Latest news with #DepartmentofRadiationOncology
Yahoo
20-05-2025
- Health
- Yahoo
6 doctors on Biden's cancer diagnosis, how it may have arisen and his treatment options
President Biden's weekend announcement that he has an "aggressive" form of prostate cancer that has metastasized to his bone sparked the usual sympathy from supporters — and sharp suspicions among detractors. The announcement comes amid fresh reporting on Biden and his inner circle hiding the degree to which his mental acuity was slipping during his presidency and campaign for reelection last year, and the advanced stage of his cancer drew immediate accusations from the right that the former president was also hiding problems with his physical health. President Trump said he was surprised the cancer "wasn't notified a long time ago," suggested the public wasn't being properly informed and said that "people should try and find out what happened." The Times spoke to six doctors who are experts in prostate cancer. They said the information Biden's office has shared about his condition is indeed limited, but also that many of the assumptions being made publicly about the progression of such cancers, the tests that can screen for them and the medical guidelines for care among men of Biden's advanced age — 82 — were simply off base. In its statement Sunday, Biden's office said the former president was seen last week "for a new finding of a prostate nodule after experiencing increasing urinary symptoms," and on Friday was "diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone." Dr. Mark Litwin, chair of UCLA Urology, said that description indicated Biden has a more advanced and aggressive form of prostate cancer than is diagnosed in most men, but that it was nonetheless "a very common scenario" — with about 10% of such cancers in men being metastatic at diagnosis. Dr. Howard Sandler, chair of the Department of Radiation Oncology at Cedars-Sinai, agreed. "It's a little unusual for him to show up with prostate cancer that's metastatic to bone at first diagnosis, but not extraordinary," he said. "It happens every day to elderly men." Read more: Cancer diagnosis and a new book fuel questions about Biden's decision to run in 2024 That's in part because of the nature of such cancer, the modern screening guidelines for older men, and the advanced treatment options for such cancer when it is found, the doctors said. Prostate cancer in small, slow-growing amounts is prevalent among men of Biden's age, whether it's causing them problems or not. Most prostate cancers can be slowed even more dramatically — for years after diagnosis — with medical intervention to block testosterone, which feeds such tumors. For those reasons, many doctors recommend men stop getting tested for prostate-cancer-related antigens, through what's known as a PSA test, around age 70 or 75, depending on the individual's overall health. That advice is based in part on the idea that finding a slow-moving prostate cancer and deciding to act on it surgically or otherwise — which many alarmed patients are inclined to do when they get such news — can often lead to worse outcomes than the cancer would have caused if simply left alone. That includes impotence, incontinence and life-threatening infections. Also, if an older patient does start experiencing symptoms and is found to have a more advanced prostate cancer, modern treatments are capable of stalling the cancer's growth for years, the doctors said — often beyond the point when those patients are statistically likely to die from something else. Even when older patients are tested and show somewhat elevated PSA levels, it is not always of immediate concern, and they are often told to just keep an eye on it, Litwin said. Simply put, doctors "typically don't get too exercised about a diagnosis of prostate cancer in an 82-year-old," he said. Dr. Sunil Patel, a urologic oncologist and an assistant professor of urology and oncology within the Brady Urological Institute at the Johns Hopkins University School of Medicine, said that's because the average life expectancy for an American man is under 85. "And so most men at that time, at 75, they're like, 'OK, well, if it's not going to kill me in the next 10 years, I'm going to leave it alone,'" Patel said. "That's a really shared decision between the patient and the physician." When advanced, aggressive prostate cancers are found, as with Biden, the prognosis — and treatment plan — is of course different, the doctors said. "He is for sure going to need treatment," Litwin said. "This is not the type that we can just observe over time like we often do." But that doesn't mean Biden's doctors dropped the ball earlier, he and others said. Biden's office has not said whether he was receiving PSA screenings. A letter from Biden's White House physician in February of last year made no mention of PSA testing, despite other recent presidents' medical assessments including that information. Biden's aides did not respond to requests for comment. The doctors The Times spoke to had no special insight into Biden's medical care, but said his diagnosis did not make them feel any less confident about the caliber of that care or suggest to them any nefarious intent to hide his condition. For starters, "it would be considered well within the standard of care" for Biden to have forgone testing in recent years, given his age, Sandler said. "Certainly after 80." Litwin said he believes Biden probably was still tested, given his position, but that doesn't mean he was necessarily hiding anything either. Some forms of aggressive prostate cancer don't secrete antigens into the blood at levels that would be flagged in a PSA test, while others can grow and even metastasize rapidly — within a matter of months, and between routine annual screenings, he said. Patel said he has personally found "very aggressive disease" in patients who had relatively normal PSA levels. "I don't think anyone can blame anyone in terms of was this caught too late or anything like that," he said. "This happens not too infrequently." Dr. Alicia Morgans, associate professor of medicine at Harvard Medical School, a genitourinary medical oncologist and the director of the Survivorship Program at the Dana-Farber Cancer Institute, agreed. Even if a patient is diligent about getting screened annually, "there will be some cancers that arise between screening tests," she said. Morgans said things gets even more complicated as men get older, when their PSA number may increase and start getting monitored before it is considered a clear indicator of cancer. "Maybe it's up a while. It was not cancer before, it hasn't really changed that much. Now it has become cancer. It's not the fault of anyone," she said. "You can do everything right and things like this can happen." Biden's office said his cancer appeared "to be hormone-sensitive, which allows for effective management." The doctors The Times spoke to were relatively bullish about Biden's short-term — and even medium-term — prognosis. "It's not curable, but it's highly treatable," Morgans said. "Without meaning to sound glib, there's never been a better time to have metastatic prostate cancer in the history of medicine," Litwin said — in part thanks to Biden's own cancer "moonshot" initiative and the funding it sent to institutions such as UCLA, which has helped develop new drugs. "There are numerous, very effective treatments for a patient in his situation," Litwin said. The standard and most likely course of care for Biden will be ADT, or androgen deprivation therapy, which involves a pill or shot that will shut down testosterone production, the doctors said. "Now, an 82-year-old doesn't have the same testosterone production as a 22-year-old anyway, so there's not that far to go. But we shut it off," Litwin said. "And by shutting it off, it cuts out the principal hormone that feeds the prostate cancer. That alone can be very, very effective." Dr. Geoffrey Sonn, urologic oncologist and associate professor of urology at Stanford Cancer Center, said Biden's cancer is serious, but the ADT treatment "will make prostate cancer cells shrink down, stop growing, at least temporarily, in the vast majority of guys." Read more: Scott Adams reveals he has metastatic prostate cancer, the same as Biden: '100% not curable' "That is, it's not a permanent fix, in that those cells will eventually figure out a way to grow even with low levels of testosterone," Sonn said. "But that can take several years, and sometimes longer." Recent studies have shown that adding additional medications to an ADT regime can extend life even further, Sonn said, to "four, five, seven, 10" years or more after a metastatic prostate cancer diagnosis. Dr. Mihir Desai, a urologist with Keck Medicine of USC, said with modern advancements, prostate cancer is just different than other cancers. "If you find, say, colon cancer or pancreatic cancer or liver cancer are metastasized, then the deterioration is fairly fast and the outcomes are very poor," he said. But with previously untreated metastatic prostate cancer, "there are many lines of treatment that can, if not cure it, certainly keep it under control for many years, with good quality of life." Sandler, who focuses on radiation oncology, said ADT treatment can cause loss of bone density or muscle mass, so Biden will likely be encouraged to stick to a fitness regimen or take medications to counter those effects. He may also receive radiation to more heavily target specific pockets of cancer, including where it has metastasized to the bone, but that would depend on the number of metastatic sites, Sandler said — with radiation more likely the fewer sites there are. "If there's cancer all over the place, then there's probably no benefit," he said. Get the L.A. Times Politics newsletter. Deeply reported insights into legislation, politics and policy from Sacramento, Washington and beyond, in your inbox twice per week. This story originally appeared in Los Angeles Times.
Los Angeles Times
20-05-2025
- Health
- Los Angeles Times
6 doctors on Biden's cancer diagnosis, how it may have arisen and his treatment options
President Biden's weekend announcement that he has an 'aggressive' form of prostate cancer that has metastasized to his bone sparked the usual sympathy from supporters — and sharp suspicions among detractors. The announcement comes amid fresh reporting on Biden and his inner circle hiding the degree to which his mental acuity was slipping during his presidency and campaign for reelection last year, and the advanced stage of his cancer drew immediate accusations from the right that the former president was also hiding problems with his physical health. President Trump said he was surprised the cancer 'wasn't notified a long time ago,' suggested the public wasn't being properly informed and said that 'people should try and find out what happened.' The Times spoke to six doctors who are experts in prostate cancer. They said the information Biden's office has shared about his condition is indeed limited, but also that many of the assumptions being made publicly about the progression of such cancers, the tests that can screen for them and the medical guidelines for care among men of Biden's advanced age — 82 — were simply off base. In its statement Sunday, Biden's office said the former president was seen last week 'for a new finding of a prostate nodule after experiencing increasing urinary symptoms,' and on Friday was 'diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone.' Dr. Mark Litwin, chair of UCLA Urology, said that description indicated Biden has a more advanced and aggressive form of prostate cancer than is diagnosed in most men, but that it was nonetheless 'a very common scenario' — with about 10% of such cancers in men being metastatic at diagnosis. Dr. Howard Sandler, chair of the Department of Radiation Oncology at Cedars-Sinai, agreed. 'It's a little unusual for him to show up with prostate cancer that's metastatic to bone at first diagnosis, but not extraordinary,' he said. 'It happens every day to elderly men.' That's in part because of the nature of such cancer, the modern screening guidelines for older men, and the advanced treatment options for such cancer when it is found, the doctors said. Prostate cancer in small, slow-growing amounts is prevalent among men of Biden's age, whether it's causing them problems or not. Most prostate cancers can be slowed even more dramatically — for years after diagnosis — with medical intervention to block testosterone, which feeds such tumors. For those reasons, many doctors recommend men stop getting tested for prostate-cancer-related antigens, through what's known as a PSA test, around age 70 or 75, depending on the individual's overall health. That advice is based in part on the idea that finding a slow-moving prostate cancer and deciding to act on it surgically or otherwise — which many alarmed patients are inclined to do when they get such news — can often lead to worse outcomes than the cancer would have caused if simply left alone. That includes impotence, incontinence and life-threatening infections. Also, if an older patient does start experiencing symptoms and is found to have a more advanced prostate cancer, modern treatments are capable of stalling the cancer's growth for years, the doctors said — often beyond the point when those patients are statistically likely to die from something else. Even when older patients are tested and show somewhat elevated PSA levels, it is not always of immediate concern, and they are often told to just keep an eye on it, Litwin said. Simply put, doctors 'typically don't get too exercised about a diagnosis of prostate cancer in an 82-year-old,' he said. Dr. Sunil Patel, a urologic oncologist and an assistant professor of urology and oncology within the Brady Urological Institute at the Johns Hopkins University School of Medicine, said that's because the average life expectancy for an American man is under 85. 'And so most men at that time, at 75, they're like, 'OK, well, if it's not going to kill me in the next 10 years, I'm going to leave it alone,'' Patel said. 'That's a really shared decision between the patient and the physician.' When advanced, aggressive prostate cancers are found, as with Biden, the prognosis — and treatment plan — is of course different, the doctors said. 'He is for sure going to need treatment,' Litwin said. 'This is not the type that we can just observe over time like we often do.' But that doesn't mean Biden's doctors dropped the ball earlier, he and others said. Biden's office has not said whether he was receiving PSA screenings. A letter from Biden's White House physician in February of last year made no mention of PSA testing, despite other recent presidents' medical assessments including that information. Biden's aides did not respond to requests for comment. The doctors The Times spoke to had no special insight into Biden's medical care, but said his diagnosis did not make them feel any less confident about the caliber of that care or suggest to them any nefarious intent to hide his condition. For starters, 'it would be considered well within the standard of care' for Biden to have forgone testing in recent years, given his age, Sandler said. 'Certainly after 80.' Litwin said he believes Biden probably was still tested, given his position, but that doesn't mean he was necessarily hiding anything either. Some forms of aggressive prostate cancer don't secrete antigens into the blood at levels that would be flagged in a PSA test, while others can grow and even metastasize rapidly — within a matter of months, and between routine annual screenings, he said. Patel said he has personally found 'very aggressive disease' in patients who had relatively normal PSA levels. 'I don't think anyone can blame anyone in terms of was this caught too late or anything like that,' he said. 'This happens not too infrequently.' Dr. Alicia Morgans, associate professor of medicine at Harvard Medical School, a genitourinary medical oncologist and the director of the Survivorship Program at the Dana-Farber Cancer Institute, agreed. Even if a patient is diligent about getting screened annually, 'there will be some cancers that arise between screening tests,' she said. Morgans said things gets even more complicated as men get older, when their PSA number may increase and start getting monitored before it is considered a clear indicator of cancer. 'Maybe it's up a while. It was not cancer before, it hasn't really changed that much. Now it has become cancer. It's not the fault of anyone,' she said. 'You can do everything right and things like this can happen.' Biden's office said his cancer appeared 'to be hormone-sensitive, which allows for effective management.' The doctors The Times spoke to were relatively bullish about Biden's short-term — and even medium-term — prognosis. 'It's not curable, but it's highly treatable,' Morgans said. 'Without meaning to sound glib, there's never been a better time to have metastatic prostate cancer in the history of medicine,' Litwin said — in part thanks to Biden's own cancer 'moonshot' initiative and the funding it sent to institutions such as UCLA, which has helped develop new drugs. 'There are numerous, very effective treatments for a patient in his situation,' Litwin said. The standard and most likely course of care for Biden will be ADT, or androgen deprivation therapy, which involves a pill or shot that will shut down testosterone production, the doctors said. 'Now, an 82-year-old doesn't have the same testosterone production as a 22-year-old anyway, so there's not that far to go. But we shut it off,' Litwin said. 'And by shutting it off, it cuts out the principal hormone that feeds the prostate cancer. That alone can be very, very effective.' Dr. Geoffrey Sonn, urologic oncologist and associate professor of urology at Stanford Cancer Center, said Biden's cancer is serious, but the ADT treatment 'will make prostate cancer cells shrink down, stop growing, at least temporarily, in the vast majority of guys.' 'That is, it's not a permanent fix, in that those cells will eventually figure out a way to grow even with low levels of testosterone,' Sonn said. 'But that can take several years, and sometimes longer.' Recent studies have shown that adding additional medications to an ADT regime can extend life even further, Sonn said, to 'four, five, seven, 10' years or more after a metastatic prostate cancer diagnosis. Dr. Mihir Desai, a urologist with Keck Medicine of USC, said with modern advancements, prostate cancer is just different than other cancers. 'If you find, say, colon cancer or pancreatic cancer or liver cancer are metastasized, then the deterioration is fairly fast and the outcomes are very poor,' he said. But with previously untreated metastatic prostate cancer, 'there are many lines of treatment that can, if not cure it, certainly keep it under control for many years, with good quality of life.' Sandler, who focuses on radiation oncology, said ADT treatment can cause loss of bone density or muscle mass, so Biden will likely be encouraged to stick to a fitness regimen or take medications to counter those effects. He may also receive radiation to more heavily target specific pockets of cancer, including where it has metastasized to the bone, but that would depend on the number of metastatic sites, Sandler said — with radiation more likely the fewer sites there are. 'If there's cancer all over the place, then there's probably no benefit,' he said.
Yahoo
19-05-2025
- Health
- Yahoo
Does Joe Biden's Prostate Cancer Diagnosis Have You Concerned About Your Own Health?
FORMER PRESIDENT JOSEPH R. Biden has been diagnosed with Stage 4 prostate cancer, his office announced on Sunday. The cancer has spread to his bones, as it commonly does in more aggressive forms. Prostate cancer is one of the most common cancers in men. About one in eight men will be diagnosed with prostate cancer during their lifetime, and an estimated 288,300 new cases will emerge this year, according to the American Cancer Society. It's more common in Black men and in all men over 65. It is generally slow-growing, and one of the big challenges with this cancer is that there are really no symptoms, especially early on, according to the American Cancer Society. By the time you do see symptoms, the cancer has likely reached an advanced stage. However, there is a screening test for it. When this is done and prostate cancer is caught early, it is often highly treatable, says Daniel Spratt, M.D., a prostate cancer management expert and a professor in the Department of Radiation Oncology at the Case Western Reserve University School of Medicine. Protect yourself against this common disease by getting screened (see the recommendations for when below) and learning to identify the common signs. Here's how. "PROSTATE CANCER IS one of those conditions that could easily be caught early,' says John Lynam, D.O., an osteopathic physician in Florida who specializes in urology. 'Because of screening and testing, it has a high cure rate once caught early.' This is especially important because there are no real early signs of prostate cancer, he says. 'Once prostate cancer causes symptoms, it is usually advanced and is often not curable at that point,' says Jonathan Shoag, M.D., a urologist and member of the Case Comprehensive Cancer Center Population and Cancer Prevention Program at Case Western Reserve University. If there are warning signs of prostate cancer, they can include: Blood in the urine or semen Problems urinating—including feeling like you need to urinate more often or a slow or weak stream Blocked urine Loss of bladder or bowel control Erectile dysfunction Painful ejaculation Pain in hips, back, ribs, or other areas Weakness or numbness in the legs or feet Fatigue Unintentional weight loss 'Prostate cancer tends to spread to the bones, which can be painful, cause fractures, and limit mobility,' Dr. Shoag says. Any time you notice any of these symptoms, visit your primary care doctor as soon as you can to get screened for prostate cancer, Dr. Lynam suggests. Dr. Spratt says many prostate or urinary symptoms often have nothing to do with prostate cancer. So it's important to rule out other potential health issues. INSTEAD OF WATCHING for signs of prostate cancer, which means it's reached an advanced stage, Dr. Lynam suggests getting regular screenings to catch it early. 'The hope is catching the cancer when it is still asymptomatic and relatively easy to treat,' Dr. Shoag explains. Following the American Urological Association guidelines, all men should be screened for prostate cancer once they turn 50, says Larry Lipshultz, M.D., a urology professor at the Baylor College of Medicine and Men's Health urology adviser. For men at a higher risk for prostate cancer, screening is recommended between ages 40 and 45. Those groups include Black men, people with a family history of the cancer, and those with a genetic predisposition, such as having the BRCA gene, Dr. Lipshultz says. Screening involves getting a prostate-specific antigen, or PSA, blood test and a prostate exam, he says. You should get re-screened every two to four years, according to AUA. PROSTATE CANCER SCREENING typically involves two tests, Dr. Spratt says. One is a digital rectal exam, where doctors feel the prostate gland for abnormalities. 'It's a quick and painless procedure,' he adds. The other is a PSA blood test, which measures the amount of a protein that's produced by cancerous and noncancerous cells in the prostate. 'Elevated PSA levels can be an indicator of prostate issues, including cancer,' Dr. Spratt. Men without prostate cancer typically have PSA levels of under 4 nanograms per milliliter (ng/mL), according to the American Cancer Society. PSA levels between 4 and 10 suggest you could have about a 25 percent chance of prostate cancer, and levels over 10 signal that your chance of having the cancer is more than 50 percent. Some have argued that a PSA test alone is enough to diagnose prostate cancer, Dr. Lipshultz says, but both are needed. 'You see somebody who has a normal PSA, and you do a prostate exam, and there's cancer everywhere because it's so undifferentiated that it doesn't make the PSA,' he explains. Undifferentiated cancer cells typically don't look or behave like the normal cells in tissues where they develop and may not produce much PSA. Prostate cancer is one of the most curable diseases when caught early, Dr. Lynam says. In some cases, lower-grade prostate cancers can sometimes be safely monitored by your doctor without needing intervention. 'The most important message I can tell patients is to know your family history and get regular prostate cancer screening and checkups,' he says. 'We are serious when we say early detection can save your life.' You Might Also Like The Best Hair Growth Shampoos for Men to Buy Now 25 Vegetables That Are Surprising Sources of Protein
NDTV
29-04-2025
- Health
- NDTV
No Scientific Evidence To Prove Urine Therapy Can Treat Any Disease: Experts
New Delhi: There is no scientific evidence to prove that urine therapy can treat any disease, said health experts on Tuesday, after Bollywood actor Paresh Rawal vouched for its benefits for his knee injury. In a recent media interview, the veteran actor claimed that he "sipped his urine like a beer first thing in the morning" to heal his injured knee. "I did for 15 days and when the X-ray reports came in, the doctor was surprised," Mr Rawal said. "As an oncologist, I must emphasise that while anecdotal experiences like Paresh Rawal's are fascinating, they should not be mistaken for medical advice. There is no scientific evidence supporting urine therapy as a treatment for any diseases whether musculoskeletal injuries or cancer," Dr. Abhishek Shankar, Assistant Professor, Department of Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital at AIIMS, Delhi, told IANS. "Even with all the scientific progress and easy access to good healthcare information, it is unfortunate that some people still look for shortcuts and try to promote them. Drinking urine does not cure any health problems. This myth has been proven wrong many times," added Dr. Rajeev Jayadevan, Convener, Research Cell, Kerala State IMA. Urine therapy, also known as Urophagia, is the practice of drinking urine. In Ayurveda, urine was used to treat asthma, allergies, indigestion, wrinkles and even cancer. However, the claims are based on anecdotes or ancient texts and have no robust scientific evidence to support the benefits. On the other hand, there is evidence to show that drinking urine has several health risks, said Shankar. Many studies showed that urine contains bacteria, which if ingested could be harmful. It can also introduce toxins into the gut and potentially cause further illnesses like stomach infections. Further, because urine is a diuretic, it may also increase a person's risk of dehydration. Mr Rawal is not the only one to claim the benefits of urine therapy. The list also includes British TV star Ben Grylls and Mexican boxer Juan Manuel Marquez. "There is no credible scientific evidence that supports this type of therapy for any benefit whatsoever, urine is actually body based that contains a lot of waste materials which the kidneys filter, and reintroducing it into the body can cause a lot of side effects like infection, electrolytic balance or delayed appropriate medical care," Dr Charudatt Vaity, a Mumbai-based intensivist told IANS. The experts noted that recovery from injuries depends on several factors like rest, nutrition, and appropriate medical care. They cautioned the public to rely on evidence-based medicine rather than unverified home remedies. "It's important to rely on facts and real science, not on myths or shortcuts, Dr. Jayadevan told IANS.
New York Times
07-03-2025
- Health
- New York Times
Their Parents Met Online. Then They Matched in Real Life.
The first time Dr. Sunpreet Singh Tandon and Dr. Shalini Moningi spoke, they already had their families' approval. Their parents first connected in 2022 on an Indian matchmaking website where relatives can create accounts on behalf of single family members. After speaking on the phone a year later, Dr. Moningi's and Dr. Tandon's parents felt confident in their matchmaking skills and exchanged their children's phone numbers. Then, it was up to the children what to do next. 'I'd been set up before and gone on these first dates, and I was just tired and irritated that evening, so I saw a text as an item on my to-do list,' said Dr. Moningi, who, nevertheless, reached out first with a short greeting. After Dr. Tandon responded, they began texting regularly, then moved to phone calls, and a connection soon developed. But there was one not-so-minor challenge: They lived a two-hour flight apart, with Dr. Moningi in Boston and Dr. Tandon in Cleveland. Dr. Moningi, 36, is an assistant professor at the department of radiation oncology at Harvard Medical School — specifically, in the Department of Radiation Oncology at Brigham and Women's Hospital and Dana-Farber Cancer Institute. She was born in Cuttack, India, and raised in Al Bukayriyah, Saudi Arabia, then Philadelphia, and, finally, Charleston, She has a bachelor's in chemistry and philosophy from West Virginia University and a medical degree from the Johns Hopkins School of Medicine. In April, Dr. Moningi will start a new role as an assistant professor in the department of radiation oncology at the Cleveland Clinic. Dr. Tandon, 37, was born in Christchurch, New Zealand, and spent his childhood in Grand Falls-Windsor, Canada, before moving with his family to Mankato, Minn., then to Andalusia, Ala., and then to Kent, Ohio. He earned a bachelor's degree in integrated life sciences from Kent State University and a medical degree from Northeast Ohio Medical University. He is a staff radiologist at Fairview Hospital in the Cleveland Clinic system. In January 2024, Dr. Tandon flew to Boston from Cleveland for his first date with Dr. Moningi. 'I was hopeful but I didn't want to get crushed,' Dr. Tandon said. They had brunch at Buttermilk & Bourbon, where Dr. Moningi discovered that Dr. Tandon doesn't drink coffee or alcohol. 'My grandma would have loved him,' she said. 'What a good boy.' They walked to the Massachusetts State House afterward — one of Dr. Tandon's goals is to visit every state capitol in the United States — and visited the Museum of Fine Arts. At the end of the 24-hour trip, Dr. Tandon invited Dr. Moningi to visit him in Cleveland. She thought he was being polite until he called her as soon as his plane landed. From that point on, the two spoke on the phone daily. 'We connected on our Midwest values, our love for our friends and family and home and our community,' Dr. Moningi said. 'My cellphone usage has skyrocketed,' Dr. Tandon said. In September, Dr. Tandon proposed during a hike at the Rocky River Reservation in Cleveland. [Click here to binge read this week's featured couples.] 'She didn't say yes initially,' Dr. Tandon said. 'I was holding her hand, I gave my spiel, and she just looked at me. She was waiting until I got on the ground.' After, they met both of their families in Richfield, Ohio, to visit the Gurdwara Guru Nanak Foundation, a Sikh place of worship, and then the Sree Venkateswara Temple, a Hindu temple, to receive blessings for their union. Dr. Tandon's family practices the Sikh religion and Dr. Moningi's family is Hindu. Dr. Moningi and Dr. Tandon were married on Feb. 22 at the Sawgrass Marriott Golf Resort & Spa in Ponte Vedra Beach, Fla., in a Hindu ceremony led by Srinathan Kadambi, the head priest of the Hindu Society of North East Florida, in front of 230 guests. On the morning of their wedding, the couple also participated in a Sikh marriage ceremony at the Jacksonville Gurdwara, led by the gyani, or congregation leader, Amandeep Singh. 'In a gurdwara, it's all about equality, so whether you're a king or pauper, everyone sits on the floor,' Dr. Tandon said. Dr. Moningi and Dr. Tandon chose the wedding location because it is close to Dr. Moningi's parents' home in Jacksonville, Fla., and because the city holds a deeper meaning for the family. Dr. Moningi's younger brother, Sanat Moningi, died in San Francisco in 2018 at 24. After several years of mourning, Dr. Moningi's parents moved to Jacksonville from Charleston, where Sanat grew up. The new city, Dr. Moningi said, 'represents a lot of the strength of our family and moving forward and being strong and surviving something we never could have imagined happening. It's about having Sanat with us but moving forward.' They honored Sanat at the reception with a memorial during which Dr. Moningi's and Sanat's friends talked about his life and accomplishments. 'There were so many people who supported me and my family through a really bad time that were there with us,' Dr. Moningi said. 'Every person from different stages of my life was in the same place, which was very cool and meant a lot.'
