Latest / The Inspired Stories Podcast / Dr. Kintur Sanghvi: The Virtua Health Leader Transforming How We Treat High Blood Pressure

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Dr. Kintur Sanghvi: The Virtua Health Leader Transforming How We Treat High Blood Pressure · The Inspired Stories Podcast

0:04
Welcome to another edition of the Inspired Stories podcast,
0:08
where leaders share their experiences so we can learn from
0:11
their successes and be inspired by how they've overcome
0:14
adversity. My name is Anthony Kotaspodi,
0:17
and today's guest is Doctor Kintur Sangvi, Chief of
0:21
Cardiovascular Intervention at Virtua Health.
0:24
They are an academic health system in South Jersey that
0:27
offers a full range of services from heart care and cancer care
0:31
to urgent care and more. Their mission is to help people
0:35
be well, get well and stay well. And they're known for their
0:40
innovative outreach programs like a pediatric Mobile services
0:44
unit and the Eat Well Initiative.
0:47
Doctor Sangby himself has been recognized as a top Dr. by New
0:51
Jersey Magazine, Philadelphia Magazine, and South Jersey
0:55
Magazine. He has performed over 13,000
0:59
cardiovascular procedures, authored multiple research
1:03
articles, and is a professor of Medicine at the Virtua Rowan
1:07
School of Medicine. He has shared his expertise
1:10
across 5 continents and pioneered the use of wrist and
1:14
foot arteries for catheterizations.
1:17
He also serves as Director at the Virtua Lords Cath Lab where
1:22
he continues to advance patient focused innovations.
1:26
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1:58
All right, back to our guest today, the Chief of Intervention
2:01
Cardiology at Virtua Health, Doctor Kintur Sangvi.
2:05
I appreciate you making the time to Share your story today.
2:09
Anthony, thank you so much for the opportunity to talk to you
2:12
and your audience and hopefully share our journey of innovation
2:19
and taking care of patient and be inspirational to each other.
2:23
This conversation should be. Looking forward to it.
2:26
So cancer, you've now done over 13,000 cardiovascular
2:32
procedures. You've trained more than 100
2:33
cardiologists, launched multiple programs across major hospitals,
2:38
and you're helping to shape what the future of cardiovascular
2:41
care looks like. But I want to go back a little
2:43
bit to the beginning for a moment.
2:45
You were 23 ish when this all started, 23 and completely
2:50
locked in on cardiovascular medicine.
2:53
What sparked that focus for you? Was there a moment or experience
2:58
that kind of lit the fire for you?
3:02
We started medical school back home in India at right after the
3:06
high school and having a immediate family member, my
3:11
mother suffering from heart value disease.
3:14
My focus was on cardiovascular Physiology and anatomy more so
3:20
over the other system. You know, because your immediate
3:25
family member has some history of cardiac condition.
3:27
And as I graduate from medical school around age 22, I would
3:34
say I had a unique opportunity to work with a cardiologist
3:42
right out of my graduation as a junior medical registrar.
3:48
And there it was very obvious that this is what I want to do.
3:54
And that started the spark happened from about 36 year old
3:57
guy who had two kids present. I still remember his face
4:01
because it was the first patient that really kind of locked me in
4:04
to do cardiovascular medicine in particularly interventional
4:08
cardiology, who came in in cardiogenic shock.
4:12
That means the heart rate was low, the blood pressure was in
4:16
90s. He had a major heart attack when
4:20
he was in the emergency room. He coded, we had to do CPR
4:25
briefly, came back and then the cardiologist who I was working
4:29
with went in and put a stent in his main artery on the left side
4:33
called left main artery, also known as Widowmaker.
4:37
And you know, this is all transpired within time of 25
4:41
minutes or less. He fortunately presented in the
4:45
daytime while we were all in the lab and almost somebody would
4:50
die in front of my eyes as a very young doctor.
4:54
Next day I was holding his hand and have him walk and seeing at
5:00
that time he had like two young kids.
5:02
This was very, very rewarding part of practicing medicine.
5:05
You know, everything we do in medical science does not always
5:08
yield prompt and solid results. If you look across all the
5:13
different sub speciality, this one was very appealing because
5:19
it was wow, this immediate response and from that day on,
5:24
so it was like early on I was locked in because of that
5:27
particular 2 reasons that I mentioned.
5:29
I have to imagine that was an emotional experience to be a
5:32
part of for the first time. Absolutely, absolutely.
5:36
You are. When you are a new medical
5:37
student and then you graduate from your clinical rotations and
5:41
now you're in a real field and everything is very complicated
5:45
at that time. Everything is very difficult.
5:47
And in that situation, a quick diagnosis, quick response, quick
5:52
treatment, all overwhelming. Still remember it.
5:55
Yeah, yesterday. Does it give you goosebumps
5:58
still to talk about it? Yeah, sure.
6:01
Absolutely. Yeah, probably.
6:03
You can sense it. Yeah.
6:05
So then, you know, after your training, you spent over a
6:07
decade at a major academic hospital in New Jersey.
6:11
You're publishing, you're teaching, performing thousands
6:14
of procedures. What do you remember about some
6:16
of those early years? You know, my journey was
6:23
definitely not easy. Was, was difficult, but I would
6:26
say that after graduating the international cardiology
6:30
Fellowship, you know, the first year as you go out into practice
6:35
and now you're on the first call and the patient comes in with,
6:39
as I said, you know, heart attack, cardiogenic shock and
6:42
somebody who had CPR in the field, things like that.
6:45
It's very, very unnerving. Even though you are trained for
6:49
it, the day you are taking responsibility of a human life
6:52
in front of you and, and also understands it's not just one
6:55
person, it's the whole family and everything that's connected
6:58
with that person. It's, it's definitely unnerving
7:03
and challenging, but I was very fortunate to have a lots of
7:06
great teachers across my career, great inspiring human beings
7:11
around me and I felt very comfortable and confident from
7:16
day one when I went out. But you know everything, you
7:23
know, life takes your places and the journey that you go through,
7:25
it's kind of, you know, you don't know what it's going to
7:29
lead to. But international cardiology
7:33
field, if I think of early days of my after fellowship
7:38
finishing, being part of a tertiary care academic place,
7:43
being involved in the cardiology and international cardiology
7:46
fellowship program and their training and their upbringing
7:51
really makes you better at everything you do because you
7:54
are now going to think through on every aspect of patient care.
8:00
And that makes you mature because you're going to teach
8:02
somebody. You want to make sure you learn
8:04
from that process. And when you're teaching
8:07
somebody, you want to teach that, right.
8:09
So I think that played a huge role in where I am today is that
8:15
interaction with the medical students, residents, cardiology
8:19
fellows and international cardio fellows and constantly getting
8:22
involved in teaching and sometimes getting inspired by
8:26
them, You know, sometimes helping them bring idea to a
8:30
fruition and, and getting a research idea executed and get
8:34
it to a publication that the entire journey kind of makes you
8:43
get involved 100% on everything you're doing on every day.
8:48
So I, I would say if I at a high level, if I think of those early
8:51
days, I would say that that was like really fun time.
8:57
A lot of new learnings. We did a lot of new programs,
9:01
new procedures. This is the, also the time when
9:04
international career field evolved through a lot of new
9:06
procedures. So we adopted some of this new,
9:08
some of them we, we were able to lead the, the revolution or, or
9:13
evolution. So it was great days.
9:16
I was very involved in what we call transfereal approach.
9:19
So doing catheterization through the wrist instead of drawing and
9:24
you know, again, that's something I can think of early
9:27
days that was really. Say say more about that
9:29
procedure. What was your level of
9:32
involvement and how did the idea come about?
9:36
So I did my first trans radial, the wrist catheterization, in
9:40
1999 back home in India. The cardiologist with who I was
9:44
working with in the Cath lab those days learned this approach
9:47
from a Japanese cardiologist named Doctor Saito.
9:50
So Doctor Patel, Tehas Patel, my mentor back home in India.
9:55
And we kind of wanted to bring this approach because it was a
10:00
safe approach. We did not think that we can
10:03
easily do this catheterization procedure that we used to do
10:06
from the the groin. And it seemed that would be very
10:13
safe for patient because it is the anatomy the groin artery is
10:17
much more vulnerable for bleeding complication after the
10:22
procedure. So if you do any catheter
10:23
pressure procedure from the groin irrespective of your level
10:25
of training or experience is just the anatomy and atomic
10:29
variation and the the the location of the artery with this
10:33
room for bleeding inside the stomach called retroperitoneum
10:36
bleed and inside the thigh can lead to large hematoma.
10:40
So a lot of patients in those days in 1999 to 2004, I would
10:45
say if you look back to the history, there's a high
10:47
mortality associated with this complication.
10:50
So you do a very important procedure, you open up
10:53
somebody's blocked heart artery, but then the patient ends up
10:57
suffering from the bleeding or even sometimes you lose the
10:59
patient from bleeding and pseudo aneurysm versus the wrist artery
11:03
which is sitting right in front of the bone which is having a
11:06
collateral circulation. That means this is not an end
11:08
organ artery. If the groin artery gets closed,
11:11
your leg can get in fact or can get gangrene or you can lose the
11:16
leg. But here if the wrist artery
11:18
gets blocked, there is a collateral circulation that
11:20
continues to perfuse the heart. So perfuse the hand I mean to
11:24
say and the easy, easy of compressibility against the bone
11:30
and stopping the bleeding right after the procedure and compared
11:33
to the groin where it is difficult.
11:35
So it was coming up from evolving need of patient safety.
11:42
We got better at balloons, we got better at stents at the
11:45
heart artery level, but we did not improve anything from where
11:49
we enter the body and how we reach to the heart.
11:52
And that's how it started. And then, you know, I was
11:55
involved early on. So I, I, I was very involved in
12:00
bringing that procedure to America in a way through my
12:04
fellowship, through my mentors here in America, Doctor John
12:07
Coppola, Dr. Cindy Grimes, The places where I went for
12:10
fellowship, I had them come with me back home to India and do
12:14
procedures with my mentor at Doctor Patel in India.
12:17
So they will do like 200 risk catheterization in two days and
12:21
bring that technique over to America.
12:23
And that's how you know the the spread happened, that the radial
12:27
procedure spread happened through Saint Vincent's Hospital
12:30
in New York City. And then we continue to
12:32
experiment and understand as going through what are the
12:35
difficulties. There is a variations in the
12:37
anatomy. How can we reach through the
12:39
heart safely? How can this become as good and
12:42
as safe as the groin procedures? Can we do it just in a regular
12:45
cases or can we start doing that for heart attack patients?
12:48
Can we do it for complex coronary blockage and blocking?
12:51
Should we start doing it for leg artery blockage or kidney artery
12:54
blockage? Or should we start doing what we
12:56
call structural heart intervention?
12:58
And that's how things evolve. And that's where I was kind of
13:00
very much involved in transadial peripheral interventions.
13:04
My first paper was in 2007 about doing transadial iliac artery
13:09
intervention. That means the arteries in the
13:12
between the belly button and the hip joint and then transfidal
13:17
structural interventions, transfidal use for complex
13:20
coordinate interventions. We did research on what happens
13:23
to the wrist artery after the catheterization.
13:26
What can we do to preserve the integrity of the wrist artery.
13:31
We came up with the design of a sheet or the excess that is
13:35
specific to the wrist artery. We came up with the design of
13:38
the wrist artery. I had a couple of my own
13:43
patterns in this area from my research and from my learning on
13:48
how to improve the access from the risk to go to the heart,
13:52
something called railway sheet less access system, which is
13:56
which is, you know, Cordis, Johnson and Johnson worked on
14:01
that product ID and it's now available across the world.
14:05
Then there was a shot and tight tip wire that I was involved in
14:09
developing. So the things like that that
14:12
play the role in in evolution of the radio approach.
14:14
So let me hop in here because there's a couple of interesting
14:18
things at play here. I think 1 to sort of zoom out,
14:21
you know, especially, you know, being based in the USI think a
14:24
lot of times we think, oh, you know, all the world's innovation
14:26
comes from here. But this is a great example of
14:29
the Japanese Doctor Who who first came up with this
14:32
procedure. It was really being advanced in
14:35
India, you know, years before the US that adopted it.
14:39
You played a big role in taking doctors to India, say, hey,
14:43
look, this is better. Look and see how they're doing
14:45
it. But then as you're talking about
14:49
this, I'm like, oh, so you didn't come up with the
14:51
procedure. What was your involvement?
14:52
And then you answered that, which was, and there's a lot of
14:56
like fine tuning, like, you know, what's the correct way to,
15:00
you know, enter the wrist and you know, the, the different
15:03
anatomy that we run into in there.
15:05
And you know, the, the patents that you came up with to kind of
15:07
improve that process. And as I heard you kind of
15:10
explaining all of that, you're also talking about, you know,
15:13
entering through other points of the body.
15:16
So are there times where the wrist is not the best entry
15:20
point, even though that you know this has far fewer complications
15:24
than entering through the groin? Yeah, absolutely.
15:28
There are patient situations that wrist is not the best.
15:32
Sometimes the wrist artery is very small.
15:35
People who have a dialysis needs, they may be needing
15:38
fistula for dialysis and you don't want to enter the wrist
15:41
artery and, and, and disrupt that wrist artery.
15:45
So there are definitely clinical situations where groin artery
15:48
access is superior. If you want to use large device.
15:51
For example, now we do transcatheter valve replacement.
15:55
It's a very large device. You cannot, you cannot get
15:57
through the wrist artery to get get that kind of device.
16:01
So, but let's say if we dial back in 2008, the first what we
16:10
call NCDR database paper that talked about radio was published
16:14
from by a guy from from a Duke University.
16:17
And at that time in America only 1% of the catheterization
16:20
procedures were done through the Hill approach.
16:23
Today that number is in upward of 50%, almost 60%.
16:29
And do you? Think it's not closer to 100%
16:31
because still there's some people who don't know about it?
16:34
Or is it because 50% of the time it's the right choice and 50% of
16:38
the time there's a better choice for that particular patient?
16:41
I think it's still not there because of people who have not
16:47
got themselves into doing it. Some of the, you know, older
16:52
physicians who started the groin did not evolve into using
16:55
radial. There are multiple factors
16:57
behind it, but if you look at our self and compared to other
17:00
part of the world, and I want to correct just a little bit.
17:03
The transhedial procedure was really not invented by a
17:06
Japanese cardiologist. It was first described by a
17:09
doctor Campo in in Quebec City, Canada.
17:16
And then in 1993, that was for a heart catheterization for 1993,
17:20
first angioplasty paper was described by a guy from
17:24
Netherland. But if you look around and if
17:28
you kind of look back in the history, there are about 6 or 7
17:31
guys or maybe 8 guys who played a huge role in spreading this
17:35
technique across the globe. And Doctor Saito and Doctor
17:39
Patel, along with probably Dr. Ian Leward and you know, few of
17:43
the other names that I mentioned are probably part of that.
17:46
And I'm glad that you mentioned that it just shows the value of
17:48
this kind of international collaboration and moving new
17:52
ideas forward. As you were trying to introduce
17:54
this to more doctors in the US, did you run into resistance from
17:59
folks that are, you know, part of the old school?
18:01
This has worked forever kind of a thing.
18:04
Absolutely yes. Absolutely yes.
18:06
How do you? Overcome that.
18:09
So first, you know, you need to have a clear understanding why
18:14
you are doing something is that you know when you have a right
18:18
objective, their objective is very clear.
18:20
It's a patient safety issue. There is reduced complication.
18:25
Does not matter how good of an operator you are is about the
18:28
anatomy, the safety of the anatomy, right?
18:32
So when the patient safety is your most important priority,
18:36
people will get you eventually. It's not about you're able to do
18:41
something superior to somebody else.
18:43
It's not like that, right? So first, that was one thing
18:46
that played a huge role. Second thing, the staffing, when
18:50
the staffing's buying came in, the staff really thought, my
18:54
God, why are you doing this? Such a use it.
18:56
I can tell you some of very well known physicians in our field,
19:00
you know, in, in conferences, when, if I talk about excess
19:03
related bleeding, we'll say why would you go to this small wrist
19:06
artery? There's a huge pipe here in the
19:08
groin. We have closer device.
19:11
We have a medication called bivalrudine or Angiomax that
19:14
doesn't allow too much bleeding. Why would you struggle to go
19:17
through this wrist, right? And so there was a resistance
19:21
all over, but eventually it became a staff involvement.
19:27
That staff said this is much better for patients.
19:30
They don't have to hold the groin for hours.
19:32
They don't have to worry about bleeding as much.
19:33
They don't have to run them or wield them to CAT scan for
19:37
rolling out bleeding in the groin.
19:38
It is so simple for patients. They can sit up right away for a
19:42
catheter ration done through the groin.
19:43
You have to lie flat for four to six hours versus when you are
19:46
doing it to the wrist. You can sit up right away, you
19:48
can eat right away. You can even walk.
19:51
And there are centers in the many centers in the world, they
19:54
don't even have the patient undressed below their pants and
19:57
and they just prep the wrist to the catheter and to the stent.
20:01
And in the outpatient center, they go do the stent procedure,
20:04
go sit in a chair for six hours, recover and go home.
20:07
So, you know, the staff really sound like a patient started
20:11
seeing it. Patients say, oh, why do I have
20:12
to lie flat while the other guy is sitting next to me is sitting
20:16
up? So patient drove it.
20:18
So you know it nothing happens over time it.
20:22
You know, it takes the, the, the, the spread of innovation
20:25
takes years and it took its own course.
20:28
There was like a point of chasm from which the spread happened
20:31
very fast. But the in early adopter being
20:35
in the 1st 3% of the operator across the globe to, to start
20:39
this procedure and to bring it to now where it is.
20:42
You know it. The initial phase took a longer
20:45
time from the point of chasm. It was a faster spread.
20:49
And then people trained each other.
20:51
And I think it's a very good thing that happened in our
20:54
field. We just translated into
20:56
improving mortality and morbidity for countless lives, I
20:59
can tell you. Do you have any idea what the
21:01
stats are on that? Difficult to say, but I can tell
21:04
you from major studies that nearly let's say 1% versus 0.1%
21:11
risk of bleeding. So you know, if you talk in pure
21:16
statistical terms, it's almost nearly 100% or 90% improvement
21:22
in excess related complications. That's amazing.
21:25
And you, you, you've been involved in a number of other
21:28
innovations. We're going to talk about 1:00
21:29
here in a moment that just received FDA approval.
21:32
But before we do that, I'm kind of curious to get your
21:34
perspective on from having been through this multiple times, is
21:39
there something that would help speed up the adoption of these
21:45
new technologies? I mean, human beings, you know,
21:48
by our nature, we're resistant to change, right?
21:50
Hey, I'm comfortable. This is the way I've always done
21:53
it. This is the way I was trained.
21:54
But is there something in your experience it's like, oh, if we
21:57
could turn this one dial or flip this one switch or it would, it
22:02
would help speed up the adoption of these new technologies?
22:05
So if you, it's a very good question, Anthony, and I think I
22:09
think about this a lot because, you know, everything that we do,
22:15
every new information has this time to spread.
22:20
And from again, a personal experience, you know, somebody
22:25
very close to me in 1980 died a premature death from cancer
22:32
because there was only one CAT scanner in the entire state back
22:38
home in India, my state where I, I grew up.
22:42
And the technology was available, let's say in America
22:47
at that time for early diagnosis.
22:49
It was not there in India, right?
22:51
If it was there, it could have been a different thing.
22:54
So if you look around and if you look through the stats, the
22:58
number of people, they lose their lives or they suffer
23:02
because of lack of spread of innovation.
23:05
Know how technique or technology across the the the globe plays a
23:12
huge role in mortality and morbidity.
23:14
For simple example, for anybody to understand, some countries in
23:17
the world today even don't have the most life saving vaccines
23:21
such as polio not given to their kids, right?
23:24
And so there are multiple factors and some beyond your
23:29
capacity, the geopolitical issues and all those things,
23:31
right? But if you look at the spread of
23:34
innovation at every step of the way, whether it is innovator,
23:39
early adopters, point of chasm, mass adoption, one thing can
23:45
play a huge role and that is education.
23:49
Education and awareness in each of this stage can speed up this
23:54
whole curve of spread from over 20 years to maybe 15 years or
23:58
maybe 12 years if the education is powerful.
24:02
And I think we are in that space now.
24:04
We are on a space where there's over information bombardment.
24:08
There's so much information hitting us from all over the
24:10
place. But we are also in a situation
24:14
where the information and knowledge can spread much faster
24:18
with the global connectivity with, you know, platform like
24:23
what you are doing, like your podcast, right?
24:26
It's going to connect so many people and bring them to
24:29
awareness. So I think this right now we are
24:31
at also point in the history of human race where our access to
24:36
tool to help spread this fast is there if we use it right.
24:42
I want to talk about another technology that you've been
24:45
involved with and this is more timely renal denervation, I
24:51
understand recently approved by the FDA.
24:55
What is this? What's the problem that it's
24:57
helping to address? So it's going to be a little bit
25:01
of a long answer, but let's define that first.
25:05
What is renal denervation? Renal denervation is a catheter
25:08
based procedure, a minimally invasive procedure, a same day
25:12
procedure in which we go to the kidney artery using a catheter
25:19
and using technologies such as ultrasound or radio frequency
25:24
energy, we tone down the overactive nurse that travels on
25:30
the outer surface of the kidney artery.
25:33
So there are nerves that are travelling on the outer surface
25:36
of the kidney artery. They are called renal nerves and
25:39
this renal nerves are what we are de nerving.
25:42
That means we are toning them down, we are reducing their
25:44
activity by using a catheter from inside the kidney artery
25:49
and and using the energy and the surrounding space around the
25:52
kidney artery. So what is the problem with the
25:54
nerves being too active? What?
25:56
What is that triggering? So first my question was what is
26:00
renal denervation? So I explained that procedure.
26:03
What is it trying to address? That's a longer answer.
26:07
What it's trying to address is the high blood pressure.
26:10
There are many chronic illnesses for us such as, and we're going
26:14
to focus on high blood pressure right now, but there's also
26:17
diastolic heart failure, sugar control, sugar resistance or
26:21
type 2 diabetes, obesity, obstructive sleep apnea, heart
26:26
failure, arrhythmia. There are many other conditions
26:29
that are associated with this overactive nerves, but we're
26:33
going to focus on high blood pressure because high blood
26:36
pressure is the number one cause of death and disability.
26:39
When we wrote the guidelines in 2017 November on the update of
26:45
the high blood pressure guideline, the driving principle
26:48
was that high blood pressure is #1 cause of death and disability
26:52
for human rights. And imagine that Hardly.
26:56
I would say 5 out of 100 people will think it that way or know
27:00
it that way, OK. And the reason is #1 it's very
27:06
highly prevalent condition. Every second American adult is
27:09
suffering from high blood pressure, OK Worldwide, about
27:16
1.8 billion people suffering from high blood pressure.
27:19
So that's number one. The prevalence is high #2 high
27:23
blood pressure over the years effects multiple organ system.
27:27
It causes effect on the heart artery to increase the risk of
27:31
having heart artery blockage and its related problems such as
27:34
heart attack. It can affect the artery to the
27:37
brain, cause blockage and also cause bleeding in the brain and
27:41
causes different kind of stroke, hemorrhaging as well as ischemic
27:44
strokes. Either bleeding in the brain or
27:46
lack of blood flow to the brain that leads to stroke is one of
27:50
the main causes high blood pressure or uncontrolled blood
27:52
pressure. It causes thickening and
27:55
stiffening of the heart muscle and causes what we call
27:58
diastolic heart failure. Eventually, if continuous to
28:02
heart continues to work against this high blood pressure, this
28:04
muscle gives up, become dilated and the contraction becomes weak
28:08
and it's called systolic heart failure.
28:13
It also leads to gradual decline of the kidney function #1 cause
28:19
for medical renal disease or failure of the kidneys is
28:23
uncontrolled blood pressure. So people with uncontrolled
28:25
blood pressure are very much more likely to get dialysis and
28:29
and go on to kidney transplant list.
28:32
It also affects the memory issue.
28:39
So there is now clear evidence people with uncontrolled blood
28:41
pressure are more likely to have dementia in their later age.
28:47
People with uncontrolled blood pressure are also likely to have
28:50
arrhythmia such as atrial fibrillation.
28:53
Ventricular arrhythmia #1 cause for atrial fibrillation across
28:59
the globe is hypertension and not valuable heart disease.
29:04
So high blood pressure effects the multiple organ and a
29:08
negative remodeling or negative way over the years.
29:11
The problem is this disease does not 'cause symptoms.
29:14
So one in three people who are having high blood pressure don't
29:17
even know they have high blood pressure.
29:20
One in three people who know that they have high blood
29:22
pressure cannot get the blood pressure under control.
29:24
Because to date whatever is available, all the medications
29:28
they try medications and Despite that they don't control blood
29:31
pressure, they try medication, they have side effect they
29:33
cannot tolerate. They keep on changing the meds
29:36
because of side effects and and they cannot control the blood
29:42
pressure, right. So it does not 'cause symptoms.
29:47
It's highly prevalent. It affects the body day-to-day,
29:50
every day. When you are talking to me right
29:52
now and if your blood pressure is 140 versus mine is 120 or
29:58
next 3.4 years from data, if we extrapolate the data from a
30:03
trial called splint, splint trial, which was a randomized
30:06
prospective stamp control trial. If we look at that trial data
30:10
and if we apply the data in next 3.6 years, your chances of
30:16
suffering a cardiovascular event is significantly high, almost
30:21
double than mine. Wow.
30:23
OK. But the lack of awareness of
30:26
this condition, lack of awareness of this implication,
30:30
and as I said, you know, it's not going to cause you a
30:33
headache. If you've got a headache, I'm
30:34
going to take Tylenol right away.
30:36
But if you don't have a headache.
30:37
You don't even know what what? So that's the other problem that
30:42
people are not compliant to their entire hypertensive
30:44
medication. So you are a good patient, you
30:47
take care of yourself, you go prevent you care.
30:49
You go to your primary care doctor, he says your blood
30:52
pressure is high. I think you need to start taking
30:54
blood pressure medicine. You are 1140I prescribe your
30:58
medicine. I'm your primary care physician.
30:59
Let's say for example 50% of the people stop their anti
31:05
hypertensive medication in the first year of their
31:07
prescription. So why?
31:10
Because of side effects or just general compliance?
31:13
Number one side effects #2 the disease doesn't cause symptoms
31:19
day-to-day. To remember to take a medicine
31:21
as your routine and be committed to it.
31:24
If you don't have enough education and awareness that
31:26
what it is doing to your body, you're not going to do it so.
31:31
What's sorry, sorry, doctor, What is the root cause of high
31:35
blood pressure for most folks? Is it diet, too much sodium?
31:38
Is it, you know, carrying too much weight or are those risk
31:42
factors there? So all of them play a role.
31:44
But one of the things that we have known, so when I went to
31:48
medical school in 1990, we were taught something called
31:51
idiopathic hypertension or essential hypertension.
31:54
It's something we don't know what causes high blood pressure,
31:56
but it's there. There has been genetic
31:58
predisposition, there has been clear establishment of that.
32:04
But one thing that we always thought that oh it's idiopathic
32:07
or it's something causing it, we don't know.
32:09
We have clear understanding that sympathetic nerve over activity
32:14
plays a huge role in causing high blood pressure, whether it
32:17
is associated with genetic predisposition or whether it is
32:22
part of our current lifestyle, our current Society of
32:24
lifestyle. But the sympathetic over
32:27
activity, so the body's fight and flight response comes from a
32:31
sympathetic nervous system and that sympathetic nervous system
32:35
over activity plays a huge role. And that is why in all the
32:38
nervation. So the the one of the root cause
32:42
of this is the activity of sympathetic nerves.
32:44
Now does diet play a role? Absolutely.
32:48
Over using of salt, processed food, junk food that tastes so
32:54
good, does that play a role? Absolutely.
32:57
Yes, it does play a role in causing high blood pressure.
33:00
Utilization of alcohol, frequent use of alcohol, tobacco use,
33:06
overweight, these are all very well known cause to cause
33:11
hypertension, but at the root cause is this sympathetic
33:17
nervous system. Now there are some other causes,
33:19
something we always learn as we call secondary causes of
33:22
hypertension or secondary hypertension.
33:24
That means something is causing hybrid pressure, for example
33:27
overactive gland that is secreting too much hormone such
33:30
as epinephrine or epinephrine, adrenaline or renin or
33:33
angiotensin. Those kind of over secreting of
33:36
hormone can cause high blood pressure.
33:38
But it's a very small number of patients that suffer from
33:41
secondary hypertension. The less than 5% of the people
33:45
who have high blood pressure has a known or established cause
33:49
other than sympathetic nervous system or activity that causes
33:52
high blood pressure. But for everybody else,
33:55
sympathetic over activity is very important or integral part
33:58
of the cause of high blood pressure.
34:00
Now if I can take two extra minutes or maybe extra minute to
34:04
explain what is sympathetic nervous system.
34:06
Yeah, just related at all to the vagus nerve.
34:08
I hear a lot of people talking about that.
34:10
Are these connected? They are connected.
34:12
It's the everything is connected, The whole existence
34:14
is connected, the whole body is connected, every organs are
34:18
connected with each other. And they all work In Sync.
34:21
And lightness. Yes, please get better.
34:23
Yeah. But the nervous system, the
34:26
two-part of nervous system 1 is somatic nerve.
34:29
So when you thoughtfully move your hand or you feel the touch,
34:32
you feel the temperature, you feel the pain, that's all come
34:35
from somatic nervous system. That all goes to the spinal
34:38
cord, into the brain, to the conscious brain and you perceive
34:41
and you respond, that's the somatic nervous system.
34:45
And the second is the autonomic nervous system, which is a lot
34:49
of things happen in the body while we are talking and the
34:54
consciously conversing. Our heart is beating, our lung
34:58
is breathing. Maybe the food that you consume
35:01
an hour ago is digesting. You know, there's so much
35:05
process. The wastage is being discarded
35:07
through the urine formation. The blood is going through a
35:11
million mile long blood vessel I would say, because in the body
35:13
if you really put them together, it's a very, very billions of
35:17
capillaries or or microscopic. And one of these things we're
35:20
actively thinking about or, or, or or initiating ourselves, our
35:24
body's just doing it in the background.
35:26
Automatically, Yes automatically and that automatic regulation of
35:31
all the organ is conducted by autonomic nervous system which
35:35
has 2 components 1 is the vagus nerve that's the you know like
35:39
for every Ying there is a yen. So vagus nerve and sympathetic
35:43
nerve. Sympathetic nerve is a
35:44
stimulator, vagus nerve is a calming down nerve.
35:47
So when you do yoga meditation, you know, you are activating
35:51
your vagal tone. So you are having a, you know,
35:54
common response to things. Your heart rate slows down with
35:56
that, your respiratory goes down with that.
35:58
What's the sympathetic nerve? You know, you say I had an
36:01
adrenergic drive. So I did this and did that and
36:03
you know, I accomplished the most non achievable task because
36:08
you are on a go, go, go. Your heart rate is working
36:10
harder. You're all organs are working at
36:13
a faster, higher paces. So that's the sympathetic nerve
36:16
system and there is a control that should happen in everybody.
36:19
Nature's design, but this control system, the negative VCs
36:24
cycle of over activity of the sympathetic nerve is what drives
36:28
the high blood pressure. And so now the recent FDA
36:33
approval is, is this a device, Is this a treatment?
36:37
What, what is this? What does it actually look like?
36:40
There are two devices. These are very small, about 2mm
36:47
or smaller diameter device that goes to the kidney artery and
36:53
performs the action. One is an ultrasound denervation
36:56
device that is approved, which emits ultrasound energy
37:01
spreading the artery in the artery wall by a balloon that
37:05
cools the inner surface of the artery and then spreads the
37:09
ultrasound energy 360° in the surrounding of the kidney
37:12
artery. And that's how it basically
37:15
disables the nerve by making the outer layer of the NERD
37:18
dysfunctional. And that's how basically it
37:20
makes the NERD dysfunctional completely.
37:23
It's called perineurium. And then the second technique is
37:26
the radio frequency energy, which is again a device that is
37:29
about 1.41 point 6mm in diameter.
37:33
It has a nickel titanium alloy with electrode on it which
37:37
basically converts electrical energy into radio frequency
37:40
energy and express the radio frequency energy at the point of
37:43
contact and in the surrounding area through what we call
37:47
adipose tissue or a fat tissue heating any nerve that is
37:51
travelling inside that becomes dysfunctional or reduce it.
37:56
So by reducing the sympathetic tone, it translates into
38:01
controlling the blood pressure. Fascinating.
38:04
So with recent FDA approval, how long before a patient could
38:08
actually have access to this? In fact there is the access to
38:11
the patient now and probably I would say every state in America
38:16
the approval happened in October, November of 2023.
38:24
Right now the you know the last year was the phase of post
38:28
approval evaluation and in that there are regulatory agencies
38:33
that goes through the approval process for reimbursement and
38:35
stuff. So 2025, January Medicare
38:39
approved what we call transition payment or TPT.
38:44
So the current issue is that many insurance companies and but
38:51
not reimbursing for the procedure.
38:53
So that was that were one of the, you know, dissipation of
38:57
innovation limitation, as I said, geopolitical and lot of
39:00
different things as a system based problems.
39:03
So but that's the the situation right now.
39:07
January 1st, Medicare approved the TPT.
39:10
Right now it's being considered for payment for the procedures
39:13
and all that by insurance companies.
39:15
So today if somebody's suffering from high blood pressure, we can
39:19
still treat them, work through the insurance company, try to
39:23
get prior authorization by a pill process and we treat them.
39:27
If they are Medicare patients, we can treat them through what
39:31
we what I just described. But that's that's, you know, if
39:35
you don't consider as the limitation right now is renal
39:39
denervation treatment available across the United States, I
39:42
would say probably almost every state has at least one center
39:47
which can offer this treatment. And in what use cases is this
39:52
better than the current treatment?
39:54
Is it better for everybody? Is it better for people who
39:57
don't respond or have side effects to the current
40:00
approaches? Anthony, what are what are you
40:03
you're writing, you're really asking very good questions.
40:06
OK, So it's not for everybody. This is a new treatment.
40:13
We have time tested treatment as medications.
40:15
Medications are being used for over 70 years.
40:19
Of course we don't have a new class of medicine in the last 25
40:22
years. There is no new innovation in
40:23
hypertension care in the last 25 years and this was very much
40:27
needed. You know, there was like a
40:29
definitely a need for new, new treatment for high blood
40:33
pressure. But there are multiple classes
40:36
of anti hypertensive medications that are available for many
40:40
years. So the first line of treatment
40:43
is your lifestyle modification. If you can quit smoking, if you
40:48
can reduce the number of alcohol intake or the drink you have
40:52
control the salt intake. There's a diet that has been
40:55
very well studied. It's called best diet that is
40:58
translated into reducing the blood pressure as much as the
41:01
medication will do a regular aerobic exercise, regular
41:04
aerobic activity, yoga, meditation.
41:07
All this has been proven in multiple different studies that
41:12
if you adopt some of this lifestyle, it can help improve
41:15
your blood pressure control significantly.
41:17
So the first line of treatment today is lifestyle modification.
41:21
The second line of treatment is the medication.
41:24
As I said, there are multiple classes of medication. 1 might
41:27
be better than other for you depending on your race,
41:31
depending on your age, depending on your coexisting current
41:34
comorbid conditions like you know if you have diabetes
41:37
associated with versus, if you have a heart condition versus
41:40
you are let's say African American versus white origin.
41:44
One class of medication may work better than other for you, but
41:47
the medication is the second line of treatment.
41:52
People who cannot tolerate medicine, who have tried
41:55
medications but cannot control the blood pressure, so something
41:58
called failure of treatment. Then there is something called
42:03
resistant hypertension where people are taking three classes
42:07
of medication, they are taking three different medication, they
42:10
are regularly taking their meds. They are very compliant to their
42:13
medications. They have tried their diet,
42:15
exercise, etcetera, whatever the best they can do.
42:18
Because, you know, idealistically for a physician,
42:20
it's very easy to say do exercise, do this, do that.
42:24
By thinking also one can say, yeah, yeah, I will do that.
42:26
But executing that on every day in a current societal lifestyle
42:30
that we live in may not be for everybody.
42:33
So you have tried your best, dad, you have tried medication.
42:37
So you're taking three class of medicine, but your blood
42:39
pressure still remains uncontrolled.
42:40
It's called resistant hypertension.
42:42
That means the blood pressure is resistant to the current form of
42:45
treatment. So those are very good patients
42:48
to consider this treatment. So resistant hypertension,
42:51
people will try and fail the treatment or they cannot
42:54
tolerate the medication. Can a young person think of this
42:58
as a alternate to blood pressure medication?
43:02
Can I like let's say I'm now 40 and I need blood pressure
43:06
medication. I'm concerned about side effect
43:08
and taking it every day. Can I try this?
43:11
For sure. The clinical trial supports
43:13
that. Clinical trial says yes.
43:15
These patients are more likely to respond to the organization
43:19
in compared to people who are in their 60s with multiple
43:22
medication. OK, but currently do we
43:25
recommend that to young people? Now we still say that go for
43:28
lifestyle and medication is your first line of treatment.
43:31
It changes in case if you suffered an event.
43:33
So let's say if you had a heart attack, you had a stroke, you
43:35
had a heart failure, you had arrhythmia, you had a kidney
43:37
failure or kidney function going down, not necessarily completely
43:40
faint kidney, but your kidney function is declining because of
43:43
uncontrolled blood pressure. In those patients, we recommend
43:47
they should go for an organization.
43:50
Because they need a quicker fix. They're more at risk.
43:53
They've already showed us. They already showed us that
43:56
look, I'm suffering, you got to do something.
43:58
Whatever you have done so far does not work.
44:00
So those are the third class or third group of patients that I
44:03
would say we want to offer them treatment right away.
44:06
Are there any known side effects to the renal denervation?
44:10
Once again, very good question. You're talking like you're a
44:13
patient. So the procedure was deemed very
44:19
safe when FDA panel. I was fortunate to be part of
44:22
the panel presenting to the FDA panel about our findings from
44:26
research styles on renewed innovation.
44:29
And I can tell you this panel is is solid.
44:32
This panel that FDA can mean for both the both the devices
44:37
presentation. They're like some geniuses who
44:40
have done 608 hundred publication from across the
44:42
globe. FDA put this panel together who
44:45
are really objectively examining every point of data that is
44:49
presented to them, whether they should approve this device for
44:51
treatment of hyper pressure or not.
44:53
And one thing that was unanimous, all these people were
44:58
there that this procedure is safe.
45:00
Based on the clinical trial data, the risk of any major side
45:04
effect or complication was less than 1%.
45:07
The main complication was the exacerbated bleeding for the
45:10
groin. So right now this procedure we
45:12
can only do through the groin approach.
45:14
But as you can imagine evolution continues.
45:17
Very soon we'll be doing this through the radial approach.
45:20
There are device iterations and all that being considered,
45:23
delivery systems are being considered and all that will I'm
45:26
sure will happen one day. But right now we do it to the
45:28
groin and the common most side effect was associated with the
45:32
groin excessive bleeding, which is about 1% the risk of any
45:37
effect to the kidney. We were concerned that would
45:39
this require multiple procedure with this because nerves do
45:42
regenerate, would the nerves regrow again and they will
45:45
require the procedure. So far we don't see that.
45:47
On the contrary, we see that that there is an incremental
45:50
effect if you look at the three years graphs.
45:52
So we have 36 months data from multiple trials that shows that
45:56
persistently there is a reduction or maintained
45:59
reduction of the blood pressure at three years.
46:02
The third concern was that what if we change this nerve
46:06
Physiology for the kidney with the kidney function decline and
46:10
we have data that are three years, the kidney function
46:12
remains same. So we look at the what we call
46:14
glomerular filtration rate or creatinine level.
46:17
So there are parameters that we evaluate the kidney function
46:20
with and the kidney function is not changing over three years.
46:24
So there was a rare side effect of the artery where we are
46:29
putting the catheter and this device through.
46:32
Can we traumatize that artery? And there's about one in 900 to
46:37
1000 reporting of requiring additional procedures such as a
46:41
stent placement if there was a disruption of the kidney artery.
46:45
So those are the potential side effects.
46:48
This is a crazy idea and a very selfish one.
46:51
But as somebody who suffered from kidney stones before, I
46:53
wonder, could this device in a different frequency be used to
46:58
help prevent the the accumulation of the calcium
47:02
oxalates in the kidney there? And I know that's outside sort
47:05
of your area of study or expertise, but something it
47:08
occurred to me, so I have to throw it out there.
47:10
Yeah, no, I don't think so. This energy is not at a level
47:15
where it can break the calcium oxalate stain.
47:17
If you use that, you know you're asked to be used directly next
47:22
to it. And you have to always think
47:25
that everything that we do comes with.
47:26
So as a physician, I always say to my patient, I always say to
47:29
my fellows that everything that we do comes with the prize, they
47:34
the good and the bad. And that's why the hypocritic
47:38
oath of do no harm because everything that we do can come
47:41
with a harm. So if you think about this
47:42
ultrasound energy or radio frequency energy, if we use in
47:45
too much high frequency, it can start affecting the surrounding
47:49
organ. It can cause strictures, it can
47:50
cause effect on the intestine, it can cause effect on the
47:53
kidney medulla oblongate or the the functional unit of the
47:57
kidney. So no, it's not OK.
48:02
Fair enough. I had.
48:03
I had to plant the seed just in case.
48:07
That's just how the innovation starts.
48:08
Yeah, crazy ideas out of left field.
48:11
And we've got a few minutes left together and I want to make sure
48:13
we talk about, you know, with your experience, Doctor Sanghvi
48:16
probably work in all kinds of places.
48:18
You know, lots of places would be lucky to have you and your
48:21
skill set. How did the opportunity to join
48:25
the virtual health system come about?
48:26
And and why did you choose to plant your flag there?
48:32
I think more than important question of how did the
48:35
opportunity came about. I think why I, I decided to join
48:39
as a more more pertinent question and I think virtual is
48:44
going through a transformation being in New Jersey for since
48:47
2009, knowing a little bit about virtual health because you know
48:51
virtual health was a small community based organization,
48:56
but they had a solid connection with their patients, their
49:00
solid, good quality clinical programs and solid financial
49:09
practices. So the organization grew
49:12
organically very fast. So in 2017 or so, I believe they
49:18
built a new hospital in Voorhees.
49:20
Now at this point, they are still a community organization.
49:23
In 2019, they buy virtual Our Lady of Lords.
49:27
It's a tertiary care hospital with open heart surgery license
49:30
in New Jersey. There's a certificate of need to
49:33
have a open heart surgery program and you cannot open new
49:36
program because you want to. You can only get if the state
49:39
approves that. So they acquire this hospital as
49:41
a tertiary care in 2023 January, they, you know, took over the
49:47
virtual Arwan Medical College. So if we look back, what they
49:50
came in with is they had a solid, you know, foot on the
49:54
ground connection with the community, well recognized in
49:58
the community, sound financial practices.
50:01
From there they grew and they're going through this.
50:03
What what what from top down the system says is the academic
50:07
transformation. So, and if you can see that
50:11
journey back, so I was entering at a point where, you know,
50:15
it's, you know, the early adoption is done and now I'm
50:18
almost at a point of chasm where I can now, you know, grow
50:21
multiple program, multiple research programs, initiatives
50:27
and there's a perfect ecosystem and there's a perfect
50:30
opportunity. So it was for me in my career.
50:32
It was perfect opportunity because what virtue is doing as
50:35
an institution, what I was seeing on a sideline on how they
50:39
grew from 2010 to now, and it made perfect sense for me to be
50:45
part of this organization. What is it that you're most
50:47
excited about at Virtua being a part of going forward with them?
50:53
I think the the solid presence across 3 county, large volume of
51:00
patient of very organized systemic leadership where there
51:07
is a proper chain of command with the proper directions and
51:13
unified approach to clear objectives and clear goals.
51:18
I think those are all very solid positive things for for
51:23
organization to have and I'm very fortunate to be part of it.
51:27
Do you attribute all of that recent growth in the last 10 or
51:30
15 years to the leadership that's there?
51:33
Are there other factors that are kind of at play that has allowed
51:36
for this accelerated growth? Honestly, I am not sure if I do
51:42
have a complete vision to kind of really answer that question
51:47
because I don't like to answer a question if I don't have
51:50
clarity. I appreciate that.
51:53
That's rare in today. So tip of my hat to you for that
51:57
one. Let's see, we've just got about
52:02
5 or 10 minutes left. I, I, I guess we'll kind of wrap
52:05
up with this question, but before I ask my last question,
52:09
I'd like to do 2 things. First of all, I'd like to invite
52:11
everybody to hit the follow button on their favorite podcast
52:14
app so they can continue to get more great interviews like we've
52:17
had today with Doctor Kinter Sangbi from Virtual Health.
52:21
And I also want to let people know either the best way to get
52:24
in touch with you or to follow your story.
52:27
Doctor, what would that be? To for for patient encounters or
52:35
for somebody who wants to, you know, get an opinion for their
52:39
healthcare from virtual.org or virtual health website, you'll
52:46
be able to easily find the lead to get an appointment.
52:53
Is there somewhere like if people are interested in kind of
52:55
the innovations that you're a part of and you know, kind of
52:58
following more of that story that they can look for that
53:02
info? Yeah.
53:03
So we do have our organizational website which talks about the
53:07
research that we are doing, but I'm also kind of active a little
53:11
bit on the social media for any important innovation that's
53:15
happening in our field with the Twitter and LinkedIn.
53:19
OK, great. We'll look for your profiles and
53:22
include those links in the show notes.
53:24
So I think maybe where I want to kind of wrap up today, Doctor,
53:28
and you know, we've got to touch on just a couple of the
53:30
innovations that you have been a part of.
53:32
Is there something else that's brewing that's in the works that
53:36
maybe you're particularly excited about or that's coming
53:39
that you want to give voice to? I think the right now, you know,
53:49
the use of the technology in improving the procedures,
53:58
improving the access to the patient, early diagnosis of
54:04
under diagnosed undertreated problems is something that right
54:10
now I'm really kind of focused on and excited about because the
54:17
goal is health. And people who are not diagnosed
54:23
or not aware of their problem and their consequences, if we
54:27
can, when there is an evidence based support to that, identify
54:31
and treat them and prevent the consequences.
54:34
So just for an example, at virtual health, people who did
54:39
not have colonoscopy as a preventive care, X number of
54:44
people were given a letter because based on the AI search
54:49
that they did not have that they were sent out information.
54:53
Some of them chose to do it from let's say about 1000 patients
54:57
chose to do the colonoscopy, 250 of them were identified to have
55:01
a polyp that could have grown into cancer that was removed and
55:04
neutralized, right. So that's just the most simple
55:08
example that I'm giving that can be understood by anybody.
55:13
But in our field in cardiovascular medicine and
55:15
international cardiology, the many other things, I'm not
55:18
working on that. So I think that's very exciting.
55:21
What do you think are the biggest levers to pull to get
55:23
sort of increased, improved diagnosis levels?
55:26
Because I mean, every time I go to my doctor, heck, even my
55:29
dentist, you know, they take my blood pressure.
55:31
And so like, that's a point of reference for me.
55:34
Oh, still good, still good, still good.
55:36
But clearly there are people who are not even taking those steps.
55:39
And so how do you reach those folks?
55:40
Do you have any thoughts on that?
55:46
Difficult but it is, it has to start at the early age in my my
55:51
and I think it is being done in overall US education system.
55:56
I hope we bring back the focus again a little bit more because
56:01
you know, like everything else on depending on the need of the
56:06
time, you know, for last few years our focus in the education
56:11
system was on different things. But I think the chronic
56:15
illnesses, the cancer, the heart attack, the stroke, the high
56:19
blood pressure, the diabetes and early on education of good
56:24
lifestyle, good diet activity that is good for physical and
56:29
mental health and awareness starting at an early age would
56:32
be the best way to do. That's the only thought I have.
56:34
Again, beyond that, I don't have much clarity to kind of see how
56:38
we can bring population on board.
56:39
Yeah, it's, it's a tough question to answer.
56:41
And, and just kind of a follow on because you, you know, you
56:44
made the reference to colonoscopies and sort of using
56:47
AI to identify folks that, you know, might be at risk and we
56:49
benefit from a colonoscopy. And is somebody who's, you know,
56:53
heavily involved being at the forefront of different
56:55
cardiovascular tech, are you seeing ways that AI is being
56:59
used in your field currently that you're excited about or
57:02
something that's kind of coming? It's it's coming soon.
57:07
Yes, it is happening. It is here, It's already
57:11
happening. It's exciting whether it is
57:13
characterizing the significant of stenosis of a blockage in
57:18
terms of anatomically that means how much percentage stenosis is
57:21
there. And in terms of physiologically
57:24
evaluating the blood flow beyond the just based on the
57:27
angiography, just based on the one angiography film, it's here.
57:32
There are other tools under development that will play a
57:36
role. We have AI use in implanting
57:40
valves. So we can we can create recreate
57:45
A3 dimensional model for individual patients anatomy.
57:49
If I'm changing the valve today and if that valve fails 10 years
57:53
from now, if I have to change that valve again, I can implant
57:56
those valve virtually in a three-dimensional model and see
58:00
what it would look like and would it work.
58:02
And there are a lot of nuances. That's a very complex question,
58:06
but we the technology's here, it's here as it's the starting
58:11
point. Yeah, this is great stuff.
58:13
And I know that we just kind of scratched the surface in terms
58:16
of the different innovations you've been a part of.
58:18
It'd be fun to have you back on in a year or two and see kind of
58:22
what new things you've gotten your fingers into.
58:24
But Doctor Kenter Sangbi from Virtual Health, I want to be the
58:27
first one to thank you for sharing both your time and your
58:30
story with us today. I really appreciate it.
58:33
I would like to be the second one to say thank you for the
58:35
opportunity to talk to you and your audience and hope our
58:39
conversation can inspire some people to live healthy, some
58:44
people to change the lifestyle, some people to seek help for
58:47
their medical condition to the doctor.
58:49
And hopefully, if we can even prevent one stroke or one heart
58:52
attack, it's a big win. Love it folks.
58:55
That's a wrap on another episode of the Inspired Stories podcast.
58:58
Thanks for learning with us today.
59:00
Thank you.