking and listening to the beautiful songs that God puts in our lives so that we can get emotional . This happens, me too, I didn't have the slightest embarrassment about crying with a patient. One time I received one, I remember it was the first time I received a mother and she arrived very laconic and

I said that I can help you and I've always been like that. I always went to pick up the patient in the room, I didn't sit with the secretary, I opened the door and he was sitting there, I took his hand, whether it was a man or a woman, with the same kindness, I hugged him, I just didn't hug him if I felt he was autistic. I showed respect but in the end I received a hug And then I noticed that this mother arrived, very laconic, she didn't want to hug me, I respected and I

sat the person down, which is a cup of coffee, which is a little water, she insisted on me serving, not the secretary, I saw it from outside to serve you and then I said that I can help you, that was a question like that, right, no one is going to a psychiatrist to say that they are very happy at the moment, I am too, exactly, I came here to say that I am wonderful and she said: Doctor, I just lost a child Then that gave me a shock so I said I can't imagine the extent

of your pain but I'm here to listen to you and try to alleviate what I can she said no but I lost the second one a week ago and I lost the first H 15 days she lost two children in 21 days and then I broke down and I started and there came a time when this woman got up and said I wish I was crying like you because I can't do it I said if Senor wants to stay here close to me I can only say that I don't even know what to say to

you because as soon as you say it, I was in my early 30s at the time, I didn't know what to say, this woman came to me, she took the tissue to comfort me and she said: I'm going to accept your help because you were the first person who didn't tell me look, this death could have been due to this because of that I couldn't say no matter how much I love God I don't know you know I have some idea that we we are brothers from some time in the world of humanity first because

I receive my patients to be waiting since I am when I was a resident I was visiting the ICU many doctors talking difficult and the patient was drooling he didn't he didn't know Tava already drooling at some point I went there I took a piece of paper I went there and dried the man's mouth they laughed at me the Nurse arrived and said like this Doctor I have never seen anyone do that so based on I always receive my patients from the waiting room at SUS I will receive them right, firstly because this is a

welcome and secondly you know better than me that the consultation has already started how are you dressed can you walk who is with you are you alone you imagine that I only get breast cancer when I I arrive in the waiting room, Dona Maria comes to hold her hand, if she does this with her cold hand, I already know or if she says this, Doctor, let's go, I'm ready talk about the issue of children that you mentioned one fine day someone wrote to me on Instagram Doctor, I'm going through a very difficult time I would

like a reflection on a sentence from you Look what a responsibility I just wrote nonsense what you think at the time Ah stay well, stay strong and on Sunday I went to mass and the moment at mass that I'm happiest is in the peace of Christ uhum The peace of Christ you exchange with others and I kept thinking about it I came back in the message in Direct I need to redeem myself with you I got you I wish the peace of Christ months ago, a patient of mine lost a 28 year old pregnant daughter

to dengue fever . what to do with her she rescheduled the appointment in 15 days and when she came back 15 days later she was not alone in the room there was another patient of mine who I live with her daughter on her deathbed from breast cancer I had two mothers who lost children In the room they entered the room one at a time and I knew that speaking to them at a certain moment they said everything they wanted and I said so I didn't want to be in your place I don't measure the pain

you have but I wish you peace of mind Christ, one of them said this, I think that's what I needed to hear, so when someone tells you something that leaves you very shaken, I wish for Christ, I'm sure I'm not wishing for her to be happy, I'm just wishing for peace, uh, have peace, have peace. no and that it receives some kind of welcome within spirituality not from the religion of spirituality of the spirituality that we all have we all have like that there are no ones who deny religion not all of us have spirituality

we all have you know that having faith is about believing faithfully that something exists or that something doesn't exactly exist who denies the presence of God He has a lot of faith that doesn't exist in there there is something that if you have time you will be able to give him which is sometimes difficult even because you deny something you are aware of the premise that you know this something Exactly I'm denying that this is a mug I assume that I know what a mug is I have enough knowledge to say that it is exactly

so when someone tells me when they deny God they say let it be OK because by denying they are already admitting in an indirect way of holding your hand from the patient, you know, you take the hand, you hug, you take the hug, it's always been like this, can I tell you a story please This is very special, I've already told you a few times, but this is very special, arriving at my SUS outpatient clinic full of people, this outpatient clinic only schedules patients only schedule patients who are in the system a patient took my

hand took my hand Dr Daniel I need you to answer me her hand was colder than this water her face was terrified Ms. Lourdes I said Ms. Lourdes I will assist you I'm going to see the scheduled patients and then I'm going to see you. I think what made me see this patient was her hand, I understand perfectly, she was terrified. See where this story will end. This patient came into my room and I didn't have any. I had to waste a minute to understand what was happening, the smell it had Dona lures Lift up

her blouse, she lifted a necrotic breast, necrosis, she had undergone reconstruction 30 years ago, it became necrotic, as it wasn't breast cancer, she couldn't get into the system to schedule an appointment with me I looked at her I said this is not worthy it was a Monday on Thursday she was operated on in three days my father and I, my hero, operated on this patient on Friday the day after the surgery a blood vessel flower months smelling of necrosis the next day smelling of flowers two weeks later I return to my living room this table

would be small for the amount of gifts she brought me bottles of alcohol, well everything was simple but it was exaggerated F Don na lures why everything That's it Doctor because the Lord saved my life I said no I saved your life I didn't I saved your life you weren't going to die from that disease you don't understand inside my bag I had a bottle of poison she was going to kill herself she was going to kill herself Because all the doors had already closed and she had a bottle of Vera she was going to

kill herself, the smell of death, right? would be dead if you didn't leave your room in that movement you wouldn't answer if it was just for the secretary the secretary selects the secretary say what you're not alive he would have died on the list he would have taken his own life exactly if you didn't perceive the world as people will leave without you doing anything I kept reflecting on how many women I didn't hold by the hand so today I hold everyone's hand I hug everyone I want to listen I want to understand your pain

how can I not do that for all the few who I have access, it's from end to end, it's what I can do, I'll do it, but I also believe that it's the Pilgrim who spirituality wants to arrive, unless you turn your back, you're there That woman, you, you gave your hand and you said, even if you gave your hand, I'm not going to do anything, so you're refusing to open the letter that came to you, right, you talked about a letter, right, going back on the pilgrimage the day you go, ahem, with me, you

already said yes, you just didn't say it. I'm thinking about the possibility where you go in your time, I have a very important part of the oncology treatment that I carry out, which are the letters that my patients give me to take to Our Lady S, so I go with a backpack and take letters from my patients from your patients or other people who in the beginning were just my patients 2019 I was without a cell phone so this was never marketing it's personal Genuine yes metastatic patients I took their letters when I was on

the hardest climb dead I said I need Getting it isn't just for me, it's not me on this journey anymore and then I pray and give it in, it's become huge and it's become there in the room, you know, the people of Miracles, exactly Miracles, and I'm going there like Ours. Madam, I pray, I deliver, I don't read The letters are all sealed , I even open some of them because they have beautiful drawings, Our Lady, I hand them over to them, it became more and more like this and I think that part of the

cure for these patients is there, it's not just in what I think what is written in the book is not in that only it is not only in the science that I believe in I believe in science I am a scientist I believe in science but it is not only there when they write in the letter to me deliver Dr Daniel, you operated on me, I operated on So now you are my messenger, take this letter and take it to the Basilica, I have evangelical patients who write because it is not a Catholic act, it

is an act of spirituality, it is not religious, esp I take these letters and now I just that now I can't it's not your letter now I'm going to take the patients how cool Saturday now Saturday now paths of healing I'm a little tired of Vibe úb Rosa terror terrorizing people I said I'm going to do it differently I said I love the pilgrimage I love medicine I love the my patients and I love the letters so I go on the pilgrimage with my patients and with the letters so I and five other mastologists and

the Flor Azul team and 12 more women treated for breast cancer leaving Paraisópolis walking more than 100 km to get to the Basilica of Our Lady similar paths of healing I'm not saying it's the path of healing it's not paths of healing healing possibilities it's just another agent it's another thing that adds up yes if we think that we are at least it is made up of three dimensions body mind spirit we have to feed too much healing and we will pray the rosary for those who like to pray the rosary we will make you

pray the rosary don't pray the rosary you have a rosary I have I have I get a lot of rosaries Look how interesting So you're going to get one more I brought it for you but this rosary is very special please because this rosary is the rosary of the paths of healing please give Our Lady to you please my dear It's funny I've been thinking seriously about praying the rosary really So I think that now you have gained a possibility and all the ones I win like this one goes in my car one goes to

my bedside all my rosaries literally one is in my bag for example I have one that I don't I go into lectures without it now you are connected to the body you have one more this is a third healing paths beautiful all the patients who will receive it like this episode what this episode will be like later so I'm not giving spoilers because they will have already received it pink rose of Our Lady written path of healing and that we can walk I was like that when I first saw you with that beautiful necklace of

Our Lady a long time ago I said like that the day I face her I have to give a gift and coincidentally or not paths of healing now the 12th day of Our Lady and Fi October fell on the day to take the rosary to her thank you very much thank you very much indeed not for sure all the texts I received were given with a lot of good energy and if one day you understand that this has to go into someone's hands, feel free to hand it over to whoever needs it the most, this

has happened to the patient, this has already happened, this is the most beautiful thing in the world, this has happened to me, everything I get you know it's for that person you receive it from one and then another comes in you say like this and I say when when it's from I won it I'm passing by I say I won it from a very very dear person beating your heart or when you think who no longer needs it, give it to whoever you think needs it. It's a current week before last. I was with my

sixth year students helping women with breast cancer and I got a lot of gifts, a lot of simple gifts, I got a lot of them, and one of the students going through a difficult health situation , you know, with a fist in her arm, a beautiful girl, in the morning she had already talked to me about issues related to the disease, I received an image of Our Lady, Beautiful, I saw that she looked at that image, she looked at it as hers, at the time the class, when the clinic ended, I said this to the

students, right? Let me tell you something, this gift already touched my heart when I received it, it doesn't have to be mine and it's true and I would like this gift to touch someone else's heart I got up, gave it to her, I cried, she cried, I hid it there but she cried So this gift is with her today and it's very beautiful, it's so beautiful, right ? hey reporter pipinho is a part that we have we have a community that today has more or less 1800 people who are sustainable human beings have a year

sustainable human beings who are people who like of good knowledge content, everything about behavior, health, spirituality, we never discuss religion, we always respect everyone, eh, and then this community, we let you know 15 days before the guest comes, we're going, we're going to welcome Dr Daniel, we talk, look at Instagram of That's Dr Daniel But you go there, you won't start following, you'll look and you'll send the questions you'd like to ask, I think they've been liking my videos there because I started to see some different likes I'm kidding, let's reinforce this warning, so let's

go there bru first what is the recommended age to start having mammograms this very well written question recommended 40 years old annually from 40 years old from annually Brazilian Society of Mastology annual from 40 years old uhum Unified Health System What is the protocol Biennial from the age of 50, so the reality in the SUS is the Biennial from the age of 50, the recommendation is annual from the age of 40 because 40% of Brazilian women who have breast cancer are in the age group between 40 and 50 years old is an age group that

has to be evaluated and screened mammography from the age of 40 40 and 50 from the age of 40 annual annual annual Yes, but within the SUS it is Biennial Biennial from the age of 50 is perfect but you recommend it as she asked recommended annual from the 40 annual from 40 perfect next Bru What are the early signs of breast cancer that women should be aware of in their daily lives Great question usually palpable nodules but I need to spend some time here so as not to scare people most of the nodules it's not

breast cancer uhum but every palpable nodule every palpable area, that is, the woman didn't feel anything in her breast, she started to feel it, she started menstruating, the breast became softer, that area remains there for another three weeks, that area remains there, it has to be evaluated then the main symptom of breast cancer is the palpable area, then there are others that are less specific, such as the retraction of the nipple, which we call the papilla, one day you had the papilla out, another day you have the papilla to inside it has to be investigated

uhum it's retraction of the breast skin one day your breast was normal another day it looks like the skin went inside but from one day to the next this can happen it's not a palpable area the palpable area this is also a question of early observation Brazil in Brazil we have three types of breast cancer uhum the tumor that is not palpable the tumor that is palpable and the tumor that is visible in the public health plan, okay, okay, that's why today I think that Pink October there's no point in just talking about mammography because

I have thousands of women who have visible tumors in the breast that she knows what it is and that they don't have a diagnosis that goes straight to a biopsy, right Dan, but you don't think it's ideal, I understand why not Time is going to be wasted what is the situation in Brazil today I just talked about mammography Ah Brazil does mammography every 2 years from the age of 50 it is not ideal the ideal is from the age of 40 Ok if I have the pen from the Ministry of Health in my hand continues

with the Biennial mammography from 50 years onwards, which for now is good and will hunt women with palpable tumors and visible tumors, I understand health agents completely cut off the path health agents Rio de Janeiro remote areas difficult to Enter there is a health agent from the family health program there perfect door to door Dona Maria I can examine your breast Oops biopsy biopsy then mammogram altered palpable tumor and visible tumor biopsy if possible already with immunochemistry then oncology center treatment you skip One step that for these women it is fundamental Fura Fila exactly high

suspension suspension if the pen were in my hand the conduct would be this and also create, right? I once had one, I went to give a lecture in a city, and if I'm not mistaken, it was Petrolina and I was in a hotel that was the literal border of a river that divided Petrolina with Joazeiro do Norte literally so much so that I said that R ah on the other side is Bahia on this side here I said oh ok And then suddenly I'm there comes one I was in the window looking at that river

São Francisco is not Rio São Francisco I was looking at that river and kind of hoping that I was going to have lunch at place I was going to see the fruit business there in São Francisco, I was all happy looking at that river, it was interesting, right? Then in a little while a bus passed by, but a bus as if it were one of those wonderful backcountry buses, but it was a pink bus, beautiful, beautiful, playing wonderful songs by Dana Sama something like that then I intercom at the hotel I said what is this

that's going on Oh it's the bus to pick up the women to go for mammograms I said It's serious, that's it then I said what a beautiful thing I said I wish see this bus she said, wait a minute, doctor, I'm going to wait, I'm going to try for you, ma'am, then you tried, got off You got on the bus, there was a hairdressing salon, there were manicurists because that conv was seen to convince women to go for the exam, it's the affection convincing the action strategy exactly And then I just know that I went

I went researching it was at the manicurist no I didn't go to the manicurist because I wasn't going to get the women's job I got there and said what a beautiful thing I also want to do but I'm not going USA I said No worry , I'm not going to steal your place and then I started researching and I said it's not city hall no no no no no Doctor who has been doing this for more than 10 years is called Veveta vi Vete Sangal is just like her and I didn't know that, right? so

that's coming and then you see a simple thing, right, made by the private sector Prada, third sector and it works, look how interesting this is, the happiness of those women going to do their ex who were afraid, when they're going to get their hair done, it's the nails, let 's go do but what you're saying is very valuable very valuable because I'm going I 'm going to go ahead in I already liked Vete Okay but I learned to admire her exactly she's strong She's the third sector taking care of the population but that's very important

I have a sector without ever having spoken but and first of all that but the most important thing is people think that the politician who is there has to do everything Maybe he had it but he can't do it so I'm a civilian and I have the idea or I have the money or I have science, take him by the hand and say, let me help you Exactly because the population needs us, it's the politician, it's the doctor, it's the health professional or it's the businessman or the evet sangal deo world exactly for more initiatives

like this so I thought this was so cool, you know, and the really beautiful, beautiful bus is nearby Bru, cysts in the breast can be a sign of cancer, this question is fantastic because the most common finding in the female breast is the cyst, the cyst, when in fact it is a cyst, it is not Cancer doesn't turn into cancer You don't need to operate You don't need to remove it You don't need to do anything Forget it exists Leave it there Leave it there Ah but it's bothering me OK so V empty uhum talking

about a simple cyst most of the ultrasound Ach especially in young women under 40 years are of breast cysts that are nothing but generate panic because no one wants to find anything in the breast. Obviously it's a cyst. Relax, it will never turn into something else, it will never turn into something else . in medical school, cysts don't turn into cancer pon dot dot next Bru it's true that malignant tumors in the breast don't cause pain it's true it's true that's why and this question is good because it already gives me another piece of information,

it's pertinent information for every woman who has a breast Will you have breast pain at some point in your life? Yes, there's no way . day with these breasts swaying, they hurt the breast and bring pain here in the upper quadrants, so breast pain is common in a woman's life Uhum So breast pain is not breast cancer Ah, but I had breast cancer that hurt, okay, maybe a tumor more advanced that causes necrosis can cause pain can cause pain can affect the skin can pull but cancer doesn't exactly hurt cancer doesn't hurt cancer doesn't hurt

that's why I'm 42 years old my breast doesn't hurt I don't feel anything palpable it's you who has to Having a mammogram is exactly where women want to convince themselves that they don't need to have a mammogram but I don't feel anything, I don't even have any pain, it's you because it's mammographic screening to look for healthy, asymptomatic women to do it small diagnosis and curing the disease, that's the glory of life, that's the glory and there's a lot of it. Not exactly, but you can get it at this exact moment. 1 cm. Our patient

arrives at the office, measuring 1 centimeter. arrives obese smoker a lot of things a tumor and 1 cm breast cancer Doctor my life is over I say he said look at this cancer we're going to treat it but we're going to have to look at a series of issues It's not just that here even for him don't get your exact figure back Because there's also that, she removes less than 1 cm. Takes it out and is relieved because you get back to the history of inflammation exactly And then you continue to smoke, continue to drink,

continue to remain in an overweight pattern Or obesity this year one patient in my outpatient clinic obese smoker with 1 cm cancer arrived desperate because of the name cancer is the worst name you can hear in life worse arrived Doctor I'm desperate, you can talk to her she relieved, reassured, there came a moment I said like this when we pass For a problem like you have, we need to look at God and talk like this . If you don't ask God, why do you ask? of lifestyle because your cardiovascular risk due to smoking, obesity, diabetes

is much higher than your risk due to breast cancer, so now we are going to take care of the cancer, obesity, smoking, that's what it's for , so That's why you have to diagnose a small tumor and it's wonderful that you can put exactly this proactive approach like, look, you're not going to die from breast cancer, forget it, because it's tiny, but you can die from cardiovascular effects, you said that I I could talk to Regina, right? Of course, my wife, dear, on Sunday we were having lunch at the restaurant, there was a patient of

mine who was being treated for breast cancer. we're going to talk later we're going to talk catch the act later we're going to talk but of course because we say this out of love, it's not out of love, of course we're not going to talk, the easiest thing is for you to not look and stay quiet but we can't, we can't, we have to give some indication because otherwise you're being omitted, right next Bru some doctors don't prescribe chemotherapy for small tumors how is this assessment done exactly as the question says basically by size uhum

very small tumors get rid of chemotherapy it's 100% no it's not 100% I'm saying in a generic way I need to evaluate immunohistochemical subtype age a lot of things uhum small tumors usually end up in minor surgery uhum conservative surgery plus radiotherapy but most of the time endocrine therapy Tamoxifen aromatase inhibitor skip chemotherapy systemic treatment chemotherapy immunotherapy antier do se therapy it is used for larger, larger tumors So that's the question, it all depends So it can, it's good that most women who have small tumors won't lose their hair because they won't do it the

sooner the smaller the treatment the smaller the treatment my father says like this I don't like this phrase but he says it like this, get a mammogram so you don't have chemotherapy, it's scientific, regularity , it's simplistic, it's scientific, but I don't like the information, that's why I don't say it, but yes, I understand, but I understand, He also, Of course, because the person who does it on a regular basis if you catch something you will catch it very small yes my father says that is exactly that I understood next What is the relationship between

obesity and breast cancer we talk a lot, right, for every 100 cases in Brazil 80 cases will occur due to lifestyle 20 cases due to genetics uhum familial genetic mutations 20% of the Brazilian population every 100 cases 20 cases will be genetic cases regardless of obesity regardless of anything the other 80 cases i.e. 80% is related to your environment is what you eat is what you training is how much you sleep is how happy you are is how healthy you are obesity causes breast cancer in both pre-menopause and post-menopause obesity The prognosis of patients who

have already been treated for breast cancer, obesity, recurrence, is also worse. This is also the oncological prognosis, obesity increases the cardiovascular risk of women who are treated for breast cancer, in other words, the relationship between obesity and breast cancer is catastrophic, let's say, this is a fact exactly a fact it's a belief I study this exactly it's not a prejudice it's a fact no people I'm not talking bad about obesity exactly I'm just saying that I have a master's degree PhD I study that's all the relationship between obesity and breast cancer is catastrophic and increases

risk worsens prognosis, basically, now I'm obese And I have breast cancer, is it worth losing weight? Of course it is, because there are a number of studies that demonstrate that obese women who start treatment with effective lifestyle changes reduce their risk, and behind this there is something very valuable n reduce cardiovascular risk yes it reduces the risk of death from any cause and behind this is a very valuable thing it increases the quality of life death certainly no one thinks right I want people want to live with What quality people quality of life is the

most important thing Of course I think you're changing a little I think nowadays you're changing a little it's already been talked about but it's still small but at least it exists in the air it's a perfume that begins aaa people fish, exactly, it has a smell next Bru, if I have dense breasts, how can this affect the diagnosis of Cancer, great, we don't understand what dense breasts are, dense breasts are nothing more than a glandular breast, a young breast, young women have a lot of glands in the breast the excessive gland in the breast when

you have a mammogram it becomes a white breast with high density uhum What is a dense breast is a young breast that has a high density on the mammogram but breast cancer is a tumor of high density on the mammography Uhum So the dense breast is white because of the gland the tumor is white because of the tonal density cell density is difficult to see I understand that's why in dense breasts we generally supplement with ultrasound when necessary it is more effective for young women to do it mammography associated with ultrasound than just mammography perfect

This is a breast that's because in ultrasound we can make that difference you can make that difference perfect next Bru Doctor I see increasingly younger women adopting silicone prosthesis surgeries what are the risks Associated with breast implants in a very calm way none linked to breast cancer nothing linked to anything uhum we have to stop trying to create myths about silicone implants silicone disease silicone lymphoma there are those who study this but even for this to be scientifically proven, we have to be careful with what we say, whether you want to put a prosthesis, look

for a good plastic surgeon and put it in. Uh, that's how it is, don't be afraid, if you have a silicone prosthesis, you won't make it difficult to diagnose breast cancer because the prosthesis is behind of the gland So if a tumor appears So it will be in the front it will be in the front so if you have a breast tumor with a prosthesis you will feel uhum if you have a prosthesis you can have a mammogram you can have an ultrasound you can have an MRI you can have it biopsy if you have

a prosthesis you can have conservative surgery for breast cancer, that is, the prosthesis does not influence any risk for breast cancer, neither as a risk factor nor as a risk factor, there is no study that proves this for now, no studies They are small, there are people trying to prove it. For now we don't have proof, we believe science is very healthy for now. Look for a good plastic surgeon, a good mastologist, don't operate when you're obese. Certainly because this is another important issue and that's it, but the silicone one relaxes and live life and

for women who had cancer, they had to have their breasts removed or part of the prosthesis removed. In this case, in relation to the issue of self-esteem, it can work, Our Lady, it's just up to you to understand and what is the stigma of a woman with a perfect mastectomy, it's very serious, very serious, right, but Today, look, but I'm saying one thing: Mastology is moving in such a way that fewer and fewer large tumors are being operated on, which we can reduce with treatment. systemic to then perform a minor surgery so mastectomy today within

a Mastology well done well done it becomes a perfect exception surgery and when the woman has silicone she has and has cancer it doesn't change anything there's nothing I've had several operations, it doesn't Oh, you said that the breast tissue is in front of the PR prosthesis, it is either behind the gland or behind the muscle that has the gland, that is, the prosthesis will always be behind the gland, which is where it will show perfect breast cancer. We have to demystify this, it's a perfect myth, next BR What are the recommendations for women with

breast implants in relation to screening exams? It's the same recommendation for the population without an annual implant from the age of 40, but uhm, women who don't have a breast implant will have two incidences per breast, in other words, you are going to have a mammogram, how is it that a mammogram is an x-ray exam that compresses the breast so that you use less dose of x-ray, basically this you do compression from top to bottom, compression from the side, so a woman who There is no prosthesis, she will do two compressions on the right breast,

two compressions on the left breast, the woman who has a prosthesis will do four compressions on the right breast and four on the left breast, why two normal ones and the other two removing the prosthesis from the mammography field, I understand, call Lund equ maneuver you pull So whoever has a prosthesis will gain additional incidences, I understand, but I don't think they also do any harm in increasing the rate of radio, X-ray, for example, I can answer the question that isn't here, can you please, it's the most important Bru makes this cut there Bru cuts

this mammogram does not cause breast cancer mammography saves lives perfect there is a non-scientific aspect and based on engagement based on Advertising that openly discloses that mammography causes breast cancer due to radiation this is criminal because the The only strategy we have in the world for the early diagnosis of breast cancer is mammography, mammograms have been emitting safe radiation for decades, you don't need to worry about your thyroid or your breast, you have to have a mammogram So this story of saying that mammography causes that the radiation from mammography causes breast cancer is the myth

of the myths of Mastology, it is a disservice, it is a disservice to the population and the health of the population while we mastologists, little ants, are walking around saying get a mammogram from the age of 40 in the meantime Americans including mammography from the age of 40, which the Americans were not, the task force started mammography from the age of 40 last year, there is an aspect that communicates very well and has wonderful communication and social media strategies that say that mammography causes cancer with an absurd breast, right? And today in Brazil, whoever has

good communication ends up becoming the owner of the truth, so to make a cut, it's not to cut, it's not to cut, it's to make the cut, no, this cut is to make the cut, it's to make the cut is very important, this fake news is what it is, it ends us, you are the one you have, you are the biggest evidence, you have a fabulous Instagram, but the majority don't, I understand, you don't, and we tell people, but people have to come together for this, but that's what is most beautiful about me, there's no

point in talking bad about people, you have to bring good information and make your truth exactly spread as much as you can, that's what's next Bru after treatment for breast cancer breast What is the importance of regular monitoring and what tests are recommended to monitor your health, is it perfect first? It depends on which breast cancer you had and how big it was. What was the stage of this tumor? As a rule, there are no control tests, although many do. Many exams, as a rule, for early tumors, you only need an annual mammogram for more

advanced tumors, it depends on the stage, whether to associate it with a tomography, an RX, ultrasound, now what is most recommended for those who have already been through breast cancer, changing the style of life, this is a medical prescription, it is the doctor who will do it, not the doctor will actively recommend it and the physical educator will do it and the nutritionist will do it and the psychologist will help and If you need a convincing coach to change your lifestyle you will have to have one and we will have to work with these groups,

right? The strength of the group is fundamental. Science clearly demonstrates the best patterns of lifestyle change in treated women. of breast cancer is by multidisciplinary groups and in groups of patients exactly United women led by United groups perfect and it works which is aaaa basis of the aa of the na of the groups, you know, they have always come together , and women who love too much, so we have to take advantage of this. therapeutic tool that groups humans have a very great strength once again the man taking care of the man the man taking

care of the man exactly nearby Bru what is the importance of the HPV vaccine in preventing cancer this question is wonderful people need to understand that it exists a vaccine that prevents cancer called the HPV vaccine the HPV vaccine is not to prevent HPV the communication strategy is wrong because when you say that the vaccine is for the prevention of PR prevention of HPV many, many conservative people will say my daughter won't take it because my daughter doesn't have sexual relations she's only 9 years old she's only 10 years old the communication strategy is wrong

we today have a fabulous weapon against cancer called the HPV vaccine I Daniel once again if the pen Ministry of Health It's in my hand, I change the name of the vaccine Cervical Cancer vaccine, you take the vaccine and you won't get cervical cancer, which is among the main types of cancer in the Brazilian population, unfortunately, mainly in the north of country, cervical cancer takes the lives of women who would be prevented by the vaccine, you have to vaccinate, there is a vaccine, there is a vaccine against cancer, yes, the HPV vaccine, and there is

no age, there is an age, yes, up to 45 years old, you can take I'm not an expert on this, okay, but up to the age of 45 you can take the best evidence is in girls who have never been exposed to the virus, who are girls who have never had sex, so in the ideal protocol, from the age of 9 or 10, vaccination begins, including for boys also because for a long time I talked about ex girls, people say my dream is the day that the cancer vaccine appears for years and people don't take

it because they think the HPV vaccine is in the case for cervical cancer for women and penile cancer for men, yes there is and there is also this Association with cancer of the oringes of the throat, so people in heaven, we pray for a vaccine against cancer to come and when it comes, we don't exactly use it in mine opinion, the error is in communication, it's not the HPV vaccine, it's the colon cancer vaccine, the cancer vaccine, we need to start talking about the cancer vaccine You said a fantastic thing, if it's publicized like this

to the population, Tom, I have no doubt about it. I have DVA there will be there will be a queue and people will still say that wow you saw that the cancer vaccine arrived and it has been there for over 10 years Exactly exactly I completely agree with you cancer vaccine forget that name HPV cancer vaccine cancer but there's a little bit of hope, right? The minister of health is from the Osval Cruz Foundation, so I hope she brings this revamp of your suggestion, which is wonderful, we need hope, exactly not a vaccine against cancer,

that's beautiful, a vaccine against cancer exh F exactly I have a 13 year old daughter a 9 year old daughter are vaccinated against colon cancer against cancer Daughter, let's go get the cancer vaccine there is a cancer vaccine you have to take it perfect perfect you are marketing you have good marketing very well done Ah, I'll learn from you next Bru Is there a myth about breast cancer that is important to demystify, perfect, I'll put up a quick series, okay, please, what do you want, it causes breast cancer, deodorant does not cause breast cancer ,

and bad diet does. causes breast cancer obesity causes breast cancer if you don't have anyone in your family who has had breast cancer you are at risk for the disease because 80% of the Brazilian population has no one in the family and only 20% only have breast cancer 20 % to treat breast cancer you don't need to have ugly breasts, you won't always be bald or You will always lose your life, quite the opposite, more and more women are cured of the disease. I think I put together the myths, the main ones and prosthetics, prostheses

do not cause breast cancer, alcohol causes breast cancer, perfect, perfect, you can tell it was all said, now you did it o I made a quick one here for you made the mental map This is to save save this exactly next Bru ah we have now arrived at what we call the moment pipinho pipinho is our mascot who is always happy, okay Hey my son I don't allow that watch television that has screens he only listens to good content while we were here talking he picked up some words that I'm going to give you now

and what he sees your head you give back If nothing comes through he's polite he won't get hurt That's a good one always love for anyone, use it without moderation, without moderation, the most beautiful phrase I know and it moves me every time I hear it, you have to love people as if there were no tomorrow, it seems like a cliché, it's not in fact, it's like that, two welcoming and fundamental when you deal with people, you don't need to be a doctor, any Inter-human relationship must have perfect support, three overcoming, we need it every

day, you don't need to go through an illness to overcome yourself, especially because those who go through an illness think that their problem is the biggest in the world and It's not the worst problem, it's yours , it's mine, and you need to overcome yourself . It's a problem but it persists persist four if you could get into a time machine which moment would you choose to visit the past or the future future can I say please the day we have a vaccine against breast cancer just as we have a vaccine against Cervical cancer will

be the happiest day of a breast doctor's life I don't care that I won't have surgery anymore I don't care that it's over I'll love the day there's a vaccine against breast cancer and do you think that's possible I think so, there is a lot of research on Mastology that has evolved a lot 15 years ago, it was one today, it's another, it's very little time in history, it's true, right? It's true, we need to remember that the biggest medical advance in recent history is the placement of homemade serum homemade serum is bigger, it's a

magazine I think the New New England thing put What is the biggest medical intervention that saved lives in recent history homemade serum, yeah, yeah, that is, there wasn't that before, there wasn't, so in the future we will have the vaccine against also Complete the sentence my purpose in life is to take care of others six happiness the family seven Complete the sentence to be healthy is to live longer eight Hope doll's name jump perfect step nine a defining moment in your career so many, right I think that's what I told you I told her about

her last smile uhum what her name was Edna Edna Edna there were so many here I already received two last smiles, right, one was from Edna and the other was from a patient who was when she explained to me what Edna had done because God speaks So, right, you didn't understand that I didn't do it for you, so wait, I'll give you a replay Wait a minute, you didn't understand, boy, you didn't understand, so come here, I'll wait for you to get older, a very vain patient lady of mine, very vain private practice a lot

of family calls me my mother urinated in her pants we took her to the hospital I said something was wrong she wouldn't do that if she wasn't well and she was very lucid uhum I arrived at the hospital the family was gone I went into the resuscitation room like a circus she gets up and lies down and four five on top of her and trying to do and get the vein that mess was in the corner I didn't say anything I just went in to see if then the doctor who knew me said do you

want to participate I said I'm not calm I'm watching when I saw that nothing was going turn around I said I can talk to her I came to her she was there she wasn't seeing me she was here and she was super I said I came here to see you she looked at me she didn't recognize me Because she was completely outside uhum calm down oh Everything will be fine, she recognized my voice, but she didn't, she recognized me, she did like this, she calmed down, turned and went and He died then I said it

was the second and last smile of my life exactly Edna do M you already had that that's why I say look for someone's smile even if it's the last I think the last one is worth more V much more I've had two and I'm looking for several You certainly have this gift, right ? From the hospital, very dear, I went in, the family left, they were very, very weak, I arrived at her side, the television was on, at the hospital, I arrived at her side and said Let's pray, she said, let's go, I said, do

you want to pray, she said, Hail, queen, I said, it can't be any other way. because this one I don't remember this one I don't have it now I said it I only remember the beginning she laughed like that Oh doctor she said like this so I want to say a Hail Mary she said like this I want to say a Hail Mary the television started Hail Mary full for free there was a priest on television but there wouldn't have been time to change the channel bring there wouldn't have been time to press play if

I hadn't said that I didn't know how to pray Hail Mary it wouldn't work she said so Doctor I want you to pray a Hail Mary began Oh I get goosebumps Hail Mary full of grace we prayed together when it was over she said like this Wow it started special she realized it was television which is television She realized that it was a message she passed away the next day happy relieved because someone sent a Hail Mary Someone said like this that's it what do you want So take this Hail Mary for yourself take it

and and someone somehow reassured her that she would be very well received She asked and she was answered this is a miracle ex certainly in the liter of death It's certainly beautiful, right? of the birds Marias was waiting for her for sure and 10 it's a thought a sentence whatever you want I don't even know you but I love you perfect from the bottom of my soul in the purest way I don't even know you but I love you perfect count on me how much I can give you and not How much you want me

to give is within my limit For what So that I can help you and not harm myself I think that's what I try to do every day is the balance of life I love you I help you, but within my limits, not yours, because otherwise I won't be ready for the next one, exactly, and there are a lot of people who need to be helped, right? There are a lot of people, my dear, thank you very much, it was an immense pleasure, cognitive, I learned a lot, spiritual, very good. It's great to have you here

today, I now wanted to give you a little gift, we have an ecobag here on the pipinho on the back, it says make it happen, inspire you, kite, I went to prove that you had it here, that's cool. Here's a little notebook for you to put all your projects and dreams for 2025 will definitely come true, who knows, maybe we'll launch a big campaign so that other city halls can actually adopt the success story of Rio Claro and the private sector can transform this reality, I believe. Together we are much stronger I saw it for

sure. Use and abuse it for this purpose. Here's a little mug for when you 're in your office having a cup of coffee. I also don't use sugar anymore. You put this here. I know I was being, it wasn't just a test. I. I was being studied here in this sense, just a test, no, I'm being studied for me, not in this, but it's not over, come on, there's a book here that I wrote during the pandemic in which I refused to be unhappy, I wrote happiness and there's a little bit about the importance of

spirituality in happiness there is a book on depression which was the first time I started talking about the spiritual dimension which I call the three dimensions of the disease of the century I talk about the importance of not becoming depressed in the treatment of any disease and here windows of the mind which is a book of stories there are 12 stories based on consultations that I made, of course, we wrote it with a friend who is Eduardo Melo, who is a wonderful short story writer, so we took real cases from the fiction office, we exchanged

names, professions, we put a little bit here for us to talk about a little bit of what we saw Which of the three am I going to read first happiness convar to to start happiness of happiness we are all in need we are all in need and this one I'm going to send to you which is a time for me which is my book it's coming out in November ok And it's going to be available on Amazon in bookstores reading eh which is the I'm proposing 365 days for us, 10 days, 10 minutes a day,

doing our mental care is mental care, right ? fake I can consider it you can give the address you want because as soon as you leave the printing shop you will certainly have time for me which I think we all have to have time for ourselves 10 minutes or 12 minutes of physical activity in the the blue flower project is so little , right ? here I admire you a lot you influence me directly what a good thing for your lightness for your happiness for the shine in you have a shine in your eyes so

beautiful there and here it is it is twice as much because yours is from the heart I am small all world, I find a lot of people on the street saying that, woman, I thought you were, woman, summer, I said not only this little thing here, but how rude people say that, you might even think it but you can't say it's cute, but it's cute because it's cute, even though it's something like that because So I hug everyone and so on, I say, but it's good to be like this so we can hug more. The

driver said this, guys, come here to do the podcast, nervous, I said, I'm not nervous, I'm very happy because I'm very happy to be here with you Thank you very much, it was an honor too, my dear, I wish you would now look at that camera, you don't need to look at me, give all your messages, you can look over there Regina, I want to help remember the messages, feel free, my purpose is for you I ca n't always help in person, I have a social network where I talk a lot about human dignity, I

talk about good medicine and even about serious illnesses, with assertive and light communication, I have no intention of scaring anyone, so Dr Daniel, but for anyone who wants it, it's a It's a pleasure, whoever wants to find me in person, then on Instagram itself, there are possibilities, and you can count on me directly or indirectly, and I maintain what I've already said, so I don't even know you, but I love you, and my initiative and hope is that you improve your lives, that's it , thank you so much, dear, I appreciate it, dear, we are

finishing another episode of kite powder and today it was with this dear, But dear, even though I already knew it from social media, but live is much, much better, we know exactly when we find a soul friend and what happened here today was a soul friend and you can tell because the same soul that met here is the same soul that he also gives to you don't forget to subscribe to the channel to share this interview with whoever you think will deserve to hear it because what happened here today was for us to become much

better human beings, thank you very much and see you next time, PIP