Latest / Come Together with Ephraim Herschmann / Health Series 6 Dr Golnosh Sharafsaleh / Dementia & Brain Care / Aging & Longevity / Beating Tragedy

Transcript

Health Series 6 Dr Golnosh Sharafsaleh / Dementia & Brain Care / Aging & Longevity / Beating Tragedy · Come Together with Ephraim Herschmann

• 0:01
  Welcome to another episode of Come Together
• 0:15
  We're Live. Welcome to another episode with
• 0:17
  Doctor Sharif Saleh. Thank you so much for coming.
• 0:20
  Thanks so much for making this happen.
• 0:21
  I'm really excited to talk to you.
• 0:23
  Thanks Yuvram. And you said my name perfectly,
• 0:26
  so happy to be here. Yes, I kind of bailed them the
• 0:29
  first name Ghanoush. Ghanoush.
• 0:33
  Ghanoush close. OK, Where's it?
• 0:35
  Where's it? Where's it?
• 0:36
  Where? Where's where are you from?
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  Where's your family from? It's like a traditional Persian
• 0:42
  name, you know, like Iran where all the conflict is going on
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  now, but like a Persian kind of Zoroastrian, I guess.
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  I don't know. So.
• 0:53
  Cool. And tomorrow's like the new
• 0:55
  year, I guess, so we're going to eat fish, so that would be nice.
• 0:58
  Yeah, yeah. What's What's the celebration
• 1:01
  usually like for New Year? So gosh, I'm so ignorant.
• 1:07
  Well, let's see. So it's kind of I think
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  originated from like this Zoroastrian holiday where it's
• 1:17
  spring. And so it's the beginning of
• 1:19
  like new comings and new beginnings.
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  And you set up this table which is sort of like a Christmas
• 1:24
  tree, but it's not a Christmas tree.
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  And there are different symbols on it.
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  Like there's a mirror on there. And there's, there's greenery
• 1:31
  which represents like, is that fertility or is there's like
• 1:35
  coins, like gold coins on there, which represent like fortune and
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  various things. And, and so my mom's very good
• 1:43
  at setting this up. And then my sister and I will go
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  to her house with our kids and family.
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  And then my dad cooks because he's an excellent cook.
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  And that's as far as I celebrate, you know?
• 1:56
  We. Celebrate like all the holidays.
• 1:58
  It's kind of interesting because you know my like Christmas and
• 2:03
  then my sisters like Russian Jewish husband.
• 2:07
  So we have like that whole thing.
• 2:09
  We just celebrate all the holidays.
• 2:11
  It's kind of fun that way. But yeah, tomorrow happens to be
• 2:14
  this one. It's nice.
• 2:16
  It's a yeah. I think it's cool.
• 2:19
  It's very cool. Yeah, we like it.
• 2:21
  We like it, you know so. So I'm so excited to talk to you
• 2:27
  about so many different things and you've got lots of, you've
• 2:30
  got a lot of fun things to say about a lot of different things.
• 2:32
  So I'm excited to, to dive into the to to this with you And what
• 2:37
  kind of caught my eye originally when I found your profile on pod
• 2:39
  match was a combination of geriatric care, dementia and and
• 2:46
  then lifestyle health. And I thought that was really
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  great because one thing that has been consistent, I think over
• 2:53
  the last few years, a lot of people have been talking about
• 2:55
  how lifestyle help less rather health helps you age more
• 3:00
  graciously and more, you know, and a little bit more
• 3:02
  forgivingly, I would say. And it's something actually, I
• 3:05
  had been arguing with my dad and bickering with him about my mom
• 3:08
  takes excellent care of herself. My dad is a little bit less so.
• 3:13
  And so he's not thriving and. He's not thriving in his old
• 3:18
  age, is that no? No, no I don't.
• 3:21
  Not physically. Not physically, not physically,
• 3:24
  he's thrived more physically, he's been, he's been in better
• 3:27
  shape. But to be fair, he's almost 60.
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  And you know, when you're, I mean, when you haven't exercised
• 3:32
  in a little while, it's hard to snap yourself into a new habit,
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  I think. But that was really, you know,
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  so that really caught my attention.
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  And then and then when you and I spoke, we talked about some
• 3:40
  heavier things that I think that we should talk about too.
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  And in your, in your book and, and I kind of want to just, you
• 3:47
  know, I'm, I'm more interested in learning from you and hear
• 3:49
  what you got to say. So I'll kind of just direct your
• 3:52
  thoughts and just I would love to dive into it.
• 3:55
  Sounds great. OK, ask your first question.
• 3:59
  So let's hear about. I'm really curious about the
• 4:04
  early signs of, of, of dementia slash Alzheimer's and ways to
• 4:09
  recognize that in people and ways to recognize that in
• 4:12
  family. And I think it's and, and
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  Alzheimer's and dementia in general, I believe is, is much
• 4:17
  more common now than it was twenty, 30-40 years ago.
• 4:20
  And you know, and if there's if there's anything that we kind of
• 4:24
  do to be preventative about it. Oh yeah, there are things.
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  So here's the thing #1 risk factor for Alzheimer's is age.
• 4:32
  So there you go. And we're living longer.
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  And I joke about this with my patients, but in reality, you
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  know, if we think about evolution, like nature tries to
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  kill us off as soon as we've like procreated and we've raised
• 4:45
  our young. But we, if we think about our,
• 4:48
  our lifespan, we think of it in like childhood, adulthood, and
• 4:53
  then our elder hood. And so that last third of our
• 4:56
  life shouldn't be where we're sick.
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  You know it. In our childhood, we're just
• 5:01
  learning to figure life out. In our adulthood, we're like
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  taking care of everybody, trying to basically just survive life.
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  And then in our elderhood, this should be a time of reflection.
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  It should be a time where we have a good health span.
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  We can see the world embrace like the things we didn't get to
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  do because of all the things we had to do in our adulthood.
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  And, and unfortunately, one of the things that happens is
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  people develop chronic disease, like they have multi like more
• 5:29
  comorbidities and they end up losing their independence.
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  And so I think as a geriatrician, so a Doctor Who,
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  you know, pediatrician, geriatrician is a Doctor Who
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  practices aging. My focus is always like, let's
• 5:45
  keep people independent and let's keep them cognitively
• 5:48
  sharp because I I truly believe that even if physiologically we
• 5:54
  develop deficits. Hey everyone real quick if
• 5:57
  you're enjoying the show, click subscribe and rate the show. 5
• 6:00
  stars helps a ton. Thanks so much.
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  In older age, if we have our mental health then that will
• 6:07
  still keep us independent. We can still narrate our life
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  versus if we don't have that, you know, the people who have
• 6:15
  dementia, these are the individuals who end up in
• 6:17
  nursing facilities. These are the individuals who
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  end up being taken care of. And maybe their their goals and
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  their wishes are not honored just because of like their care
• 6:27
  needs. And so that is constantly what I
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  think about. And one of the emerging areas of
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  medicine is to really try to detect signs early, you know,
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  dementia and signs of cognitive loss.
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  They start decades earlier than before we actually have
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  cognitive disease. So around 10 years ago in my
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  career, when I was first really treating people with dementia,
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  family members would bring someone in who had some memory
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  issues, but by then their disease was like in a moderate
• 7:02
  stage, so there wasn't much to do.
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  Unfortunately. Now people are coming to me
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  themselves like earlier on. And they're like, hey, I'm
• 7:10
  noticing that I'm having trouble with words.
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  I'm noticing that it's taking me longer to learn things.
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  I'm noticing that I'm having trouble with names.
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  And my first question is, always has this always been the case?
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  Because if you're someone who's been bad with names forever, OK,
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  that's fine. Like, hey, buddy, this has been
• 7:27
  your norm. That's not cognitive deficit.
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  But if you are like, I was great with names and now I'm
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  forgetting names, there's an issue there.
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  Or if I walk into a room and I can't remember why I walked in
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  there and this is not my baseline, then there's a problem
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  here. And we need to think about it
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  and we need to screen. And so this is where I I start
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  screening people. And some of our common
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  standardized tests are only standardized to like an 11th
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  grade education. So then you have people who are
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  who have a higher education than that and they can compensate for
• 8:01
  those and their primary care doc might just say, oh, you're fine.
• 8:04
  There's nothing wrong with you when something is brewing.
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  So really keeping track of those minute changes that occur that
• 8:11
  are not your baseline, I think that's where something needs to
• 8:17
  like happen. And, and one of the things you
• 8:19
  can do is if you don't have access to a geriatrician or a
• 8:22
  neurologist, you know, your primary care doc can refer you
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  to a cognitive psychologist. They can do a battery of
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  neurocognitive tests and, and try to weed out like, Hey, what
• 8:33
  areas of cognition do you have deficits in?
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  And, and do we need to do something about it?
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  The cool thing is you can actually work on your brain and
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  different areas of cognition. I mean, I often send people to
• 8:45
  cognitive rehab so that they can work on areas that they're
• 8:48
  struggling in. They get better You didn't think
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  of. That what's what's cognitive
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  rehab look like or what's your date in that life?
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  You know, just like people get a prescription for physical
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  therapy, like let's say you get a shoulder replacement or
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  surgery or hips or knees, and you go to physical therapy and
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  they lay out a plan for you. We're going to do this and this
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  and this for this length of time, and these are your goals.
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  Cognitive rehab is generally done by speech therapists.
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  They have additional training and they will set up a goal.
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  So they have initial cognitive assessments and then they're
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  going to say we're going to improve on working memory and on
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  delayed memory. And we're going to work on
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  executive function and orientation and task management.
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  And, and they will work with you and you improve and you meet
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  your goals and then you you continue with those things.
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  So, you know, there's, there's opportunity there.
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  And I think people don't even know about it.
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  I mean, when I have patients in my office who come in for a
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  cognitive assessment and I tell them, well, I think we should
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  send you to cognitive rehab. Like they asked me the same
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  point. Like, what is that?
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  I've never heard of it. Not very many people who know it
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  exists now. It's a shame, by the way, and
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  there's a lot of different types of cool rehabs that that that
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  exist that, you know, I think if not for a little bit of stigma
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  that we could really take a lot of advantage of.
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  I just did a episode yesterday with, with, with the neurologist
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  and physiologist who part of what she researches is music in
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  the brain and using music to, you know, for, to, to help with,
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  you know, with different potential diseases.
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  As far as learning or as far as even I, I've read other accounts
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  of, you know, playing music having a huge impact on
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  neurodegenerative diseases like Ms. or Parkinson's or Tourette's
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  or, you know, I mean, a whole, there's a whole library of, of
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  potential neurodegenerative disord disorders that are really
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  that, that could be helped with music.
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  And how many people think to just play music as a, you know,
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  when you're diagnosed with miss or Parkinson's, God forbid, you
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  know? Right.
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  And, and even like when we think about dementia and music
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  therapy, sometimes what's fascinating is I'll have a
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  patient who, you know, forgets everything, but you put them in
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  front of their piano and they used to play piano forever and
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  they will just like start playing.
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  And for a moment you have that person back, you know, and it's,
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  it's pretty fascinating. It's.
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  It's, it's amazing you say that I date.
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  So I dated a girl, a girl for a bit, and her mother, while we're
• 11:23
  going out, had this disease. And I think it was very, very
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  hesitantly diagnosed as Parkinson's because some of the
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  symptoms matched up with Parkinson's, the freezing up.
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  But there's certain things that didn't exist.
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  She didn't really have the tremors quite in the same way as
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  I've seen a lot of other Parkinson patients.
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  They weren't sure really. But one thing that did happen
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  was she did play piano and the accordion growing up.
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  And so while we're going, yeah, I'd ever seen, if we'd ever go
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  over and anyone is playing music or she decided to ever like pick
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  up something, you could see the you could see that like her
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  whole body would loosen up or we'd even play music and she
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  would start dancing and she could dance even those moments
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  moments ago really frozen up. It's crazy.
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  It's incredible. It's incredible.
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  And sometimes like in, in terms of, I mean, you had this a whole
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  episode, but this like neurodegenerative disorders,
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  like with lasers and music, like how different parts of the brain
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  will activate And then you, you stop that, that freezing and all
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  of a sudden you have a fluid movement.
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  It's, it's, you know, it's amazing because I'm like, what
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  is our brain capable of? And even in the midst of
• 12:36
  disease, how can we, you know, retrain our brain And we're,
• 12:41
  we're not using every part of our brain that we need to use.
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  And, you know, this whole concept of neuroplasticity is
• 12:48
  it's a new emerging concept, like when someone has a stroke
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  or when someone has some type of an insult to their brain, How
• 12:55
  can we learn to rewire and rehone and learn the skills that
• 12:58
  we had and learn to move the way we used to?
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  So, you know, I think neurology is just a fascinating emerging
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  field, especially as far as, you know, dementia goes.
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  I think that's where I'm so interested because I'm like, if
• 13:13
  I can preserve the brain and preserve independence, that's
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  all I want to do. Especially we, we have dementia
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  in my family. So I'm like always like, you
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  know, I, I have a personal investment in this.
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  I tell patients like I am invested in you, you're my
• 13:28
  patient, I care about you, but I'm also personally invested in
• 13:30
  this. I want to figure out any new
• 13:32
  emerging therapies out there, and I want to be able to
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  implement them if they're appropriate for you.
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  Yeah, for sure. One of the one of the really
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  incredible, you know, I, I've, I've spoken to this a lot of my
• 13:46
  podcast in different applications all across
• 13:48
  different like worlds. But one thing that everyone
• 13:51
  talks about recently is the fact that institutional trust has
• 13:55
  pretty much collapsed since COVID.
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  And there's a million different reasons why and a different
• 13:59
  million applications. And, you know, whatever it may
• 14:02
  be one way or the other, one of the, one of the benefits that I
• 14:05
  really strongly believe in is that it's kind of encourages
• 14:09
  more open mindedness and more play and more figuring new
• 14:13
  things out that like we were so set in our ways.
• 14:16
  You know, it felt like forever, even though I mean, again, in
• 14:18
  the, in the, in the concept of history, I mean, talk about
• 14:21
  being from, you know, Persian and like, Hey, I'm American 250
• 14:24
  freaking years old. That's it.
• 14:26
  You know, I mean, like, you know, we, we figured everything
• 14:28
  out. And hey, there's a lot of,
• 14:30
  there's a lot of wisdom out there.
• 14:32
  There's a lot to learn and there's a lot to figure out.
• 14:34
  And sometimes it's good for institutions, institutional
• 14:37
  trust to break just for people to kind of feel like, like, hey,
• 14:41
  you know, what if I don't know what the doctor at Harvard said,
• 14:44
  then like, let me try this music therapy.
• 14:45
  Oh, my God, it works. Like, that's incredible.
• 14:47
  Like, you know, like, OK, so then someone in Harvard will
• 14:49
  pick up their being, get into it.
• 14:51
  So I think that's really, it's I, I think that we're at
• 14:53
  exciting time. I'm really excited about what we
• 14:55
  could be accomplishing. Yeah.
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  And you're totally right as far as I think just opening our mind
• 15:02
  to not just practicing medicine or living our life based on a
• 15:06
  set of beliefs or set of standards when it comes to even,
• 15:10
  you know, when it comes to health.
• 15:13
  I have a patient I recently, this is a funny story.
• 15:16
  Just this past week. I, I somebody I recommended they
• 15:19
  have acupuncture and they're like send that more of a placebo
• 15:23
  thing. As for the thing that they had.
• 15:25
  And I like sent them a bunch of papers and this person, you
• 15:30
  know, has a background where they understand research and
• 15:34
  paper and I'm like, actually not, there is a lot of data
• 15:38
  behind it. And here I am as a medical
• 15:39
  doctor and occasionally I'll send, I'm like, you should see a
• 15:43
  chiropractor for this or let's try this supplement for this in
• 15:47
  addition to this medicine for this.
• 15:49
  And they're like, who are you? You have to kind of embrace all
• 15:53
  of it. You know, I am a medical doctor,
• 15:56
  but I think like if I just stuck to these standards, then I'm not
• 16:02
  going to give my patient the entire like pot, you know, of
• 16:06
  everything that they could possibly benefit from.
• 16:09
  So I am, I do take a very holistic approach when it comes
• 16:14
  to cognitive health, not only as far as thinking, OK, let's
• 16:20
  detect cognitive impairment, but then let's talk about what are
• 16:23
  these, what are these other factors that could be causing
• 16:27
  progression of your cognitive impairment?
• 16:30
  For instance, like diet, you know, I work with people on
• 16:32
  their diet and really focus on like a diet that like kind of a
• 16:37
  mind diet, sort of a keto flex diet where that their brain is
• 16:43
  also benefiting from that and they're not having like glycemic
• 16:47
  index issues. I focus on blood pressure
• 16:49
  control, sleep apnea, exercise. I mean, exercise is like a huge
• 16:53
  part of what I do with my patients.
• 16:55
  And then in my office I use the scale called the in body scale.
• 16:59
  I don't know if have you heard of it tell.
• 17:02
  You about it? Talk about it.
• 17:04
  So I don't even want to talk about it because I'm a little
• 17:07
  bit like hurt. But like Peter Attia, you know,
• 17:10
  he was all over the Epstein files.
• 17:12
  But his book was good. Outlive was a really good book,
• 17:14
  you know, but he talks. About, by the way, I.
• 17:18
  Mean, I was like, I was so sad. I read the book three times and
• 17:23
  I like preached about it and then all of a sudden my partner
• 17:26
  was like, did you hear what happened?
• 17:30
  Crap is that every man? Is that every single man?
• 17:33
  But anyways, it's still a very good book, you know, and but the
• 17:37
  the in body scale doesn't just look at your weight or your BMI.
• 17:40
  It actually looks at your skeletal muscle mass.
• 17:43
  It looks at your percent body fat.
• 17:45
  And for my patients, again, as you're aging, I don't want
• 17:47
  people to get frail. So I'm constantly like, all
• 17:50
  right, are you doing the exercises we're talking about?
• 17:53
  Are you building muscle and all of those things?
• 17:56
  You know, managing the body holistically is protecting the
• 18:01
  brain essentially. So I do that, you know.
• 18:04
  It's awesome. It's I actually so it's funny
• 18:06
  you actually bring that up because I got AI sell medical
• 18:09
  equipment on the side. I actually not in the side as a
• 18:13
  living and, and one of the big things that have been very
• 18:16
  popular now or bone or bone density machines that people are
• 18:19
  buying for whole body composition and body fat
• 18:22
  composition. And someone calls me up in
• 18:24
  Austin, TX a couple of months ago, tells me, hey, you know, I
• 18:28
  want to buy this machine. I'm like, that's cool.
• 18:29
  And he goes, yeah, if you give me a good deal, like, you know,
• 18:30
  I'm buddies with this guy, you know, yeah, you heard of Doctor
• 18:33
  Peter Tia. And I'm like, yeah.
• 18:35
  Then I'm like he's like, yeah, you know, and we were trying to
• 18:37
  base our our health model on him and.
• 18:40
  And by the way, you know, like. I know.
• 18:45
  So that to be like a case of separating the art from the
• 18:47
  artist. They're like, you know, like.
• 18:49
  So hard. Science and the dude and like,
• 18:53
  you know, like, what do you say? What do you do about that?
• 18:56
  Oh, my sister was said that about Kanye.
• 18:59
  She's like, you got to separate the artist.
• 19:04
  I was like, all right, all right.
• 19:07
  Yeah. It's, it's still very difficult,
• 19:09
  you know, because I think as a female, a physician, and it was
• 19:12
  like, I was just so disappointed, you know, and,
• 19:17
  and, and, and my partner was like, do we burn the books
• 19:21
  because we have a little library?
• 19:23
  And she was like, but we're not book burners.
• 19:25
  Are we book burners? No, but yeah, but I do.
• 19:30
  I do think there was. Every book by every creep that
• 19:33
  was out there, then we would not have a lot of literature.
• 19:35
  Burning every book, yeah. But really the concept, you
• 19:38
  know, makes sense in that book. And I did, I think, develop a
• 19:42
  lot of my thoughts as far as and sort of I adapted a lot of
• 19:48
  things there, but it was only like in in one realm of, of
• 19:51
  mine, like health framework that I use.
• 19:53
  You know, when I, I see people in aging, I, I call it, you
• 19:57
  know, it's like, it's the art of health span.
• 19:59
  So health is this acronym where the HS like how we age and then
• 20:04
  the Ms. of a geriatrics which I think.
• 20:08
  Are for not just the geriatric population, but they are
• 20:12
  relatable to everyone, which is like, So what matters to you?
• 20:15
  Before I even treat you like I shouldn't just to all this
• 20:19
  medicine, I should understand what actually matters to you.
• 20:22
  And then what your mindset is that you know, is it a mind
• 20:25
  disease or is it like your mindset, your multimorbidity,
• 20:29
  the medical problems that you have, the interactions between
• 20:31
  them, the medications and then your mobility keeping you
• 20:34
  upright. And then the E was the is
• 20:36
  energies from a cellular level to disease specific level that
• 20:40
  are energy dependent. And that's where like Peter
• 20:42
  Atilla was talking about, you know, some of the energy
• 20:45
  dependent diseases where you think about cardiovascular
• 20:47
  disease, cognitive disorder, cancer, metabolic disease.
• 20:51
  Well, that's just like in the E. And then the A is for activity
• 20:54
  and how our bodies are like meant to be in motion and not
• 20:57
  like going to the gym, but what do we want to be able to do and
• 21:01
  our reserve and capacity. The L is the longevity piece.
• 21:04
  So then you know, those pillars of lifestyle medicine like
• 21:07
  social engagement, diet, sleep, you know, those pieces.
• 21:12
  And then the T is for transformation and how we do
• 21:15
  transform. So like, you know, these
• 21:18
  longevity people that I, I'm, I'm sort of, I think I stand
• 21:21
  outside of their realm is like, no, we are supposed to age and
• 21:25
  our life is not supposed to be forever.
• 21:28
  And so then how do we adapt to that transformation?
• 21:32
  So our adaptation to change so that we can live fully and have
• 21:36
  the best quality of life possible.
• 21:38
  And the last age is habits and something I used to always say,
• 21:43
  and everyone was like, where did you get that?
• 21:46
  I'm like, I don't know, I pulled it out of somewhere, but I used
• 21:49
  to be like, what's the reset technique?
• 21:51
  So I guess nobody like had used it before because I ended up
• 21:55
  buying the domain. It's mine.
• 21:57
  I don't do anything with it, but anyway, but it's like these
• 22:01
  incremental changes, you know, our life moves along and our
• 22:05
  habits like you walk into a room, you flip on a light,
• 22:08
  that's your automatic habit. So how do we build our small
• 22:11
  habits in into our life, kind of like Atomic Habits.
• 22:15
  That book is a fantastic book, but but then, you know, we can't
• 22:19
  maintain our habits all the time because life happens.
• 22:22
  So how do you have these like small incremental resets so that
• 22:25
  you can sort of pick up and just redefine yourself again so that
• 22:28
  you're not like giving up? You know, so I can, I kind of
• 22:31
  see health in that framework. And then that's my approach when
• 22:35
  I take care of a patient. And surprisingly, my patients
• 22:40
  are like super motivated. Like they come back and most of
• 22:44
  them are doing amazing. You know they do all the things
• 22:48
  and it works so when they do. I would, I would guess that part
• 22:52
  of the reason why they do so well is because I think that for
• 22:58
  a lot of people, if you're getting treated, you are
• 23:02
  receiving something and you expect, and your role is very
• 23:05
  passive and with a lot of lifestyle type of medicine,
• 23:09
  you're putting the person's decision making in their own
• 23:12
  hands and say, Hey, if you want to be healthy, you need to sit
• 23:17
  down and stand up three times a day.
• 23:18
  You know, if you want to be healthy, walk up and down a
• 23:22
  flight of stairs and to say, Hey, this is in your hands.
• 23:25
  I can't force you to do it. And, and you will see that
• 23:27
  you'll feel better if you do it. But like, I think that I think
• 23:30
  that when you give people license to take care of
• 23:33
  themselves and you say, hey, there's a very tangible playbook
• 23:36
  that links your movement with your cut, with your cognition,
• 23:40
  let's be on top of that. Like they'll say, hey, if that's
• 23:42
  all it takes and that's all, and then I didn't realize that, then
• 23:45
  let me keep on doing it. That's awesome, you know.
• 23:48
  Yeah, I think in, in, in some senses, though, you know, like
• 23:53
  sometimes, because I do have elders.
• 23:55
  Most of my patients are elders. I have a few like in their 40s
• 23:58
  and 50s who came to me because I took care of their parents and
• 24:01
  they're like, they're doing better than me.
• 24:03
  Will you take me on as a patient Now?
• 24:06
  I have like these young adults that I don't like, I'm like, Oh
• 24:09
  my God, that's amazing. You know, this is fascinating,
• 24:12
  like new area of exploration. But you know, sometimes my elder
• 24:17
  patients are like, oh, you don't, you don't know, like you,
• 24:20
  you don't know what having chronic pain is like.
• 24:23
  I'm like, oh, but I do, you know, and I tell them I'm like,
• 24:26
  you know, I had both my hips replaced like literally a year
• 24:29
  ago and they're like you did. I'm like, yes.
• 24:32
  And I was limping and I wasn't sleeping and it was like 3 years
• 24:35
  of no sleep and paint chronic pain.
• 24:38
  But I did what I needed to do, you know, and, and I was just
• 24:42
  unfortunately like born wrong, like a dog, you know, dysplasia,
• 24:45
  but you move on, you know, or they're just like, they don't
• 24:50
  get it. Like I share my personal stories
• 24:53
  with them, which I think help them to see that I'm also human.
• 24:57
  So I, I sometimes do this very take this very non traditional
• 25:01
  approach to medicine, which I think we also need to think
• 25:05
  about as physicians. Like I, I made a house call the
• 25:10
  other day because the patient had had surgery and when I got
• 25:12
  there, the dogs needed walks. So I ended up like walking the
• 25:17
  dogs. There were these cute little
• 25:19
  puppies and I met the neighbors like, oh, I'm the doctor.
• 25:24
  But you know, you kind of meet your patients where they need to
• 25:26
  be. Like, I mean, that's like a very
• 25:27
  drastic example, but you need to meet your patients where they
• 25:31
  need to be. They need to see the human side
• 25:33
  of you, the imperfect side of you.
• 25:34
  So they can be like, all right, this person doesn't know, you
• 25:39
  know, or like, it's OK. Like they're not perfect either.
• 25:42
  So I, I, I always remind them how abnormal and inadequate.
• 25:50
  And, you know, I tell them about my failures of like the night
• 25:54
  time. I get up and have a little piece
• 25:55
  of chocolate and then I have to reset again.
• 25:58
  Like what did you just do, you know?
• 26:01
  But I think that's the other part of medicine that's that's
• 26:04
  important. Just the human part that we
• 26:06
  don't, that will help our patients succeed.
• 26:10
  I for sure, for sure. It's very interesting because
• 26:13
  they bring that up because there's two things.
• 26:15
  So there's two responses. I'd love to hear your thoughts
• 26:17
  to the first part is I'm reading a book now called Empire of Pain
• 26:23
  and it's about the Sackler family and painkillers and to do
• 26:27
  pharma. And one thing that Arthur
• 26:30
  Sackler was who's the, I guess the leader of the clan and, you
• 26:34
  know, the the father of the family, so to speak, was famous
• 26:38
  for was he kind of linked advertising and the public's
• 26:43
  perception of MD's and doctors and associated and sold that as
• 26:49
  a package to the American public and said, hey, doctors are
• 26:52
  doctors are not wrong. Doctors are above people.
• 26:55
  Doctors are always right. And we in our medical sense are
• 26:59
  only trying to achieve the highest truth, which is
• 27:02
  scientific truth and rigor and basically use that as a method
• 27:07
  to get away with selling, you know, incredibly, incredibly
• 27:11
  addictive painkillers as strong, stronger than heroin for for
• 27:14
  decades, right. And on the other hand, and on
• 27:18
  the other hand, my grandfather, who's a gastroenterologist for,
• 27:22
  you know, for 50-60 years in Miami Beach, he has lifelong
• 27:28
  patients. And he was lamenting to me how
• 27:31
  the new hospital systems that have taken over that are buying
• 27:35
  out private practices don't allow a doctor patient
• 27:39
  relationship, essentially. And that you're basically not
• 27:41
  encouraged to ever kind of like whoever you walk into the room
• 27:44
  is who you're dealing with. And then you walk out of the
• 27:45
  room and you never deal with them again.
• 27:47
  And he's like, I used to check in on my patients on a daily
• 27:51
  basis and they would call me and they tell me I'd saved their
• 27:53
  lives just from being their doctor, not from there being
• 27:56
  their GI, from being the doctor. So like, you have two to the way
• 27:59
  that people could treat being a doctor.
• 28:02
  You have like the Sackler type of family that just, you know,
• 28:05
  holds themselves as above everyone and wants to take
• 28:07
  advantage of the rest of the mortals down here.
• 28:10
  And then you have the doctors that are doing the work of
• 28:13
  caring for people, you know, and, and part and again, you
• 28:16
  know, and I think that there's a misconception today or maybe a
• 28:19
  reconception of, of a doctor, someone that just tells you
• 28:23
  what's wrong with you. And the primary purpose is
• 28:26
  diagnosing not not as much preventative and not as much,
• 28:30
  you know, the building up and the lifestyle aspect that you're
• 28:33
  referring to. But I I hope that with with
• 28:36
  technology and AI, it's going to be easier for people to come
• 28:40
  become more. You have a personalized form of
• 28:43
  healthcare for sure. I think that's kind of what
• 28:46
  healthcare needs to be like. What, what is it that you want
• 28:49
  me to help you with? And that's really my question.
• 28:52
  Every time they come, patients come in, I'm like, what can I
• 28:54
  help you with? What are you concerned about?
• 28:57
  You know, and, and that's sort of where the the approach
• 29:01
  starts. And then I and then I also tell
• 29:03
  them like, OK, well, I've detected this and this and, you
• 29:06
  know, I have patients who are like, I am not taking the statin
• 29:09
  drug. I'm like, OK, let's work on
• 29:12
  doing it another way and and we can try this, you know, and I
• 29:17
  really, I guess that's the reason I left at the corporate
• 29:21
  world. And yeah, I know we're going to
• 29:23
  talk about my book, but I always am like, if somebody in
• 29:27
  corporate medicine reads my book, they will never hire me in
• 29:31
  a hospital again because I slam the hospitals.
• 29:35
  And, you know, I was getting involved with administrative
• 29:39
  care administration. I was, I was in a faculty, I was
• 29:41
  a teacher forever as a program director.
• 29:44
  And so I was getting involved in the with the C-Suite operations
• 29:48
  a little bit. And, and I think once with one
• 29:51
  of the execs, I kind of really got into it.
• 29:54
  And I got home and I got really mad.
• 29:55
  I was like, OK, I told my husband and he's a physician
• 29:58
  too. He's a critical care doc.
• 30:00
  And I said, Jace, what's his name?
• 30:02
  I like either. They don't know what they're
• 30:04
  talking about. I don't know or they're lying to
• 30:09
  me. But I've only learned medicine
• 30:12
  and I have to figure this out. So I'm going to go to Business
• 30:14
  School. And that's what we did.
• 30:16
  The two of us went to back to Business School and got our
• 30:19
  MBAs. I was like for three years, you
• 30:21
  know, here were full time docs, full time parents and like our
• 30:26
  early morning study dates and our nighttime study dates.
• 30:31
  And you know what happens when a doctor goes to Business School,
• 30:33
  the OCD and type A personality comes out.
• 30:36
  So you still get like a four point O And I remember I'd been
• 30:38
  in Business School with these other students doing projects
• 30:41
  and they're like struggling. They were just out of their
• 30:43
  bachelor's and they're like, how are you?
• 30:45
  How are you not struggling? Because I'm like, I don't know,
• 30:48
  there's this like crazy comes out and I, and I have to like
• 30:51
  prove something to myself. But what it taught me, what it
• 30:55
  really reinforced in me was that I can, I can take my time with
• 30:59
  my patients, I can make money, I can be profitable.
• 31:04
  And one day, you know, it was towards the end of business.
• 31:07
  So I walked into the clinic where I worked for this
• 31:09
  hospital. I turned on the lights and I
• 31:11
  think COVID had sort of jaded me anyways, you know, like I was
• 31:15
  just like this, something's got to give.
• 31:18
  This is not good. And I was doing a lot of
• 31:20
  palliative care consults. So I think emotionally I was
• 31:23
  just drained being with people as they were dying and, and I
• 31:29
  was like, I'm keeping these lights on, nobody else's.
• 31:33
  If I don't walk in here, like the nurse doesn't get paid, the
• 31:37
  front desk doesn't get paid. And and then the execs in the
• 31:41
  C-Suite don't get paid and they're taking my money.
• 31:44
  No one's going to take my money ever again.
• 31:46
  So then I was like, OK, I'm going to come up with this whole
• 31:48
  plan. And, and I left, you know, and I
• 31:50
  called my one of my fellows, Kate, who's my partner now.
• 31:54
  And I was like, hey, we're going to do this.
• 31:57
  We're open this practice. And either it's going to work
• 32:00
  and it's going to be great or it's going to suck and we're
• 32:04
  going to just be employed physicians again.
• 32:06
  But either way, you know, it can't be any worse than this.
• 32:09
  And it and it works, you know, and it's like we're trying to,
• 32:12
  we're looking at adding another physician now and you know, who
• 32:17
  are five years into it, Like we're both at our capacity for
• 32:20
  patients and it's been wonderful.
• 32:22
  But I get to spend an hour with my patients.
• 32:25
  I get to go to the hospital and see them and I get to go to
• 32:27
  their home and I get to see them and I get to be like the doctor
• 32:30
  I wanted to be and I envisioned not like what they expected me
• 32:34
  to be, you know, and, and, and that's so valuable and I'm like,
• 32:38
  we need more doctors and I so now one of the, my motivations
• 32:42
  for having medical students is to show them, but like guys,
• 32:45
  there are other ways to practice.
• 32:47
  You do not need to work for this institution.
• 32:51
  Unfortunately, that's the model. They they teach us to be a
• 32:53
  commodity and then the patient relationship goes away and then
• 32:58
  patients suffer, People suffer because of that.
• 33:01
  You know it's awful you. Know what you can't you can't
• 33:05
  count health without relationships because like the
• 33:09
  worst thing that you can do to a human being, the worst, the
• 33:12
  worst thing they do to you in prison is solitary confinement.
• 33:15
  And like, and the worst thing that you do, you could do to
• 33:18
  someone is to just take away their relationships and people,
• 33:21
  people that people will, God forbid, kill themselves over
• 33:24
  over relationships, You know, like you could have all the
• 33:28
  world, you could have all the comfort, you could have a house,
• 33:30
  you could have friends, you know, like if you don't have it,
• 33:32
  but the chances are actually like if like you probably don't
• 33:36
  have friends if that's the place you're at.
• 33:37
  But the point is that relationships are everything and
• 33:41
  your health for sure. And, and it's funny because for
• 33:46
  a long time, you know, people have said, OK, well, emotions
• 33:49
  and like relationships and stuff, that's like one thing.
• 33:51
  But like we need to stick with the tangible.
• 33:53
  But they do have a tangible, tangible impact on, on for sure
• 33:58
  human beings. And definitely the, the, the
• 34:00
  old, the, I guess the people in the, the later stages in their
• 34:03
  lives. But I know, for example, that my
• 34:05
  my grandfather, my mom's dad. Sorry.
• 34:08
  Yeah, My mom's dad was off his nails his whole life and he was
• 34:11
  living by his own. My grandmother died 2530 years
• 34:16
  ago and he didn't even go on a date since the day she died.
• 34:19
  Like he was like my wife, but he lived alone and he took care of
• 34:25
  the house and he was A and he was a professor.
• 34:27
  And then when he retired, he still kept, he'd come to our
• 34:30
  house to help take care of our house.
• 34:32
  And then he, I think went like 91 or 92, he had a stroke.
• 34:37
  And the second he stopped being able to help himself and the
• 34:41
  second he stopped being able to go to the supermarket and get
• 34:44
  his own girls, he used to walk 3 miles a day at 90 years old, you
• 34:46
  know? And the second that the
• 34:48
  relationships and the and the and the and the independence
• 34:53
  faded away, he was like, check me out, like, you know.
• 34:56
  I know this is I'm ready to. Yeah, exactly.
• 34:59
  This is what I'm here for. And and you don't want to be a
• 35:03
  burden. That was the other thing.
• 35:04
  And like to feel like you're a burden is terrible.
• 35:06
  And the truth is that you said something really, really awesome
• 35:08
  at the beginning of the podcast, which is that we go through it
• 35:11
  like different stages in our lives.
• 35:13
  And the later stage of our life is to, you know, aside from
• 35:16
  enjoying is to be the wise people for our family and for
• 35:20
  the community and the world around us and to say, Hey, we've
• 35:23
  lived through a lot of this stuff.
• 35:25
  And you don't need to do this this way.
• 35:26
  And you don't need to go through this pain and this hurt.
• 35:28
  And you don't have to do this. And like, when you have that,
• 35:32
  like that gives you a reason to exist, that gives you a place in
• 35:35
  the world. My, my grandfather, when he was
• 35:37
  a doctor, he aged 10 years the year that he retired.
• 35:40
  And it was, you know, it was heartbreaking, but that's, you
• 35:43
  know, the way that life is. Yeah, I was at a meeting tonight
• 35:47
  with a a couple of the older doctors in town and one's like
• 35:51
  68, the other one's in the 70s and they're working.
• 35:53
  And like, we still love to work. My God, stay in it.
• 35:57
  And this is, you know, these old school docs that I'm like always
• 36:01
  just so inspired by. But again, that's kind of what I
• 36:03
  talk about in my book as well. It's all it's like this sort of
• 36:09
  I, I try to really honor my. Patients, let's talk about your
• 36:12
  book now. Well, OK, so I wrote this book
• 36:16
  called Life Love, and in between a geriatrician's journey through
• 36:21
  aging and the meaning of life. And it started out I was
• 36:25
  speaking at a women's conference in 2016 and, and it was a, you
• 36:29
  know, it was supposed to be like a motivational talk.
• 36:32
  And I had just lost my son to a congenital heart defect a few
• 36:36
  months earlier. So I'm speaking at this
• 36:38
  conference and I kept thinking like, what am I going to talk
• 36:41
  about? Like, like I'm, I've come out on
• 36:43
  this other side, you know, of having a child who was in
• 36:46
  Hospice and which is, you know, I kind of like always think the
• 36:52
  universe like puts things in front of like, I kind of felt
• 36:55
  like our son James like had like we were meant to have him
• 36:59
  because we knew how to take care of him.
• 37:01
  You know, it's the things that we did and based on, you know,
• 37:05
  managing patients at the end of their life or doing the critical
• 37:07
  care things. But also it taught us like how
• 37:10
  to be better human beings Because for the first time when
• 37:13
  like I had to give him morphine when he was short of breath in
• 37:16
  Hospice, like I freaked out. I was having a hard time, yet I
• 37:20
  realized I so comfortably write these scripts for morphine for
• 37:24
  my Hospice patients. And then it it clicked like this
• 37:28
  is hard for people. So he helped me be a better
• 37:30
  human, I think a better doctor. But anyway, some of the talk was
• 37:34
  about my experience and how I went through that whole stage.
• 37:39
  And what really got me through it was the lessons that my
• 37:43
  patients had taught me. And what I was talking about in
• 37:45
  the book was, you know, I get to sit with these people.
• 37:48
  I don't have like 1 mother and one father, one set of
• 37:51
  grandparents or whatever. I have many every day.
• 37:54
  And and I almost feel guilty because they pay me to take care
• 37:58
  of them, but I almost owe them more.
• 38:01
  But the book talks about, like, how fragile we are and how much
• 38:04
  we need to appreciate our lives. And each chapter has a theme and
• 38:09
  has stories from my elder patients and the lessons that I
• 38:12
  learned, you know, like about love and just the stories of how
• 38:16
  these people are meant to be together and how they're
• 38:20
  together for decades and finding the spaces in between and not
• 38:23
  taking advantage of the time that we have or, you know, at
• 38:28
  the thought of empathy and transparency.
• 38:31
  And and so this is all of these themes and not, you know, really
• 38:36
  not, not, not lying to yourself, not lying to others.
• 38:39
  And the very last chapter of the book is called relevance.
• 38:43
  And I was sitting with a patient and this person, I mean, this
• 38:46
  person is like has been my hero. And they're very sick.
• 38:50
  I mean, almost dying. And they looked at me one day
• 38:55
  and I said, I no longer feel relevant.
• 38:57
  And I just, and I you know, I know these people like so
• 39:03
  intimately. I think I spent so much time
• 39:05
  with them and in my head I was like, I can't handle this
• 39:08
  anymore. So I started to like, I pulled
• 39:11
  like my Eckhart Tolle stuff out and I have things in there from
• 39:16
  like philosophers on failing, like Pima Chodrin.
• 39:19
  And so there's a lot of, it's poetic, it's philosophical, but
• 39:23
  I thought about it. I thought, OK, So what happens
• 39:25
  when I'm no longer a doctor and I'm no longer a mother and I'm
• 39:30
  no longer a wife? Where do I find relevance when
• 39:34
  all of my labels have been torn away?
• 39:37
  And how do I sit with myself and I'm still relevant as this human
• 39:40
  being, you know? So the book, I think, I'm hoping
• 39:43
  it teaches people these wonderful lessons that I've
• 39:46
  learned from my elders. It tells a little bit of about
• 39:49
  my story and my upbringing and then the way I met my husband.
• 39:52
  And that was very special. But at the very end it says, you
• 39:56
  know, what? If you want to learn anything
• 39:58
  about this world and about. Surviving this world and living
• 40:01
  a better life. Just sit with your elders.
• 40:03
  Just sit with them and they will teach you all the lessons you
• 40:05
  need to know. And it seems like you sort of
• 40:09
  have some of that in you. You know, you have your
• 40:12
  grandfather's stories, and you seem to.
• 40:14
  Old people. You love old people.
• 40:17
  I love them too. I love old people.
• 40:19
  I'm an old soul myself, so I, well, I used to, I used to visit
• 40:22
  the assisted living homes in college and organize, have
• 40:25
  students, you know, organize trips and you know, and I, and
• 40:30
  you know, I've always been an old soul as far as, you know,
• 40:32
  music and culture and stuff. So it's, you know, we'd say like
• 40:35
  Frank Sinatra and we'd sing some of the classics and you know,
• 40:38
  we'd hang out, we'd have birthday parties in the assisted
• 40:40
  living homes. And there's the sweetest woman
• 40:43
  named Ruth. And I remember her.
• 40:45
  So she had, she's super, super, super short term memory loss,
• 40:49
  but was an incredible physical shape.
• 40:52
  Yeah. So she's always down to around
• 40:54
  looked great. And she would ask me, we would
• 40:57
  have the same conversations 30 times in half an hour.
• 41:00
  And I would tell, you know, I'd be like, So what do you study?
• 41:02
  And I'm like creative writing and just like, cool.
• 41:04
  It's just So what are you studying?
• 41:05
  And I'm like astrophysic writing.
• 41:07
  Oh, that's amazing. Yeah.
• 41:09
  Pretend like you had the first conversation every time, which
• 41:13
  is OK, you know. But so much you, you, you, you
• 41:18
  learn, listen, there, there, there's no, I, I, we always, I,
• 41:21
  I always grew up, I grew up Orthodox Jewish.
• 41:23
  And, you know, and one thing that that we always had was just
• 41:28
  like, you know, the, the, the, I guess the Jewish perspective is
• 41:32
  that the older the people are, the closer they are to the
• 41:34
  original source. And so the fact that they
• 41:37
  deserve, you know, so we didn't grow up looking at old people
• 41:39
  like they're relevant. We looked at them like, you
• 41:42
  know, they've. Got spiritual source.
• 41:45
  Yeah, but the source to like, like this is where you get your
• 41:49
  enlightenment from, you know, you, you, you hang with, with
• 41:52
  them. Yeah.
• 41:53
  And I, you talk about some a friend of my best friend when I
• 41:57
  was 13, I, I talked about her. I had always wanted to write
• 42:01
  about her, about Alma. I was, she was 80 when I was 13.
• 42:04
  And I used to always go to her house.
• 42:05
  So I was never in trouble because I was always at Alma's
• 42:07
  house. And we used to watch Doctor
• 42:10
  Zhivago together. And she used to tell me she was
• 42:12
  like, she lived in Germany during World War 2.
• 42:15
  And so she told me all about just everything she had
• 42:19
  witnessed and experienced. And so I have stories of that
• 42:23
  and in my book too. And but she taught me about
• 42:27
  love. She was always like, you know,
• 42:29
  when and her husband had passed, but she was like, the love you
• 42:33
  have when you meet, like your husband is going to be so
• 42:37
  different than any other love. I mean, and it was just, again,
• 42:41
  I remember like when I first met my husband, I was like, oh,
• 42:44
  that's what she was talking about.
• 42:46
  That's what Alma was talking about.
• 42:49
  You don't know until. Well, my my friend Mel she she's
• 42:55
  been reading my book. So I was telling you earlier she
• 42:58
  wrote this thing and said I was like, dear God, lady, I just
• 43:01
  finished chapter 2 in tears. This is so moving and then do
• 43:04
  not tell Jace, but I secretly like him as a human.
• 43:07
  Now is my husband comes across as this like very just stiff,
• 43:12
  like, you know, he does what he does, but I have the, I have
• 43:16
  these other parts of him that nobody else does, you know, and,
• 43:18
  and, and I think in the book, I show that, that this other human
• 43:23
  that nobody's used to seeing, you know, this other incredibly
• 43:27
  wonderful soft human. But yeah, so I hope, I hope
• 43:33
  people like the book. I really wrote it for, you know,
• 43:36
  caregivers. I wrote it for anyone who's
• 43:38
  struggling with aging. And, and I wasn't even sure like
• 43:43
  how it was going to go, but I just felt like I need to get
• 43:46
  these words out and, and I need to be as like poetic as I want
• 43:53
  to be in it because all I'm used to writing is like medical
• 43:56
  things. Yeah.
• 43:58
  This was definitely a lot more fun.
• 44:00
  And it was heavy and it was also therapeutic too.
• 44:02
  So. And I thought, you know, what,
• 44:05
  if it, if it becomes a great book and becomes a great book,
• 44:08
  and if it it doesn't, that's OK too.
• 44:11
  You know, it was just my way of honoring the people that have
• 44:15
  given me so much. So.
• 44:17
  Yeah. I wanted to and this is please,
• 44:21
  you know, as as much as you feel comfortable with the talking
• 44:24
  about being measured that you lost your son James.
• 44:27
  Yeah. What can you.
• 44:29
  You said that he he that he had a heart condition.
• 44:32
  What how old is he? What happened as as much as
• 44:34
  they're comfortable with. Yeah, I know.
• 44:36
  I'm pretty comfortable talking about it now.
• 44:38
  It was 10 years ago. He would have just.
• 44:40
  Yeah, sorry. It's.
• 44:41
  One of the it's one of the hardest things we could go
• 44:43
  through. It is, but you know, I think it
• 44:46
  was also one of those lessons that helped me see another side
• 44:52
  of medicine and it also helped me see another side of humanity
• 44:54
  because you know, I have always been super like pro-choice and
• 45:00
  doctor physician relationship. And you know, so when I was it
• 45:05
  was my third child. So I had Mila and Zoe and then
• 45:10
  we had it and then we had James. But we, I went to the hospital
• 45:15
  to get my ultrasound. I was so excited because I had
• 45:18
  the other two in medical training, so I didn't have a
• 45:20
  chance to like do all the fun pregnancy things that moms get
• 45:26
  to do. As I went there and all of a
• 45:28
  sudden the radiologist came and was like your baby's heart like
• 45:33
  the apex. So the the side of the heart is
• 45:36
  pointed to the right, it's supposed to be pointed to the
• 45:38
  left. I was like where are all the
• 45:39
  other organs and everything else was in the right place.
• 45:41
  So anyways, he ended up having this very severe congenital
• 45:44
  heart defect called heterotaxy. And they said that he would he
• 45:51
  was fine as long as I carried him.
• 45:54
  But when he was born, he would have days to months to live.
• 46:00
  And then we could opt for some surgical procedures that were
• 46:03
  going to be palliative. You know, he would have been, he
• 46:05
  would have always been sick and and then if he lived to two, he
• 46:10
  could have had tried to have a heart transplant.
• 46:12
  Well, I think my husband and I had so much.
• 46:16
  We read a lot and we did a lot of research and I think a lot of
• 46:19
  like soul searching. But when we met with the
• 46:22
  cardiologist, they were sort of surprised when we said first
• 46:25
  they were like, well, you could terminate the pregnancy.
• 46:27
  And so here's what's interesting.
• 46:28
  You know, here you're like, like, you know, it was like
• 46:33
  these decisions that people have to make about like life and
• 46:37
  termination of life and all this stuff sort of came into it.
• 46:39
  And I was like, what are you talking about?
• 46:41
  Like, why would I terminate my pregnancy?
• 46:43
  You know, they're like, it's not like, what the heck are you
• 46:45
  talking about? Like, so, you know, we carried
• 46:48
  him and then they thought because I was going to continue
• 46:51
  the pregnancy that I was going to do all these medical things.
• 46:55
  And then I was like, what are you talking about?
• 46:57
  It's like, I'm not going to let him suffer.
• 47:00
  I can't do that to him. And so we took him home.
• 47:05
  And you know, the only time I saw my husband cry was our
• 47:11
  pastor came to the hospital and baptized him there because we
• 47:14
  don't know how long we had that was that was really awesome.
• 47:18
  And then we took him home and eight weeks.
• 47:23
  So he lived 8 weeks and he, he died at home.
• 47:27
  And, and then I, it just, I think I, I learned so much about
• 47:35
  myself and I learned so much about, you know, how I need to
• 47:40
  be sensitive in a different way just because I, I perceive
• 47:43
  things in a certain way as a physician.
• 47:45
  So I think he definitely changed the way I practice medicine.
• 47:50
  But then also, like I had said, my patients had sort of prepared
• 47:54
  me for all this, all the lessons they had taught me.
• 47:56
  And after he had died, sometimes I you, you question like, what
• 48:01
  did I do? Did I do the right thing?
• 48:03
  Should he have done all these surgical procedures?
• 48:05
  And I ended up talking to a mom who had had a kid who had
• 48:07
  heterotoxy who passed away. And she's just sort of crying.
• 48:11
  And I said, are you OK? And we were just talking.
• 48:13
  Her son passed. My son passed.
• 48:15
  And she said, I, I did all the medical things and I spent so
• 48:20
  much time being his nurse that I never got a chance to be his
• 48:25
  mother. And you had every minute you
• 48:27
  spent with him, you were his mother.
• 48:30
  And we did, we took him on hay rides to see the Easter Bunny to
• 48:34
  the bar with his cousins, little 4 LB baby and her like, you
• 48:38
  know, I'm like, you're going to live it up.
• 48:39
  I don't know how long you're going to live, but you're going
• 48:41
  to live your life up, kid. And it was, it was really cool.
• 48:46
  It was incredible. And then, yeah, you know, and
• 48:49
  you also learn how much like, like I learned how much my
• 48:51
  husband loves me because we were at the doctor and they were
• 48:54
  like, we shouldn't have another pregnancy because you have these
• 48:57
  complications. And I'm like, well, you know, we
• 49:00
  could probably have another baby after James.
• 49:02
  And, and he was like, she will never have another pregnant.
• 49:05
  You know, when he thinks like he thought my life was at risk and
• 49:09
  I was like, wow, he really loves me.
• 49:11
  That's so sweet. And you know, but then we got
• 49:15
  involved with foster care and after that and we were doing
• 49:19
  respite foster care and somehow again, like life works out the
• 49:24
  way that works out. You know, we, we ended up with
• 49:27
  Peyton in our life and, and we were able to adopt her.
• 49:31
  And so I ended up somehow with three anyways.
• 49:35
  And you know, you just kind of like, I think that's the other
• 49:40
  part that I I talk about in my book too, is like I had just
• 49:45
  planned my entire lifeout since I was 6, like I'm going to do
• 49:48
  this by this time and this by this time.
• 49:49
  And even if things didn't work out a little bit, I still
• 49:52
  figured it out and everything still stuck to my calendar until
• 49:56
  like the the world God and everything that all the powers
• 50:01
  that be were like, no, no, life doesn't work out that way.
• 50:05
  You go with the flow like you have to you know, you you can't
• 50:09
  do that. And and that was, you know, it
• 50:12
  takes, it takes like 37 years for me to have that lesson,
• 50:15
  which was pretty incredible. I'm kind of thankful for it.
• 50:21
  But but even now, you know, and I think that it just changed who
• 50:26
  I am. And yeah, I don't sometimes I'm
• 50:28
  like so inappropriate because I was in a patient's room the
• 50:32
  other day in the hospital and I'm wearing jeans because they
• 50:34
  end up in the hospital. I just went because I didn't
• 50:36
  know. And I have my head be on the
• 50:39
  bed, like my legs were up. And the nurse came in like, who
• 50:42
  are you? And I showed him my doctor
• 50:43
  badge. Like they thought I was the
• 50:45
  patient's daughter. I was like, well, I kind of am.
• 50:47
  I'm their advocate. I'm.
• 50:49
  I was taking the charts, seeing what was going on, you know, and
• 50:52
  and then, yeah, he helped me, I think be more human than
• 50:57
  anything any other time in my life.
• 51:00
  So I just let things go now. It's incredible that you can,
• 51:03
  that you, I mean, you know, I mean, I, I don't know what the
• 51:06
  alternative is. And I know the alternative is,
• 51:08
  but I mean it's incredible that you like that you, you're able
• 51:15
  to, you're able to turn it into, meaning you're able to turn it
• 51:18
  into, into something tangible that you take with you.
• 51:21
  You know, I, I did, I, you know, I guess I, I did a breath work
• 51:27
  class. My wife had encouraged me to try
• 51:29
  1 and it was more of that like and I breathe out until you, you
• 51:35
  know, I was in and exhale and I wanted to and I've done
• 51:38
  psychedelics before. So I was a little familiar with,
• 51:41
  with, you know, the kind of place that I was supposed to end
• 51:43
  up at. And, and I at this point, I've
• 51:49
  been a father, this is probably a year ago now.
• 51:50
  And I've been a father for two years.
• 51:52
  And I was still struggling with the idea of me being a father.
• 51:55
  And I was not, I don't think I was still, I still, I still
• 51:58
  thought of myself and I'm still transitioning in my head from
• 52:01
  thinking myself as like a kid and a teenager to being like a
• 52:04
  dad that's responsible for, you know, for two kids right now
• 52:08
  and, and a home and a wife and a family and, and my grandfather
• 52:14
  and my grandfather had just passed away, you know, a couple
• 52:16
  months earlier. And I was doing this deep
• 52:20
  breathing and I, I, I swear to God, I felt his soul.
• 52:25
  And he was like the father figure kind of role of my life.
• 52:28
  My dad, who I work with, I'm very, very close with, is always
• 52:31
  more of like a friend. Yeah.
• 52:32
  And he didn't, like, he wasn't the authoritative father figure
• 52:36
  that, like, you look up and say, like, this is a dad.
• 52:39
  You'd be like, oh, this is like, this is my dad.
• 52:41
  Love him. He's funny.
• 52:42
  Yeah, he's cute. My grandfather was like, you
• 52:45
  know, like this Holocaust survivor and like, you know,
• 52:47
  strict, strict but loving and has priority set straight.
• 52:50
  So, you know, I'm doing this breathing.
• 52:54
  And like he came to me and like, and I was just like sitting with
• 52:59
  his presence. And it just helped me process
• 53:04
  for a minute like, hey, like he was scared and he made it and
• 53:09
  you were scared and like your life is a total breeze and like
• 53:13
  you're going to be fine. And like he's with you.
• 53:15
  And like, like, you know, like you have the direction and you
• 53:17
  have the people and like, and, and almost felt like it almost
• 53:22
  came to a little bit of some kind of resolution, some kind of
• 53:25
  spiritual resolution that I really, really felt like, and I
• 53:28
  felt like, you know, he had to be acknowledged that like he
• 53:31
  behaved a lot of the way that he did a lot of time because he was
• 53:32
  afraid and frustrated. And, you know, I and I had to
• 53:36
  come to the conclusion like I, it was a fearful kid.
• 53:38
  And I don't have to be a fearful kid anymore.
• 53:40
  I could just be a dad now that like learns from his grandfather
• 53:44
  how to be a dad and like you learns and like, and what's
• 53:47
  incredible is what's you've taken that lesson from, you
• 53:50
  know, the elderly community and applied it to your life and a
• 53:55
  child and, and child like, you know, like, which you would
• 53:57
  imagine is the total opposite. But I feel like they, the wisdom
• 54:01
  is so deep that and, and they, they, they have to cross, you
• 54:04
  know, like they, they definitely, you know, they,
• 54:07
  they, they, they, they flow into one another.
• 54:09
  And, and if you're willing to if and you look and it sounds like
• 54:13
  you're, you've been able to accept it from either end, you
• 54:16
  know, from learning from the youth and learning from the
• 54:18
  elderly. And it's, it's extremely,
• 54:22
  extremely admirable and it's really, really beautiful to be
• 54:24
  able to just even listen about and hear about.
• 54:27
  So I really, really, I give you so much credit for for choosing
• 54:32
  to handle things in the way that you do.
• 54:35
  Which, you know, it's really interesting being on this
• 54:37
  podcast with you because like you're, you know, looking at
• 54:41
  you're like, you're obviously like younger, yes, young family
• 54:44
  and, but like, and culturally, like after having this
• 54:49
  conversation with you, like wow, we are like a lot alike, you
• 54:52
  know, as far which like, I think we've, I think like we've, we've
• 54:59
  lost that. Do you know what I mean?
• 55:01
  Like I, I wish we would have more of that.
• 55:04
  And, and, and I, and I love that you can talk about this because
• 55:08
  I do think like you being younger, you can definitely be
• 55:11
  like this amazing role model for your peers, you know, because
• 55:18
  I'm like, I know how. Role model.
• 55:19
  I've encouraged them. To you know, it's.
• 55:22
  I am, you know, I'm just a regular dude.
• 55:24
  I, I don't think, I don't think myself very highly at all.
• 55:26
  I think a lot of people are working.
• 55:27
  Like, you know, it's like you're when you're some someone who's
• 55:30
  like relatable. Like if you, you know someone
• 55:32
  who's like, OK, no, like I, I can relate to you in this sense.
• 55:36
  You know, just like, I think I'm like mid career women are
• 55:42
  struggling with some of the same things I'm struggling with.
• 55:45
  Can like relate to me, you know, and it's like, so, you know, but
• 55:51
  but what's cool is every stage is like beautiful and every
• 55:56
  stage is just like, embrace it because you're going to lose it
• 56:00
  even with your babies. Like, Oh my gosh, like I, I keep
• 56:05
  looking at Mila's pictures when she was a baby and I'm like, Oh
• 56:08
  my gosh, I've got this like big teenager that's taller than me
• 56:12
  and like, where did that go? So I don't, I don't know.
• 56:16
  I feel like our life is so, is so short and we're so lucky to
• 56:21
  be alive, you know, and, and we're so lucky to, to get to
• 56:25
  experience life. And I think we shouldn't take it
• 56:27
  for granted. I think that's what elders teach
• 56:30
  us. Yeah, and I think it goes hand
• 56:33
  in hand with everything we've been talking about.
• 56:34
  When you love your life, you want to take care of it, you
• 56:37
  want to, you want to cherish it. And like, I mean, I, I've had, I
• 56:40
  had friends that just came over and they're a little bit
• 56:42
  helicopter parents either first times and they are, you know,
• 56:47
  and like, you know, we, we, we understand, like I like, you
• 56:50
  don't want that person to get hurt.
• 56:52
  You like you don't want it and you know, you want to protect
• 56:55
  them. But at a certain point, like,
• 56:56
  you know, there's a great book, The Anxious Generation by
• 56:58
  Jonathan Haidt. Shot a great book, yes.
• 57:01
  It's the most important book I've read other than any
• 57:04
  religious book I've read. I like that book is like.
• 57:07
  It's transformational. It's a fantastic book, yes.
• 57:10
  I read. Everyone should read it.
• 57:12
  I mean, he's, he's an incredible social psychologist.
• 57:16
  But what was the other book he wrote that I read first?
• 57:19
  But he's, he's incredible, yeah. Another favorite He wrote a
• 57:23
  book, The Coddling of the American Mind, too.
• 57:26
  That wasn't the one I was thinking about something.
• 57:28
  I mean, I was thinking about the Dan Ariely book and it was like,
• 57:31
  it's it's hard to remember which one, but he's so smart and he's
• 57:37
  so right on. You know, like 10 years ago I
• 57:39
  was like telling my in laws like, don't let don't let Mila
• 57:42
  on this phone. It's going to give her ADD.
• 57:44
  And now you're like up. Sia told you all the studies are
• 57:48
  up too late now. Yeah, that's it.
• 57:52
  It's gone. It's gone.
• 57:53
  I have it too. I have it too.
• 57:55
  I've been hit, I've been hit. I'm addicted.
• 57:57
  I'm addicted for sure. I wanted, I wanted to, I wanted
• 58:01
  to ask you because my wife was really excited when I was
• 58:04
  preparing for this. I was, I was talking through, I
• 58:07
  was going through your website with her and we're talking a
• 58:09
  little bit about de prescribing because I think that, you know,
• 58:14
  we talked about the American pharmaceutical treadmill that
• 58:16
  people are on where you always on it and it just keeps on.
• 58:19
  It keeps on chugging along and like no matter what you're
• 58:21
  doing, it's just always tagging more on it's.
• 58:23
  Never taken more. Yeah, exactly.
• 58:26
  And so how do you go? I'd like to hear how you go
• 58:29
  about de prescribing. And I think that a lot of this
• 58:34
  stuff does not just exist in a vacuum.
• 58:36
  If it applies for geriatric, I'm sure it applies for, you know,
• 58:40
  young adults. I'm sure it applies for
• 58:41
  middle-aged people, I'm sure it applies for youthe.
• 58:43
  So what are some things that you've learned about the process
• 58:47
  of de prescribing people and what replaces that?
• 58:51
  So when people this is how I am, I, I see medicine, you know,
• 58:55
  you're like in your 40s, your blood pressure goes a little
• 58:58
  high, you start to get a little blood pressure medication.
• 59:02
  Do you know? And then cholesterol goes up and
• 59:05
  you get a little bit of a my little my middle child just
• 59:09
  wanted, but you're you're you're Hey, Zoe, you're you're.
• 59:14
  Well, good, yes. OK, so in your 40s, you take a
• 59:18
  little bit of medication, another one for cholesterol, and
• 59:22
  then your blood sugar goes up, they give you something else and
• 59:26
  then you have a side effect from the cholesterol medication or
• 59:29
  the blood pressure medication. So you get on something else.
• 59:31
  You know that we call that the the prescribing cascade where
• 59:34
  they, you know, you end up on another medication for the side
• 59:37
  effect. So like on a nausea medicine now
• 59:39
  because you have nausea from another medication, he's like
• 59:41
  the time you're like 60, you're all of a sudden I'm like 6 to 10
• 59:46
  medications. And we consider polypharmacy is
• 59:49
  when you take a lot of medications and then and there's
• 59:52
  like over 110 definitions of polypharmacy, but the most
• 59:55
  common one is 5 or more medications.
• 59:57
  And, you know, as we age, the way we take a medication and the
• 1:00:01
  way that medication is distributed, the way it's
• 1:00:04
  metabolized and eliminated from our body changes because our
• 1:00:07
  body changes, You know, our skin changes, our kidney changes, our
• 1:00:11
  liver changes. And, and, and so we have to, as
• 1:00:15
  a geriatrician, we have to think about, well, is this medication
• 1:00:19
  still appropriate? And so when I see a patient, is
• 1:00:22
  this medication still appropriate for their kidney
• 1:00:24
  function? Is this medication still
• 1:00:26
  appropriate for like primary prevention?
• 1:00:29
  Is the risk of prescribing it, you know, is the benefit
• 1:00:33
  outweigh that risk? And, and thinking about side
• 1:00:37
  effects that they were, they're experiencing.
• 1:00:39
  And I kid you not, I had a patient in my office who came in
• 1:00:42
  who I was testing in like the moderate dementia stage.
• 1:00:45
  I took her off of half her medications over a six month
• 1:00:49
  period and she tested in the normal cognitive range.
• 1:00:53
  So she was and, and I mean, this was like the classic, I cannot
• 1:00:59
  believe they. So she was able to drive again
• 1:01:02
  and she was about to move in with her son and she was able to
• 1:01:05
  go back home. I mean this is I mean I.
• 1:01:08
  Prescribing. Yes, and I think, you know, and
• 1:01:11
  then these some of these are like extreme cases, but you
• 1:01:15
  know, we, we have to really be as a, as a good doctor, we think
• 1:01:20
  about prescribing, but we have to equally think about de
• 1:01:22
  prescribing. Now when we think about younger
• 1:01:24
  people. So if that young person before
• 1:01:28
  they were placed on their blood pressure medication, what was
• 1:01:31
  the reason for their blood pressure issue?
• 1:01:34
  Was it because of their weight? Do we need to think about weight
• 1:01:36
  management? Is it because of, you know,
• 1:01:38
  stressors and they're like cortisol at all levels?
• 1:01:40
  Is it because of hormone levels? Like you have to kind of think
• 1:01:43
  about this person holistically, You know, is it a genetic?
• 1:01:46
  Is it a genetic factor? Is it a kidney factor?
• 1:01:50
  So really I'm thinking about that.
• 1:01:52
  And then if we can sort of address the underlying issue
• 1:01:56
  before we prescribe that medication and see if we can get
• 1:02:00
  and achieve the goal that we need without the prescription
• 1:02:02
  medication. And sometimes we need the
• 1:02:03
  prescription medication. I mean, medicine is cool.
• 1:02:06
  It's we've created all sorts of awesome things, but sometimes we
• 1:02:11
  go overboard. So, you know, if the cholesterol
• 1:02:15
  example, you know, can we lower the cholesterol by by thinking
• 1:02:19
  about a more plant based diet? And every time people are like,
• 1:02:23
  why can't I can't be a vegan, you know, or I don't ever tell
• 1:02:26
  them you need a ketogenic diet And they're like, I can't just
• 1:02:30
  eat meat. And I'm like, no, my husband is
• 1:02:32
  a vegan and he eats a ketogenic diet.
• 1:02:34
  Like it's not about meat and it's not about, you know, he
• 1:02:38
  gets plenty of protein. I can't.
• 1:02:41
  I eat what is. Different protein.
• 1:02:43
  What is what does he, what does he get for?
• 1:02:45
  What food does he eat for that? So lots of soy, like I would say
• 1:02:48
  tempeh and, and like lots of beans, you know, and I make like
• 1:02:54
  these alternative common foods, like I'll make like a falafel,
• 1:03:02
  but it has like walnuts in it and nutritional yeast and you
• 1:03:07
  know, and I'll, it's, it's baked and not fried.
• 1:03:10
  And, and then we eat like very good, like like good oils, you
• 1:03:14
  know, not seed oils. Those are inflammatory.
• 1:03:16
  But yeah, like great. Like good olive.
• 1:03:19
  Like it's so it's, yeah, I mean, that's, that's a lot of a lot of
• 1:03:24
  lots of nuts. And, and you know, sometimes
• 1:03:27
  I'll make stews and mix a lot of nuts in there or it's and my, my
• 1:03:31
  elder patients that they're like, I'm going to go vegan.
• 1:03:33
  Like you are not going to go vegan because you are going to
• 1:03:37
  get sick. We haven't been sick many years
• 1:03:40
  to, you know, to get to a place where you're meeting your macro
• 1:03:43
  micronutrients, but I can help you get more plant based, you
• 1:03:46
  know, and and still maintain that and lots, you know, lots of
• 1:03:50
  vegetables and you know, it's it's not hard it, but it is
• 1:03:55
  hard, you know it. You have to have like someone
• 1:03:58
  who's patient with you. And so like I had a guy kind of
• 1:04:02
  leave you with this big one, but came to me depressed because
• 1:04:05
  wife had died, didn't know how to cook was like 304 lbs.
• 1:04:09
  The sweet man. So didn't like had gained all
• 1:04:12
  this weight, diabetes was out of control, blood pressure was out
• 1:04:14
  of control. And, and I had, I told them, I
• 1:04:17
  said, listen, we're going to make some changes.
• 1:04:20
  But for the next three weeks, every time you go to the grocery
• 1:04:22
  store, I need you to call me. I'm going to show you how to
• 1:04:24
  read food labels. So we did.
• 1:04:26
  I showed him how to read food labels, how to prep food, how to
• 1:04:29
  make food. So over 2 years he went from 304
• 1:04:32
  lbs to 240 lbs. And that was, do you have that,
• 1:04:37
  do you have this process on your blog?
• 1:04:39
  Like, do you have this like in a commonly available, accessible
• 1:04:42
  way that like anyone could like take a look at this because like
• 1:04:46
  we care about, I think young, the young, young, the generation
• 1:04:49
  cares about health nowadays. They really.
• 1:04:51
  Do I know I love that too. So I'm I'm writing this book
• 1:04:56
  because all this stuff is like kind of mish mashed in my blog
• 1:04:59
  post because and in the blog post come from a patient asks me
• 1:05:02
  a question and I'm like, oh, I need to write about this.
• 1:05:05
  You know, I got to I got to make sure they have access to this
• 1:05:07
  information. And then I'm in the office and
• 1:05:09
  I'm like, oh, hey, you need your Omega threes.
• 1:05:11
  Here are your plant based Omega threes and here are your animal
• 1:05:15
  mice Omega threes. Print out the thing.
• 1:05:17
  Here's the blog post. But I'm writing this book now.
• 1:05:20
  I'm actually on the very last part, the H the habit.
• 1:05:22
  So I try to like package it all. So it is in this like sequence.
• 1:05:27
  But you can find like all this information on jerryacademy.com
• 1:05:31
  and and the blogs not for old people.
• 1:05:33
  It's for everybody, you know, who's who thinks about their
• 1:05:36
  aging and we should think about our aging and like our second,
• 1:05:39
  third decade of life, not just like when we're 50 and 60.
• 1:05:43
  We've lost all that time, you know, So I, I love how younger
• 1:05:47
  people are thinking about it. I mean, my 15 year old measures
• 1:05:51
  her food and kind of obsessively, but in a really
• 1:05:54
  healthy way. She makes her lunch every day,
• 1:05:56
  but make sure she has like, she measures everything that she
• 1:05:59
  puts in there, you know, and I'm like, this is, this is kind of
• 1:06:02
  good. OK, Maybe like the OCD parents,
• 1:06:06
  the Type A parents have, you know, done that to her.
• 1:06:11
  But it's OK, you know it. But you know, yeah, all of this
• 1:06:14
  stuff, you could kind of, you can find it in the blog.
• 1:06:16
  There's like healthy things and I and I keep adding more to it.
• 1:06:20
  But, yeah, I'm hoping I have to find, like, a literary agent
• 1:06:24
  first for this book to see if I can get, like, what as far as,
• 1:06:28
  like, publication goes. But I just was like, I got to
• 1:06:31
  start writing this. And.
• 1:06:34
  But all the information is like, in bits and pieces in the blog.
• 1:06:36
  You just, like, look for the thing you want to look up.
• 1:06:39
  But yeah, he got a dog. He ended up walking.
• 1:06:42
  He ended up moving closer to his daughters.
• 1:06:44
  Like, this was all transformative, you know, after
• 1:06:47
  losing 60 lbs and he was continuing to lose weight.
• 1:06:51
  But, you know, it was, it wasn't hard.
• 1:06:54
  Somebody just needed to teach him what to do.
• 1:06:57
  Yeah, I I totally agree. I, I have AI have a group of dad
• 1:07:00
  friends around here and you know where I live and you know, I and
• 1:07:06
  when I have one particular friend who since I've met him a
• 1:07:10
  couple of years ago, probably lost 150 lbs without
• 1:07:13
  exaggerating. And no one ever like told him
• 1:07:16
  that he was overweight And like he never had, like he told me he
• 1:07:19
  had a, you know, a doctor was like, Hey, you got to be
• 1:07:21
  careful. But what happened, I think was
• 1:07:24
  he became, he became friends with me and a couple other guys
• 1:07:28
  that do exercise a lot and just talk about it.
• 1:07:30
  You know, we just talk about like, we like really talk about
• 1:07:32
  how good we feel and how it's part of our everyday schedule.
• 1:07:34
  And then, and then, and then, you know, we have a group chat
• 1:07:36
  and he's, you know, and then he started sending like, you know,
• 1:07:38
  the videos of, of people jogging and like, you know, so one day I
• 1:07:42
  got a random Tuesday, someone's in the video of them jogging.
• 1:07:44
  And then within the next hour or two, everyone else in the video
• 1:07:47
  of them, Hey, you know what, I have 20 minutes now.
• 1:07:48
  Let me get up and let me work out for a little bit.
• 1:07:50
  And like, I think that he's also such such an integral part of,
• 1:07:54
  of health as far as building habits and encouraging healthy
• 1:07:57
  habits, because a habit, you know, it's hard to build when
• 1:08:02
  you're kind of swimming against the stream.
• 1:08:03
  But when it's your, when it's your norm, then it's like, hey,
• 1:08:06
  you almost want to do it. Like, I mean, you know, all the,
• 1:08:09
  and you could talk about the motivation and the value or not
• 1:08:11
  and how much intent matters or not.
• 1:08:13
  At the end of the day, if someone's losing 150 lbs at 35
• 1:08:16
  years old, that's awesome. You know, like, I don't, you
• 1:08:18
  know, if, if you're doing it with your friends, you're doing
• 1:08:21
  it, you guys are laughing, you're doing it, you guys, you
• 1:08:22
  know, agree that, you know, cutting back on drinking for,
• 1:08:25
  you know, drinking X amount XY and Z is probably beneficial.
• 1:08:30
  You know, the way you eat, probably beneficial.
• 1:08:31
  Stop eating at a, you know, particular restaurants or
• 1:08:34
  particular types of food. And like we just, everyone is
• 1:08:38
  just doing better now than they, they had before and their lives
• 1:08:41
  are crazier. They're, you know, it really
• 1:08:43
  helps with balance for sure. Yeah, like we love craft beers
• 1:08:49
  and it's really cool that there's all these like non
• 1:08:52
  alcoholic craft. Beers.
• 1:08:56
  Every time we go somewhere, you know, like now we are like,
• 1:08:59
  let's try the non alcoholic craft beer.
• 1:09:02
  Oh, Asheville's like the best beer place ever.
• 1:09:05
  Have you been to burial? Oh, yes, burial's close to me.
• 1:09:11
  Yeah, it's. Incredible.
• 1:09:13
  I get beer shipped from them down to South Florida and make I
• 1:09:16
  make my dad go there to pick to pick up for me.
• 1:09:19
  Here's a log cabin right near there and I make him go to
• 1:09:21
  burial and ship me beer. Oh my gosh.
• 1:09:24
  Yeah. No, we we love it.
• 1:09:27
  I mean, we, we love, we love craft beer, but that's kind of
• 1:09:30
  really cool because the whole like shift, because it's just
• 1:09:33
  kind of like an experience. And now they they make all these
• 1:09:35
  like, yes, amazing. Like Sierra Nevada has a whole
• 1:09:38
  bunch of really yummy, you know, non alcoholic beers, but a lot
• 1:09:43
  of. You guys right?
• 1:09:45
  Voodoo Rangers Sierra Nevada to the same company.
• 1:09:48
  Yeah, and then who? Like Hillman Brown?
• 1:09:52
  I mean, there are so many. Such a.
• 1:09:58
  Cool. Like, you know, and then that's
• 1:10:00
  like our, our weekend. We're at a brewery with our kids
• 1:10:04
  and there's like music and we just chill out and it's good.
• 1:10:07
  That's the culture's good. But again, like, there are ways
• 1:10:10
  to, to live healthy now, you know, They're just like, you
• 1:10:12
  know, if I have one beer a week, OK.
• 1:10:14
  But then if I want something else, yeah.
• 1:10:16
  Like my husband only drinks some alcoholic beers now.
• 1:10:18
  He's just kind of giving up alcohol completely.
• 1:10:21
  I still do like a glass of wine a week or a beer once a week or
• 1:10:25
  something. Just that's good.
• 1:10:27
  You know, what do you do? We have our vices and then we
• 1:10:30
  reset again, right? Yeah, definitely, definitely.
• 1:10:35
  You guys have great music there too.
• 1:10:36
  You guys have an awesome music scene there.
• 1:10:38
  Billy Strange just played three nights there.
• 1:10:40
  I know my nurse went every night.
• 1:10:43
  She thought it was there. She got tickets every night.
• 1:10:45
  And then what did I just do? Oh, I just bought tickets to
• 1:10:47
  Lollapalooza to take my two daughters.
• 1:10:50
  And she saw that. Yeah, I was on the like on the
• 1:10:53
  website today trying to get the tickets.
• 1:10:54
  And then my oldest was like, I can't go.
• 1:10:58
  I have volleyball tryouts. Like, OK, I already bought the
• 1:11:02
  tickets, so I'll sell it when I get there.
• 1:11:05
  Like, really? Wow so cool, it's a great place
• 1:11:10
  to live. How long you been in Asheville
• 1:11:11
  for? We've been in Asheville, let's
• 1:11:13
  see, like since 2020, but I was only an hour away and then we've
• 1:11:19
  been in North Carolina since 2013, so.
• 1:11:22
  So my dad has a log cabin about half an hour from Burnsville,
• 1:11:27
  which is Tennessee from you guys.
• 1:11:29
  Yeah, city to him is Johnson City, TN.
• 1:11:34
  It's only like an hour from us. Yeah, it's close.
• 1:11:36
  It's not. Far Yeah, yeah, totally,
• 1:11:38
  totally. And we and, and when I was yeah,
• 1:11:40
  during COVID in 2020, you know, I my, my, my there was this log
• 1:11:44
  cabin no one's around it's the middle of nowhere.
• 1:11:47
  And I used to go with my, and I was like, I'm sick and tired of
• 1:11:49
  being locked up. So I, I would take a group of
• 1:11:52
  friends and, you know, we'd take 5 or 6 of us.
• 1:11:54
  We'd go to like in the cabin and going to Asheville during the
• 1:11:57
  day and then, and then go back to the mountain at night.
• 1:12:00
  It's awesome. I love that part of the.
• 1:12:02
  It's such a fun, different place and like anything goes, you
• 1:12:07
  know, you go downtown and somebody's just doing yoga and
• 1:12:11
  everybody else walking. It is just like a wild just and
• 1:12:16
  people are just so, I don't know, like everyone is so
• 1:12:20
  helpful and kind and and I think.
• 1:12:24
  That was affected by the by all the flooding.
• 1:12:27
  Yeah, it was. That was hard.
• 1:12:30
  That was awful. Luckily, like our house was
• 1:12:32
  fine, but we didn't have water or electricity for many, many,
• 1:12:35
  many weeks. And I had to close my office
• 1:12:39
  because we had no running water. And eventually I, we, we opened
• 1:12:45
  and we were like, we'll just bring water in.
• 1:12:47
  And you know, it made house calls and it made, I mean, it
• 1:12:50
  was, it was, it was crazy. And then our virtual assistant,
• 1:12:53
  she lives in the Philippines, you know, we made international
• 1:12:56
  news. She called us.
• 1:12:57
  And I was like, are you guys OK? We were trapped in our house for
• 1:13:02
  like, we like on our street, we couldn't get out for like 3
• 1:13:05
  days. And then we're every, nobody was
• 1:13:08
  helping, you know, because nobody could get to anybody.
• 1:13:10
  And finally all the night everyone took their like
• 1:13:13
  chainsaws and cleared the roads so you could get out.
• 1:13:16
  And by the time we got out, we didn't know there was like
• 1:13:19
  everything was shut down and it was crazy.
• 1:13:23
  And we ended up getting our kids out of town so that they could
• 1:13:28
  go. And, and then we ended up coming
• 1:13:30
  back to help, you know, do whatever we needed to do.
• 1:13:32
  But it was, that was wild. I can't believe we went through
• 1:13:37
  that. Hopefully the last one And
• 1:13:39
  Asheville's just perfect now because I, I really do love it
• 1:13:41
  here. It's like my favorite place I've
• 1:13:43
  ever lived. That's awesome.
• 1:13:45
  I love. Yeah, I'm happy to hear that.
• 1:13:46
  Yeah. That.
• 1:13:47
  So we've we've gotten stuck there, if you want to.
• 1:13:49
  The truth is that as far as like America goes, if you want to
• 1:13:53
  kind of have trouble in America, like, you know, like natural
• 1:13:56
  trouble and stuff like that, like N Carolinans treat each
• 1:13:59
  other so well and like the people like gone.
• 1:14:01
  You know, we've got stuck in the mud so many times or you know,
• 1:14:04
  like we've broken down or something's happened.
• 1:14:06
  And like the people are just good people.
• 1:14:09
  They just, they just have that, like they just have that
• 1:14:12
  goodness in their heart. I really like, I really, I
• 1:14:14
  really being around there. Before you wrap up, I want to
• 1:14:17
  ask your advice and final thoughts on things for people to
• 1:14:24
  avoid as far as their brain health and development as they
• 1:14:27
  age, and things for people, A couple of things to avoid, a
• 1:14:30
  couple of things to proactively take care of and do.
• 1:14:35
  OK, so processed food, like avoid it.
• 1:14:38
  It is a killer. No, that's a tough one, but it's
• 1:14:41
  a it's a killer and everything is now processed, you know, like
• 1:14:45
  just anything that comes out of a box, try to avoid it.
• 1:14:48
  Eat fresh foods. I would, I would say it's
• 1:14:50
  probably the big thing, but avoid processed food, avoid not
• 1:14:55
  sleeping. That's really, really bad.
• 1:14:56
  Make sure you get at least 7 hours of sleep because lack of
• 1:14:59
  sleep, you know, and I, I struggle with not getting enough
• 1:15:02
  sleep, but insomnia can increase your risk of dementia.
• 1:15:06
  Make sure that you know, don't, don't smoke smoking is bad.
• 1:15:09
  Don't, don't vape. We don't know all the data yet,
• 1:15:11
  but bad things are happening like we're finding bad things.
• 1:15:15
  So don't don't put anything in your body that's harmful.
• 1:15:18
  Just like treat your body like it's a temple, you know, try to
• 1:15:22
  really know alcohol is the best thing, but a little, you know,
• 1:15:26
  try to don't drink daily because that's not good for you either.
• 1:15:31
  So those are the things that I would say exercise almost daily,
• 1:15:35
  not just cardiovascular. You know, you should probably do
• 1:15:37
  weight training. I hardly ever do like
• 1:15:40
  cardiovascular stuff. It's like I'm basically doing
• 1:15:43
  weight training. And most of the time when you're
• 1:15:45
  weight training, you're hitting that zone too.
• 1:15:47
  So you're getting your cardiovascular needs met
• 1:15:49
  anyways. But yeah, I'm strength training.
• 1:15:51
  I think like almost everyday you should be doing something to
• 1:15:56
  stay active. And then, you know, I think
• 1:15:59
  there's some good stuff about fasting that's going to that's.
• 1:16:02
  We're. Still figuring all that out, but
• 1:16:05
  I don't I don't not into this like these big long fast.
• 1:16:08
  I'm still trying to figure that. I know David Sinclair talks
• 1:16:10
  about these fast. You know, he wrote the book
• 1:16:12
  Lifespan. He's like so smart.
• 1:16:15
  But I, I'm, I'm more of a, hey, let your body do a natural fast.
• 1:16:20
  So don't eat late at night. Finish your dinner at 6:00 PM.
• 1:16:23
  Don't eat anything else. Just have some water until the
• 1:16:25
  next day before you want to eat. Eat when you're hungry.
• 1:16:28
  Don't don't suffer, but eat something good.
• 1:16:31
  I mean, those are like the basic things I tell.
• 1:16:33
  People, that's really cool. So avoid smoking, avoid vaping,
• 1:16:39
  processed foods, a lot of alcohol.
• 1:16:42
  And what was the last thing to use?
• 1:16:45
  I think the top. Three, sleep.
• 1:16:47
  Make sure you're getting plenty of sleep.
• 1:16:48
  You know, sleep. Right.
• 1:16:50
  Project to. Get enough sleep, exercise, and
• 1:16:53
  potentially stretches of fasting in whatever capacity that might
• 1:16:58
  be. So from from dinner time to
• 1:17:01
  breakfast time, breakfast time to dinner time.
• 1:17:03
  Whatever. Yeah, just kind of, you know,
• 1:17:05
  these natural fast eat when you're.
• 1:17:06
  Hungry. Does that include water?
• 1:17:07
  Does that include water or no? Oh, yeah, yeah.
• 1:17:10
  I think like you should just drink as much water as you want.
• 1:17:12
  Like water is key. Do you know, even like you can
• 1:17:16
  even stay hydrated with some coffee and tea if you're like
• 1:17:18
  going throughout the day. You know, I mean, as a doctor,
• 1:17:21
  like people are like, oh, when do you take lunch?
• 1:17:23
  I'm like, I don't take a lunch. So all I do is I have, you know,
• 1:17:28
  my breakfast, which is sometimes like couple of eggs or like a
• 1:17:32
  protein ball or something. But then that somebody from the
• 1:17:36
  gym makes and some coffee. But then the rest of the day,
• 1:17:39
  like if I'm hungry, I'll have like a handful of nuts and then
• 1:17:42
  I get home and I eat. But doctor, diets are perfect.
• 1:17:46
  You don't. We don't worry too much about
• 1:17:47
  weight gain. We just don't really have an
• 1:17:49
  opportunity to sit down and chow down just fine.
• 1:17:54
  Busy enough to not get unhealthy?
• 1:17:56
  Basically is this is the answer? Yeah, and I'll, I'll put up some
• 1:17:59
  more blog posts on like specific like diet things.
• 1:18:04
  I think that that would be a fun, you know, a good thing to,
• 1:18:07
  to put up. And I always tell people like
• 1:18:09
  don't like follow all my vitamin supplement.
• 1:18:11
  It's not advice. It's just information so that
• 1:18:14
  you can advocate for yourself, you know, and, and you can talk
• 1:18:19
  to your healthcare professional. And that's the other piece of it
• 1:18:22
  before my Internet knocks out. But you know, if there are only
• 1:18:27
  only 13% of people have access to a geriatrician, we are, we
• 1:18:31
  need 30,000 by 2029 when the last of the baby room returns
• 1:18:35
  65. And we only have a like close to
• 1:18:37
  7000. We have those retiring.
• 1:18:39
  We only train 250 a year. And so I think healthcare really
• 1:18:43
  needs to become like your own, like you have to own it.
• 1:18:47
  And yeah, I do think AI and tech is going to help us achieve some
• 1:18:53
  of that where they're going to be a little bit of a lack in
• 1:18:55
  healthcare. And then people should advocate
• 1:18:58
  for themselves and seek, seek truths other than some of the
• 1:19:01
  weird, like weird stuff, you know, that that's out there
• 1:19:04
  like. You mean like to live forever,
• 1:19:06
  be like a lizard person kind of thing?
• 1:19:09
  Like drink something you're in or I don't know.
• 1:19:12
  Yeah, yeah, yeah, yeah, yeah, yeah.
• 1:19:13
  All the Epstein popular stuff. Avoid all the Epstein.
• 1:19:16
  Falls no. Avoid all that, yeah.
• 1:19:19
  Seriously doctor, this is such a fun conversation and honestly I
• 1:19:25
  had such a blast. This was a emotional roller
• 1:19:28
  coaster, but so informative and so much fun and quite frankly,
• 1:19:33
  this was awesome and you killed it, so thank you so much.
• 1:19:36
  For taking. Popping on.
• 1:19:38
  Thank you. And then yeah, I'm going to
• 1:19:40
  connect with you because I do want one of those like bone
• 1:19:42
  density machines. I was looking.
• 1:19:44
  At Oh, definitely. Yeah.
• 1:19:46
  Like maybe we can connect. Definitely.
• 1:19:49
  Definitely. I'll do what I can for you,
• 1:19:51
  Doctor. Thank you.
• 1:19:52
  Of course. Thank you.
• 1:19:53
  Thank you. We said goodbye, but before we
• 1:19:56
  go, how do we find you? OK, so you could check out
• 1:20:00
  jerryacademy.com, geriacademy.com it has a link to
• 1:20:05
  my book if you're interested. And then the book again is
• 1:20:07
  called Life, Love and the In between, a geriatricians journey
• 1:20:11
  through aging and the meaning of life.
• 1:20:13
  So. And I'll put that link on the
• 1:20:15
  website and on the on the episode page.
• 1:20:17
  So I want to be able to find it very easily.
• 1:20:20
  That sounds great. Thank you.
• 1:20:23
  OK.