Darrin Godin: Hello and welcome to Talking Hope. I'm your host, Darrin Godin. Today I'm pleased to be speaking with Dr. Seth A. Cohen. Dr. Cohen is a urologic surgeon, a urogynecologist, and the program director of City of Hope's Fellowship and Cancer Survivorship and Reconstructive Urology. He specializes in complex reconstruction of the pelvic floor, including pelvic organ prolapse repair.
And he is widely published in medical journals on topics including mesh-associated complications and urinary incontinence, Dr. Cohen practices at City of Hope Orange County Lennar Foundation Cancer Center, the most advanced comprehensive cancer center in Orange County. And we are thrilled to be speaking with him today about hope for pelvic health disorders. Dr. Cohen, thank you so much and welcome to the podcast.
Dr. Seth Cohen: Oh, it's my pleasure to be here, Darrin. Thanks for having me.
Darrin Godin: So, let's start with what drew you to become a physician and why have you chosen to practice at City of Hope?
Dr. Seth Cohen: A lot of reasons for all of the above. The ability to be a physician for me is truly an honor and a privilege. It's really about the human connection. Growing up, I grew up in Orange County, North Orange County, in Yorba Linda. We, my brother, who's also a physician at City of Hope Orange County, Josh Cohen, he's the medical director for gynecological oncology, both volunteered at St. Joseph's Hospital actually in high school and really developed a strong passion for helping people, for identifying people in need, that human connection.
The science is very interesting and intellectually stimulating, but it's really the ability to meet someone and be a part of their transformation and their journey in their healthcare challenge that drives me to be a part of medicine. As far as why City of Hope Orange County, it's home. This is home. I was practicing with City of Hope for a number of years in the San Gabriel Valley, in the Pasadena area, in the Arcadia area, in Glendora area. That was very satisfying.
They actually still serve that region in our Duarte campus once or twice a month. But when the opportunity came up to join City of Hope's efforts in Orange County and really come back to the place we loved growing up in and elevate as much as we can the opportunities for healing here in Orange County, it was something I couldn't possibly turn down. And once again, it's an honor and privilege to be here doing just that.
Darrin Godin: Well, say more about the science that you referenced and why that's so important for you to practice at City of Hope because of the science.
Dr. Seth Cohen: City of Hope, the ecosystem of discovery and intellectual curiosity here is second to none. It really rivals the most impressive institutions across the country in the diversity of thought, of the innovation, and in the clinical trials that the scientists are pushing through really from bench to bedside. Very commonly at City of Hope with the resources we have at our institution, it's not uncommon to see the future therapies here and now really being brought to patient bedside on a daily basis.
And so when we look at an ability to really make change, to actually enact change, there couldn't be a better place to be in offering a patient everything we possibly can on a day-to-day basis, the most up-to-date tools, the most current surgeries, the most innovative thought processes, all here at City of Hope Orange County. And the culture at City of Hope is so important. It really focuses on the person, the soul, the human being. We don't lose sight of that even as we're really trying to integrate these advanced scientific breakthroughs into their care plan.
Darrin Godin: So for the patient then, that really means that not only do they have access to some of the best physicians and scientists that are practicing today, but they also have access to the best science that's going on and we're taking care of them all at the same time. So it's really the best place for the patient to be as well.
Dr. Seth Cohen: It's really a fantastic access point for extraordinarily high level of care in the region. There's so many people in need. When you look around the landscape of healthcare in Southern California and America in general, people are getting sicker, younger, scarier processes, more aggressive processes in people that are otherwise in their prime. Just really, really concerning developments.
And it's so absolutely essential that we be here and be available to help those in need. We have many different specialists, many different healthcare challenges we manage and deal with, but just to be here and be available and give people more access to this care is so important to all of us.
Darrin Godin: Very meaningful for sure. So let's talk about your role as a urologic surgeon and urogynecologist. What do you find most rewarding about your specialties?
Dr. Seth Cohen: My specialty is really all about giving back dignity and quality of life. And pelvic floor disorders is a catch-all term, really includes things that we generally don't talk about with our colleagues, our friends, perhaps even our family. It's the day-to-day functions of going to the bathroom and voiding or peeing, of not leaking urine on ourselves, of not experiencing recurrent urinary tract infections, of not having tissue, painful, bulging, irritated in areas that we otherwise really wouldn't want them to be.
It's about managing both patients that are in a cancer journey or cancer survivorship journey and suffering with the sequelae and challenges of their systemic therapies and treatments. It's also about helping people that just need a high level of pelvic floor reconstructive care, urogynecology care, and they come and seek us out and we're more than happy to see them and help them as well.
And we take people that perhaps don't have the ability to go out and live the lives they want to live because of these embarrassing circumstances and we try to make them whole. We try to give them back the opportunity to be the people they want to be and to participate in the activities they want to participate in so they can be full whole beings for themselves and for their loved ones. And what's even more special about our facility is the really robust program that we have in women's healthcare.
As I mentioned, my brother, Josh Cohen, is the director for gynecologic oncology here at Orange County. It's just amazing to work with him on a day-to-day basis and to really provide integrative plans for patients going through their cancer journey, their gynecologic oncology cancer journey. When they're experiencing these quality of life challenges, we can help them. Not only can we try to treat their cancer process, but we can also improve their quality of life and try to make them human beings that reflect the people that they want to be.
We also got a fantastic breast surgery team, Dr. Jennifer Tseng, Dr. Irene Kang. These are really just amazing physicians that give City of Hope Orange County a truly, truly robust women's health program that I'm really proud to be a part of.
Darrin Godin: Wow. Thank you for sharing all that. So I know you mentioned a few reasons why folks might need your services. But when should someone see a urogynecologist? Give us some things that might be going on that they should seek care from someone like you?
Dr. Seth Cohen: Most certainly. Why would you seek a urogynecologist out? We see generally women who are suffering with challenges like urinary incontinence, leaking urine on themselves and inopportune times, whether that's with coughing, sneezing, laughing, trying to work out, trying to go to the gym, perhaps feeling like you're living in the bathroom, going to the bathroom all the time, urgency and frequency of urination. You just can't seem to get out without having the need to run back and use the restroom.
People experiencing defecatory dysfunction with fecal accidents, soiling themselves. Embarrassing, unfortunately. People that may be developing a lot of recurrent urinary tract infections. You just can't seem to get off antibiotics. You're just in pain all the time. You've got irritated voiding, burning with urination, and you just feel like you're just chronically infected in the lower urinary tract. People that are seeing blood in their urine. God forbid. That's a very concerning process and that would need to be evaluated to make sure there wasn't a cancer in the urinary tract.
People with fistulas, connections between the vaginal canal and the bladder, or perhaps the colon and the vaginal canal. Really organs that should not be connected, but for many unusual reasons can be, whether that's because of previous surgeries, previous radiation or chemotherapies, previous accidents, sometimes motor vehicle accidents, trauma accidents, some sort of unfortunate life event. You can develop a fistula or connection between the vaginal canal and the bladder and urethral anatomy.
People that have gone through surgeries that unfortunately haven't gone well, whether that was previous attempts at reconstructive surgery of the pelvis for the urethra, the bladder, the vaginal canal, and they just continue to have challenges. Come and see us. We want to help you. We want to see if we can put you back on the track you need to be on to be the person you want to be.
All of these reasons and perhaps many more, but really anything having to do with the pelvic floor, with the day-to-day toileting. These are efforts that we want to try to make as straightforward and easy for you as possible because it's just a part of having the dignity and respect we want you to have.
Darrin Godin: Great. And you're an expert in this area, so how does your area of expertise intersect specifically with gynecologic cancer care?
Dr. Seth Cohen: Absolutely. There's a large overlap. Gynecologic cancer impacts reproductive organs of women, uterus, ovaries, cervix, vaginal tissue, vulvar tissue. And unfortunately, when those cancers arise, there are therapies that patients go through that can be life-saving, literally life-saving, life-changing, but there are therapies that have other adverse outcomes. So whether that's radical surgery, whether that's chemotherapy, whether that's radiation, all these very focused specific therapies.
And the people we have doing those are excellent, excellent radiation oncologists, medical oncologists, Josh Cohen, my brother, the gynecologic oncologists, really top-notch people. Even with their efforts, challenges arise because these therapies by nature are meant to kill tissue. It's meant to kill cancer cells. And so in those efforts, people can have their normal tissue challenged as well, and so they can develop urinary incontinence. They can develop recurrent urinary tract infections.
They can develop painful voiding. And we can help them. There's ways to make that better, whether that's through conservative therapies like medications or physical therapy or perhaps additional surgeries. For instance, tendon transfer, where you take a tendon from the thigh and transfer that underneath the urethra to support the urethra, so there's less leakage with coughing and sneezing and moving. There's absolutely ways to try to improve this for people.
Darrin Godin: Wow. So do you do this in conjunction with those other oncologists that you referred to? When you're planning the care of a patient, do you plan this so that you can do all this kind of at the same time? Are these separate visits in some cases? Or do you try to do it all at once? How does that work for the patient?
Dr. Seth Cohen: Well, that's what's really special about our facility and our ability to integrate that care is there's no absolute right answer or wrong answer and it's very unique for the particular patient in their particular course of care. And so we have the ability to really focus and make the plan unique to the patient and the particular needs with that patient. And it's really all the above of what you just said. Sometimes things are done in conjunction, your concomitant surgeries.
Sometimes there is a delay where we do cancer treatment first, do the cancer treatment first, give person time to heal, come back, reassess, and see what reconstruction needs to be done. So it really is unique to the circumstances of the patient and the particular challenges they're facing. And we try to really tailor that to the particular patient. It is absolutely a part of who we are to make sure that we work together and give the patient the best possible multi-specialty core data plan they can have.
Darrin Godin: Well, let me ask you this question first. Can you talk about something in your medical career that has given you the greatest sense of accomplishment and perhaps share an example? Perhaps that's a patient story or something that's really given you that sense of I'm doing the right thing here.
Dr. Seth Cohen: It's really the aggregate of patients coming back to see me over the course of their experiences and saying we made a difference for them. We improved their quality of life and let them live the quality of life that they want. Perhaps as an example, I ran into the family member of a patient that I had seen maybe five years ago, and we had done a reconstructive surgery for her. And she was mature in her life, elderly.
And at the time the family was debating whether or not it was the right thing to undergo a surgery because she was in mature age. But her quality of life challenge was important enough that it was very limiting for her. And so really in a shared decision-making discussion, we all agreed we would go ahead with the surgery. And we did the surgery for her and she did great. She really did great. She got through the surgery fine.
She went home. I saw her a couple more times for the follow-up. And to my knowledge, she was doing well. I ran into her daughter within the last couple of weeks actually, and she had mentioned that within the last couple of years, she had passed on. But as a result of the surgery, and this was very meaningful for me, she had a significant improvement in her quality of life and got so much more out of those last few years that she had than she would've otherwise.
And you just can't understate how important that is for someone like me, to give someone a quality of life that they really deserve, for a few years to get as much meaning as they can out of that, to be able to participate with family and be present as a person that perhaps they otherwise wouldn't have been. That's why I do what I do. That's why I do what I do.
Some of the more satisfying patient stories are some of these fistula challenges, where patients come in and have had a fistula develop between the bladder and the vagina and they're leaking urine all over themselves. And it's just not the people they want to be. They're in diapers and pads. And we take patients with surgeries, and gosh, it's so satisfying to see them come back. It's night and day. They're out of diapers or out of pads.
They really seem like a completely different person. I wish I could say every story was a success story. And being completely transparent, it's not, but that's life. And even in the circumstances where we don't get the exact outcome we want, I'm there for you. We're going to still work together. We are shared partners. We are going to give you the best quality of life we possibly can no matter what the outcome is. And I'm there for you every step of the way.
Darrin Godin: It's such a unique perspective on the idea of hope, because I hear a lot of patient stories and unfortunately a lot of patients will say that they've been somewhere else for care and they weren't given hope. They were just given a treatment and they were kind of just told like this is the way it is or this is the way it's going to be. And yet they come to City of Hope and we give them hope. Maybe it's in the type of treatments we can offer. Maybe it's in the research that we're doing.
But even from your perspective, it sounds like another perspective of hope that we're giving them that sense of dignity. We're giving them that quality of life, and things that may not be specific to the cancer, but it's all wrapped up into who they are and how they want to live their life. It's really encouraging, and thanks for sharing that, Dr. Cohen. Along those same lines then, so what does hope for you particularly mean? What does the concept of hope mean to you?
Dr. Seth Cohen: Hope for tomorrow to have everything you need to be the person you want to be in that moment in time. Does it mean being present for your family to give them some more hugs? Does it mean being able to walk your dog and not have to be in diapers? Does it mean being able to lift your grandchildren and not worry about having an embarrassing circumstance? I want to give you the hope to be the person you want to be, to give you the quality of life you deserve, the dignity and respect you deserve.
And I want to arm you with tools to do that. And perhaps it's not even exactly you've closed your eyes and envisioned it, but maybe we can give you another vision and still meet those expectations, still meet those goals. That's what hope is to me, hope to be the person you want to be, to be able to be with who you want to be with, and give meaning to every day, every day.
Darrin Godin: That's awesome. Hope to be the person you want to be, that's great. Well, thank you so much for sharing with us today. I want to give you the opportunity, is there anything else that you'd like our listeners to know about pelvic health or your area of expertise?
Dr. Seth Cohen: This care exists. Sometimes, especially women are taking care of their family members. They're often making decisions for their family members about others' healthcare. These are moms, aunts, grandmothers, daughters, sisters. No matter where you are in the walk in life you're taking, if you're having a pelvic floor challenge and you're limited, come and see us. We want to help you. Again, we want to give you the quality of life you deserve.
And these can be embarrassing discussions sometimes, but I would say there's no such thing for us. This is medical care that we are honored and privileged to be a part of and to deliver for you. And whether that's part of a cancer journey, a survivorship journey, or no cancer or survivorship at all and you're just someone in the region that wants that care, come and see us for this care.
We'll be more than happy to see you and do our best to take care of you. I've got some amazing colleagues I work with, Dr. Tseng, Dr. Kang, Dr. Cohen, Josh Cohen, all of them are here. We're a really robust team. And with all of us together, we can really deliver on the goal of making you the person you hope to be.
Darrin Godin: Wow. Thank you so much, Dr. Cohen. I mean, you and all those other physicians you just mentioned and so many more are really the reason why City of Hope is a nationally ranked top 10 cancer center right here in Orange County, and we couldn't be more proud to have you on our medical team and medical staff. So thank you for joining us on the podcast today. I really appreciate you taking the time.
Dr. Seth Cohen: My pleasure. Thanks so much for having me, Darrin. It's really an honor. Thank you.
Darrin Godin: At City of Hope Orange County, we offer a broad range of expertise in cancer treatment, including renowned gynecologic oncology and urogynecologic care. Patients who receive care at our comprehensive cancer center experience the most advanced treatments and technology along with the support to heal the whole person, mind, body, and soul, from prevention to diagnosis, treatment, and survivorship care.
When it comes to cancer, it's hope first. So visit us at cityofhope.org/oc to learn more or call us at 888-333-HOPE. That's 888-333-4673. Thank you all for listening and please join us next time on Talking Hope.