Latest / White Coat Black Sheep / Parkinson's, Dementia & the Insurance Fight Nobody Talks About

Transcript

Parkinson's, Dementia & the Insurance Fight Nobody Talks About · White Coat Black Sheep

0:00
Welcome to White Coat, Black Sheep, where science gets curious and dogma gets
0:04
uncomfortable. I'm your host, Dr. Steveli.
0:06
Today we talk physiology, evidence, and real-world medicine, plus the questions
0:11
you're not supposed to ask but probably should.
0:14
If you care about health and think there's a better way, welcome to the show.
0:23
Hello, Dr. Shan Raja. Thank you so much for joining me today.
0:28
Thank you for having me. It's a pleasure to be here.
0:30
Man, I'm excited to really get into-- I know we got to chat a little bit briefly
0:35
before we-
0:36
Uh-huh
0:36
... signed on here. So you're a neurologist.
0:39
I am.
0:40
Practicing in Bakersfield, California.
0:42
Currently, yes.
0:43
And it sounds like you're from Canada.
0:46
I grew up in Canada. I was born in Sri Lanka.
0:48
I moved around a lot so-
0:50
Wow
0:50
... so if you want to listen to all of this.
0:52
Yeah.
0:52
So I was born in Sri Lanka. There was a civil war at the time, so we left when I
0:57
was about four or five. We landed up in Manhattan,
1:02
lived there, I want to say, for maybe a year, and then we went to Canada.
1:06
Then I grew up in Canada till I was about 21, 22.
1:10
Then I went to medical school in the Netherlands, Antilles, on an island-
1:14
Ooh
1:14
... called Bonaire.
1:16
Okay.
1:16
And then I did my clinicals in Chicago, Illinois.
1:20
Love it.
1:20
I did my residency at the University of Iowa.
1:23
Okay.
1:24
Then I lived in Medford, Oregon, and then Kyle, Texas, and now I'm here.
1:30
Wow. I love that journey. And I kind of know the places that you were at.
1:35
So, like Mount Sinai for Chicago?
1:37
Mm-hmm. Mount Sinai.
1:38
Maybe I saw you there and you didn't even know.
1:41
Was there a Mount Sinai there? I worked at a hospital called Jackson Park-
1:46
Oh
1:46
... which is all the way in the south side of town.
1:48
I did OB rotation there.
1:50
Oh, you did?
1:50
Yeah.
1:51
Oh, wow. So did you, were you scared when you-
1:54
Terrified.
1:55
I used to think-
1:55
I'm scared everywhere in Chicago, to be honest.
1:58
You know, they scare you a lot, but what I found that...
2:01
And I lived on the north side of town, so I lived in, what was it called?
2:05
Lake Shore. So it was-
2:06
Same
2:06
... near Wrigleyville.
2:08
Yeah.
2:09
But I would go to work on the bus sometimes.
2:13
Mostly the car, but every now and then, I would take the bus, and I found that
2:16
everybody was much more pleasant on that side of town.
2:18
They would say, "Hey, how are you?" Whatnot.
2:21
Now, would I leave my car open or walk around in the middle of the night?
2:25
Probably not, but-
2:27
Yeah
2:27
... but I enjoyed it. I grew up in Montreal, but we were immigrants of war, so we
2:32
grew up in the poorer part of town.
2:35
Wow.
2:35
There was a lot of Caribbean food and mostly African Americans or Caribbean
2:40
Americans, so that part of town felt like home to me.
2:44
Wow. That is so-- It's fun to hear, especially-- Okay, so Iowa.
2:49
Uh-huh.
2:49
Tell me about that one. I roughly know where that was. Is that Hawkeyes?
2:53
Iowa is Hawkeyes, yes.
2:54
Okay. They're obsessed with it, right?
2:56
They are. What is it? They say the population in Iowa is like 15 to 20,000, but
3:02
on game day, it goes up to 70,000, which is-
3:05
Yeah
3:05
... Iowa City, which is-- It's insane there.
3:08
Quad Cities?
3:09
Quad Cities is near Iowa.
3:11
Yeah.
3:11
So Iowa City is where the Hawkeyes play.
3:13
Okay.
3:13
Quad Cities, I want to say we drove there a lot, maybe an hour and a half from
3:16
there.
3:17
Okay.
3:17
Yeah.
3:18
Yeah. I actually lived there for a short duration of time.
3:21
In Quad Cities?
3:22
Yeah.
3:22
Which part?
3:23
Random. Oh, on the Iowa side, downtown.
3:27
Okay.
3:27
Is it Bett-
3:28
Davenport?
3:29
Oh, Davenport.
3:29
Yes.
3:30
I lived in Davenport. I lived in downtown Davenport.
3:33
Davenport, Iowa, yeah.
3:34
Yeah. It was like a really cool, like concrete-
3:36
Mm-hmm
3:37
... I don't know, modern type building.
3:39
Did you go to the old soda shop there?
3:43
I don't remember that.
3:45
It was a while ago.
3:45
Yeah, I don't remember going to that.
3:47
But Iowa was nice. A farm town.
3:50
Yeah.
3:50
And there's something to be said about less options.
3:52
It's like the Netflix conundrum.
3:55
Yeah.
3:55
I have spent an hour and a half trying to pick a movie because there's just too
3:59
many choices, whereas-
4:00
Oh
4:00
... it was cable, just the first channel looked so interesting.
4:03
Yeah.
4:03
And that's kind of like how I think of Iowa City.
4:05
There's maybe two or three restaurants.
4:08
You don't have to think too hard to go somewhere.
4:10
Yeah.
4:11
So yeah. It kind of takes away choice, which gives you more freedom almost.
4:15
I don't know how Canada is. Definitely Sri Lanka is probably very warm.
4:20
Sri Lanka is humid and warm, but I-
4:22
Right
4:22
... but I love warm.
4:23
I do too. So living up in that area, like Chicago or Iowa, I
4:29
was out of place.
4:31
Oh, it was terrible. I lived in Iowa where the polar vortex happened.
4:35
And we had two small dogs, a seven-pound Maltese poodle-
4:39
Cute
4:39
... and about a four-pound toy poodle.
4:41
And the Maltese poodle, we would take him out, and during the polar vortex, he
4:46
would sit down and kind of say, "Hey, I'm giving up.
4:48
This is the end for me."
4:50
That's me. I really like relate to-- I resonate with him.
4:55
Like subzeroes, forget it. Why are we alive?
4:58
Uh-huh.
4:58
How is this like compatible with life?
5:00
It was bad.
5:01
Yeah.
5:02
One of the reasons we left, because I loved Iowa, but I just couldn't.
5:05
My genetics likes warm weather.
5:07
Me too, me too. Yeah, and I realized, like even just like what I-- You know, you
5:12
kind of have like this thing that you imagine people should dress, or like I had
5:17
too-- I wore too many colors.
5:18
Uh-huh.
5:18
Okay, so I'm clearly Florida, California, right?
5:21
I w-
5:21
So you stood out in Iowa.
5:23
So ba- And I was actually told that I was too tan.
5:26
Oh, wow.
5:28
I just love it. Anyway, so yeah, you kind of find your region, and your region
5:32
finds you.
5:33
Uh-huh.
5:34
Do you-- Oh, go ahead.
5:35
I was gonna say, this region found me because my wife is from here, so I have-
5:38
Oh
5:38
... no say in the matter.
5:40
Wow. Is she in medicine?
5:42
No, she is at home with my son right now.
5:45
Okay.
5:46
I'm actually gonna open up my own neurology clinic, and she-
5:50
Congratulations
5:50
... is gonna be part of that.
5:52
That's so cool.
5:53
Thank you. I'm excited.
5:55
Man. Here in town?
5:55
Here in town.
5:56
Okay.
5:57
Yeah.
5:57
What area?
5:58
It's gonna be at the Doctor's Park on Ming and Neustie.
6:01
Great area.
6:02
Yeah.
6:02
Yeah.
6:02
So, I mean, right, we're just starting out, so we're renting for now.
6:05
Love it.
6:06
It's gonna be-- The way I describe it is mom and pop neurology clinic.
6:12
Yeah.
6:12
Because I want it to be personal. There's gonna be-
6:15
It needs it
6:15
... and I have nothing against NPs or PAs, but the patient is gonna see me every
6:19
time they come back.
6:20
Yeah.
6:20
There's not gonna be four different doctors seeing them.
6:22
Yeah.
6:23
I wanna build relationships. I wanna have that doctor-patient relationship where I
6:27
can remember your son's name or what your daughter's doing or how your dog is.
6:32
And I wanna include, actually, functional medicine and-
6:36
Yeah
6:36
... integrative medicine in there. I wanna have acupuncture, STEMWave.
6:40
I love that.
6:41
The goal is to eventually maybe even get people to meditate, but that might-
6:46
Yeah
6:46
... be overly ambitious.
6:47
No, I don't think so. No, I think everybody's so over-stimulated.
6:50
It is, it is.
6:51
Even the iWatch, I can't personally handle it. I feel like my HRV is affected, so.
6:56
Mm-hmm. I agree.
6:57
I can't-- I, yeah, I don't think that that's wild.
7:01
Yeah. I was at my current work in I think February of last year.
7:06
I realized I wasn't very happy with what I was doing, that I needed a change.
7:11
I got into meditation. I'm Hindu, so I should've been meditating my whole life- ...
7:16
but I wasn't. So I got into-
7:18
You still have to practice it, right?
7:20
Yeah, you have to practice it. Yeah.
7:20
Doesn't matter who you are or your background.
7:23
Exactly. So I got into meditation.
7:24
I actually took a trip to India to one of the oldest living cities in the world
7:28
called Kashi or Varanasi.
7:30
Okay.
7:30
I spent two weeks there meditating, learning meditation.
7:33
I came back, incorporate it into my life, and it's kind of changed me as a person,
7:38
and I feel like it could change everybody.
7:42
Have you heard of the default mode network?
7:44
No, but I feel like I need to.
7:46
So the default mode network is a brain pathway of ours that basically
7:52
is, it goes in a loop when we're not paying attention to anything.
7:56
So when you're sitting there daydreaming, it's the pathway that thinks about the
7:59
past, the future, who you are, your anxiety, and all of that comes back.
8:04
That's the default mode network. And they found that meditation actually can shut
8:09
that down. So in Hinduism or yoga, you don't wanna see
8:15
things as what can the past be about it, what can the present, you know, future be
8:19
about it. You wanna see things as they are.
8:21
You don't wanna include all your experiences and put a label on this that may not
8:27
be true.
8:28
Yeah.
8:29
So if you could turn off that default mode network, you can see everything as it
8:33
is.
8:33
I tried that with every next marriage that I did.
8:37
Jokes aside, okay.
8:39
Uh-huh.
8:39
So that was just two, but who's counting?
8:42
But yeah, no, it really is important, right, to have like a fresh start, but then
8:46
still somehow learn from your past-
8:49
Mm-hmm
8:49
... mistakes-
8:50
Yes, absolutely
8:52
... so you don't create the same-
8:53
Yes
8:53
... patterns.
8:54
Yes. You've learned what you need to learn.
8:58
Yeah.
8:58
But at the same time, when you sit there daydreaming, I mean, if you go back in
9:02
these loops of anxiety, fear, you're never gonna experience anything new.
9:07
Yeah.
9:08
And those are the things that you kind of need to turn off.
9:10
I mean, look at me, for example. I don't know that a year ago I would've had the
9:14
courage to open up my own clinic. I still don't know that I know everything about
9:19
opening up a clinic. I didn't know that you had to get a DBA.
9:22
I learned that-
9:23
It's disgusting.
9:25
It's called a... What's it called?
9:27
Doing business-
9:27
Business as. Yeah. And I had to go there about six times to try to get this DBA
9:32
license because I sent my wife, and that wasn't enough, then they needed me to sign
9:35
something.
9:36
I love it.
9:37
Then I went there and they're like, "Oh, but your wife started the process, so now
9:40
you need to have her come back, or you need to do it a separate way." It was--
9:43
Yeah. So, there's so many things that I'm learning, but-
9:46
Yeah
9:46
... but I'm happy. I'm very happy to where this is headed.
9:50
And I get to work with my wife, who, when you have kids and you have a career, it's
9:54
like you almost never see each other, so I'm excited about that, too.
9:57
I love this.
9:58
Yeah.
9:58
Okay. So, I'm excited to see in six months, how everything's going.
10:02
Me too.
10:03
It's hard, right?
10:04
It is hard, yeah.
10:04
But everything is hard.
10:06
Mm-hmm.
10:06
If you didn't do this, it would be hard.
10:08
Yeah.
10:08
If you are doing it, it's like you're just choosing which hard am I going to go
10:13
with?
10:13
Yeah.
10:13
Right or left.
10:15
So we have a word for it in Hinduism called svadharma.
10:20
It's your true calling. And it doesn't mean just because you like to play the
10:24
guitar, that's your true calling.
10:26
Mm-hmm.
10:26
Not everybody's going to be Led Zeppelin, but your true calling has to get you up
10:31
in the morning, motivate you, and it has to change you as a person.
10:36
And I found finally-
10:38
Mm-hmm
10:38
... after meditation, that every time I see a dementia patient, or every time I see
10:43
a patient with a disability, it kind of reminds me of my own
10:49
dad who has dementia, or a friend of mine that passed away from a disability.
10:55
And it's changing me because I'm kind of connecting with them, and I'm vested in
10:59
how well they do, and-
11:01
Yeah
11:01
... that as physicians, we kind of get thrown into this cog wheel of the machine,
11:06
and we forget that aspect. And I'm happy that I got that back.
11:11
That's awesome. And I think it's really special to hear that you're
11:17
not numb to it.
11:19
Yes.
11:20
You can turn off and be blind to suffering.
11:24
Mm-hmm.
11:25
And I don't ever want to be there.
11:27
No. I can't, and I'll be honest, I can't say that I was always like
11:33
this. I think the last year really changed me because in residency,
11:37
it's just the way the machine works, right?
11:40
They throw you in, you're not sleeping, you're seeing 30 patients a day, and then
11:45
there's no way to get through that unless you figure out a way to turn it off.
11:49
It's only the people- ... that can somewhat turn it off, make it through.
11:52
But then you forget to turn it back on when you have to.
11:55
Yeah.
11:56
And you kind of rush through life, and then you-
11:58
Yeah.
11:58
Yeah. So, yeah. So I'm excited. So svadharma, I think I was saying, so it has to
12:02
change you. It has to have purpose, make you get up in the morning, and it needs
12:08
to bring value as well. It needs to earn a living for you.
12:12
Yeah.
12:12
You have to have value in the service that you're giving, and that's not taken away
12:16
when we talk about life's true purpose.
12:19
So yeah, there's these YouTube videos on, there's a
12:24
guru called Rohit Arya. I think the videos are from nine years ago, but I'm
12:29
surprised that these things are not golden, everybody's not watching them.
12:35
Look them up.
12:36
The first time I saw his video, I was like, "Who is this pompous man?" Because he
12:40
sounded very pompous. But I kind of started listening to him a little bit more, and
12:45
I was like, "Wow, this is gold." Everything he says is just matching up with
12:51
everything I want to be. And, yeah, he doesn't know who I am, but I'm giving him
12:56
credit for changing me.
12:58
Like inspiring in some way.
13:00
Yeah, yeah.
13:01
Yeah. I think you can take a little something from everybody.
13:05
Mm-hmm.
13:05
Because you're not just randomly mixing with any patient encounter or any
13:11
friends or strangers. You're in the right place at the right time at all times.
13:16
Yes, exactly. Yes.
13:17
Yeah.
13:19
Somebody said,
13:21
"Do you realize when you are sitting in front of a plate of food, how thankful you
13:26
have to be?" Actually, it's another guru, it's Sadhguru. He's pretty famous now.
13:31
Rihanna even went there and I think performed for him.
13:34
But he said that, "When you're looking at this plate of food, do you realize how
13:38
much work that farmer put into it? And then how that got processed
13:44
somewhere, and some truck driver drove that, then it went to the market, got
13:48
stacked there, and then you cooked it." So imagine everything that had to happen.
13:53
Someone had to get a DBA.
13:54
Someone had to get a DBA to get this food on your plate.
13:58
Yeah.
13:58
And that you should be thankful just to be able to eat that.
14:02
So yeah, every moment is special.
14:04
Yeah. We'll stop complaining. Just say thank you.
14:09
Oh my gosh. So, okay, let's talk about dementia.
14:13
Okay.
14:13
Because you did bring it up, and it is something, I would say as a new grad-
14:18
Mm-hmm
14:18
... way back 2023, working with elderly patients with dementia,
14:24
I thought it was horrific, horrific.
14:27
Mm-hmm.
14:27
And then I transitioned into this, you kind of watch your own journey.
14:33
So then I was like, or is it a gift? Because maybe they want to
14:38
forget, or maybe they don't want to be aware of how their body is right now.
14:44
Mm-hmm.
14:44
And so now that I'm here, I'm just like, I don't think I've made a decision.
14:48
I don't want to wish it on myself-
14:51
Mm-hmm
14:51
... and I don't want to even imagine having it, but in the same time, for
14:57
some people, it does almost look like it is a good thing.
15:01
I think it depends on the type of life you lived.
15:04
Yeah.
15:04
One thing-- Okay, I'll say this. Me and my father don't have a good relationship.
15:09
He was an alcoholic, which is why he has dementia now.
15:13
So that being said, I'll see him now, he's kind of oblivious.
15:19
He thinks he's fine. He thinks he's healthier than everybody around him.
15:23
But every now and then, I'll kind of see him staring off into space, and I'll
15:26
think, is he wondering what he's forgetting?
15:30
Yeah.
15:30
Yeah.
15:30
So that's exactly what I'm talking about, right?
15:32
Yeah.
15:32
The bad memories.
15:33
Yeah.
15:34
Or is there any reflection in there?
15:37
It's-
15:38
I don't know. I think that's a question that science hasn't answered yet.
15:42
Yeah.
15:43
And then, with all the advances in quantum physics that we're making
15:49
with consciousness, and hopefully one day we can answer it.
15:53
Yeah, like maybe a body scan.
15:56
To tell if he is remembering certain things?
15:59
I guess if you could do a functional MRI, you can see what parts of the brain are
16:03
lighting up.
16:05
That's true.
16:05
But even then, is it what specific memory?
16:08
I don't think we'll ever know unless they're able to tell us.
16:11
The other part of that equation is a lot of the Alzheimer's patients, at least
16:15
language is one of the first things to go, so they even have a hard time explaining
16:18
it in words.
16:21
My family does have Alzheimer's.
16:25
Okay.
16:26
And I feel like it's more female than male.
16:29
Mm-hmm.
16:31
And it's scary to me.
16:33
Mm-hmm.
16:33
I am going to do the DNA testing for myself-
16:37
Okay
16:37
... just to know.
16:38
Mm-hmm.
16:38
Because some things you can prevent now, especially, I'm 42, I don't know your age,
16:43
but-
16:43
Mm-hmm. I'm 42, actually.
16:44
Oh.
16:45
Turning 43 next month.
16:46
Okay. 1983?
16:48
Yeah.
16:48
Yeah. Awesome. So,
16:51
yeah, if there's some action, like maybe it's nutrition or maybe it's something
16:55
like an enzyme, what can I do?
17:00
Yes. Keeping up with your vitamin D levels, the omega-3s are important.
17:06
But maybe I'm biased because I'm an exercise enthusiast, but a lot of the studies
17:11
show that physical activity is more important than anything else.
17:15
If you can have a good physical activity routine, I think that goes a long way.
17:21
That goes for both Alzheimer's and my Parkinson's patients.
17:24
In my 14 year-ish career between the university and moving around, all the patients
17:30
that do well are the ones-
17:32
Mm-hmm
17:32
... that have been physically active, and especially Parkinson's patients.
17:35
It's night and day. I have some jujitsu guys,
17:40
some gym guys, that somehow feel like they're beating the disease because they're
17:45
not progressing. That being said, you should get checked also because the new
17:49
medicines that are out now, and I'm not supporting big pharma, but the new
17:53
medicines that are out now have shown promise in slowing down the progression.
17:57
The five-year data looks really good.
17:59
That's amazing.
17:59
Yeah. And that's what I try to get all my patients on.
18:03
I know they categorize as mild cognitive impairment versus moderate dementia versus
18:08
severe dementia.
18:10
Mm-hmm.
18:11
And I don't like to follow test scores.
18:13
So if I can talk to a patient-
18:14
No
18:14
... and they still have activities that they like to do, and they can hold a
18:18
conversation-
18:19
Mm-hmm
18:19
... I'm going to try to get them on the medicine because that's important, to be
18:23
able to preserve that brain if they want to preserve the memories like you were
18:28
saying before.
18:29
Right. If they're good memories.
18:31
Yeah.
18:31
It's interesting. I have an aunt.
18:37
Exercise has helped her.
18:38
Mm-hmm.
18:39
She was non-verbal. We did a few interesting therapies.
18:43
I'll tell you about it later. But, I feel like the exercise probably was-
18:48
Mm-hmm
18:49
... profound.
18:50
Mm-hmm.
18:50
But then I also wonder, the environment, how much impact that has.
18:55
Because if you're raised in, say, a very comfortable situation that you control
19:00
everything, and then now you're older, you can't really speak for yourself.
19:03
Mm-hmm.
19:05
And I would say a lot of times,
19:08
they're with a partner who maybe can take care of themselves-
19:12
Mm-hmm
19:12
... but not the actual person that has the cognitive-
19:16
The dementia, yeah
19:17
... dementia. Yeah.
19:18
Yeah.
19:18
So, yeah, I just wonder the impact of the caregiver, the environment, all of those
19:24
things.
19:25
It goes both way, because a lot of dementia patients towards when they progress,
19:31
they're oblivious. It's the caregiver that takes the brunt end of that.
19:34
Yeah.
19:35
That being said, letting go of control is hard.
19:38
I try my hardest to let my patients drive for as long as possible-
19:42
Oh, yeah
19:42
... because I think independence is so important.
19:44
The moment you take away independence, I feel like they decline fast.
19:48
So if I can keep them driving, I usually do, as long as they're safe.
19:54
But that's where the frustration comes in.
19:56
A lot of dementia patients will get angry, frustrated, and I think that-
20:00
Oh, yeah
20:00
... like you said, is the loss of independence.
20:02
And if you ask me-
20:03
Yeah
20:03
... what my biggest fear is, it's not death, it's loss of independence.
20:07
Having to depend on somebody else to do my activities of daily living, like feeding
20:11
myself-
20:12
Yes
20:12
... or washing myself. I think that's my biggest fear.
20:14
You cannot perform your calling.
20:16
Yeah.
20:16
You cannot create change-
20:18
No
20:18
... or purpose.
20:19
Right.
20:20
I don't know what that would look like, but I know that it's super important to me
20:24
now.
20:25
Mm-hmm.
20:25
It brought me to become a doctor.
20:27
Mm-hmm.
20:28
Because I tried to quit several times, and I'm like, "Forget it.
20:32
I don't need to be a doctor."
20:33
Mm-hmm.
20:33
Because it's miserable.
20:34
Mm-hmm.
20:35
It's a horrible process. All the exams, all the cost.
20:41
I'm the first doctor in my family. It is tremendous to make that leap.
20:45
Mm-hmm.
20:46
Are you-
20:46
See, I am the first doctor in my family.
20:48
My father, like I said, we were immigrants of war.
20:52
My father was in engineering school before we left Sri Lanka, and my mom was doing
20:56
naturopathic medicine. But once we got to Montreal-
21:00
Wow
21:00
... they had to give that up. They had to work in factories pretty much most of
21:03
their lives.
21:04
Wow.
21:04
My father retired as a pizza delivery man. My mom retired as a factory worker.
21:08
So I am the first doctor in the family.
21:11
That's huge. No pressure.
21:13
Right.
21:15
Oh my gosh. Did you have any interesting visa...
21:20
Or no, because you were-- Yeah, were there visa issues making that leap from a
21:25
country of war into Canada, into the States?
21:28
No, we were refugees of war, and at that time they were welcoming us.
21:32
Oh, okay.
21:32
So Canada was not a problem. And thankfully because of my Canadian citizenship,
21:36
getting to the US was not a problem either.
21:38
Good. Yeah, there's some crazy situations that I've come to learn just being in
21:44
medicine.
21:44
Mm-hmm.
21:45
And you hear your colleagues and where they're from, and what kind of situations or
21:49
paperwork they have to do.
21:50
Yeah, it's tough. I see it both ways.
21:53
I think when you're young, you say, "Well, everybody should be able to go wherever
21:56
they want." And then you grow older, and you have a kid, and you're like, "Wait a
21:59
minute. Is that safe?" So you kind of land somewhere in the middle where you say,
22:04
"Well, there's two sides to every story."
22:06
Yeah, no, definitely. So when it comes to Parkinson's, let's go back to that.
22:12
Yeah.
22:13
You were mentioning medications.
22:16
I see a lot of patients in that facility-
22:19
Mm-hmm
22:19
... section, like skilled nursing-
22:21
Mm-hmm
22:21
... assisted living. So there's a lot of rules.
22:25
Mm-hmm.
22:26
I
22:27
see the point of them, right?
22:29
Mm-hmm.
22:29
So if you are a patient, you have dementia, you don't understand where you are, why
22:33
you're there.
22:34
Mm-hmm.
22:35
Every day is confusing. You don't know if it's day or night.
22:38
Mm-hmm.
22:39
And there's a lot of anger, agitation.
22:42
They have no rules-
22:43
Mm-hmm
22:44
... I mean, no rights as far as
22:47
their schedule, their food, and all this stuff.
22:49
So managing the anger and agitation-
22:52
Mm-hmm
22:53
... right? And the confused person or combative.
22:57
Mm-hmm.
22:58
There's this many medications that we can-
23:00
Yeah
23:01
... give them, but they're also falling and getting fractures.
23:05
Right. It's bad.
23:06
Horrible.
23:06
Yeah.
23:06
And horrible.
23:07
Yeah.
23:08
I don't know the answer. I know we're not doing the Thorazine in the neck anymore,
23:13
okay? That's TV.
23:14
Yeah. And we're not doing lobotomies anymore, thank God.
23:18
Keep your brain.
23:20
Yeah.
23:20
But yeah, I don't know. That is a tough one, but like-
23:23
So all the antipsychotics could make the Parkinson's worse, which then makes them
23:28
more rigid. Unfortunately, we don't have anything else out there, so at some point
23:33
even I have to say, "Okay, well, they might need this." But I try to slow it down
23:38
as much as I can. We have some new medications that came out that kind of help with
23:44
the dementia agitation without causing the Parkinsonism, a few selected ones, but
23:50
then you run into the insurance problem.
23:52
"Well, why haven't you tried A, B, C, and D?"
23:54
Oh my gosh.
23:55
"Well, because A, B, and D causes worsening of the Parkinson's."
23:58
Mm-hmm.
23:58
"Well, you still need to try it," and then we're at their mercy.
24:02
Ugh. What are some symptoms that people would
24:08
typically start to see? So if anybody's listening-
24:11
Mm-hmm
24:13
... what would you kind of pick up on right away?
24:15
Parkinson's you mean?
24:16
Mm-hmm.
24:17
Oh, a good neurologist can walk into the room and diagnose this.
24:22
You usually don't even usually need to touch the patient.
24:24
But what I look for is decreased blink reflex, so they don't blink as much.
24:29
They got this stare going on. And what we call masked faces or decreased facial
24:35
expression, so
24:37
they kind of look like they're just very serious all the time. They'll look rigid.
24:42
There may or may not be a tremor. A tremor I know is very highly associated with
24:45
Parkinson's, but that's not always the case.
24:48
Mm-hmm.
24:48
So I don't always look for a tremor.
24:50
It's really the decreased blink reflex, the masked faces that you can tell as soon
24:54
as you walk in.
24:56
Okay.
24:56
Now, there's some what we call non-motor symptoms in Parkinson's that starts-- So
25:01
Parkinson's doesn't start when we diagnose you.
25:04
The degeneration of that dopaminergic
25:08
pathway starts sooner.
25:11
Mm-hmm.
25:13
So some of the earlier non-motor symptoms are loss of sense of smell,
25:18
constipation,
25:21
vivid dreams where they punch or kick in their sleep.
25:24
Wow.
25:24
It's called REM behavior sleep disorder. So those are some of the early symptoms.
25:29
The handwriting is getting smaller.
25:31
Now, that's a motor symptom, but patients notice that.
25:34
They're like, "Oh, I'm writing very small," or-
25:35
Hmm
25:36
... "The handwriting is getting off." So those are things that I usually ask about
25:40
as well, but that's mostly for curiosity, but you can tell as soon as you walk in.
25:46
Now we have a scan called a DaT scan that's more readily available.
25:49
So-
25:49
DaT?
25:50
Yeah, DaT. That checks to see if that dopamine is
25:56
decreased in the area where we would expect it to be decreased.
25:59
I don't think I've heard of that. It's a brain scan?
26:01
Mm-hmm. It's kind of like a specialized CT scan.
26:04
They give you a tagged dopamine so that it lights up-
26:07
Oh
26:07
... and then they check to see if it's in that area.
26:10
This is a good thing.
26:11
Yeah.
26:11
Right?
26:12
Yeah. It's been around for a while now.
26:14
Oh.
26:14
It was mostly used for research university purposes.
26:17
Mm-hmm.
26:17
Now it's readily available for anybody to use.
26:20
The idea back then was that a good neurologist doesn't need the scan to diagnose
26:24
Parkinson's.
26:24
Mm-hmm.
26:25
That's part A, so you diagnose this, and then diagnose it.
26:29
And the second part of it is you try to give them the medicine, the dopamine.
26:33
If they're reactive-
26:35
Mm
26:35
... to the dopamine, then you've essentially confirmed the diagnosis.
26:38
Okay.
26:38
So you didn't need the scan, but nowadays it's available, and patients like to
26:41
confirm it. Nobody wants to take your word for it.
26:44
Yeah.
26:44
Which is fine. I wouldn't either, probably.
26:46
Yeah. Well, ChatGPT says.
26:48
Yeah.
26:50
Is this like a-- I guess obviously you do an MRI, all the other regular things
26:55
first.
26:55
Mm-hmm.
26:57
What point would you step into that testing?
27:02
That scan? I start with an MRI, just because you want to rule out all the mimics or
27:07
strokes or et cetera.
27:09
Mm-hmm.
27:09
And then once they come back for that return appointment, if the MRI doesn't show
27:13
anything, then I would usually order it right away.
27:15
Okay. Do you ever do any of those, the testing for Alzheimer's, like
27:21
ApoE or any?
27:22
Mm-hmm. We do that. I don't do it at the beginning because we have a PET scan now
27:26
that confirms the diagnosis.
27:28
Oh, great.
27:28
Yeah. So I usually do the ApoE testing if we're thinking about the
27:34
infusion therapy-
27:35
Mm-hmm
27:36
... because that'll tell us the risk of bleeding with the infusion therapies,
27:40
because those therapies-
27:40
Mm-hmm
27:41
... come with a risk of bleeding. And those are microbleeds.
27:44
Oh.
27:44
So you may not feel it, which is why there's some serial MRIs to be done at the
27:50
beginning to make sure we're not missing the microbleeds.
27:52
But the ApoE testing tells us if you're a high risk or a low risk, so that's
27:58
when I do it.
27:59
That's fantastic.
28:00
Yeah.
28:01
When you open your clinic, will you be taking insurance or it's-
28:05
Yeah.
28:05
Yeah.
28:07
Like I said, I'm new to this, so I contracted with a company that will credential
28:11
me for about 15 insurances, and then if there's some that come in that I'm like,
28:15
"Oh, we can always add some more on." But yeah, I'm wanting to take all the
28:18
insurances.
28:19
Yeah. I wish that I was better at handling the process of insurance.
28:25
I personally, I just, I don't know, I feel like a slight meltdown. I do.
28:31
I'm not going to sugarcoat it.
28:32
Trying to get things approved, you mean?
28:34
Yeah.
28:34
Yeah.
28:34
When a form comes back to me and I'm like-
28:36
Yeah
28:36
... "No, no." It's like it's-- I know.
28:39
And then they want to do the peer-to-peer.
28:41
Ugh.
28:41
And then the other person on the end of the line doesn't know anything about
28:46
dementia or neurology.
28:47
Yeah.
28:48
And you're trying to explain it to them, and it's just-
28:49
It's like giving a cat a bath. I just reject it.
28:54
It's bad. But I think, I wasn't doing it where I'm at now because the policy was we
28:59
just don't do peer-to-peer. It takes too long, I think.
29:03
I might start doing it at my own practice because I'll probably have a bit more
29:07
time to do it. I think it'll just be a case-by-case basis.
29:10
Yeah.
29:10
Because a lot of the times when I used to work in Iowa or Oregon, if you just
29:15
called at them and got angry for a couple of minutes, they would say yes.
29:19
That's wonderful.
29:20
Yeah.
29:23
Just twist their arm a little bit.
29:24
A little bit, yeah.
29:26
So.
29:27
Man, yeah. Insurance is just, it's almost a game.
29:31
Mm-hmm.
29:31
And I hate to even say it that way, but like-
29:34
Yeah
29:34
... it's not fair for any of us.
29:36
No.
29:36
None of us are winning or loving it.
29:38
To play devil's advocate, the other side of the coin isn't great either.
29:42
I used to think Canada was amazing, but the population there grew, and now my
29:46
parents are having a hard time getting to see doctors. The wait time is incredible.
29:51
So-
29:52
Hmm
29:52
... I don't know what the solution is because Canada has socialized healthcare.
29:55
Yeah.
29:56
And here it's not, and neither of them are good.
29:59
There's got to be some middle ground.
30:00
But I'm not smart enough to come up with that. That's not my sweater.
30:04
It seems like there's space then for both.
30:07
Yeah, maybe.
30:08
Right? Like it's-- yeah, I don't know. We're not going to solve that today.
30:12
No, probably not. I mean, there's people that have been trying for years, and-
30:16
Yeah
30:17
... yeah.
30:18
Yeah, both are definitely complicated.
30:20
But, yeah, when it comes to all these specialty tests, I mean, functional medicine,
30:25
that's very much within what I do, like genomics.
30:28
Mm-hmm.
30:28
I think it is the future. It's your body's roadmap.
30:32
Mm-hmm.
30:33
And some of these tests that I like to, if the patient will allow it-
30:38
Mm-hmm
30:38
... it really shows you with different level of certainty.
30:42
Mm-hmm.
30:42
This is a tier one, evidence-based-
30:46
Mm-hmm. Yes
30:46
... recommendation. It gives you the action items, and if you follow these, here's
30:50
the likelihood of it being effective.
30:54
Okay.
30:55
Or it'll tell you, "This is weak evidence for this," so you could try it-
30:59
Okay
30:59
... but it may not work. We're not sure.
31:02
Do you have a hard time getting that testing approved?
31:06
It's-- I don't even try. It's cash-based.
31:09
Okay. It's cash-based, got you.
31:10
Yeah. On average, it's about $1,700.
31:12
Oh, wow. Okay.
31:13
So it is expensive.
31:14
Mm-hmm.
31:14
I went to a conference last December, and there was a skin test out that you can do
31:20
a biopsy.
31:21
Okay.
31:21
And that will tell you a lot of brain-related information.
31:27
Okay.
31:27
And it was-- I mean, they had a lot of good research studies that they give with
31:33
this biopsy kit.
31:36
Mm-hmm.
31:36
I have never done one before. Is this something that you've ever heard of?
31:40
I haven't even heard of it, no. I'd have to look into it.
31:43
Yeah.
31:43
But no, I have not heard of it. But I mean, there's definitely evidence for
31:48
functional medicine in neurology, and so I'm sure that's valid.
31:53
Yeah. Do you take melatonin?
31:56
I do and I don't. So if I need to sleep at a certain hour because I need to
32:02
wake up the next day, I will.
32:05
Mm-hmm.
32:05
But I find that then the days when I-- like, let's say I take it Monday to Friday-
32:10
Mm-hmm
32:10
... then I can't sleep on Saturday till 3:00 AM.
32:13
Like I guess-
32:14
Oh
32:14
... my body gets so used to it. So I-
32:17
Interesting
32:17
... try not to take it. I mean, I'm a workout enthusiast.
32:21
Like I do jujitsu, mixed martial arts, go to the gym, so I try to work out as much
32:26
as I can so I'm fatigued by the end of the night. Yeah.
32:29
And then the meditation has been helping, too, so yeah.
32:31
How long do you meditate?
32:33
Ooh. So I meditate for about an hour in the morning and probably an hour to an
32:39
hour and a half at night.
32:41
That's actually really good.
32:43
Yeah. It's a lot. It's a lot.
32:44
That is a lot. You're very disciplined.
32:46
It is, but it's incorporated into religion for me, so it kind of helps in that
32:51
sense.
32:52
Yeah.
32:52
I feel like I'm kind of learning about my religion and meditating at the same time.
32:57
But it is intense, but there's some-- like sometimes you just get these experiences
33:01
where like at one point when I first started meditating, I would hit these points
33:07
where everything would go white, and you'd just feel bliss.
33:12
And then I read about it because I'm-
33:13
Huh, I need this
33:15
... I don't-- I want to connect science with
33:19
meditation and not just-
33:20
Yeah
33:20
... the mystic aspect. And I read about it, and they say that there is a certain
33:26
point in meditation where these kind of endorphins do get released, and they're
33:30
comparing it to kind of psilocybin a little bit.
33:33
Okay.
33:34
Yeah. So you can meditate and-
33:36
I need more of that.
33:37
Yeah.
33:38
And get that same feeling.
33:40
That is awesome.
33:41
Yeah.
33:43
So I mean, I know it's a practice, right?
33:45
Yeah.
33:45
Like your body has to-- you're focusing.
33:47
Yeah.
33:48
You are calling neurotransmitters to-
33:50
Mm-hmm
33:50
... a certain site.
33:51
Mm-hmm.
33:51
And you're activating like different parts of your brain.
33:54
Exactly. And you're shutting down different parts of your brain.
33:56
I think the shutting down is the part that people don't realize.
34:00
Huge.
34:00
Yeah.
34:01
I'm curious, I don't know if you wear a wearable device. I have this ring.
34:06
I want to because I think I-- but the problem is most of my physical activity is
34:11
combat sports, and I can't wear a watch.
34:13
The ring will probably break, so I've never been able to like accurately calculate
34:19
how many calories I'm burning.
34:20
Yeah. Well, what about a Whoop? Like the-- it's like a, just a band.
34:24
It doesn't have anything-
34:24
I haven't heard of it. I'll try it. I'll look it up, yeah.
34:26
Yeah. For-- I think my recommendation is mostly the Whoop-
34:31
Okay
34:31
... moving forward, because with this, like you said, if I'm doing weights or
34:34
something-
34:35
Yeah
34:35
... it's uncomfortable.
34:36
It is, yeah.
34:37
But, and then if I, there's the iWatch. I feel like that's too soothing.
34:41
I have the iWatch, it's just, I can never wear it when I'm doing my jujitsu or
34:46
doing my Muay Thai, so it's kind of-- then I stop wearing it, and I'm like, "Well,
34:50
it's not really measuring what I want it to measure."
34:52
Yeah.
34:52
Now it's just me wearing something with EMF on me all day for no reason, you know?
34:57
Yeah, seriously. Well, okay, so if you did or when you do wear a
35:03
device-
35:04
Mm-hmm
35:04
... and it's during your meditation, I'm curious what your vital trends would show.
35:09
It would be interesting to see. So I've always been the guy, just because of my, I
35:14
think, jujitsu, all of that, that goes to the doctor and the blood pressure is
35:18
usually like 105 over 65, and my heart rate's somewhere in the 50s to 60.
35:24
So it's always kind of low.
35:26
Yeah.
35:27
So I would, I'd be interested to see that too.
35:29
Yeah.
35:29
So I'll have to try it.
35:30
Do you feel like there's spikes when you initially start the meditation?
35:36
Spikes meaning a little burst of anxiety?
35:40
Mm-hmm.
35:40
Because it's a detox, essentially.
35:43
Kind of. So there's two aspects to it.
35:45
So if you look at it in the Hinduism aspect, they say when you first start
35:49
meditating, you try to-- you start burning off karma faster. So- ...
35:54
actually bad stuff starts happening to you.
35:56
Okay.
35:57
Which-- you were gonna say something?
36:00
No.
36:00
Okay.
36:00
Go on, please.
36:01
That's the mysticism aspect of it.
36:03
You're burning it off because you want to get rid of it.
36:05
Yeah.
36:05
You want to get rid of it as fast as you can.
36:07
Like bad karma?
36:08
Bad karma, exactly.
36:09
Okay.
36:10
And then there's the experience part of it.
36:13
Yes, when I sit down to meditate, all those thoughts kind of like from the day kind
36:17
of flood in.
36:18
Mm-hmm.
36:18
And I think what I've been told to do is kind of step back, just watch the
36:24
thoughts, observe them, and like realize they're there, and they'll slowly fade
36:29
away. If you try to actively fight them, you will fail.
36:32
This is very helpful.
36:34
Yeah.
36:35
Yeah. I mean, I definitely know I'm not alone, but a lot of people say, "When I lay
36:39
down to go to sleep-
36:40
Mm-hmm
36:40
... my mind just spins."
36:42
Oh my Lord. That is the biggest complaint I get from a lot of the-- and it's funny
36:47
because it's a lot of the immigrant population, older women That's kind of
36:53
the main complaint. "Can I turn my brain off? Can I turn my brain off?
36:57
Can I turn my brain off?" And, I give them medications because I'm a doctor, and at
37:02
the end of the day, they're there to see you, get medicine.
37:05
But I'm always telling them, "Can you just please try to exercise? Try it.
37:09
I bet you you'll feel better when you go to bed."
37:11
Yeah.
37:11
And if I could get them to meditate, hey, we've won the lottery then.
37:15
Yeah. Getting, especially my women, to exercise is really hard.
37:21
A lot of people say they do walks.
37:23
Mm-hmm.
37:23
I don't believe any of them. Just so you guys know, I don't think any of you guys
37:27
are walking. None of them. So it's like ...
37:31
This is what I tell them. "If you're not sweating by the end of it, I'm not going
37:34
to consider it as exercise." And then they're usually like, "Oh, okay.
37:37
Well then I guess I'm not really exercising."
37:40
Do they then tell you, "I just never sweat"? Do you hear that one?
37:44
I haven't heard that yet.
37:45
I hear that often. And I'm like, "That is weird."
37:48
Yeah.
37:48
That is very weird. And then I prescribe them to this red light sauna that's 190
37:53
degrees.
37:54
Uh-huh.
37:54
And like you stay in there for 15, 20 minutes.
37:56
Do they sweat?
37:57
Well, they need to show up first.
38:00
So I have an infrared sauna.
38:02
I have that.
38:02
I actually believe in that. So I have one-
38:04
Right
38:04
... at my house that I go in, whenever I get the time.
38:08
I think it heals me very well, and it warms you up.
38:11
There's a huge difference between an external sauna and an infrared sauna, that
38:16
warming from the inside.
38:17
Yes.
38:18
Yeah. It's nice.
38:19
Yeah. I actually don't know the science really that is making it so effective-
38:24
Mm-hmm
38:24
... except that the red light is anti-inflammatory-
38:26
Mm-hmm, mm-hmm
38:27
... and that sweating is detoxing.
38:29
Yeah.
38:29
But, I mean, just at a superficial level, my skin, I see a major difference.
38:34
Mm-hmm. I feel different the next day, especially guys like Justin, throw me
38:39
around, and then I have neck pain, knee pain, whatnot.
38:42
So, I go in there, and the next day I feel like I can go back to rolling, go back
38:47
to fighting, go back to running around at work. Yeah.
38:50
That's amazing.
38:51
Yeah. And then we tried the cold plunge. It works, too. Don't get me wrong.
38:54
Mm-hmm.
38:54
It's just I'm not a fan of cold, so it's like torture to me.
38:57
And I'm like, I don't want to stress myself out thinking about this cold plunge.
39:01
So I don't do that anymore.
39:02
Okay, let's talk about that.
39:04
Uh-huh.
39:04
So what I know to be true about the cold plunge, there are a lot of
39:10
benefits-
39:11
Mm-hmm
39:12
... with-- And it's really time-dependent, right?
39:13
Mm-hmm.
39:13
So one to three minutes, up to five minutes-
39:16
Mm-hmm
39:16
... is theoretically documented as it's very helpful for healing, immune boost,
39:24
really giving you energy.
39:25
Mm-hmm.
39:26
So I guess theoretically, if you had a low morning cortisol-
39:30
Mm-hmm
39:30
... it would be advised to-
39:31
Oh, yeah. Absolutely
39:33
... do a cold plunge, right? Like one to five minutes.
39:35
Have you heard of heat shock proteins and cold shock proteins?
39:37
Yes.
39:37
Yeah. So the cold plunge releases cold shock proteins. It'll go out there.
39:41
I think of it like, "Pac-Man" style things.
39:43
It'll go-
39:44
Yeah
39:44
... out and eat the bad stuff.
39:45
Yeah.
39:45
And that's how I explain it to patients.
39:47
I love that.
39:48
Yeah.
39:48
I know. I find myself making like cartoon, like different animated situations.
39:53
Yeah.
39:53
Sometimes they make sense-
39:55
Yeah
39:55
... and they hit, and other times they're just blinking at me.
39:58
And I'm like-
39:58
So here's one that I use often that I find interesting-
40:00
Please, yeah
40:01
... because it's hard to explain to patients that
40:04
this medicine will not change the outcome of the disease. You know?
40:08
That's hard to process for them. So I compare my, there's a couple of medicines out
40:13
there like memantine or donepezil-
40:16
Mm-hmm
40:16
... that are memory boosting pills, but they don't really change the outcome of the
40:19
disease. They don't slow it down. So I say, "It's like coffee.
40:22
Coffee will give you energy, but it's not going to change you or make you a more
40:25
energetic person."
40:27
That's helpful.
40:27
"Once it's out of your system, it's out of your system, and then you go back to who
40:31
you are." So, I like that little analogy because it's hard to explain.
40:35
I'm going to use that.
40:37
Yeah.
40:37
Yeah, because I really was not, yeah, I was not explaining that one well.
40:42
So if somebody does have a little bit of a tremor, I know thyroid can be
40:47
involved.
40:48
Mm-hmm.
40:49
Do you have any underlying premise or opinion about the thyroid's
40:55
role with Parkinson's?
40:58
Ooh. I don't know that I've ever read into that. That'd be interesting.
41:02
I mean, hypothyroidism or hyperthyroidism can technically have some
41:08
similar symptoms. So hyperthyroidism could cause that tremor-
41:11
Mm-hmm
41:11
... that kind of agitated feeling that the Parkinson's patients get.
41:15
I don't know if you've heard this, but a lot of them will describe this like
41:18
anxiety, increased anxiety, and internal tremor.
41:21
Yeah.
41:22
So hyperthyroidism could certainly cause that, and then hypothyroidism can slow you
41:26
down and, you know, make you feel fatigued, which is also another complaint of
41:30
Parkinson's patients. I'll have to look into that if there's ever been research to
41:34
connect the two dots.
41:35
If you take that one step further-
41:37
Mm-hmm
41:37
... I also think of that in the terms of the loop, the HPA, right?
41:42
So-
41:42
Mm-hmm
41:43
... if you're low in one area-
41:44
Mm-hmm
41:44
... like that's going to kick-
41:46
Yes
41:46
... another, like the next-
41:47
Yeah
41:48
... level, right?
41:49
Yeah.
41:49
To send a signal. So I just, I think there's a lot of connected pieces-
41:54
Mm-hmm
41:54
...
41:55
that whole circuit that we're not really-
41:57
Oh, yeah. I mean, we've had research for years.
41:59
We still don't know what all the triggers for turning on Parkinson's in a patient
42:04
is.
42:04
Yeah.
42:04
We know it's associated with
42:08
pesticides, we know head trauma, but we still don't know every detail of how this
42:14
patient goes from here to Parkinson's.
42:16
So-
42:16
Mm-hmm
42:17
... yeah, thyroid might play a part. We still haven't figured it out yet.
42:21
Yeah. Or sleep, right? The impact of poor sleep.
42:25
Mm-hmm.
42:26
How often do you hear, "Oh, I only sleep four hours a night, I feel great"?
42:30
I might have to hide my face on that one because I usually do that.
42:32
Well, sir, when's your body supposed to heal? How?
42:36
I'm with you. I think sleep is important. I just haven't had the time.
42:42
So I work, my eight to five-
42:45
What? You have a job?
42:46
Yeah, eight to five job. Then I want to do my jujitsu.
42:49
Yeah.
42:49
I want to spend time with my five-year-old. I have two dogs.
42:52
I have a blue heeler and like a pit bull mix.
42:57
He-
42:57
Oh, fun mixture
42:59
... so we usually take the-- He's a black cur, I think is the other part of him.
43:03
So I have to take them for their walk because they're both under two, they're
43:06
puppies and they're restless. So they need their outlet.
43:10
And then a little bit of time with the wife, then my meditation, then whatever
43:14
tasks. You know, as a doctor, you're not done when you leave.
43:17
No.
43:17
There's like 50 forms to fill out. "Oh, can you finish this mandatory compliance
43:23
training?" You know, there's always something.
43:25
Nothing is lost. If it's on my desk, it is lost. Nope, didn't see it.
43:30
So yeah, when do I sleep? Yeah, that's the problem.
43:33
Man. Gosh. Yeah, I love to do it all. I don't want to miss anything either.
43:37
Yeah.
43:38
So, and I don't have kids-
43:39
Mm-hmm
43:40
... yet, so I don't know the answer.
43:43
Well, the perfect life, I think, is balance between all of that, and that's what
43:47
I'm hoping having my own practice will do.
43:50
Sharing time with my wife, finding balance for all of it-
43:53
Yeah
43:54
... where we can not just kind of close our eyes and coast through life, but
44:00
live it.
44:01
Yeah.
44:01
We've been in California for two years.
44:03
You know, we've not been to LA to actually like look at LA.
44:07
We've only been to the airport to pick up family members.
44:10
I don't really know what there is to look at.
44:12
I mean-
44:12
Yeah, I guess not.
44:14
I don't know. I went to Santa Monica.
44:16
Mm-hmm.
44:16
I mean, I used to really enjoy going there, right? Like it's kind of picturesque.
44:20
Yeah.
44:20
You've got the Ferris wheel.
44:21
Uh-huh.
44:22
You have the pier, but then there's this guy who's on a megaphone-
44:27
Okay
44:28
... yelling out his message. And I mean, it was the entire weekend.
44:32
There was not-- You would think that he would be arrested. He was not.
44:37
It was like, it was horrible. So I'm like, "Well, that was a waste."
44:40
So you heard him the whole time you were there.
44:41
The whole time.
44:42
Yeah. And then my perfect getaway isn't really the city.
44:45
I was using that as an example. Like if I could take my blue heeler and go for like
44:49
a nice hike, I think that would be much better.
44:52
Okay. That's pleasant, yeah.
44:54
Yeah. We went to General Sherman, Big Sherman.
44:57
Oh, yeah. Yeah, the tree.
44:59
But the, like you have to park somewhere, then take a bus.
45:02
We had our blue heeler, we had my five-year-old who was not five yet.
45:07
It was hot, and we were like, "No, forget this." We went past Big Sherman.
45:12
We saw another big tree, and we're like, "This is Big Sherman for us today."
45:17
I wasn't going to wait in that one-hour line to take a-- It was ridiculous.
45:20
No, that's horrible.
45:21
That is not relaxing. That's not what you go to the forest for.
45:23
What about the redwoods? Did you make it to that?
45:26
So we used to go to the redwoods a lot when we lived in Oregon.
45:28
Okay.
45:29
And I do miss it. I'm a big "Star Wars" fan.
45:31
My poodle's name, he passed away now, was Anakin, so- Yeah.
45:36
When we went to the redwoods and it reminded us of the movie, it was great.
45:39
I love it. I feel like Carmel is pretty beautiful.
45:44
Carmel is nice. Expensive, but nice.
45:45
Yeah, just don't look at the numbers.
45:46
Yeah.
45:47
Money's not real.
45:49
Yeah. But that white sandy beach, you don't get that anywhere else on the coast.
45:52
Yeah.
45:52
So Carmel is nice just for that. It was really windy when we went there, but it
45:57
was-- Let me think. My favorite place along the coast would probably still be
46:03
Oregon, because I think the Oregon coast is quieter and-
46:06
I can bet it
46:06
... not as jam-packed.
46:07
Mm-hmm.
46:08
We went to a little town, I want to say called Wheeler, Oregon, if I remember this
46:12
correctly.
46:12
Sounds adorable.
46:13
There's only one restaurant in that town.
46:16
It was right on the coast, and the best fish tacos I've ever had in my life.
46:21
Ooh.
46:21
Me and my wife talk about that all the time.
46:24
That's awesome.
46:25
It's a storybook town, too, so there's some cliffs that go up, and we always say,
46:29
"Maybe we'll retire there and write books while we watch the rain on the ocean."
46:32
I love that. Okay, that's romantic.
46:35
Yeah.
46:36
Super cute. They probably have Airbnbs that you could rent.
46:40
Mm-hmm. I bet you. Yeah.
46:41
Okay, so that's living.
46:42
That's living.
46:43
I think that's beautiful.
46:45
Yes.
46:45
That's really just taking it in, enjoying the beauty of life, and we're not
46:50
trained to do that.
46:52
No, we don't have the time.
46:53
Yeah.
46:53
The Western life is different. I think we say we have all the
46:59
luxuries, but we don't have the time to enjoy the luxuries.
47:03
Yeah.
47:03
I have this beautiful backyard. I think the people that owned it before us were a
47:08
retired judge.
47:09
Mm-hmm.
47:10
We have a rose fountain. We have a natural pond. We have a koi pond.
47:14
I don't know how much time I spend in it. I'm too busy working.
47:18
I'll get to go out around when the sun goes down.
47:20
By then, mosquitoes are killing me, and I'm like-
47:22
Yeah
47:22
... "Let me go back inside."
47:25
You're like, "Well, that was not lovely."
47:28
Yeah.
47:29
Man, yeah. Definitely after going through residency and everything leading up to
47:35
that, you're just juggling, right?
47:36
Mm-hmm.
47:37
It's constant.
47:38
It is. It's like no time to put your head down.
47:41
Yeah. So learning how to just be still-
47:46
Mm-hmm
47:47
... to manage all of this energy-
47:49
Mm-hmm
47:50
... it's hard.
47:51
It is really hard.
47:52
I'm trying to do that now. I don't sit still.
47:55
Mm-hmm.
47:55
I'm very fidgety. That's my baseline. I've always done that.
47:59
So have you done any meditation on your own?
48:02
No, I need to.
48:03
Okay. I feel like this is something that I'm passionate about that I could
48:06
hopefully in the future impart on you.
48:09
Please. No, for my health and my longevity-
48:12
Mm-hmm
48:12
... I must learn this.
48:14
Mm-hmm. I got my wife, who was an anxious person, onto
48:20
Kriya Yoga, which is breathing techniques, and she's really liking it and she's
48:24
enjoying it. So yeah, it's definitely, I think it works.
48:27
I need to look that one up and I'm going to-- Yeah, I need to make changes.
48:32
Yeah. I want to see more of the world.
48:35
And when we were growing up, that's the dream, right? I want to travel.
48:38
I know.
48:38
And I've gone to one foreign country other than the US or India, which to us
48:44
is like home, is I went to Portugal with one of my best friends.
48:48
Oh, that's gorgeous.
48:49
It was a great time, but other than that, I haven't seen anything else.
48:54
I realized my travel, I guess you have to have a reason-
48:58
Mm-hmm
48:59
... because I don't know. I don't know why I have to have a reason.
49:01
Mm-hmm.
49:01
I don't just do vacations. I do trips where I learn.
49:05
Ah.
49:05
It's a conference.
49:06
Okay.
49:06
So I find, Rand, if you're doing a conference and it's way over there in a
49:11
different country, I'm more likely to make it to that than the Marriott down the
49:15
street.
49:18
I
49:19
guess I could see how that's nice because you're multitasking, but then you're not
49:23
really turning off, are you?
49:25
Never.
49:25
Yeah.
49:26
I'm not turning off.
49:26
So that's why I liked India. Even the phone barely worked there. I was turned off.
49:31
I need to be-- Yeah.
49:32
I didn't even know the language. So India has like, I don't even know, I'm probably
49:37
making this up, but 300 languages or something like that, right?
49:40
Yeah.
49:40
And I didn't speak the dialect there. It was just somehow I got by.
49:44
I didn't even use my phone. It was a lot of hand signaling, and I just felt-
49:48
Oh my gosh
49:48
... finally I felt free.
49:49
That's something.
49:51
Yeah.
49:51
I feel like when I'm holding my phone, it fuels almost like an energy like this
49:57
through-
49:57
Mm-hmm
49:57
... like a loop.
49:59
Yeah.
49:59
Is that crazy?
50:00
No, I don't like to have my phone on when I'm at home.
50:03
And as a physician, it's hard. We're on call.
50:05
Yeah.
50:05
So when I'm on call week, it's practically glued to me.
50:08
Yeah.
50:08
But I try to throw it when I get home and not try to deal with it.
50:12
Yeah.
50:12
But it's also, every few seconds you're like, "Okay, let me go answer that email.
50:17
This is the time to do it."
50:18
Yeah, there's one more thing.
50:19
Yeah, exactly.
50:20
But you will never finish your list.
50:22
No.
50:23
Ever.
50:24
So I always tell my wife, I was like, "I just want to be caught up one day so I
50:29
could relax."
50:29
Never.
50:29
And she's like, "That's never going to happen."
50:32
Impossible.
50:32
"You're going to have to learn to relax while there's stuff to do."
50:35
Right? It just tastes bad.
50:37
Yeah.
50:37
It sounds bad. But she's right.
50:40
Yeah, she's absolutely right.
50:42
Wholeheartedly.
50:42
She's always right. I've fought her for God knows how long.
50:46
We've known each other for 20 years, and she always ends up being right.
50:49
You're a smart man already.
50:50
Yeah.
50:50
At 42 years old. Some guys, it takes them their whole life.
50:54
Oh, yeah. No, these last few years, I think when Yoda was born, my son,
51:00
it kind of just brought us together in that we had one goal and it's to survive
51:05
this. We didn't have any help. We didn't have my parents there.
51:09
We didn't have her parents.
51:10
Sounds like growing our own kids.
51:11
Kids are like that, aren't they?
51:12
Oh my God. Okay, I don't have kids yet. I will never pull the trigger.
51:17
Just proceed. Okay, go ahead.
51:18
Yeah, so we didn't have her parents. We didn't have my parents.
51:21
I was working, and she was going to school at the time doing her master's, and we
51:25
just somehow had to survive this period.
51:29
Yeah.
51:29
And that, I think, brought us closer and just kind of an understanding of each
51:34
other.
51:34
That's badass.
51:36
Yeah.
51:36
It's like this isn't about love or feelings right now.
51:38
No.
51:38
We have to live through this.
51:40
Yes, exactly right.
51:41
Oof. Man.
51:42
And my son is, I don't know. I've been around kids.
51:44
Me and my younger brother are 14 years apart, so I've been around kids-
51:49
Mm-hmm
51:49
... and I've kind of helped raise my brother.
51:51
But my son is probably the most stubborn kid I've ever seen.
51:55
If you tell him, "The sky is blue," he'll fight you until you say the sky is red,
52:00
and he'll want-- It's unbelievable.
52:03
It depends on the time of the day.
52:04
Yeah.
52:04
Maybe he is right if it is at sundown.
52:07
Yeah. We named him Yoda, which in Sanskrit, which is our version of Latin,
52:12
basically the oldest Indian language-
52:14
Yeah
52:14
... it means warrior. And my mother-in-law always jokes that, "Well, you named him
52:19
warrior. What did you expect? Maybe you should've named him Don or something."
52:24
Something more soft.
52:25
Yeah, exactly. Names have power, absolutely.
52:29
Oh my gosh. So what is your full name?
52:33
My name is Sulakshan, my first name.
52:35
Okay.
52:35
My last name is Mahendrarajah. So Sulakshan, Su in Sanskrit I think means more, and
52:41
Lakshan means radiant. So my first name means more radiant.
52:46
And Mahendrarajah is Maha means great.
52:50
Indra is the name of the king of the gods, and Rajah means king.
52:54
So I guess my last name means great king of gods or something like that.
52:59
You cannot be a loser. You had to--
53:03
Good thing that you're not, right?
53:05
Yeah.
53:05
Man, what a great name.
53:06
I try.
53:07
Yeah.
53:08
Yeah.
53:09
At what point did you start going with Shaun?
53:11
You're like, "These people can't."
53:12
So as soon as we moved to Montreal, my first teacher
53:18
there said, "Oh, well, we're not going to pronounce this.
53:21
We're going to call you Sulak." So the first part of my first name, Sulak.
53:25
Oh, man. How old were you?
53:26
So for-
53:27
Four?
53:27
... grade one, grade two.
53:29
Yeah.
53:29
Yeah. So I was Sulak for a while. A lot of my Montreal friends know me as Sulak.
53:34
Then I went into retail. I had a lot of jobs.
53:38
Immigrants-
53:39
Mm-hmm
53:39
... not a lot of money, so I've worked every job you could think of.
53:42
So I went into selling clothes, and I wanted to relate because I was working on
53:46
commission, and I wanted to relate to the customers, and my name wasn't going to do
53:50
it. That's when I went with Shaun. Then I went to residency, and everybody always
53:55
thought Shaun was easier, so.
53:57
You had to clean it up.
53:59
Yeah.
53:59
Oh my gosh.
54:00
Shaun has a good meaning in our language, too.
54:02
I think it means shine or something like that, or sun or something, so.
54:06
So you're still radiant.
54:06
Yeah, still radiant.
54:07
Yeah. That's cool. Yeah, mine means brave.
54:13
Oh, I like that.
54:14
Yeah. Valerie Valor
54:16
Oh, yeah.
54:17
Yeah.
54:17
Yeah. So that's Latin. Is it the under the final background of that?
54:23
I wish I knew-
54:25
Okay
54:25
... as much as you about my name. So my middle name is Felice-
54:29
Okay
54:29
... which is from Malta.
54:31
Okay.
54:32
It's a common last name there.
54:33
Okay.
54:33
It's my grandma's middle name.
54:35
Yeah.
54:35
I mean, that's her last name. It's my middle name.
54:37
And then Savelli-
54:38
Okay
54:39
... is my last name.
54:39
Malta is beautiful.
54:41
It is.
54:41
And no extradition. I know this because of a USA show called "White Collar" I used
54:47
to watch.
54:47
Oh. Good to know. Yeah, they have some interesting Bitcoin
54:53
laws there now.
54:54
Okay.
54:55
It really, really upgraded their harbors.
54:58
Oh, nice.
54:59
I went there throughout different points in my life.
55:02
Uh-huh.
55:02
And I still have a lot of my family that's there.
55:05
Oh.
55:06
Yeah, so I went there this past August.
55:09
Mm-hmm.
55:10
And I just was shocked with the harbors-
55:13
How it changed. Uh-huh
55:14
... from rowboats to mega yachts, like packed.
55:18
That's me when I went to, so Colombo is Sri Lanka's main city, and I went there,
55:22
and we actually had a skyline, and I was like, "Whoa, when did this happen?"
55:26
Isn't it crazy?
55:26
Right? Yeah. It's crazy.
55:28
Man, do you still have family there?
55:30
Yeah. My father's side had... So there were seven kids on his side.
55:35
So he lives in Montreal, but a lot of the uncles, aunts, cousins, they're still all
55:40
in Sri Lanka. I mean, they had to live through the war, so I always feel a little
55:43
bit guilty when I go back because I escaped-
55:45
Do you really?
55:46
... the war, and they didn't. They had to live in concentration camps, and I'm
55:50
like,
55:52
I don't have an excuse for-
55:54
Wow. That is,
55:57
yeah.
55:58
Yeah.
55:58
That is a good one.
56:00
Yeah.
56:00
I can't even imagine. I mean, I don't think I have any
56:06
family that... No, I take that back. So Malta did have the Great Siege.
56:11
Mm. Okay.
56:12
So that did drive a lot of my family out of there.
56:16
Okay. Got you.
56:17
So my grandfather, he came over on a boat.
56:21
Okay.
56:21
But I don't think at that time they were escaping war.
56:24
Okay.
56:24
They never spoke about it if they did, but he snuck in.
56:27
He was illegal here for 20 years.
56:29
Oh, yeah. When I first came to the US from Canada, it was illegally, I think, but
56:35
luckily when we went to Canada, we got our citizenships.
56:37
But yeah, I
56:39
mean, my father looked like, I think, one of the main
56:45
persons in the rebel side. So before he left, he left before us.
56:50
So my father left, and we didn't have contact with him for about four years.
56:55
Him and my mom weren't getting along at the time.
56:57
So me and my mom actually grew up in a orphanage temple type place.
57:01
Mm-hmm.
57:01
So I grew up in a temple, which is where my faith got stronger, I assume.
57:05
But anyway, so before he left, he got caught and tortured, and the story that
57:11
he tells us is that he was tied upside down.
57:14
Oh, my goodness.
57:15
And they put gasoline on those burlap bags.
57:20
Mm-hmm.
57:21
And then they put a rat in the bag, and they tie it to your head.
57:26
And the rat goes crazy from the gasoline smell, and it starts trying to gnaw at
57:30
you.
57:31
Oh, my goodness.
57:32
It's crazy stuff.
57:34
It just makes you, I feel gratitude.
57:36
Yeah.
57:37
I just feel gratitude that I do not-
57:40
Didn't have to
57:41
... have to experience that.
57:42
Same. Yeah, absolutely.
57:43
Gosh. The things people live through.
57:46
Yeah.
57:47
It makes me feel weak.
57:48
Yeah. It's crazy. I mean,
57:51
nowhere near what my father lived through, but just crossing the ocean, getting
57:56
there, living through, like in Montreal, where we lived, I've had a few friends
58:01
pass away from gang violence. So I've seen some stuff, too, and I'm just always
58:07
like, I can't believe I got away and I'm here, sitting here.
58:10
Just my story of war-torn Sri Lanka to hear sometimes surprises me when I think
58:15
about it.
58:15
Oh, my gosh. No, you feel guilt, which is-
58:18
You do, yeah
58:19
... yeah, it's interesting.
58:19
Survivor's guilt. Yeah.
58:21
Yeah. That's a real thing.
58:23
Yeah.
58:23
Or the fact that your ability to earn income is-
58:26
Mm-hmm
58:26
... now dramatically different.
58:28
Yes, absolutely.
58:30
Yeah. Generational wealth is something of interest to me.
58:35
Mm-hmm.
58:36
Just breaking through. I feel like the middle class is, it sounds so, I don't know,
58:42
like why should I complain, right?
58:44
Mm-hmm.
58:44
But I feel like no matter where you drop in at life, you're there-
58:49
Mm-hmm
58:49
... and it's your duty to do the very best, break through whatever barriers
58:55
are given to you-
58:56
Yeah, absolutely
58:56
... because you can and should.
58:57
Yeah.
58:58
Right? Fulfill your purpose.
58:59
You don't want to be complacent.
59:00
Yeah.
59:01
No.
59:01
So-
59:01
I believed in that, too. Right?
59:03
Yeah.
59:03
I want to make a, for me, there's purpose.
59:06
I want my son to say, "Okay, well, I have that savings."
59:09
Yeah.
59:09
"Now what do I want to do? What is my purpose in life?" Not, "Okay, well, this is
59:13
what's going to make me money."
59:15
Yes. To take from-
59:16
Exactly.
59:17
Yeah.
59:18
I hope whatever he does makes him money, but I want him to find his true calling
59:24
and not have to do 15 odd jobs, waiter, working at the bus stop, and-
59:30
Yeah
59:30
... selling clothes as Sean to try to get through with.
59:33
But that was your journey.
59:34
Yeah, that was my journey.
59:35
Yeah.
59:35
And it made me who I am.
59:37
Totally, and you wouldn't be who you are-
59:39
Yeah
59:40
... without it.
59:41
No, absolutely not. So I wouldn't even be a doctor if it wasn't for my first job.
59:45
So my first job was in a factory called Pantorama, and the job I got
59:51
was pushing a cart, and then they'd sew clothes.
59:54
So you would take the clothes, there would be a sticker on it, and you put it in
59:58
the box of the store it goes to, and then you would lift boxes, too.
1:00:02
So you worked 40 hours a week, and the pay at the time, per hour, was
1:00:07
$5.90.
1:00:09
Oh, that's beautiful.
1:00:09
And you got a half an hour lunch. That was my first job at 16.
1:00:13
I think my parents planned this because as soon as I was done that summer, I told
1:00:17
myself, "There is no way this is what I'm going to do for the rest of my life."
1:00:20
Like, I have to figure it out.
1:00:22
Yeah. No, I mean-
1:00:23
Okay
1:00:23
... I think those are the moments-
1:00:25
Mm-hmm
1:00:25
... that you really develop that thought.
1:00:28
Yeah. Absolutely.
1:00:30
And that mission to change it.
1:00:32
Yeah.
1:00:32
Yeah. I worked at Applebee's. I was a hostess.
1:00:35
Uh-huh.
1:00:36
And then
1:00:38
I worked at a place that sold chicken wings.
1:00:42
Okay.
1:00:42
So I was a server.
1:00:45
I've done telemed, or not telemed. What is it?
1:00:50
Like the call center.
1:00:51
Mm-hmm.
1:00:52
Yeah.
1:00:52
Oh, telemarketing. I did that, too.
1:00:54
Telemarketing.
1:00:54
I thought my soul lost some credibility after I worked there.
1:01:01
It's so bad.
1:01:01
It was bad. It's so bad because you're-
1:01:03
It's so bad
1:01:03
... selling stuff. I think we were selling those rolls that go in the receipt
1:01:08
machine.
1:01:08
Yeah.
1:01:09
And I think you could get that for free from the bank.
1:01:11
So I still remember it, the pitch or whatever they say is-
1:01:15
Yeah
1:01:16
... "Hey, we noticed that it's time for you to renew your sale, and we're running
1:01:22
a special." And it wasn't really a special.
1:01:25
It was no special.
1:01:26
I'm probably living some of that karma now.
1:01:29
Let it go in the next section.
1:01:33
Right.
1:01:33
Yeah. I think mine was a nonprofit.
1:01:36
So saving, I don't know. It was something related to kids.
1:01:40
Okay.
1:01:41
So I mean, yeah.
1:01:43
You do what you got to do, right?
1:01:45
Yeah.
1:01:46
I was 16.
1:01:46
I only lasted at that job for two weeks.
1:01:48
Yeah.
1:01:48
I felt so guilty that I wasn't selling, and at some point, I started pretending to
1:01:52
have a Texan accent just to get through the day.
1:01:54
Oh, let's hear it.
1:01:55
I'd be like, "Howdy, today is the day that we have a special going on.
1:02:00
What do you think about it?" It was a long time ago.
1:02:02
It was probably better back then, but-
1:02:03
It's pretty good
1:02:04
... but I would just try to make the day go by, and then they caught onto it
1:02:08
because they would listen to your, some of your calls, and they called me in.
1:02:11
They're like, "Yeah, this isn't going to work out."
1:02:13
This isn't going to do that.
1:02:13
I was like, "I know. We were about to switch ways.
1:02:16
Don't worry about it."
1:02:17
Oh, my gosh. I did radiology, so I was a tech first for about-
1:02:22
Uh-huh
1:02:22
... 10 years.
1:02:24
Oh, okay.
1:02:24
Yeah, MRI, CT, and I thought I wanted to be a radiologist.
1:02:30
Okay.
1:02:31
But then I was like, "No, I have too much personality to be in a small room."
1:02:34
Yeah, you would be in a dark room all day. No, that wouldn't work.
1:02:38
Because same with me, talking about the accent made me remember something.
1:02:42
Did you know, and I know this for a fact, that somebody that works for Dutch Bros
1:02:46
told me they have to initiate conversation with you.
1:02:49
Have you ever driven through Dutch Bros?
1:02:51
Yes, I have.
1:02:51
You know what I'm talking about? I'm not going to name him.
1:02:53
I don't want him to get caught for corporate espionage, but-
1:02:56
You remember this person's name.
1:02:57
Yeah. Well, yeah. I do jujitsu with him. So yeah.
1:02:59
So he works at one of the Dutch Bros, and he says they have to do it.
1:03:03
So whenever I go through, I try to have fun with it. I'll come up with stories.
1:03:08
They're like, "What are you up to today?" "I'm going to drive through because I've
1:03:12
just given up on living in Bakersfield. I got my dog here.
1:03:15
We're about to just drive, and the first place I want to stop, I'm going to stop."
1:03:19
Sometimes it's, "Hey, I just got my bounty hunter license today.
1:03:22
I'm going to get my first job." And it's always fun.
1:03:26
It gives them something fun to think about, but if my wife is ever there, she'll
1:03:29
call me out, too. "He's lying. Don't listen to him." I'm like, "You just ruined his
1:03:32
day. He was telling a good story."
1:03:34
Yeah. And it's like, I wonder what his face actually looked like.
1:03:38
Yeah, exactly.
1:03:38
Because he's really like, "Is this for real?"
1:03:41
Exactly.
1:03:43
Surprise.
1:03:43
Yeah, you broke script.
1:03:44
Now you're going to want to try it.
1:03:45
Yeah, for sure. Although, I have to say, I'm not my best self going through, say,
1:03:50
Starbucks.
1:03:51
Uh-huh.
1:03:54
Yeah. No, they try to do the conversation thing, and I want to just hit the roll
1:03:57
the window button.
1:03:59
That used to be me, but now I try to make-
1:04:02
Well, not profits
1:04:04
... and there are days when I just don't feel like speaking, but-
1:04:06
Yeah
1:04:07
... my wife is always like, "You know, I'm so pleasant to everybody.
1:04:10
Nobody wants to have a conversation with me.
1:04:13
You're over there in your hoodie, and everybody wants to tell you their life
1:04:16
story." I'm like, "I don't know. I don't know what to tell you."
1:04:20
Right. That is so cute. That is just real life.
1:04:24
Yeah. That's real life. I think I was like, "I think they know that I don't really
1:04:28
want to hear it, and you're too eager for it." I was like, "Just tone it down."
1:04:32
They could feel like the-
1:04:34
Yeah
1:04:34
... what is it? It's pick me vibes, right?
1:04:37
Exactly.
1:04:38
Yeah. I think the last person at Starbucks was like, "So what's your favorite
1:04:42
movie?" And I was like, "We don't
1:04:45
need to. I'm good."
1:04:47
Oh, man. It's funny. But no, I try my best to connect with people now.
1:04:53
I'm a little bit different with...
1:04:56
I think Yoda, my son, really kind of made me change a lot, so-
1:04:59
That's good
1:05:00
... no, I have fun with it.
1:05:01
Okay, but that it's also you're going to live longer like that.
1:05:04
Mm-hmm. Yeah.
1:05:05
Right? We know that to be true.
1:05:08
Fun fact.
1:05:09
Yes.
1:05:10
I think they did a survey, and don't ask me for where I got this from, but I read
1:05:14
somewhere that they did a survey about what constitutes happiness.
1:05:19
So they surveyed people that were happy, and they found the common factor was not
1:05:24
money, was not living in the forest. It was a sense of community.
1:05:29
Huh.
1:05:29
Sense of community is what makes you happy.
1:05:32
So you have to have a cult.
1:05:34
Something like that, yeah.
1:05:34
I'm kidding. I'm joking.
1:05:37
Probably why they're always smiling in a cult.
1:05:40
They keep showing up. You're like, "This is great."
1:05:42
Yeah.
1:05:43
You should-- No, I actually, I think that is-
1:05:45
Sense of community.
1:05:46
Huh. Okay. Yeah. That makes sense.
1:05:50
Sure.
1:05:51
But yeah. Is it the connecting part?
1:05:55
I think it's just connecting with people, being, I think,
1:05:59
selfless, right? If you have a sense of community, you're doing something for
1:06:03
somebody without expecting anything in return sometimes.
1:06:07
And all religions teach us that that's really the ultimate, right?
1:06:11
Yeah.
1:06:11
That makes you happy, sometimes to just be able to help without any expectation.
1:06:16
Okay. So on that, okay, I was raised with that.
1:06:19
Mm-hmm.
1:06:20
And I didn't realize that it is a religious-based-
1:06:23
Mm-hmm
1:06:23
... concept. It confuses people to be selfless.
1:06:29
Mm.
1:06:30
They're like, "What do you want?" I'm like, "Nothing."
1:06:34
Right.
1:06:36
So it's almost fishy.
1:06:37
Yeah.
1:06:38
Right? But it is genuine.
1:06:40
In this day and age, it is fishy.
1:06:41
Yeah.
1:06:42
Yeah.
1:06:43
And I'm like, "Why are you confused?"
1:06:44
I know I'm selfless, but if you try to be selfless to me, I might not trust you.
1:06:48
That's just the world we live in, right?
1:06:50
It takes me a while to say that, yeah.
1:06:55
Yeah. So, it's not common, but it is a spiritual base.
1:07:00
It is, yeah. I think to help, yeah.
1:07:04
Well, it looks like we're getting the wrap up-
1:07:06
Oh, okay
1:07:06
... signal. But yeah. I definitely enjoyed having you on.
1:07:10
Yeah. It was fun being here.
1:07:11
Yeah. I'm excited for your practice.
1:07:14
Thank you.
1:07:14
I love what you're doing. And functional medicine, if you ever need that element-
1:07:19
Mm-hmm
1:07:19
... in your practice, and you want to collaborate, I would be honored to do that.
1:07:23
Oh, yeah, definitely. And then we'll talk more about meditation.
1:07:26
Yes. Absolutely. Thank you so much.
1:07:29
Well, thank you so much for having me. It was very fun.
1:07:31
Thank you guys for joining.
1:07:32
Thank you guys.