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The Cardiologist Who Biohacks: Heart Health, HRV, Cold Plunge, and the Medicine Nobody Is Teaching · White Coat Black Sheep

• 0:00
  Welcome to White Coat, Black Sheep, where science gets curious and dogma gets
• 0:04
  uncomfortable. I'm Dr. Sevelli, and today we talk physiology, evidence,
• 0:08
  and real-world medicine, plus the questions you're not supposed to ask
• 0:12
  but probably should. If you care about health and think there's a better way,
• 0:16
  welcome to our show.
• 0:23
  Thank you so much for joining me today.
• 0:25
  I have the honor and pleasure of introducing Dr.
• 0:28
  Sandhu, cardiologist. Tell us more about you.
• 0:32
  Thank you. Thanks for having me. I'm an interventional cardiologist,
• 0:36
  and I'm in private practice for a while with a heavy bent towards
• 0:40
  wellness and all things health.
• 0:42
  Which I love.
• 0:43
  Exactly. So that's what brings me here. Let's talk.
• 0:47
  Yes. Let's talk. What does your day look like, just out of
• 0:51
  curiosity? What time did you start?
• 0:54
  Typically, I'm an early starter, so the day I do procedures, I usually
• 0:57
  start my day at 6:30.
• 0:59
  Okay.
• 1:00
  So some cases earlier in the day. And then the office time, typically 7:30 to
• 1:04
  8:00. And that goes on till 3:00 if I'm in office
• 1:08
  all day or if I'm doing procedures, oftentimes half-a-day procedures.
• 1:13
  Then depends on what's going on for the rest of the day, whether it be
• 1:17
  meetings or some admin work, and then back to home.
• 1:20
  Love it. I didn't hear exercise. Do you typically exercise or-
• 1:24
  I'm usually an evening person for that.
• 1:25
  Oh, okay.
• 1:26
  So could be 5:00, 6:00. So usually that's the
• 1:30
  first thing I would do soon as I get home.
• 1:33
  Mm-hmm.
• 1:33
  Before I do anything, that's when I would try to hit gym.
• 1:36
  Okay.
• 1:37
  Do the training and-
• 1:37
  Fasted?
• 1:40
  Typically not.
• 1:41
  Okay.
• 1:41
  So I've had lunch most days.
• 1:42
  Mm-hmm.
• 1:43
  But it's about three hours apart-
• 1:45
  Mm-hmm
• 1:45
  ... in any case, so usually I would try to hit around 4:30 or
• 1:49
  5:00.
• 1:49
  That's good.
• 1:49
  And that's about an hour of weight training at that time.
• 1:52
  Mm-hmm. Love it. Do you take any sort of pre-workout before you do that?
• 1:56
  I don't know if you feel a crash at the end of the day or fatigue.
• 2:00
  Some people do.
• 2:01
  Mm-hmm. Typically not.
• 2:04
  I usually would stick to EAs.
• 2:07
  Mm-hmm.
• 2:08
  So to me, that's good enough for a pre-workout.
• 2:11
  Love it.
• 2:12
  Sometimes I take some taurine.
• 2:13
  Okay.
• 2:14
  And that helps.
• 2:15
  That's really good.
• 2:18
  I feel like for me, the taurine, sometimes it can give you a little
• 2:22
  too much-
• 2:22
  Mm-hmm
• 2:22
  ... right, don't you think?
• 2:23
  It can. I mean-
• 2:24
  Yeah
• 2:24
  ... there's a reason they use it in energy drinks.
• 2:27
  Yeah.
• 2:27
  So it works.
• 2:28
  Yeah. I'm not quite sure the mechanism, but I know I definitely can-- I notice it.
• 2:32
  Yes. It does work. I mean, the brain does get a little sharper, and-
• 2:36
  Yeah
• 2:37
  ... you feel a little more of a lift.
• 2:39
  That's great. So in the morning when you wake up, do you
• 2:43
  feel like, "Let's go. I'm ready to conquer the day"?
• 2:46
  Do you feel bursting with energy, or are you kind of a slug?
• 2:50
  Most days, yes. So my morning's usually like
• 2:54
  wake up, get ready. I do meditation in the morning.
• 2:58
  Oh, that's great.
• 2:58
  So I learned Kriya Yoga, so I spend about good 20
• 3:02
  minutes after my prayers and spend time doing
• 3:06
  Kriya Yoga. And then depending on the day,
• 3:10
  some days I will do red light therapy in the morning and-
• 3:13
  Love that
• 3:13
  ... alternate with plunge some days, depending on what day of training I'm in.
• 3:17
  Mm-hmm.
• 3:18
  And then just grab my morning protein
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  shake with some creatine and-
• 3:24
  Yes
• 3:25
  ... glutamine and-
• 3:27
  ... gotta go.
• 3:29
  Yeah. It really makes a difference, all of those little steps that you just
• 3:32
  described. You preload with your day with the
• 3:36
  protein and just habits.
• 3:38
  Mm-hmm.
• 3:39
  All of that together.
• 3:40
  A routine, I guess that helps-
• 3:42
  Yeah. Yes
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  ... most of all.
• 3:44
  Yes.
• 3:46
  With the red light therapy and the cold plunge, there's a reason to do it or
• 3:50
  not do it. Do you apply-- or what reasoning do you apply
• 3:54
  to each of those when you do them or not do them?
• 3:56
  So typically, I mean, cold plunge, the reason I stack it in the morning on
• 4:02
  some days,
• 4:04
  evening workouts and, of course, cold plunge, it will reduce
• 4:08
  your soreness, but it does also negate some of the muscle growth effect.
• 4:12
  So
• 4:14
  I'll have 12 hours in between at least maybe 14, 15, and in the morning-
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  Mm-hmm
• 4:18
  ... I can do my three minutes. And typically, I mean, the
• 4:22
  science says about 11 minutes a week, and after that, it's diminishing returns for
• 4:25
  cold plunge. So typically-
• 4:27
  Mm
• 4:27
  ... when I get in, it's usually about three minutes or so.
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  So three or four days of that will do it.
• 4:33
  Yeah.
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  So-
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  Feel charged.
• 4:35
  Exactly.
• 4:36
  Yeah.
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  I mean, going in is not fun, but coming out, you feel great.
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  That-
• 4:39
  You feel amazing.
• 4:40
  Exactly.
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  Like very euphoric in a sense.
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  Very.
• 4:43
  Yeah.
• 4:44
  And it sets you up for the day better than any cup of coffee.
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  It really does. You can't even be mad.
• 4:48
  No.
• 4:48
  There's nothing that would like shift you into that space where you're like,
• 4:51
  "Okay." No. So that's awesome. Is there
• 4:55
  anything that outside of that that you would recommend for
• 4:58
  lymphatic drainage?
• 5:01
  Haven't had a whole lot of issue with that.
• 5:04
  I have used the Hyperice
• 5:07
  boots.
• 5:08
  Mm-hmm.
• 5:09
  But usually that's after a leg day.
• 5:11
  Mm-hmm.
• 5:11
  I'd spend some time doing that.
• 5:12
  Yep.
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  There are days I would do the morning would
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  include when I do yoga, there are some
• 5:21
  Surya Namaskar, so sun salutation, that will get your muscles going
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  a little bit.
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  Oh, that's good to know.
• 5:27
  Yes.
• 5:27
  Those specific moves. I know the twist really is helpful.
• 5:30
  Mm-hmm.
• 5:31
  So, okay.
• 5:32
  Yep. So I mean,
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  it's a series of moves, so part of it is stretches your
• 5:38
  hamstrings-
• 5:39
  Mm-hmm
• 5:39
  ... part of it is you're doing downward dog.
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  So it-
• 5:42
  Yep
• 5:42
  ... a lot of it kind of adds up in a sequential fashion.
• 5:45
  Yes. Yeah. Definitely highly recommend.
• 5:50
  What initially brought you into cardiology?
• 5:54
  I know it's a very long path.
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  Mm-hmm.
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  There's a lot of pre-med and aspiring doctors.
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  If you rewind to the thing that was really
• 6:05
  your why-
• 6:06
  Mm-hmm
• 6:06
  ... what does that look like?
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  So I mean- I grew up in India,
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  and
• 6:14
  of course, it's a very different system.
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  So
• 6:19
  you're 18 when you pretty much decide what you're going to do with the rest of your
• 6:23
  life. So there is not a trend of undergrad, four years college or
• 6:26
  whatnot. You just go, so from 12th grade you're in medical
• 6:30
  school.
• 6:31
  Mm-hmm.
• 6:32
  And I don't think most of us are smart enough-
• 6:35
  No
• 6:35
  ... to know at that time what the hell I want to do with my life.
• 6:38
  So when I started med school,
• 6:40
  I thought I wanted to do this, but then I really didn't like it for first year.
• 6:45
  It was not fun.
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  And
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  it took me a while to, okay, I'm in it now,
• 6:53
  so let's get in it to win it.
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  Yeah.
• 6:55
  And then things got better. My heart was in it.
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  Finished my
• 7:02
  medical training there and landed up in New York here.
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  And
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  residency was
• 7:11
  a lot of fun, learning medicine the new way.
• 7:13
  Do you mean fun?
• 7:15
  It was actually. If I look back at it-
• 7:17
  Okay
• 7:17
  ... it was a lot of fun. I mean, first month was like a little deer
• 7:21
  in the headlights.
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  Yeah.
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  And then, as you start getting a hang of it,
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  oftentimes you make your best friends in that time.
• 7:28
  Yeah.
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  Because it's like you're in the trenches together.
• 7:31
  Yes.
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  You're learning-
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  Trauma bond.
• 7:33
  Exactly. You're learning together, you're doing things together that sometimes are
• 7:37
  comfortable, sometimes not.
• 7:38
  Yeah.
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  Sometimes you're exhausted, you're covering for each other.
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  So I feel, yes, it can be tough, but
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  it builds character.
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  That means, woo, it had some rough moments.
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  Oh, yeah.
• 7:51
  Those character building.
• 7:53
  That is true.
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  Ugh, my mom and dad used to always tell me that.
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  Anything that was suffering-
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  Mm-hmm
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  ... builds character.
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  That's one way to look at it, right? It keeps you going.
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  Yep.
• 8:03
  I was drinking the Kool-Aid full time, right?
• 8:06
  Yeah.
• 8:07
  And then,
• 8:10
  initially I was kind of torn between, we had a very strong transplant
• 8:14
  hepatology program, so liver transplant and whatnot. Found it fascinating.
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  Mm-hmm.
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  Enjoyed it. But to me, the turning point was my
• 8:22
  critical care CCU rotation. Really loved it.
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  Ooh, that sounds so good. I like how it lights you up a little bit whenever you
• 8:30
  just talk about it.
• 8:31
  Yeah. No, it was
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  that defining moment, and
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  that's when I really started working, and I was fortunate. I got great mentors.
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  They helped me, they guided me.
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  And
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  I had a fun time learning. And
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  now if I look back, I could say, you know what?
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  If I wasn't doing cardiology, I really can't see myself doing anything else in
• 8:55
  medicine. I do enjoy it that much.
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  I have no idea what I would be if I'm not a doctor.
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  I-
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  Yes. It's fun to imagine-
• 9:04
  Mm-hmm
• 9:04
  ... the what if.
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  True.
• 9:06
  Yeah.
• 9:07
  I don't think I want to know myself-
• 9:09
  Well, it-
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  ... like that.
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  I think the introspection helps. Like you and I both kind of had a...
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  You are into wellness, functional medicine now.
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  You had the courage to kind of take the plunge.
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  Which it does take-
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  Which I applaud
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  ... thank you. It does take courage.
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  Exactly. It takes-
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  It's not mainstream.
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  It's not mainstream yet. I think it is, you wanted to do
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  this, and you
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  took that first step.
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  Mm-hmm.
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  You took the full length leap in.
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  Yes.
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  Which I applaud.
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  Thank you.
• 9:36
  And
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  I have-
• 9:37
  Like let them laugh.
• 9:39
  Exactly. That's okay.
• 9:40
  Yeah.
• 9:40
  That's okay.
• 9:41
  Totally fine.
• 9:41
  I mean, at the end of the day, we are here to help people.
• 9:43
  Exactly.
• 9:44
  And we do it the way we best see fit with us, right?
• 9:46
  Yes.
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  And
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  I enjoy wellness. I enjoy a
• 9:53
  lot of
• 9:54
  biohacking. I read about it a lot. I talk a lot about my patients.
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  So I live on that fringe. I still haven't taken the leap, as you
• 10:01
  say.
• 10:02
  So I flirt with that border quite a bit as I talk to them, but...
• 10:06
  That's the cutest way to say it. I like that.
• 10:10
  Yeah, I
• 10:12
  still practice traditional medicine, especially
• 10:16
  for the insurance based patients, right?
• 10:19
  Mm-hmm.
• 10:19
  Those we have to. We don't have a choice.
• 10:21
  Mm-hmm.
• 10:21
  But having additional tools in our chest to offer
• 10:24
  people and to use the science that we do have
• 10:29
  available at our fingertips, and then make those scientific
• 10:33
  connections. Because I never want anything to be Valerie's
• 10:36
  opinion.
• 10:37
  Mm-hmm.
• 10:37
  I want it to be based on the information that we have, and all of
• 10:41
  these other things have failed.
• 10:43
  There must be something that will work.
• 10:46
  No, I agree. And I think so many times the frustrating part is we see
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  this
• 10:51
  whole functional medicine versus mainstream medicine as
• 10:55
  either/or.
• 10:57
  I know.
• 10:57
  I don't believe that's the case.
• 10:58
  Me either at all.
• 11:00
  I think the true care, the right way to care for people
• 11:04
  exists in the middle, where there is good elements in both.
• 11:07
  Mm-hmm.
• 11:07
  And you could use both.
• 11:09
  Yes. Oh, totally. And I really think back
• 11:12
  to biochemistry days, right?
• 11:14
  Mm-hmm.
• 11:14
  Whenever you're learning the purine pathways.
• 11:17
  Mm-hmm.
• 11:17
  You're learning oxidative stress.
• 11:19
  You're learning what the liver does and where it chops things up, and what is
• 11:23
  released when glucose enters the bloodstream, and then the insulin
• 11:26
  receptors. So all of those things at that
• 11:30
  level of considering the mechanism is what I think about
• 11:34
  when I'm talking to the person and I'm hearing their problem, and I'm
• 11:37
  thinking chicken versus egg. Which one came first?
• 11:41
  Because a lot of the things that patients are describing are the symptoms that are
• 11:45
  downstream. But what was the original?
• 11:49
  I think that
• 11:51
  knowing those mechanisms is everything, and that's how I really approach
• 11:55
  it.
• 11:55
  I totally agree. For me, the light bulb moment was, it was a few
• 11:59
  years ago as I got more and more into
• 12:02
  Sort of wellness part of it-
• 12:03
  Mm-hmm
• 12:04
  ... and
• 12:05
  working on metabolic disease, thinking about it that way.
• 12:09
  It was that light bulb moment, "Huh, that's why they taught us biochemistry."
• 12:12
  I know. I had the same light bulb. Isn't that so funny?
• 12:16
  Because it's like, "Why do I have to know stoichiometry?"
• 12:20
  Exactly.
• 12:20
  "What is the point of this?" It clicks way later.
• 12:24
  Exactly. So that was that whole first year and a half when-
• 12:27
  Mm-hmm
• 12:27
  ... biochemistry was torture.
• 12:29
  I was like, "Okay, I guess that's why."
• 12:32
  That's why. Exactly. You're so funny.
• 12:35
  I had the same thought.
• 12:37
  Ugh. Yeah, or the pH in the GI
• 12:41
  tract, in your mouth.
• 12:42
  Mm-hmm.
• 12:43
  How important is the mechanical chewing of your food
• 12:47
  to break it up, and how much we chew, and then
• 12:51
  the process of it going all the way down, and then the peristalsis that
• 12:55
  happens.
• 12:56
  Mm-hmm.
• 12:56
  And then the timing of your valve opening so it can go to your--
• 13:00
  It's just crazy. It's so detailed and
• 13:03
  intricate. So I just circle back to those,
• 13:08
  the minutia.
• 13:09
  Yeah.
• 13:09
  Right? Because I feel like that's where the problem is.
• 13:13
  It's going back to the basics or-
• 13:15
  Yeah
• 13:15
  ... first principles approach. Let's go back to the-
• 13:18
  Yeah, fundamentals.
• 13:19
  Exactly.
• 13:20
  Square one.
• 13:21
  Yeah.
• 13:22
  Yeah. So
• 13:24
  I don't know. As you are right now, how do you think everything is going
• 13:28
  in private practice and cardiology?
• 13:32
  Because I know you've ventured-- Just in the time that I've known you-
• 13:36
  Mm-hmm
• 13:36
  ... you've had different business ventures, right?
• 13:39
  So are you at the place where you're like, "This is fun"?
• 13:43
  Yeah, most days, I would say yes, this is fun.
• 13:45
  And we all have those days when it's not so much fun.
• 13:48
  This is work.
• 13:49
  And that's life. But-
• 13:51
  Yeah
• 13:51
  ... no, I
• 13:53
  started my current group about three years ago,
• 13:57
  with the intent we want to provide great care to people,
• 14:01
  and get really, really good cardiologists here to do
• 14:05
  that.
• 14:06
  Mm-hmm.
• 14:06
  And fortunately, I'm blessed, I have awesome
• 14:10
  partners.
• 14:11
  I love your team. I like every single person there.
• 14:14
  Hand-selected, great people.
• 14:17
  No, thank you. We take pride in providing good care, and
• 14:22
  most days, I feel we are able to accomplish that, I hope for most people.
• 14:27
  Yes.
• 14:27
  And
• 14:29
  we are expanding the team this year, getting
• 14:33
  hopefully two new people. Both are very accomplished, good people, so-
• 14:36
  Cardiology?
• 14:37
  Cardiology.
• 14:38
  Okay.
• 14:38
  So that
• 14:40
  should further help
• 14:42
  us grow and do things better. We just brought in
• 14:46
  PET/CT.
• 14:47
  Yes.
• 14:48
  So-
• 14:48
  How's that going?
• 14:50
  It is good. To me, that's
• 14:54
  the best form of non-invasive assessment that I could get for a patient.
• 14:57
  And not only am I able to see the regular what a stress test would
• 15:01
  show in a more high-definition fashion, so to speak-
• 15:04
  Oh, wow
• 15:04
  ... then calcium scoring at the same time, see if there is calcific build-up in
• 15:08
  the arteries, correlate that, and then do myocardial blood flow, which
• 15:12
  means if the arteries actually behave the way they should
• 15:16
  behave when they get a stimulus, if the blood flow increases as it should.
• 15:20
  So all those add up-
• 15:21
  Mm-hmm
• 15:21
  ... to give you a lot of confidence.
• 15:23
  If it's completely normal, okay, I know you don't have disease.
• 15:26
  Chances are we didn't miss anything.
• 15:28
  Or-
• 15:28
  Mm-hmm
• 15:29
  ... if there is a problem, going in knowing-
• 15:33
  Wow
• 15:33
  ... what we are going in for.
• 15:34
  Absolutely. What age do you recommend people to
• 15:38
  do that? When would I start to think-- And really in the
• 15:42
  preventative-
• 15:43
  Mm-hmm
• 15:43
  ... medicine outside of the algorithm that we're trained in.
• 15:47
  So not for PET/CT so much, but for calcium scoring initially.
• 15:50
  That's where I would start for most younger age group.
• 15:53
  The disease is moving younger. We have seen that.
• 15:56
  Mm-hmm.
• 15:56
  Part of it is biologic, part of it is the environment that we live in-
• 16:00
  Mm-hmm
• 16:00
  ... and the foods that we eat. So all-
• 16:03
  Yes
• 16:03
  ... of that comes together, right?
• 16:04
  Right.
• 16:05
  And of course,
• 16:07
  not to downplay the stressors of modern life-
• 16:10
  Yes
• 16:10
  ... that we live in.
• 16:11
  Yes.
• 16:12
  So
• 16:14
  for a lot of people, if there is no risk factors, whatnot, but
• 16:18
  for most people around 40, I would say get some sort of assessment,
• 16:22
  whether that be cholesterol check and then a calcium score.
• 16:25
  Mm-hmm.
• 16:26
  That's an easy two-minute scan. There is no IV or dye.
• 16:28
  And to measure how much calcium is built up in the arteries.
• 16:31
  We've known that for ages, like 30, 40 years, since
• 16:35
  we started-
• 16:36
  Wow
• 16:36
  ... doing CTs, that if you have calcium build-up in your heart arteries, it's not a
• 16:39
  good thing. And-
• 16:40
  Not a good thing
• 16:41
  ... it correlates directly, the very early data that showed that over
• 16:45
  300, the event risk is over 12%. However, if you're zero,
• 16:50
  then the chances of having anything significant is pretty close to zero.
• 16:53
  It's not exactly-
• 16:54
  Mm-hmm
• 16:55
  ... zero, but-
• 16:55
  Yeah
• 16:55
  ... it is pretty close.
• 16:56
  Wow.
• 16:57
  That's helpful. Is there any signs that would be precursors
• 17:01
  to
• 17:04
  a high calcium load in the arteries of the heart?
• 17:07
  Symptoms-wise, you may not feel anything at all.
• 17:10
  A lot of-
• 17:10
  What about in the legs?
• 17:11
  The legs is different. So the physiology, you may have a little
• 17:15
  calcium build-up. So how do you get calcium?
• 17:17
  So if you go back to you have cholesterol build-up initially, the
• 17:20
  arterials, inner coating, which is the endothelial cells.
• 17:23
  That's like the inner insulation on the cell-
• 17:26
  Mm-hmm
• 17:26
  ... blood vessels.
• 17:27
  Yes.
• 17:28
  As it gets a little rust, so to speak, in the commonest term, your kind of
• 17:32
  cells are not healthy-
• 17:33
  Mm-hmm
• 17:33
  ... comes off. You create a little area of injury or a little tear.
• 17:37
  That's where the whole pro-inflammatory process starts.
• 17:40
  And you'll form a little scar or a fibrous tissue or some cholesterol
• 17:44
  plaque build-up there. And as it gets old, the healing
• 17:48
  process, without going too much into technicalities, will have some calcium
• 17:51
  deposition in it, and that's what you measure.
• 17:55
  I think of it as like a custard or like a soufflé.
• 17:59
  Mm-hmm.
• 17:59
  It's like a shell on the top-
• 18:01
  Exactly
• 18:02
  ... with some nasty-
• 18:02
  You got your own crème brûlée?
• 18:06
  Crème brûlée. Yeah, it kind of grosses me out to think of it that way, but is that
• 18:09
  what it looks like when you're actually in there and you-
• 18:11
  So calcium can be pretty hard, actually. It's literally like a rock.
• 18:15
  Well, that's the top layer.
• 18:16
  Yes. And sometimes it goes pretty deep.
• 18:19
  And when you're opening up these arteries, sometimes that's your enemy in
• 18:23
  delivering the equipment that you need to deliver.
• 18:25
  So there are tools that you use, whether that be rotablator, where it's a
• 18:29
  little diamond burr that shaves off the calcium.
• 18:31
  So cool.
• 18:32
  Or, yeah, some newer technologies like shockwave, where it's like you're putting a
• 18:36
  balloon that does lithotripsy and breaks up the calcium on the inside-
• 18:39
  Wow
• 18:39
  ... before you work. So there are some tools to work around it.
• 18:42
  Man. When you do that, is it kind of like instant
• 18:46
  gratification for you, in a sense?
• 18:48
  Certainly, it is.
• 18:49
  I could see how that would be.
• 18:53
  Generally, if you do get it right, one and one add up to two generally.
• 18:59
  I love when it works that way.
• 19:00
  Exactly.
• 19:01
  Yeah, like no complications, all goes well.
• 19:03
  And sometimes things don't go well, and that's part of what we do.
• 19:07
  Yeah.
• 19:07
  But as long as I believe you've done it for the right reasons to help
• 19:11
  that patient-
• 19:12
  Yeah
• 19:12
  ... and whatever comes, you can deal with it.
• 19:15
  These are not low-risk procedures to start with.
• 19:18
  We've made it sound that way. But it's-
• 19:20
  We do. Like it's putting on an outfit, but it's invasive.
• 19:24
  It is invasive and...
• 19:26
  Yeah.
• 19:27
  I forgot the vagal nerve stimulator.
• 19:30
  Mm-hmm.
• 19:31
  I forgot it.
• 19:31
  I forgot it, too, actually.
• 19:33
  Oh my gosh.
• 19:33
  We got to do it some other time.
• 19:34
  Man.
• 19:34
  Yeah.
• 19:34
  Who's running this thing? Two doctors are not doing
• 19:40
  what-
• 19:40
  That'll be fun to do next time. Let's do it again.
• 19:42
  Yeah. Okay, perfect. You got a deal.
• 19:44
  No, it's funny to see doctors assist doctors. It's really bad.
• 19:47
  Isn't it really bad?
• 19:48
  We're not used to that.
• 19:49
  We're not used to it. Yeah, we stand in the wrong place. I don't know.
• 19:54
  It-
• 19:54
  I agree.
• 19:56
  Thank God for medical assistants.
• 19:59
  Oh, gosh. Well, yeah, on the topic of the vagal nerve
• 20:02
  stimulator, there's so many different versions of those
• 20:06
  devices that have come out. Some of them are for just in general stress,
• 20:10
  anxiety, some are for sleep, some are, I don't know, they're
• 20:14
  like a full collar-
• 20:15
  Mm
• 20:15
  ... or some just sit right over the baroreceptors. What are your thoughts on it?
• 20:20
  So, I
• 20:22
  feel we are going to know more in time to come as to how the vagus nerve
• 20:25
  stimulation works.
• 20:26
  Mm-hmm.
• 20:27
  We know what vagus nerve does. We know it traverses the whole
• 20:31
  pathway up and down, and we know a healthy vagal response
• 20:35
  is perhaps a good thing if you're living a stressful life.
• 20:38
  Mm-hmm.
• 20:39
  Now, when you start hacking this, how does that work?
• 20:42
  Yes.
• 20:43
  Okay. So that,
• 20:45
  I would say,
• 20:48
  to an extent it may be helpful.
• 20:49
  Mm-hmm.
• 20:49
  And there are different kinds of devices you can use.
• 20:52
  Okay, what's the
• 20:53
  easiest one that you can do? Just your breathwork. Okay.
• 20:56
  Yeah. That's true.
• 20:57
  Okay. Lower lobes in the lungs expanding with deeper breaths,
• 21:01
  double the inspiration, and slow down your expiration like eight seconds.
• 21:05
  That will actually slow down your heart rate, right?
• 21:08
  Yes.
• 21:08
  So that is vagus nerve stimulation in its most rudimentary form.
• 21:13
  Then there are devices which work directly, like what we
• 21:17
  were talking about.
• 21:20
  You can have a device on your neck.
• 21:21
  Mm-hmm.
• 21:22
  Pulsetto, that can kind of give microcurrents and training the
• 21:26
  vagus nerve that way. And then there are vibration-based devices, like
• 21:29
  Sensate. So it's like a pendant.
• 21:32
  Oh.
• 21:32
  You can wear it and
• 21:34
  when you're going to lay down for 10, 15 minutes, you can wear it with the
• 21:38
  headphones on. And the principle there is,
• 21:41
  you have air conduction with how you hear, and you have bone conduction.
• 21:45
  All your bones absorb the vibrations also.
• 21:47
  Yes.
• 21:48
  So it creates those music and sound-based vibrations
• 21:52
  that will actually hopefully put you in a little bit-
• 21:56
  Interesting
• 21:56
  ... easier state and relax you, so to speak.
• 21:59
  Okay.
• 21:59
  So that is relaxation in another way.
• 22:02
  Then there are other vagus nerve stimulators like Nereupod and whatnot, which are
• 22:06
  a little more fancier, and
• 22:10
  depending on
• 22:12
  who you read, they do work.
• 22:14
  Yeah.
• 22:14
  I've used a few of these.
• 22:17
  I like Sensate. I use it time to time.
• 22:20
  I've seen, at times, for my sleep, it does affect my heart rate
• 22:24
  variability in a good way.
• 22:26
  Mine is low.
• 22:27
  How low?
• 22:28
  I don't want to say.
• 22:29
  Okay. We're not going to put it out there then.
• 22:31
  No, I need to fix it.
• 22:34
  Sometimes in the 20s and 10s.
• 22:38
  I didn't even know you could go as low as mine.
• 22:40
  Well, you can, but you shouldn't, right?
• 22:43
  And this is-
• 22:44
  Why is that? Why do you think is that?
• 22:47
  Well, I just started a business. So I think that is a
• 22:51
  major
• 22:52
  factor,
• 22:54
  but the fact that it's showing on my data, which
• 22:57
  is objective-
• 22:59
  Mm-hmm
• 22:59
  ... means that I must be breathing differently-
• 23:02
  Mm-hmm
• 23:02
  ... and I must be sleeping differently.
• 23:05
  Right.
• 23:05
  My exercise hasn't changed. My food hasn't changed.
• 23:09
  Everything else is exactly the same.
• 23:12
  You do travel a lot.
• 23:13
  I do. Altitude maybe?
• 23:15
  No. I feel it's
• 23:17
  your social jet lag that affects it to an extent.
• 23:21
  And your travel, you have actually jet lag. You go between East and West Coast.
• 23:24
  Yeah.
• 23:25
  Three hours.
• 23:25
  Yeah.
• 23:26
  And affecting the sleep time, of course, any time you switch, it takes a little
• 23:30
  bit of time for the body to adapt to it and get in a good sleep rhythm.
• 23:34
  There is actually,
• 23:35
  I'm blocking on the exact reference, but there is a
• 23:39
  thought that when there is some basic science data on this, that if you
• 23:43
  actually sleep in a hotel room or a place you're not familiar, your body does not
• 23:47
  feel familiar. For the first night or two, actually, there's more micro-awakenings,
• 23:51
  and your heart rate does stay-
• 23:52
  Wow
• 23:53
  ... a little bit higher-
• 23:54
  Wow
• 23:54
  ... because you-
• 23:57
  Even though you don't perceive it, your body perceives it as an unfamiliar.
• 24:01
  So if I'm traveling in a new hotel or whatnot, first night
• 24:05
  or two nights, you can measure it, your sleep will be a little bit
• 24:09
  off.
• 24:09
  I'm seeing this in my data.
• 24:11
  Yep, and then it starts settling in.
• 24:13
  Oh, no.
• 24:19
  I'm just taking that in.
• 24:21
  Because it matters. It's a vital sign.
• 24:24
  Mm-hmm.
• 24:25
  Absolutely. And then, how you structure your wind-down routine, I feel we are
• 24:29
  really good at warming up.
• 24:31
  Yeah.
• 24:31
  We are really terrible at winding down.
• 24:34
  I'm really bad at winding down.
• 24:36
  Exactly.
• 24:37
  I need to be told to wind down.
• 24:39
  Do you look at your phone when you're ready to sleep before that?
• 24:42
  I try so hard not to.
• 24:45
  But you do.
• 24:46
  I do.
• 24:47
  If you spend 30 minutes on that... So there was
• 24:51
  a very interesting experiment out of Australia, I think it was over 10 years ago.
• 24:56
  And,
• 24:57
  what they saw was
• 24:59
  you could do the same book on iPad reading versus actual book.
• 25:04
  And in the iPad reading group, the sleep was terrible
• 25:08
  that night.
• 25:09
  So you could expect that, okay, but what-
• 25:12
  Right, with the light to the eye
• 25:13
  ... Right, the blue light, predominantly blue light wavelength.
• 25:16
  Okay. Mm-hmm.
• 25:16
  But
• 25:18
  what you won't expect it, that effect lasted several days after.
• 25:21
  So it was like a drug-
• 25:22
  Several days, it's toxic
• 25:24
  ... It was like a drug that hung out for a while.
• 25:26
  That is horrible. That is horrible, but so insightful.
• 25:30
  And how many of us do that, right?
• 25:32
  Oh.
• 25:34
  Yeah, and then I even try to justify it in myself as it's work,
• 25:38
  because I know my partner, if the nurses don't reach me, they're reaching
• 25:42
  him, and I know they reach me first
• 25:45
  just by the order of... I'm sure how they typically
• 25:49
  default.
• 25:50
  Mm-hmm.
• 25:50
  So, I feel guilt-
• 25:53
  Mm-hmm
• 25:54
  ... and like a bad partner if I don't catch it
• 25:57
  first. So I'm like, "Oh, no, it's going to affect this person." But then that
• 26:01
  person's also a team player and worst case scenario, they're going to the ER.
• 26:06
  True, and you don't want that. No one wants that.
• 26:08
  No.
• 26:08
  But-
• 26:09
  Yeah
• 26:09
  ... at the same time, responsibility, yes, that's part of we
• 26:14
  learn to live with that because-
• 26:15
  Yeah
• 26:16
  ... we are there to help people. But,
• 26:18
  at the same time, I always give this analogy to my partners
• 26:22
  who also feel the same way about we want to help
• 26:26
  everyone all the time.
• 26:28
  Mm-hmm.
• 26:28
  And
• 26:31
  we have to learn to balance.
• 26:32
  Yeah.
• 26:32
  All of us are guilty of that because even in the plane, they tell you to wear
• 26:36
  your mask first before putting on the person next to you.
• 26:39
  So if I am
• 26:40
  awake, alive, and healthy, I'll be able to help that many more people.
• 26:44
  It is so true. I need to always circle back to that.
• 26:48
  Right.
• 26:49
  Yeah. So with the travel back and forth, and
• 26:53
  if I remained in a state of low
• 26:56
  HRV, which is not good-
• 26:58
  Mm-hmm
• 26:58
  ... that means higher body stress, that means higher heart rates-
• 27:02
  Mm-hmm
• 27:02
  ... and probably higher diastolic.
• 27:06
  Mm-hmm.
• 27:07
  So long term, what would that look like? High blood pressure.
• 27:11
  That would have impact.
• 27:13
  Yeah, the direct correlation data,
• 27:16
  I don't think there is a ton of it, but it does tell
• 27:20
  you that your sleep is not very restful.
• 27:22
  Mm-hmm.
• 27:23
  It does tell you you're not getting into deeper sleep.
• 27:25
  How much deep sleep do you get?
• 27:29
  Okay. So right now it's not good. Probably two hours.
• 27:32
  Two hours is not bad, but two hours of deep sleep and give or take two hours of
• 27:36
  REM.
• 27:37
  Yes, and then the rest is light sleep.
• 27:38
  Yeah, that's reasonable. That's kind of within ballpark if you sleep seven hours-
• 27:42
  Yeah
• 27:42
  ... you're going to get about 20% and then another 20% of REM, 20,
• 27:46
  25% of REM on a good day.
• 27:48
  Okay.
• 27:48
  So that's good. Four hours of restorative sleep is actually not
• 27:51
  bad. Then in that phase, so this is
• 27:55
  like we figured out, okay, how long-
• 27:58
  Mm-hmm
• 27:58
  ... but how deep do you go on that?
• 28:00
  Yes.
• 28:00
  So that's what HRV and resting heart rate will tell you how well you
• 28:04
  recover on that.
• 28:05
  Okay.
• 28:05
  When you go deep sleep, how
• 28:08
  good of a rest you're getting.
• 28:09
  Yes.
• 28:10
  So-
• 28:10
  On average
• 28:11
  ... HRV is not a comparison between you and I.
• 28:13
  HRV is a comparison between you and you. You will see your trend.
• 28:17
  Oh, my worst enemy and opponent.
• 28:21
  Exactly. So you want to better yourself-
• 28:24
  Yeah
• 28:24
  ... not someone else.
• 28:26
  Yes.
• 28:26
  So a lot of times people ask me, "What's a good HRV?"
• 28:29
  Mm-hmm.
• 28:29
  Okay, I can give you a statistical ballpark number that doesn't make
• 28:33
  a difference to you today because-
• 28:35
  Right
• 28:35
  ... we are on a path here.
• 28:37
  Yes.
• 28:37
  So
• 28:39
  now you're here. Let's see how we can make it better.
• 28:43
  Yes. And I know for a fact, my HRV is typically much higher.
• 28:46
  Mm-hmm.
• 28:47
  So this is
• 28:49
  not my norm.
• 28:50
  In short periods, we can all take them, right?
• 28:52
  Yeah.
• 28:52
  We burn a little brighter that day, and that's it.
• 28:56
  But if nothing changed, it's not good.
• 28:59
  Yes. So if nothing changed, mean you will need to prioritize your health, right?
• 29:03
  Yes.
• 29:04
  And will that be-
• 29:05
  Yeah
• 29:05
  ... whichever way we do it with a wind-down routine, and a lot of it is simple
• 29:09
  fixes, actually.
• 29:10
  Yeah.
• 29:12
  I agree.
• 29:14
  Well,
• 29:15
  I would like to pull from the bowl of random questions-
• 29:19
  Let's do it
• 29:19
  ... if you're okay with it.
• 29:25
  Okay. This is just more of a social
• 29:29
  thing, a social text style.
• 29:32
  Mm-hmm.
• 29:33
  If somebody texts you, "Hey"-
• 29:35
  Mm-hmm
• 29:36
  ... or, "How are you?"
• 29:38
  Mm-hmm.
• 29:38
  Nothing else. What do you think?
• 29:41
  It's weird.
• 29:45
  Right?
• 29:45
  I am very used to the point text.
• 29:48
  Yes.
• 29:48
  Say, "Okay, tell me what you
• 29:51
  need." If someone haven't spoken to you in ages, okay, and someone
• 29:54
  texts me, yeah, I get that. We haven't spoken-
• 29:57
  Do you say, "Hey," back?
• 29:59
  I will just say, "I'm good. How are you?" And I would want to know, okay,
• 30:03
  is it just casual or are we want... And it depends.
• 30:06
  If someone is your friend, yes, that's different.
• 30:08
  Or if it's a person you don't talk to often, of
• 30:12
  course, it comes different.
• 30:13
  For me, this falls in the pet peeve category. It's probably why I wrote it.
• 30:19
  I get it.
• 30:20
  Yeah. I think, at least in my experience, it's followed by the
• 30:24
  ask.
• 30:25
  Yes.
• 30:26
  It's like, "What do you want? Give me a bottom line."
• 30:28
  Exactly. Tell me, and again, it's contextual.
• 30:32
  It's who is texting is the key also, right?
• 30:34
  Yeah. What if it's your mom?
• 30:37
  Well,
• 30:38
  then I think it means a little different.
• 30:40
  She might actually just be wanting to know if I'm okay, right?
• 30:46
  Yeah. That's fair. You're just, "I'm fine, Mom.
• 30:48
  What about you?"
• 30:51
  Yes.
• 30:51
  Okay.
• 30:53
  Does it affect you
• 30:55
  if you are going to sleep and the
• 30:58
  pillowcase and the
• 31:02
  sheets are not completely fresh and ready and tucked from a made
• 31:06
  bed?
• 31:07
  I think I'm 50-50 on that.
• 31:09
  Does it bother you?
• 31:09
  I like it, I prefer it-
• 31:11
  Yeah
• 31:12
  ... but I'll just make do and fix it the best I can, then do
• 31:16
  it.
• 31:18
  Some people spiral with that.
• 31:20
  Yeah, I guess my OCD is just not at that level yet.
• 31:24
  It's getting there.
• 31:27
  I love it.
• 31:30
  Let's see.
• 31:33
  Are you the personality type to talk about it if
• 31:37
  something is upsetting you, or just let it go and start fresh the next
• 31:41
  day?
• 31:42
  Whether or not it happens again, what is your style?
• 31:46
  I generally prefer to talk-
• 31:50
  Yeah
• 31:50
  ... about it. And so there is a very interesting
• 31:54
  TED Talk that I heard a while ago,
• 31:58
  and primarily what he divided into is every
• 32:02
  conversation
• 32:04
  has a primary
• 32:07
  sort of flavor to it, so to speak. Okay.
• 32:10
  You want to be heard,
• 32:12
  in which case you can converse that way.
• 32:15
  When two people are not on the same wavelength, that's when you don't understand
• 32:19
  each other, and that's when conversations spiral, right?
• 32:22
  Yeah.
• 32:22
  So
• 32:24
  when I'm conversing with you,
• 32:26
  I come to you with a problem, and that I try to apply in my work also.
• 32:31
  If someone comes to me with a problem, okay, you want to be heard, which means
• 32:34
  you're just frustrated, and it'll be good if I hear it out and see if
• 32:38
  I can do something about it.
• 32:40
  Mm-hmm.
• 32:40
  You want to be helped. If it's a problem-specific thing,
• 32:45
  okay, give me your problem, and I'll do my best to solve it.
• 32:48
  Like they're actually looking for a response, like weigh in.
• 32:51
  Problem, solution.
• 32:52
  Yeah.
• 32:53
  Or I'm just telling you this, I know it may not be solved, but I'm telling you
• 32:56
  this. Or number three, you want to be hugged.
• 33:00
  If it's just an emotional conversation with someone you like-
• 33:02
  Oh, that's true
• 33:03
  ... and a friend. And that's where I think
• 33:07
  it goes sideways. Someone could be just coming, it could be a friend or a family
• 33:10
  member coming for just a conversation of hugging,
• 33:14
  basically. They just want-
• 33:16
  Yeah, like, "Hold me. Life was hard."
• 33:18
  Exactly. And then if I approach it in a helped
• 33:22
  way, it doesn't go very well.
• 33:24
  So sometimes I'm like, you know what?
• 33:26
  Why can't we just
• 33:29
  put a header on every conversation? This is a heard conversation.
• 33:31
  This is a helped conversation.
• 33:35
  That's so funny. I know if we could just start there, that would also help
• 33:39
  me.
• 33:39
  Exactly.
• 33:40
  Like you don't need anything from me. You just want me to listen.
• 33:43
  You're going to talk at me.
• 33:44
  Just tell me.
• 33:44
  I'm fine with that.
• 33:45
  Exactly. Give me the header in the beginning, and I'll comply.
• 33:51
  Gosh, that would help in relationships, too.
• 33:53
  Yeah.
• 33:54
  That really would... That wavelength, it's like this.
• 33:57
  Exactly. Sometimes you're just two trains crossing each other because you're both
• 34:01
  on different tracks.
• 34:02
  Yeah. Are you married?
• 34:04
  I am.
• 34:04
  Yeah.
• 34:05
  Three kids.
• 34:07
  I forgot you had three kids.
• 34:09
  Yeah.
• 34:09
  Wow. How old are they?
• 34:11
  So the boys are going to be in eighth grade now.
• 34:15
  Okay.
• 34:16
  So.
• 34:17
  Man.
• 34:18
  And my daughter, she is going to be a senior.
• 34:20
  Okay. Wow. Anything fun with the
• 34:24
  talks and being a parent and a cardiologist,
• 34:28
  essentially you do it all. Anything fun come
• 34:31
  up?
• 34:33
  So,
• 34:37
  like you learn to be a cardiologist.
• 34:39
  Mm-hmm.
• 34:40
  I think there is a learning to be a parent as well.
• 34:44
  And there is no manual on that.
• 34:47
  Yeah.
• 34:47
  Okay.
• 34:47
  I can see that. It looks hard.
• 34:49
  Looks hard, right?
• 34:50
  Yeah. It's wild.
• 34:51
  So to me, that's like the hardest job.
• 34:54
  Kids don't come with instruction manuals.
• 34:56
  It'd be nice if they also came with headers and manuals.
• 34:59
  And they are all different, right?
• 35:01
  Oh my gosh.
• 35:04
  And it's a lot of fun. But
• 35:08
  I realize in my early career, of course, there is cardiology, which
• 35:12
  is a busy trade to begin with. Then business.
• 35:17
  Putting it all together,
• 35:19
  the thing that initially takes the short shift for most of us, I would feel,
• 35:23
  in medicine, is the family.
• 35:26
  And
• 35:28
  that's the part that
• 35:31
  is like, okay, initially you do it.
• 35:35
  Mm-hmm.
• 35:37
  And
• 35:39
  if you have a supportive partner, that works, right?
• 35:41
  Yes.
• 35:42
  On the same wavelength.
• 35:44
  Exactly,
• 35:45
  and fortunate to have that. But then-
• 35:49
  Lovely
• 35:49
  ... as I learned more over time, the balancing, you
• 35:53
  learn a little more balancing.
• 35:56
  And
• 35:58
  then, I'm in my 40s, so what we call the 40s
• 36:02
  squeeze.
• 36:03
  So
• 36:05
  Your professional career is at a different wavelength.
• 36:08
  Uh-huh.
• 36:08
  Your personal life, kids are growing up.
• 36:10
  You want to spend time with them. You want to actually be a part of that life too.
• 36:15
  Yeah.
• 36:15
  Because their life is changing in a different way too.
• 36:19
  So it's how do you balance everything?
• 36:22
  Oof.
• 36:22
  That's the key.
• 36:23
  I've never heard that term. I think I'm in the 40 squeeze.
• 36:28
  Could be.
• 36:29
  You see this light bulb above my head?
• 36:35
  Okay.
• 36:36
  Well, asking for a friend, is
• 36:39
  it possible?
• 36:40
  Very much so, I would say.
• 36:42
  There's a lot of living you can do in one year, six months, three months.
• 36:47
  There is. Again,
• 36:50
  like anything, so
• 36:53
  if you get in that state where you're actually
• 36:56
  in that moment... So,
• 36:58
  have you read that book, "The Power of Now?"
• 37:01
  No, but I need to.
• 37:02
  Eckhart Tolle,
• 37:05
  I think if I had to give top 10 books in my life, that would be definitely one of
• 37:08
  them.
• 37:08
  Oh my gosh, I'm going to add it to my 40 squeeze.
• 37:13
  It's now on the list.
• 37:15
  Perfect. So most of
• 37:19
  our problems, and I'm guilty of that like anyone else, too.
• 37:22
  Yeah.
• 37:22
  Okay? We worry about, okay, what's the business going to be tomorrow?
• 37:26
  What's happening tomorrow? Oh, did I do this for this person?
• 37:29
  Did I take care of this patient? Did I do this?
• 37:30
  Yeah.
• 37:31
  It always goes on, that ticker
• 37:34
  tape keeps going in your brain, right?
• 37:36
  To-do list. Real.
• 37:37
  Exactly.
• 37:38
  Mm-hmm.
• 37:38
  But whether I look into the Eastern
• 37:42
  wisdom, which I practice yoga, so I've read quite a bit
• 37:46
  into that,
• 37:49
  or
• 37:50
  even
• 37:51
  some of the modern spiritualism, so to speak,
• 37:55
  the solution to everything is in this moment,
• 37:59
  because frankly, I love that line in
• 38:02
  that "Power of Now" he'll say,
• 38:04
  "Do you really have a problem in this moment?" And if you think of it-
• 38:08
  No
• 38:08
  ... the problem is really never in this moment.
• 38:12
  It's not.
• 38:12
  It's always in the past or in the future.
• 38:14
  It never is in this moment.
• 38:16
  True. Yeah.
• 38:18
  So I-
• 38:18
  Right now, everything is fine
• 38:19
  ... exactly. So I try to kind of remind myself of that a lot of times, and there
• 38:23
  are times we get caught in the emotion and keep moving.
• 38:26
  Mm-hmm.
• 38:27
  But, most of our anger,
• 38:31
  rage, or frustration, they come from, as they call, place of
• 38:34
  unconsciousness.
• 38:35
  Mm-hmm.
• 38:36
  Learned that in yoga also. If you're
• 38:40
  conscious, I don't think you'll manufacture misery for yourself.
• 38:45
  Or people around you.
• 38:45
  I hope not. If I'm doing that to me, I really wish I would stop.
• 38:49
  But we do that a lot of times unconsciously, though, right?
• 38:52
  Oh my gosh. Yeah. It's true. Yeah.
• 38:55
  So the answer is to just stop doing that.
• 39:00
  Easy.
• 39:05
  It's like keep it simple, stupid, right?
• 39:08
  Just the simplest things.
• 39:10
  It's the hardest thing, actually,
• 39:13
  to be present.
• 39:14
  Yeah.
• 39:15
  Most of us, I think that's a disease with all of us.
• 39:18
  Totally is.
• 39:18
  Not being present. Most of us,
• 39:21
  and it was bad enough, and then came the smartphones.
• 39:25
  Mm.
• 39:25
  And it got worse.
• 39:26
  Yeah. Definitely, yes.
• 39:29
  Now,
• 39:31
  the ones who were actually still in the present are even now in the smartphone.
• 39:35
  So...
• 39:36
  It's overstimulation. It's constant.
• 39:39
  Yes.
• 39:39
  Constant things.
• 39:40
  Exactly. So your attention and awareness.
• 39:43
  So in one of my interviews, I talked to Dandapani
• 39:47
  about awareness and focus, and that is
• 39:50
  one of the main issues, our awareness actually is just all over
• 39:54
  the place.
• 39:55
  He was funny.
• 39:56
  He was really good, huh?
• 39:59
  Yeah. Yeah, there were a lot of good one-liners that I feel I
• 40:03
  definitely apply and recycle.
• 40:06
  Very nice.
• 40:07
  Yeah, I give him credit. I can't say his name, though.
• 40:09
  Dandapani?
• 40:10
  Dandapani.
• 40:11
  Yes.
• 40:11
  Okay, that helps.
• 40:12
  Yes.
• 40:12
  I had to practice it.
• 40:15
  Yeah, just imagining no problems exist
• 40:19
  in the now.
• 40:20
  It starts in your mind.
• 40:22
  Yes.
• 40:22
  It's been the theme of today. Really, it's come up so much, but why is it
• 40:26
  so freaking hard to apply that, the actual
• 40:30
  applying of it?
• 40:31
  Because we need to consciously remember it in that moment.
• 40:33
  Is there any tools that we can use?
• 40:36
  He had a moon picture.
• 40:39
  Mm-hmm.
• 40:40
  So basically, what he taught was to, your
• 40:45
  awareness is like an orb of light. Move it to that area
• 40:49
  consciously.
• 40:50
  Yes. In front of you.
• 40:51
  Yes.
• 40:51
  So you're looking at-- Like I'm looking at you, you're in my awareness and
• 40:54
  consciousness.
• 40:54
  Exactly. Your awareness is right now here.
• 40:56
  Yes.
• 40:57
  In this room.
• 40:58
  But I could drift off in conversation.
• 41:00
  Yes.
• 41:01
  But-
• 41:01
  You just have to learn to bring it back. That's called being distracted, right?
• 41:06
  Were you there whenever I talked to your staff?
• 41:10
  As you're in the team-building meeting?
• 41:12
  I wasn't there that day, actually. I was out of town.
• 41:15
  But I heard it was good.
• 41:16
  Can I tell you? I don't know if anybody mentioned to you, but
• 41:20
  everybody was facing me, and so I'm facing, I could see
• 41:24
  outside.
• 41:25
  And I was just in the middle of talking, and then I see this little
• 41:29
  squirrel
• 41:31
  that is like, he's looking in the glass, and I'm like, "Oh my gosh, you guys, this
• 41:35
  squirrel."
• 41:38
  I went from hormones to, "Look at his ratty tail."
• 41:42
  So off topic. That is distraction, right?
• 41:45
  Well, that is-
• 41:46
  If people joke about it
• 41:46
  ... but then you found something cool and you went with it, and that's
• 41:50
  okay.
• 41:52
  It was definitely real.
• 41:54
  Oh, gosh. And I find that the cadence that people speak,
• 41:59
  that matters, too.
• 42:00
  Mm-hmm.
• 42:00
  Some people, and the rise and fall, tonation
• 42:04
  matters.
• 42:04
  Mm-hmm.
• 42:05
  Some people have a slow, it's so slow,
• 42:09
  I feel like I took five naps.
• 42:12
  Yeah, I know I'm guilty of that, too.
• 42:13
  No, yours is not too slow.
• 42:15
  No.
• 42:15
  Yours is-
• 42:16
  When I'm listening,
• 42:18
  I have a tendency, I zone out sometimes, and then I catch
• 42:22
  myself doing that. "Okay,
• 42:24
  stay here. Stay here."
• 42:26
  It definitely impacts my listening skills.
• 42:29
  If somebody talks too slow, I'm like, "What is the rest of the sentence?
• 42:32
  I just took a nap, and now I woke up, and then what was the rest of it?"
• 42:37
  You guys are slow talkers. Remember, people are probably taking naps and checking
• 42:40
  out.
• 42:41
  Or maybe not. Maybe we are just not good listeners. That happens.
• 42:44
  I like that you identified with that.
• 42:47
  It wasn't a shout-out to you or calling you out.
• 42:52
  Do you think you talk too slow?
• 42:54
  I don't think so. But again-
• 42:56
  I don't think so
• 42:56
  ... I won't know it. Someone else will.
• 43:00
  Well, your pattern of speaking is not too slow for me.
• 43:03
  That works, then.
• 43:04
  Yes. If it were maybe a few notches more,
• 43:07
  then
• 43:09
  maybe... I guess you'll see if I forget the question.
• 43:12
  Exactly. Then the podcast episode will be two hours long.
• 43:16
  Well, thank you so much for taking time and coming on. I appreciate it.
• 43:20
  And that's a wrap. Thank you, guys.
• 43:21
  Thanks for having me.