Latest / The Driven Athlete / Inside Concierge Medicine: Burnout, Breakthroughs, and Better Care | Ep 100!

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Inside Concierge Medicine: Burnout, Breakthroughs, and Better Care | Ep 100! · The Driven Athlete

0:00
SPEAKER_01: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what?
0:06
SPEAKER_01: This podcast is for you.
0:08
SPEAKER_01: This is the Driven Athlete Podcast.
0:12
SPEAKER_01: What's up, y'all?
0:12
SPEAKER_01: It's your man, Dr.
0:13
SPEAKER_01: Kyle.
0:14
SPEAKER_01: Welcome back to the Driven Athlete Podcast.
0:16
SPEAKER_01: We have the legend, Dr.
0:17
SPEAKER_01: Chase Van Mall, with us here.
0:19
SPEAKER_01: She's uh super busy, um, concierge doc, uh practice owner here in West Palm Beach.
0:25
SPEAKER_01: So thanks for coming in and um sharing some insights.
0:27
SPEAKER_01: Thank you.
0:28
SPEAKER_01: I appreciate it.
0:29
SPEAKER_01: Happy to be here.
0:30
SPEAKER_01: Um, so tell us where you're at, like and what what you do.
0:34
SPEAKER_03: Uh, so I am an internal medicine physician.
0:37
SPEAKER_03: I started my concierge internal medicine practice about a year and a half ago.
0:41
SPEAKER_03: Prior to that, I was a hospitalist.
0:44
SPEAKER_03: So I was doing primary care only in the hospital for about nine years.
0:50
SPEAKER_01: Wow.
0:51
SPEAKER_03: And then transitioned out of the hospital after COVID.
0:54
SPEAKER_03: Um, really ransacked medicine and hospitals.
0:58
SPEAKER_03: So I was there during COVID and then post-COVID and and just kind of got burned out and decided I needed change.
1:06
SPEAKER_01: So I um, I mean, I bet.
1:09
SPEAKER_01: I mean, COVID was such a it just changed everything.
1:12
SPEAKER_01: I feel like a huge awareness and just a lot of stuff.
1:15
SPEAKER_01: Yeah.
1:15
SPEAKER_01: Where what hospital during that?
1:17
SPEAKER_03: I was at Boca Regional for about uh eight years, and then I moved up to Good Sam, Good Samaritan in West Palm, and I was the medical director there of the hospitals program for about three years.
1:30
SPEAKER_01: Wow.
1:30
SPEAKER_01: So and that's where you were at.
1:32
SPEAKER_01: So from 2018, 19 and 20, you were at Good Sam?
1:35
SPEAKER_03: Well, so it was 20, I guess 2020, 21, 22.
1:42
SPEAKER_03: Um, and then into 23.
1:44
SPEAKER_01: Okay, and then that's when you made the leap to the doing your own conscience practice.
1:48
SPEAKER_01: Yeah.
1:48
SPEAKER_03: So I I started the program, um, the hospitalist program at Good Sam in the middle of COVID, right before the Delta wave, and uh never been more stressed out in my life.
2:01
SPEAKER_01: I'm I can't even imagine.
2:02
SPEAKER_01: Yeah, it was insane.
2:03
SPEAKER_01: I mean, I know hospitalists like from like the short stints of internships we did in the hospital just to get our feet wet in those in that realm.
2:11
SPEAKER_01: Um, I mean, they're busy.
2:13
SPEAKER_01: Like hospitalists are bouncing around rooms and managing a lot of different kinds of cases.
2:19
SPEAKER_03: Yeah, yeah.
2:20
SPEAKER_03: I mean, I I would never go back and and um, you know, I don't regret at all having that experience.
2:27
SPEAKER_03: I mean, I've seen more than probably any other concierge physician at this point, having been in the hospital for so long.
2:36
SPEAKER_03: Um, you know, but I went from seeing like 40 plus patients a day to my practice seeing, you know, three a day.
2:43
SPEAKER_03: Yeah.
2:44
SPEAKER_01: It's a bliss.
2:45
SPEAKER_01: Yeah, it's awesome.
2:46
SPEAKER_03: It's amazing.
2:47
SPEAKER_03: I mean, and at the end of the day, it's it's way better medicine.
2:50
SPEAKER_03: I mean, in the hospital, you have time, everything is time sensitive.
2:54
SPEAKER_03: And the whole role is to like get people better, you know, get them stable and then get them out.
3:00
SPEAKER_03: And unfortunately, we're kind of like waiting for them to come back again.
3:04
SPEAKER_03: And now my focus can be more on preventative medicine, you know, trying to prevent chronic disease that would end up people in the hospital as opposed to treat them and street them.
3:16
SPEAKER_01: What with the the chaos as a hospitalist during COVID?
3:22
SPEAKER_01: Um, I mean, I'm sure the culture at Good Sam during that time frame was way different than the Boca regional culture.
3:27
SPEAKER_02: Yes.
3:28
SPEAKER_01: You were, I'm sure, running around like just like a crazy person like at Good Sam.
3:33
SPEAKER_01: What like what was that like?
3:34
SPEAKER_01: Like seeing the hospital during that during that time.
3:39
SPEAKER_03: I mean, as a physician, it just it was a very helpless time.
3:43
SPEAKER_03: You know, we've never had we've been through pandemics.
3:47
SPEAKER_03: I mean, there was swine flu, there was monkeypox, there was um, you know, all these other things that have been thrown at us, but we've never been in a position where so many people were coming in so ill and we were helpless.
4:02
SPEAKER_03: I mean, no one knew what to do.
4:04
SPEAKER_03: The things that we were doing weren't working very well.
4:07
SPEAKER_03: Um, so giving people steroids, you know, whether to intubate them or whether not to intubate them.
4:16
SPEAKER_03: Um, you know, the the newer antivirals that came out in the middle of COVID, it was just throw things at them and then hope that it works.
4:24
SPEAKER_03: And the thing about COVID is that the pathophysiology was just so foreign to anything that we've seen.
4:31
SPEAKER_03: I mean, I guess I could compare it most to swine flu or even a really bad influenza.
4:38
SPEAKER_03: But the cytokine storm and the amount of inflammation and then all the aftermath of that was just, you know, nothing that we knew how to deal with.
4:48
SPEAKER_01: Most of the inflammation being in their lungs.
4:53
SPEAKER_03: Really everywhere.
4:55
SPEAKER_03: I mean, microvascular inflammation, large vascular inflammation, causing thrombosis.
5:01
SPEAKER_03: Um you know, and then obviously all the lung effects and um it was just so unknown.
5:12
SPEAKER_03: And usually, I mean, every doctor is quite controlling.
5:16
SPEAKER_03: I would say that kind of goes with a profession.
5:19
SPEAKER_03: And when we can't control anything, it just makes you feel really, really lost.
5:24
SPEAKER_01: Helpless, stressed, anxious.
5:27
SPEAKER_01: Yeah.
5:27
SPEAKER_01: Um, so what like with the patients that were coming in?
5:32
SPEAKER_01: I imagine there were different degrees of like um severity for different people.
5:37
SPEAKER_01: Did you see like any any differences, like correlations between like, oh, here's a profile, they're usually going to decline quickly, or this person usually handles it well.
5:44
SPEAKER_03: Yeah.
5:44
SPEAKER_03: I mean, so there were like two different waves in the beginning.
5:47
SPEAKER_03: It was the people that would typically get sick, older people, people with lots of comorbidities.
5:54
SPEAKER_03: Um, you know, that wasn't so unexpected.
5:58
SPEAKER_03: But when the second wave came, uh the first wave I was in Boca, um, had just had a baby.
6:04
SPEAKER_03: And then the second wave came when I had already transitioned to good Sam.
6:09
SPEAKER_03: So with that, it was completely unpredictable.
6:12
SPEAKER_03: I mean, I was having, you know, a 30-something year old come in and die from COVID.
6:17
SPEAKER_03: Um, you know, they did somewhat have a prototype of, you know, obesity or um maybe like some insulin uh sensitivity, but other than that, it was really unpredictable.
6:32
SPEAKER_01: And I had heard stories, like, well, what is that?
6:35
SPEAKER_01: So, all right, so like this a 30-year-old, a younger person who's somewhat healthy, like more or less healthy.
6:40
SPEAKER_01: Healthy, yeah.
6:41
SPEAKER_01: Maybe a little bit overweight, insulin sensitive, and then they come in with a COVID diagnosis.
6:46
SPEAKER_01: When they come in, are they like um uncom like out or are they breathing, walking around fine?
6:52
SPEAKER_01: Like, what's what's that look like?
6:53
SPEAKER_01: I mean, when they decline, what does that look like?
6:56
SPEAKER_03: Yeah, I mean, most people came in looking okay, hypoxic, but meeting criteria to be admitted.
7:04
SPEAKER_03: And then the worst part comes where you're just watching them decline and decline, decline day by day, getting more and more hypoxic, and and there's only so many things that we had in the armory to give them.
7:19
SPEAKER_03: And um and they will just continue to decline.
7:23
SPEAKER_01: Hypoxia was the main driver for the decline.
7:26
SPEAKER_01: Yeah.
7:27
SPEAKER_01: And what does that look like?
7:28
SPEAKER_01: Like what happens?
7:29
SPEAKER_03: Um, I mean, you know, we had continuous pulse ox on a lot of people.
7:33
SPEAKER_03: There there was a step-down unit where, you know, you're not sick enough to be in the ICU, but you're not well enough to be on the floor, and um, you know, just letting people ride in the 80s um of you know hypoxia and giving them everything that we can, but then they continue to decline.
7:57
SPEAKER_03: And there were a lot of a lot of codes, a lot of transvers, back and forth.
8:02
SPEAKER_03: It was it was very dynamic and um, you know, unfortunate.
8:08
SPEAKER_01: Wow.
8:08
SPEAKER_01: So hypoxia, like the pulse oximeter would would show below 90 in the 80s, high 80s, and then they would just continue to go down to low 80s, and then they would code.
8:20
SPEAKER_03: Yeah.
8:20
SPEAKER_01: And then you would revive or try.
8:23
SPEAKER_01: I mean, was it like rooms were coding, code, code, like another code?
8:27
SPEAKER_03: Yeah.
8:27
SPEAKER_03: I mean, at one point this was not a good idea.
8:30
SPEAKER_03: I wouldn't go back and do it.
8:31
SPEAKER_03: But at one point, we um had one person covering the step-down unit, and it was basically just like every every room in there was a code, was a COVID patient.
8:41
SPEAKER_03: And, you know, you turn one way and see one patient who is declining, and then another, you'd go down the hall and there's another patient deteriorating, and then you get a call about somebody else that you just saw that looked fine and they're deteriorating.
8:57
SPEAKER_03: And it was really, really tough.
9:02
SPEAKER_01: Wow.
9:02
SPEAKER_01: That's all that's crazy.
9:03
SPEAKER_01: Yeah.
9:04
SPEAKER_01: Um, and just for reference for people that aren't listening, that coding means that their heart stops.
9:08
SPEAKER_01: Is that correct?
9:09
SPEAKER_03: So it's either a respiratory code or a cardiac code.
9:13
SPEAKER_03: Um, you know, if somebody starts to become even more hypoxic, then eventually, yes, you you stop getting enough oxygen and and your heart will uh arrest, but most of them are respiratory codes.
9:26
SPEAKER_03: So prior to needing CPR, you just need more oxygen and and eventually get intubated.
9:32
SPEAKER_03: Wow.
9:32
SPEAKER_03: Put on a ventilator.
9:33
SPEAKER_01: Wow.
9:34
SPEAKER_01: That's crazy.
9:36
SPEAKER_03: I like reliving all of this.
9:38
SPEAKER_01: I'm sorry.
9:38
SPEAKER_01: Okay, it's just so interesting.
9:39
SPEAKER_01: And I feel like people never get like an inside look of like in the floor, what does it look like?
9:44
SPEAKER_03: Yeah.
9:45
SPEAKER_03: Yeah.
9:45
SPEAKER_03: I mean, I I've believe me, I've gotten into it with a lot of patients.
9:48
SPEAKER_03: I don't want to talk about vaccines right now, but um, you know, I don't think a lot of people realized what it was like in the hospital on the front line every single day in the middle of COVID.
9:59
SPEAKER_03: And you're not just worried about patients.
10:01
SPEAKER_03: I mean, at the you're also worried about yourself.
10:03
SPEAKER_03: I mean Yeah.
10:04
SPEAKER_01: Because I mean it's so flipping.
10:05
SPEAKER_03: I could have gotten it, um, taken it home to my kids.
10:08
SPEAKER_01: Right.
10:09
SPEAKER_03: Um, you know, my husband's a physician too, bringing it, you know, having him bring it home.
10:14
SPEAKER_01: So and he's a cardiologist.
10:15
SPEAKER_01: Correct.
10:16
SPEAKER_01: Yeah.
10:16
SPEAKER_01: Wow, that's cool.
10:17
SPEAKER_01: Um the uh yeah, no, it's because it's so unknown, like don't know what this thing is and what's going on.
10:24
SPEAKER_01: So there's obviously a lot of panic, right, amongst the public the populace, you know, and the public.
10:30
SPEAKER_01: Where um I know there's I mean, a lot of people that were healthy still would get it and then decline quickly.
10:37
SPEAKER_01: There's no like rhyme or reason, like, well, you have elderly that are a lot of comorbidities, obese individuals if they're overweight, insulin sensitive, whatever, and then they decline.
10:45
SPEAKER_01: They're like, okay, well, that I could see that makes sense.
10:48
SPEAKER_01: But yeah, healthy individuals that were, you know, solid as a rock, and then all of a sudden they decline and deteriorate as well.
10:55
SPEAKER_01: Yeah.
10:55
SPEAKER_01: So it's like, what like was there some kind of genetic predisposition that those people had that made them more susceptible and risky with COVID?
11:04
SPEAKER_01: Like, what do you think was the reason?
11:06
SPEAKER_03: Yeah, I think so.
11:07
SPEAKER_03: I mean, there's there's a lot of the populate most of the population at Good Sam is African American or Hispanic.
11:14
SPEAKER_03: And certainly we saw that be, at least in my small, you know, survey that that would definitely be a predisposition, whether it has to do with socioeconomic status or actual genetics.
11:28
SPEAKER_03: I have no idea.
11:30
SPEAKER_01: But you just saw a lot of that for sure.
11:32
SPEAKER_01: Interesting.
11:33
SPEAKER_01: Um, I I had COVID.
11:35
SPEAKER_01: I've had COVID a couple of times, I think.
11:37
SPEAKER_01: You know, also is tough because like, um, I mean, a lot of people, like it was just a bad cold, pretty much, is what I had, and I lost my sense of smell and taste, which is really weird.
11:46
SPEAKER_01: For like I had no sense of smell or taste for like 10 days, at least seven days.
11:52
SPEAKER_01: Where like I had a bottle of like whiskey at my house at the time, and I was like, let me test.
11:56
SPEAKER_01: You ever like open a bottle of whiskey test and you just like take a huge whiff and it like stings and you you know, didn't smell anything.
12:03
SPEAKER_01: Nothing.
12:04
SPEAKER_02: No get drunk after that.
12:05
SPEAKER_01: Well, I didn't taste, I didn't drink anything.
12:07
SPEAKER_01: Um, but I was like a bad cold, my neck hurting.
12:10
SPEAKER_01: What was interesting, like my neck and my shoulders hurt.
12:12
SPEAKER_01: It was like achy.
12:13
SPEAKER_01: And uh like a really bad, just like a bad cold, you know.
12:16
SPEAKER_01: Um, and then when the cold like the stuffy nose kind of went away, I still had my sense of taste and smell gone.
12:23
SPEAKER_01: But then I was like, this is weird.
12:25
SPEAKER_01: I couldn't taste anything.
12:26
SPEAKER_01: My wife was like making food for me, and my, you know, um, my daughter was not born yet.
12:31
SPEAKER_01: She was pregnant at the time, but like seven months pregnant.
12:34
SPEAKER_01: But anyway, I was like, she's like, So what do you think?
12:36
SPEAKER_01: I'm like, this is amazing, you know.
12:37
SPEAKER_01: Like, shoot, I can't even taste anything.
12:39
SPEAKER_01: You know, I don't think I've ever told her that.
12:40
SPEAKER_01: So she's listening.
12:42
SPEAKER_03: I don't know if I've ever even had it.
12:43
SPEAKER_03: I'm sure I have, but I'm like in the uh never gonna test group.
12:49
SPEAKER_01: So what I was gonna say is like, um, I mean there's huge false positive uh rate, right, with the testing.
12:56
SPEAKER_01: So it's like as soon as you got test it was like positive.
12:58
SPEAKER_01: Well, it's to be super sensitive so that you knew you didn't have it, right?
13:02
SPEAKER_01: Yeah.
13:03
SPEAKER_01: Um, but like for well, it's more dangerous to have a um a high false negative rate than a high false positive rate, right?
13:12
SPEAKER_03: Yeah, especially when we're still quarantining people, right?
13:14
SPEAKER_01: Exactly.
13:14
SPEAKER_01: So if you don't have it, you want to be very confident that you don't have it.
13:17
SPEAKER_01: So it's a very sensitive test, right?
13:19
SPEAKER_01: So um anyway, there's a lot of high false positives.
13:22
SPEAKER_01: So anyway, people are like, well, you don't who knows, right?
13:25
SPEAKER_01: I'm like, it didn't look like you had COVID.
13:26
SPEAKER_01: You tested positive one time.
13:28
SPEAKER_01: I'm like, yo, take three tests and see if they all come back positive.
13:32
SPEAKER_01: But anyway, uh it was just a lot of panic, you know, people didn't know what was going on, and it was just so weird because like if healthy people that just declined really quickly, and you'd have like um people that were totally fine, had nothing, you know.
13:43
SPEAKER_01: Um, but it was just a crazy time.
13:45
SPEAKER_03: Yeah, there was no rhyme or reason to it, and still nothing.
13:48
SPEAKER_03: I mean, I I you know, it all the treatments that we have even now are not they're inadequate.
13:54
SPEAKER_01: So I think another scary thought is like, well, okay, what does this look like 20 years from now?
14:01
SPEAKER_01: I heard something recently, and there's another thing too, just don't know what to believe, you know.
14:04
SPEAKER_01: But I heard something recently where it was like somebody the uh markers for COVID, it's like a huge correlation or um indication of chronic and future like lung cancer or liver cancer.
14:19
SPEAKER_01: Have you heard that?
14:19
SPEAKER_01: I haven't.
14:20
SPEAKER_01: Where it was like, if you've gotten COVID, there's a mi a massive link to future some kind of cancer in the future.
14:28
SPEAKER_01: And I'm like, think about how many billions of people got what does that look like 20 years from now, then you know, or 30 years from now.
14:34
SPEAKER_01: Yeah, but I just don't know what to believe though, you know, there's a lot of headlines and talking points and hysteria, you know.
14:40
SPEAKER_03: Yeah.
14:41
SPEAKER_03: Well, I do know, I mean, I I do think that a lot of cancers originate from viruses.
14:46
SPEAKER_03: I mean, we have evidence that HPB causes cervical cancer, right?
14:50
SPEAKER_03: Like that, you know, causes head and neck cancer.
14:53
SPEAKER_03: So I have no doubt that there will probably be some, you know, clinical correlation that you know COVID causes a certain type of cancer.
15:01
SPEAKER_03: What kind?
15:02
SPEAKER_01: I have no idea or the genetic predisposition to express that.
15:06
SPEAKER_01: Yeah.
15:07
SPEAKER_01: But um, it's just unknown, you know, it's crazy.
15:10
SPEAKER_01: So that, all right.
15:11
SPEAKER_01: So you went beyond so next step box.
15:14
SPEAKER_01: Yeah, next life from there you went conscience medicine.
15:18
SPEAKER_01: Um, and that was a year and a half ago.
15:20
SPEAKER_01: What was the ultimate deciding factor?
15:25
SPEAKER_03: Um well, I mean, it all kind of happened uh serendipitously.
15:30
SPEAKER_03: I was taking care of a patient in the hospital, and she was a prominent woman on the island, was already in a concierge practice, and then went back to her physician and said, Oh, you've got to meet this physician.
15:44
SPEAKER_03: She would be great, you know, to join the practice with you.
15:47
SPEAKER_03: So I actually joined another practice um after being kind of plucked out of the hospital.
15:54
SPEAKER_03: And that was then taken over by a bigger practice and decided to go out on my own.
16:02
SPEAKER_03: So it all happened in I know mysterious ways, but obviously it was I couldn't be happier in my position now.
16:11
SPEAKER_01: And how long were you in that practice before it was bought out?
16:14
SPEAKER_01: Like a year.
16:15
SPEAKER_01: Okay, and then you quickly from there.
16:17
SPEAKER_01: Mm-hmm.
16:17
SPEAKER_01: Gotcha.
16:18
SPEAKER_01: Interesting.
16:19
SPEAKER_01: Um, and now you're on your own doing your thing.
16:20
SPEAKER_01: Yeah.
16:21
SPEAKER_01: That's awesome.
16:21
SPEAKER_01: That's fantastic.
16:22
SPEAKER_01: And it's bliss because you're seeing a lot less volume.
16:25
SPEAKER_01: Yes.
16:26
SPEAKER_01: You're able to practice medicine in a way that you said you feel is meant to be it's more effective.
16:31
SPEAKER_02: Yes.
16:31
SPEAKER_01: And what you said was it's the goal is to prevent chronic illness.
16:35
SPEAKER_01: What do you mean by that?
16:37
SPEAKER_03: So, I mean, you know, in med school, we're taught pharmacology, we're taught physiology, all of these are disease processes and how to treat them once they're already there.
16:49
SPEAKER_03: We're not really taught about trying to prevent things before they happen.
16:53
SPEAKER_03: So, and especially in the hospital, obviously, I was treating people who already were sick.
16:58
SPEAKER_03: Um, but I've really transitioned my not just my thought process, but my practice to get ahead of things before they start.
17:09
SPEAKER_03: So, you know, even though somebody may not meet the criteria for pre-diabetes, their A1C isn't quite 5.7 yet, but we know they have a family history, or they um, you know, are trying to be very aggressive with their health, those are the kind of people that I would treat much earlier.
17:28
SPEAKER_03: So, you know, the point is to to prevent anything from happening uh longer term because we can push, you know, kick the can and delay, delay, delay, and then wait till they meet clinical criteria to be treated for a disease.
17:44
SPEAKER_03: But that's not really, you know, how I want to practice.
17:47
SPEAKER_03: And I don't think that that's um the direction that medicine is going to begin with.
17:52
SPEAKER_01: Yeah.
17:54
SPEAKER_01: From the vibes that I've been getting in conversations, definitely a little more proactive and preventative, looking future steps down the road versus like, oh, now your A1C is too high.
18:03
SPEAKER_01: Cool.
18:03
SPEAKER_01: Now we'll start insulin treatments.
18:05
SPEAKER_01: And if you have type 2 diabetes, yeah, now we know how to treat it.
18:08
SPEAKER_00: Yeah.
18:08
SPEAKER_01: So that's what you mean.
18:09
SPEAKER_01: Preventing type 2 diabetes in adults um with A1C incline and then um yeah, insulin resistance and all that stuff.
18:18
SPEAKER_01: What what do you recommend to patients for that?
18:21
SPEAKER_03: Uh, I'm a huge fan of metformin.
18:24
SPEAKER_03: Um, I have a lot of patients on GLP ones, like trzepatide, uh, semaglutide.
18:30
SPEAKER_03: Um, I think I've realized that I mean, obviously we knew obesity is an echo is an epidemic, but the lower you can get your um glucose, the less inflammation you have, the less obesity, the healthier you are.
18:48
SPEAKER_03: I mean, I always start everybody, you know, in my practice with the basics, and that is what is your cardiovascular risk, what's your metabolic risk, you know, what are you what are your lipids?
18:59
SPEAKER_03: What's your family history?
19:01
SPEAKER_03: You know, we address all of those on day one and make decisions based upon that.
19:07
SPEAKER_01: Um how do you how do you assess someone's cardiovascular risk, cardiac risk?
19:13
SPEAKER_03: So family history is huge.
19:15
SPEAKER_03: I mean, you can't change your genetics, whether you like it or not, it's gonna catch up to you.
19:19
SPEAKER_03: So family history is really, really important.
19:22
SPEAKER_03: And then also looking at um, you know, an advanced lipid profile, we're using um apolipoprotein B and lipoprotein A as markers.
19:34
SPEAKER_03: We use inflammatory markers like high sensitivity CRP.
19:38
SPEAKER_03: Um, so those give me a good idea numbers-wise, where someone stands, that with family history.
19:45
SPEAKER_03: And then also I do um a little bit more diagnostic testing.
19:50
SPEAKER_03: So coronary calcium scores, I'm a huge fan of corneary calcium scores or coronary CTAs.
19:56
SPEAKER_03: What does that represent?
19:58
SPEAKER_03: So um when you have plaque in your arteries, that it over time the way, the way the body can deal with it and stabilize it is by making it calcium, calcified.
20:09
SPEAKER_03: So when you go and get a uh calcium score, it's basically like an X-ray looking specifically at the vessels of your heart.
20:17
SPEAKER_03: If there's calcium there, then we know there's plaque there.
20:19
SPEAKER_03: And if there's plaque there, that's already secondary prevention.
20:23
SPEAKER_03: So primary prevention is trying to prevent something from happening.
20:27
SPEAKER_03: Secondary prevention is treating it once you've already had it.
20:30
SPEAKER_03: So if you have a positive calcium score, you already have coronary disease.
20:34
SPEAKER_03: You essentially have already had a heart attack.
20:36
SPEAKER_03: I mean, you haven't had one.
20:38
SPEAKER_03: You may or may not have had an actual heart attack, but you have coronary disease.
20:43
SPEAKER_01: Interesting.
20:44
SPEAKER_01: So what do you do then?
20:46
SPEAKER_03: So that's when you look at all everything else altogether.
20:49
SPEAKER_03: You look at um inflammatory markers, cholesterol, and really optimizing a person metabolically.
20:56
SPEAKER_03: So the lower the A1C, the better.
20:59
SPEAKER_03: The lower the LDL, the better.
21:01
SPEAKER_03: And I'm sure people will argue with me on this.
21:03
SPEAKER_03: But we're talking about secondary prevention.
21:06
SPEAKER_03: We're talking about someone who already has coronary disease.
21:09
SPEAKER_03: So yes, I do believe that the lower the LDL, the better.
21:11
SPEAKER_03: The lower the lipoprotein B, the better.
21:14
SPEAKER_01: Gotcha.
21:15
SPEAKER_03: So I'm very aggressive with those people.
21:17
SPEAKER_01: And then you said, uh so is there like when we've I've heard people in the past that are like, yeah, I get my arteries cleaned out.
21:24
SPEAKER_01: Like, is there a stent or something like that?
21:26
SPEAKER_01: Like, is there some kind of like um yeah, a clean out procedure that can be done to remove that stuff?
21:32
SPEAKER_01: Or does this happen over time of lifestyle changes and medications?
21:36
SPEAKER_03: Well, we don't have good medications or lifestyle that you can do to reverse what's already there.
21:42
SPEAKER_03: There is, you know, like a little bit of evidence that some of some of the cholesterol medications can decrease the plaque burden.
21:51
SPEAKER_03: But can that be statins?
21:53
SPEAKER_03: That would be statins, that would be the PSK9 inhibitors like Rapatha.
21:58
SPEAKER_03: Um, but it's not great.
22:00
SPEAKER_03: I mean, so basically we're not reversing things.
22:02
SPEAKER_03: Um when somebody talks about getting their arteries cleaned out, I guess they would be referring to getting a stent.
22:09
SPEAKER_03: So if there's a lesion, I mean, if you think of like a hose and there's um something stuck in it, you know, then a stent goes in into the hose, opens up that uh that area that's narrowed and lets the flow go past it.
22:26
SPEAKER_01: Right.
22:26
SPEAKER_01: Yeah, yeah.
22:27
SPEAKER_01: So then if it's not reversible once there's calcium buildup evidence of plaque that has accumulated, um, that we can't reverse that.
22:37
SPEAKER_01: So then it's crucial, like the thought would be like, all right, so take action.
22:41
SPEAKER_03: Yeah.
22:41
SPEAKER_03: I mean, it's crucial at that point to number one, keep it from getting any worse.
22:45
SPEAKER_03: So you don't want to add more plaque to it.
22:48
SPEAKER_00: Yeah.
22:49
SPEAKER_03: Number two, to stabilize the plaque that's there.
22:52
SPEAKER_03: So the calcified plaques are not dangerous per se.
22:57
SPEAKER_03: They're already have become part of the lining of the artery.
23:01
SPEAKER_03: It's the friable inflamed flap plaques that cause heart attacks.
23:06
SPEAKER_03: So you have a little piece of an inflamed plaque that breaks off, that causes a clot, and then that causes a heart attack or a stroke.
23:15
SPEAKER_03: So decreasing the inflammation of those plaques that are already there is key.
23:21
SPEAKER_03: And we do that with um statins, you know, lowering they do decrease inflammation within the vessels, but then also, you know, optimizing things metabolically.
23:33
SPEAKER_03: So controlling glucose, um, you know, decreasing inflammation by doing all the lifestyle things too, you know.
23:41
SPEAKER_03: Yeah.
23:42
SPEAKER_03: Not, you know, exercising every day, getting good sleep, lowering cortisol levels.
23:47
SPEAKER_01: Yeah.
23:48
SPEAKER_01: I think um, so all right, so then like people in their 30s and 40s, it's like do everything you can to prevent this kind of buildup, which would include everything you're saying.
23:59
SPEAKER_01: Cortisol, managing cortisol levels, stress, anxiety, exercise, not smoking, not drinking, sleep well, sleeping well, eating non-processed foods and low, not high sugar foods.
24:11
SPEAKER_03: Yeah.
24:11
SPEAKER_01: All that stuff combined is the best recipe.
24:13
SPEAKER_03: Yeah, absolutely.
24:14
SPEAKER_03: I mean, obviously the first step is knowing whether you have it already or not, because it's not uncommon that I'll get somebody in their 40s who already has a, you know, a positive calcium score or already has some evidence of disease.
24:27
SPEAKER_03: But even before that, I mean, it's all about sleep, nutrition, and exercise.
24:32
SPEAKER_03: Those are the three things that everyone has control over.
24:35
SPEAKER_03: Yeah.
24:36
SPEAKER_03: Um, and are really the foundation of future health.
24:42
SPEAKER_01: Um, stress would be on that list.
24:45
SPEAKER_01: Yes.
24:45
SPEAKER_01: Which we can control.
24:46
SPEAKER_01: It's hard.
24:47
SPEAKER_02: Yeah.
24:48
SPEAKER_01: But we can but I like that because it's like those are things we can definitely control.
24:52
SPEAKER_01: Um, you mentioned GLP1s and semaglutide.
24:56
SPEAKER_01: Semaglutide will be a Zempic.
24:57
SPEAKER_01: Yes.
24:58
SPEAKER_01: Right?
24:58
SPEAKER_01: GLP, what are GLP ones?
25:00
SPEAKER_03: So they're peptides.
25:02
SPEAKER_03: Um they yeah, I mean, I'm sure everybody's familiar with them, you know, slow gastric emptying make you feel full.
25:11
SPEAKER_03: They work on the reward system to uh make you basically not think about food as much.
25:18
SPEAKER_03: Um, but originally they were developed as diabetes drugs.
25:21
SPEAKER_03: So the, you know, the the weight loss is a secondary gain from that, but they actually lower glucose and and in doing so treat diabetes.
25:30
SPEAKER_01: So what peptides are the GLP ones?
25:33
SPEAKER_03: Um, so semaglutide.
25:36
SPEAKER_03: Okay, so glutide, trzepatide, retitrutide, lirotrede.
25:41
SPEAKER_01: Got it.
25:42
SPEAKER_01: Okay.
25:42
SPEAKER_01: Is it what so what would make you choose one of those per person?
25:46
SPEAKER_03: Um, so semaglutide is kind of like the you know, beginning or beginner peptide, I guess.
25:53
SPEAKER_03: Um it has one mechanism, one mechanism of action.
25:57
SPEAKER_03: Uh terzepatide is better.
25:59
SPEAKER_03: It has two mechanisms of action.
26:02
SPEAKER_03: It um is better tolerated, fewer side effects.
26:05
SPEAKER_03: Retitrutide, which is not commercially available yet, um, is even better.
26:11
SPEAKER_03: So three mechanisms of action for treating diabetes and for um, you know, lowering glucose and weight loss, all the good things.
26:20
SPEAKER_01: Uh I was I had also heard recently there was a one of those that's more it it enables to prevent um muscle wasting and bone mineral density loss while also still targeting fat loss.
26:33
SPEAKER_01: One of those more specific for that, like the mechanism action you're talking about?
26:37
SPEAKER_03: Um, I mean, I think the biggest thing with preventing muscle loss is that you do it slowly.
26:43
SPEAKER_03: You should always use the lowest effective dose.
26:45
SPEAKER_03: It should be done in conjunction with working out.
26:49
SPEAKER_03: And um, you know, there are other peptides that can help maintain muscle mass or help you build muscle mass while you're doing it.
26:56
SPEAKER_03: If you lose a significant amount of weight, you're going to lose muscle mass.
26:59
SPEAKER_03: There's no question about that.
27:00
SPEAKER_03: It's just trying to minimize it during the whole process.
27:05
SPEAKER_03: So I think the the key really is doing it slowly and continuing to lift weights.
27:11
SPEAKER_01: What uh peptide helps prevent muscle loss?
27:16
SPEAKER_03: Uh so there are a lot of them.
27:18
SPEAKER_03: Um, the biggest ones that people have probably heard of are the growth hormone secret dogs, like CJC 1295 with hippermoralin, sermorelin.
27:28
SPEAKER_03: Um, I have a lot of patients on those.
27:30
SPEAKER_01: And and I think So the growth hormone pulse facilitators.
27:34
SPEAKER_01: Yes.
27:34
SPEAKER_01: Gotcha.
27:35
SPEAKER_01: Interesting.
27:36
SPEAKER_01: I've also heard that those also help with fat loss as well.
27:39
SPEAKER_03: Yeah.
27:40
SPEAKER_03: I mean, there are some other peptides that help target um specifically, like tesimerelin will help target uh visceral fat loss.
27:47
SPEAKER_03: That's actually an FDA-approved drug for um HIV patients who get lipidystrophy from certain antiviral medications.
27:56
SPEAKER_00: Interesting.
27:56
SPEAKER_03: Um but that helps, you know, get tar specifically target the the visceral fat, which is all the fat that surrounds the organs.
28:05
SPEAKER_03: And we know that that's a negative predictor for cardiovascular disease.
28:11
SPEAKER_01: Um the uh CJC ipomerelin, um what was the other one?
28:17
SPEAKER_03: Tessamerelin.
28:18
SPEAKER_01: Tessamarellin, yeah, yeah.
28:19
SPEAKER_01: Um so those help with uh preventing muscle loss while taking something like semaglutide or trisipatide.
28:26
SPEAKER_03: I would say maintaining muscle mass while working out while we're while losing weight.
28:33
SPEAKER_01: So it's like you must exercise.
28:34
SPEAKER_02: You must exercise.
28:35
SPEAKER_01: And have enough protein intake, I would assume, with that to sustain or to to have the sustenance to build that.
28:42
SPEAKER_01: Um I heard recently um the FDA is on a direction to try to relabel peptides under the term by under the umbrella of biologics to then be able to patent it and have it under their umbrella.
28:58
SPEAKER_01: Of course they are, and then take it off of the compound pharmacy businesses, small businesses and stuff.
29:05
SPEAKER_01: Um I and I've also heard, I mean, like I know uh other peptides like BPC 157, a PDA, TB500, those are all like the recovery ones, right?
29:16
SPEAKER_01: Um the BPC 157 was made illegal recently and then re put back on the market again.
29:22
SPEAKER_01: Is that correct?
29:23
SPEAKER_03: So it was on the market and now it's not on the market.
29:27
SPEAKER_03: Um, it's like in a gray area for sure.
29:29
SPEAKER_03: I mean, I, you know, you can order it or physicians can order it, I guess, from some pharmacies that are still doing it.
29:36
SPEAKER_03: So the thing about peptides is that they're naturally occurring, they can't actually be patented.
29:42
SPEAKER_03: The um Ozempic and Wikobi and all of those things, they were they patent the delivery system.
29:49
SPEAKER_03: So they're patenting the um, you know, the auto inject pin.
29:55
SPEAKER_03: Um, and in and all of this is changing day to day with, you know.
30:00
SPEAKER_03: Whatever the FDA decides to whatever they try to do.
30:04
SPEAKER_03: Yeah.
30:04
SPEAKER_03: I mean, at the end of the day, it's all about money.
30:06
SPEAKER_03: Which is unfortunate.
30:08
SPEAKER_01: I was gonna say, like, I'm like, okay, so here's some things that are really helpful.
30:12
SPEAKER_01: It seems like from the patients that we've worked with that that also take, you know, they're like, hey, I have a this shoulder issue or back hurts, like knee, what knee pain, like whatever.
30:21
SPEAKER_01: It's like, oh, in conjunction with some uh physio work, right?
30:25
SPEAKER_01: Manual therapy, dry needling, corrective exercises to fix and stabilize movement patterns.
30:30
SPEAKER_01: BPC 157 could be helpful to facilitate the healing process of the phone.
30:35
SPEAKER_01: It's an incredible.
30:36
SPEAKER_01: I mean, it's in the peptide.
30:38
SPEAKER_01: It's awesome.
30:38
SPEAKER_01: Why would they make it illegal?
30:40
SPEAKER_01: Why not double down on funding and like prov proliferating the activity of this thing or in the community?
30:46
SPEAKER_03: I mean, I I you know it's unfortunate that there's so much money involved with pharmaceutical companies and the FDA.
30:52
SPEAKER_03: And um, I think it really gets in the way of being able to treat people.
30:57
SPEAKER_03: I mean, there are ways to get around it, which is what I'm doing in my practice.
31:00
SPEAKER_03: And everybody, every patient I talk to knows like this is not FDA approved.
31:05
SPEAKER_03: We don't have long-term studies on it.
31:07
SPEAKER_03: I use it, my dad uses it, my brother uses it.
31:10
SPEAKER_03: The results are fantastic.
31:12
SPEAKER_03: And I think as long as you have that relationship with a patient and they understand these are the risks, these are the benefits.
31:18
SPEAKER_03: Um, you know, people are still willing to do it despite all the skepticism and yeah, all that stuff.
31:27
SPEAKER_01: Um I also I would imagine too, like being smart with it and monitoring and then getting it from a reputable source.
31:34
SPEAKER_01: Exactly.
31:35
SPEAKER_01: Versus like getting it online.
31:36
SPEAKER_03: Yeah.
31:37
SPEAKER_03: Research only peptides are, I don't know.
31:40
SPEAKER_03: Uh I'm sure at the end of the day, everything comes from the same source, which will be overseas and likely the the raws are made in China.
31:50
SPEAKER_03: Um, but at least when you're getting it from a reputable source, as in with the guidance of a physician who's able to order it from somewhere that they trust.
31:58
SPEAKER_01: Like a legit pharmacy.
31:59
SPEAKER_03: Yeah.
32:00
SPEAKER_01: They they know that it's vetted for cross-contamination.
32:04
SPEAKER_03: Yeah.
32:05
SPEAKER_03: I mean, at least it comes to the United States.
32:07
SPEAKER_03: It's put together in a lab.
32:09
SPEAKER_03: There's third-party testing that you can find on the website that we know that there's a, you know, a level of purity.
32:15
SPEAKER_00: Yeah.
32:16
SPEAKER_03: Um, but it's the same thing, you know, drugs are recalled too.
32:21
SPEAKER_03: Even FDA-approved drugs are recalled because of the ways that they're made, or they, you know, have some secondary side effect that comes up later once the general population is using it.
32:31
SPEAKER_03: So everything that we do has a risk and a benefit.
32:35
SPEAKER_03: And that's what I try to explain to patients is that, you know, what are you afraid of here?
32:40
SPEAKER_03: What, you know, what would be the worst risk that could happen?
32:43
SPEAKER_03: And what are the potential benefits that you can get from this?
32:46
SPEAKER_03: And are you willing to take that risk?
32:48
SPEAKER_03: And it's different for every person.
32:50
SPEAKER_01: Yeah, of course.
32:51
SPEAKER_01: Um, I uh obviously like a lot of headlines and things that come out here, like just it's such a very sensitive time right now, right?
33:01
SPEAKER_01: But um, it's a bummer.
33:03
SPEAKER_01: What so the hard thing is we just don't know what to believe when we hear things, right?
33:07
SPEAKER_00: Yeah.
33:08
SPEAKER_01: Um as an example, like the Tylenol thing that just came out, it's a hot topic.
33:13
SPEAKER_01: We don't have to get into it.
33:14
SPEAKER_01: Vaccines are, of course, hot topic, and like it's very sensitive with a lot of opinions.
33:19
SPEAKER_01: What do you like?
33:20
SPEAKER_01: What do we believe?
33:21
SPEAKER_01: You know, like how what do you go towards to be like, oh, this is my this is what I go to to sort of vet information.
33:28
SPEAKER_03: Yeah.
33:28
SPEAKER_03: I mean, I use an app called Open Evidence.
33:31
SPEAKER_03: Um, it uses AI to basically compile all the available medical journals out there and give an overall um synopsis of what the literature shows.
33:43
SPEAKER_03: I mean, I'm a scientist, I'm very black and white when it comes to what I believe and don't believe.
33:50
SPEAKER_03: And I try and base it as much as possible on the actual clinical trials or what evidence we have available.
33:56
SPEAKER_01: Yeah, no, that's really cool.
33:57
SPEAKER_01: So it's it's synthesizes information.
34:01
SPEAKER_03: Um and I heard the guy who made it just sold it for like two billion dollars.
34:05
SPEAKER_01: Oh, wow.
34:06
SPEAKER_03: Mm-hmm.
34:07
SPEAKER_03: Should have thought of that.
34:08
SPEAKER_01: To to who?
34:09
SPEAKER_03: I don't know.
34:10
SPEAKER_01: It's a bump, like I'd be a concern.
34:12
SPEAKER_01: Like did they sell to the FTC?
34:13
SPEAKER_02: Private no, private equity, I'm sure.
34:15
SPEAKER_01: But like if they have their who knows, right?
34:18
SPEAKER_01: Because everything's I would agree, money-based, it seems like.
34:22
SPEAKER_03: But well, and there's so many biases.
34:24
SPEAKER_03: Everybody just takes AI as truth, which you have to be extremely careful with anyway.
34:31
SPEAKER_03: I mean, they even have a disclaimer at the bottom of Chat GPT that AI can make mistakes.
34:35
SPEAKER_01: So um it's also just going off of what they find on the internet, and anything could be on the internet.
34:40
SPEAKER_03: Oh, I mean, I'm so tired of people sending me Instagram posts of like, you know, random, non-certified and anything about how bad statins are and they're gonna cause diabetes and they're gonna cause dementia.
34:56
SPEAKER_03: And I'm like, consider your source.
34:58
SPEAKER_03: The first thing I do is open up the Instagram reel, go to the profile, and then try and figure out what the person's degree is.
35:05
SPEAKER_03: And a lot of times it is nothing.
35:07
SPEAKER_01: They're a health coach.
35:08
SPEAKER_01: Yeah.
35:08
SPEAKER_03: Or like which I have respect for all the people who are out there saying the things, but you have to consider where it's coming from and it is it actually based upon truth, which in my opinion is medical literature.
35:23
SPEAKER_01: Right.
35:24
SPEAKER_01: Yeah, yeah.
35:25
SPEAKER_01: Um, no, that's good.
35:26
SPEAKER_01: Open evidence app.
35:27
SPEAKER_01: I mean, I'm gonna check that out because I've not heard that before.
35:29
SPEAKER_03: That's great.
35:29
SPEAKER_01: That's really cool.
35:30
SPEAKER_01: Um, where are you from originally?
35:32
SPEAKER_03: Georgia.
35:33
SPEAKER_01: Where where in Georgia?
35:34
SPEAKER_03: Athens.
35:35
SPEAKER_01: Athens, Georgia.
35:36
SPEAKER_01: Okay, so you're a Bulldog.
35:37
SPEAKER_01: Bulldog fan.
35:39
SPEAKER_01: Um, they uh they seem to be, you know, they're all right this year, right?
35:43
SPEAKER_03: Yeah.
35:43
SPEAKER_03: We've been all right for quite a few years.
35:45
SPEAKER_02: Uh-huh.
35:46
SPEAKER_01: It's uh yeah.
35:48
SPEAKER_02: Last year was uh a bummer, but yeah, you know, the past two years.
35:51
SPEAKER_03: Yeah, three years have been great.
35:54
SPEAKER_01: Um interesting.
35:55
SPEAKER_01: What what brought you down?
35:56
SPEAKER_01: Where'd you go to med school?
35:57
SPEAKER_03: Uh I went to med school in Augusta, Georgia, at Medical College of Georgia.
36:01
SPEAKER_03: It's called a different name now, but it used to be Medical College of Georgia.
36:05
SPEAKER_03: Under Georgia, like the University of Georgia's Well, it's affiliated now with University of Georgia, but back then it was its own entity.
36:12
SPEAKER_01: Um in Augusta, Georgia.
36:14
SPEAKER_03: In Augusta.
36:15
SPEAKER_03: Yeah.
36:15
SPEAKER_03: Okay.
36:15
SPEAKER_03: Ain't much going on there besides one week of the masters.
36:19
SPEAKER_03: Exactly.
36:20
SPEAKER_03: Best time of the year.
36:21
SPEAKER_01: But did you go?
36:22
SPEAKER_03: I did.
36:23
SPEAKER_03: Yeah, I lived right next door to um Augusta National.
36:28
SPEAKER_01: So Were you able to get in as like a like a health practitioner or something?
36:32
SPEAKER_03: No, no.
36:33
SPEAKER_03: I just had friends whose, you know, grandparents had tickets and they would come stay with me for free and then take me to So it's a good trade-off.
36:42
SPEAKER_01: Yeah.
36:42
SPEAKER_01: Come stay with me for free and then we'll walk over.
36:44
SPEAKER_03: Yeah, I mean, there were probably like 18 people staying in my little three-bedroom house.
36:48
SPEAKER_01: Yeah, that's awesome.
36:50
SPEAKER_01: Um, I'm sure that like people rent out their homes in the neighboring area for a lot of money, an egregious amount.
36:57
SPEAKER_03: Yeah.
36:58
SPEAKER_03: Yeah, my for that week.
36:59
SPEAKER_03: My husband, which is where we met, he used to do that and it would rent out his house every day.
37:03
SPEAKER_01: You met him in Augusta?
37:04
SPEAKER_01: In med school.
37:05
SPEAKER_03: I was in med school and he was in cardiology fellowship.
37:09
SPEAKER_01: Oh, wow.
37:09
SPEAKER_03: He taught me EKGs.
37:12
SPEAKER_01: Cool.
37:12
SPEAKER_03: Among other things.
37:14
SPEAKER_01: It's funny.
37:15
SPEAKER_01: Can you teach me more about this EKG thing?
37:18
SPEAKER_03: We have a private lesson.
37:19
SPEAKER_01: Yeah, exactly.
37:20
SPEAKER_01: I'll come over later.
37:21
SPEAKER_03: Um, but I so I did med school there and then I did residency.
37:25
SPEAKER_03: I did my internship in Chicago and then came back to Atlanta to finish internal medicine residency at Emory.
37:32
SPEAKER_01: Cool.
37:32
SPEAKER_01: And that's a how long is that residency?
37:34
SPEAKER_01: Three years.
37:35
SPEAKER_01: Wow.
37:36
SPEAKER_01: Um, what made you want to go uh internal medicine?
37:40
SPEAKER_03: Uh everything uh I love mysteries.
37:43
SPEAKER_03: I mean, it's never boring.
37:44
SPEAKER_03: You can never know everything.
37:46
SPEAKER_03: It's very humbling.
37:48
SPEAKER_03: Um, and it's like Jack of all trades, master of none.
37:53
SPEAKER_03: I always tell people like they're like, ah, you do everything.
37:56
SPEAKER_03: You have kids, you're a doctor, da-da-da.
37:58
SPEAKER_03: I'm like, yeah, doing it all and none of it well.
38:01
SPEAKER_01: Well, so here's okay, here's what I've heard.
38:03
SPEAKER_01: Jack of all trades, master of none is still better than a master of one.
38:07
SPEAKER_02: That's true.
38:07
SPEAKER_01: That's that's I was like, oh, that makes because I've been told I've been called Jack of all trades as well.
38:12
SPEAKER_01: And I'm like, I guess I'm above mediocre for a lot of things.
38:14
SPEAKER_01: Uh-huh.
38:15
SPEAKER_01: So, like, I don't know.
38:16
SPEAKER_02: That's a good place to be.
38:17
SPEAKER_01: I think so.
38:17
SPEAKER_01: And I I mean dabble in a lot of things.
38:19
SPEAKER_01: Yeah.
38:19
SPEAKER_03: I mean, my husband specialized, so he did cardiology and then he did interventional cardiology.
38:25
SPEAKER_03: And he'll ask me some things.
38:27
SPEAKER_03: I'm like, Are you sure you're a doctor still?
38:30
SPEAKER_03: Like, how do you only know about cardiology?
38:32
SPEAKER_03: He's very knowledgeable about cardiology.
38:34
SPEAKER_01: That's his like snitch.
38:36
SPEAKER_03: Yeah.
38:37
SPEAKER_03: I mean, I tried, I I saw him try to, you know, pull some peptides out of a vial, and I was like, Are you sure you're still a doctor?
38:45
SPEAKER_01: So you have to insert the needle like this.
38:47
SPEAKER_02: Put the needle in, then you pull back.
38:50
SPEAKER_01: That's funny.
38:51
SPEAKER_01: Oh yeah.
38:51
SPEAKER_01: Um, but uh well, we need them.
38:53
SPEAKER_01: We know we need people like that.
38:55
SPEAKER_01: Yeah, you know, no, and then people like yourself, you know.
38:57
SPEAKER_01: So you want to do all right, so you like to be just solving mysteries, learning about a lot of different things.
39:03
SPEAKER_01: So you like um just variety, yeah.
39:07
SPEAKER_01: Variety of things.
39:08
SPEAKER_03: I mean, it's never it like I said, it's never boring.
39:11
SPEAKER_03: You can never know everything.
39:13
SPEAKER_03: I'm constantly learning every single day.
39:15
SPEAKER_03: I learn something new, whether it's from patients asking me questions or you know, self-guided learning.
39:22
SPEAKER_03: Um, and and it's con it's always changing.
39:25
SPEAKER_03: And there's so many new things um happening every day.
39:29
SPEAKER_03: I mean, I just started learning about peptides probably like a year ago.
39:34
SPEAKER_03: And it's completely changed my life, my family's life, the way that I practice and what I'm able to offer people.
39:42
SPEAKER_03: Um, so I love that about medicine.
39:45
SPEAKER_03: It's it's hard because you can't keep up with everything, and people ask you questions and you're like, um, let me get back to you.
39:53
SPEAKER_03: Hold, let me let me check something in the other room and then you have to go look it up so that you look like you know what you're talking about.
39:58
SPEAKER_01: Okay, totally.
39:59
SPEAKER_01: Um, let me let's circle back on that one.
40:02
SPEAKER_01: Um so you are and the the route to become a hospitalist is med school and then three-year internal medicine residency.
40:11
SPEAKER_01: Correct, yeah.
40:11
SPEAKER_01: That's the route for hospital.
40:12
SPEAKER_01: Yeah.
40:13
SPEAKER_01: And then is there different specialists of hospitalists, or like is that that's the hospitalist?
40:18
SPEAKER_03: Yeah, no, that's just um that's just a subspecialist, I guess, of internal medicine.
40:23
SPEAKER_03: So internal medicine, you can go do what I'm doing now, which is primary care.
40:28
SPEAKER_01: Um, or you know, a lot of hospitalists go into I mean, I've always thought that like the like the most challenging academic, rigorous direction is a med pre-med, mCAT, medical school, and then like residency, and then after even fellowship.
40:45
SPEAKER_01: Man, it's so it's just rigorous, you know.
40:48
SPEAKER_01: Yeah, it was really hard.
40:50
SPEAKER_01: It was really hard.
40:51
SPEAKER_01: There was this cardiologist that um wanted internships I was doing in the hospital.
40:55
SPEAKER_01: Because I mean, you know, DPT school is challenging and like it's a three-year program, it's rigorous, of course, like it's hard.
41:01
SPEAKER_01: But um residency is not mandatory, right?
41:05
SPEAKER_01: After PT school or fellowship, right?
41:08
SPEAKER_01: So, like not many PTs go that route, you know, doing specialty stuff or whatever field they want to get into, especially if you're outpatient orthopedics in sports.
41:17
SPEAKER_01: So, like anyway, something like one or two percent of all outpatient PTs are actually fellowship trained.
41:25
SPEAKER_01: So it's like a very small number.
41:26
SPEAKER_01: So that all right, so that's the one you do a fellowship, yeah.
41:29
SPEAKER_01: Okay so that's the one thing that I'm not a jack of all trades in.
41:32
SPEAKER_01: That I niche down into that to be like a specialist in that.
41:35
SPEAKER_00: Yeah.
41:36
SPEAKER_01: Because I thought it was interesting.
41:37
SPEAKER_01: I was like, oh, this is cool.
41:38
SPEAKER_01: Yeah, you know, like in PT school, you're learning about like prosthetics, orthotics, pediatrics, some cardiology stuff, you know, cardiology.
41:45
SPEAKER_01: And I'm like, this is I this is interesting.
41:48
SPEAKER_01: But then when I went to like sports, I was like, that I was like, that's what I want to do.
41:52
SPEAKER_01: I was like, oh, there's like fellowship training and residency stuff for just sports.
41:56
SPEAKER_01: It's like that's what I want to do.
41:58
SPEAKER_00: Yeah.
41:58
SPEAKER_01: And then I dove all in and like that was just interesting to me.
42:02
SPEAKER_01: Because I'm not, like I said, I'm not like a school person, you know.
42:04
SPEAKER_01: I like to learn hands-on and like get out and do stuff.
42:07
SPEAKER_03: But um how long is the fellowship?
42:09
SPEAKER_01: It was a three-year fellowship.
42:11
SPEAKER_03: Okay, yeah.
42:12
SPEAKER_01: So PT schools, three years, right?
42:14
SPEAKER_01: Undergrad, I was a biology major.
42:16
SPEAKER_01: And then um, yeah.
42:18
SPEAKER_01: There was a brief moment when I was thinking med school, but I was like everybody says that.
42:22
SPEAKER_01: Chemistry moment.
42:23
SPEAKER_01: There was a moment.
42:24
SPEAKER_01: I was like, but chemistry and pharmacology is not my thing.
42:26
SPEAKER_02: Yeah.
42:27
SPEAKER_01: But when we with like biomechanics and as it relates to like sport like sport movements, you know, like how what does your shoulder do when you throw a baseball?
42:35
SPEAKER_01: You know what I mean?
42:35
SPEAKER_01: And then like what injuries would come because of that?
42:38
SPEAKER_01: And then what like limitations would lead to that injury or back pain or pelvic instability, like SI joint pain, stuff like that.
42:46
SPEAKER_03: And there's so much that I could learn from you.
42:49
SPEAKER_03: I mean, even though I I learned anatomy a million years ago, unless you're really, you know, diving into, like you said, biomechanics.
42:58
SPEAKER_03: I mean, I'd I'd I should come spend some time here and observe.
43:02
SPEAKER_01: It's really as I mean, like we're nerds on that stuff, you know, and it's just like we just get really passionate and and excited, you know, it's like, oh, this person has hip impingement, you know.
43:11
SPEAKER_01: Let's investigate their ankle and how the dorsiflexion is inflicting their hip posterior rotation, you know.
43:18
SPEAKER_01: Um, and then where does their pelvic and their core stability relate to that as well, you know?
43:22
SPEAKER_01: So anyway, that's just compensations like that.
43:24
SPEAKER_01: So um, anyway, that's what made me want to be like, oh, I think PT school will be really cool.
43:29
SPEAKER_01: Got in there, and it's just like a broad scaffold of information you learn, just like med school with everything, and then you graduate, and then a 98% of physical therapists just work.
43:41
SPEAKER_02: Yeah.
43:42
SPEAKER_01: Where only a small subspecialty of them actually goes through some kind of specialty direction, right?
43:48
SPEAKER_01: Um, and I I mean, I'm always an advocate for mentorship and guidance from experts that you want to be like.
43:56
SPEAKER_01: And that's where I was like, oh, I my eyes were opened, and I was like, I want to be like you.
44:01
SPEAKER_03: Well, and you can tell the difference between a very knowledgeable physical therapist and somebody who's just kind of like doing the basics and going through the emotions.
44:09
SPEAKER_03: I think it's the same, obviously, with any profession.
44:11
SPEAKER_01: Just same with any profession.
44:12
SPEAKER_03: Yeah.
44:13
SPEAKER_01: Totally.
44:13
SPEAKER_01: But anyway, so I'm just excited and passionate and live vicariously through the patients we work with.
44:18
SPEAKER_01: And I just think so do I.
44:20
SPEAKER_01: It's cool.
44:20
SPEAKER_01: Right, exactly.
44:21
SPEAKER_03: I just want to be them.
44:22
SPEAKER_01: Exactly.
44:24
SPEAKER_01: Um, or like so it's a it's always it's tough, but it's cool at the same time.
44:28
SPEAKER_01: Or like college athletes that come in and they're they're like, Yeah, we have camp coming up soon, or this training program, or whatever.
44:34
SPEAKER_01: And I'm like, I know, I'm like remembering my own experiences and what is your play?
44:40
SPEAKER_01: Football and volleyball.
44:41
SPEAKER_01: So I played two sports in college.
44:42
SPEAKER_01: Nice.
44:43
SPEAKER_01: I played football and then men's volleyball.
44:45
SPEAKER_01: Football was division two, and then volleyball was actually division one.
44:48
SPEAKER_01: Because men's volleyball is a small niche.
44:50
SPEAKER_01: But um, yeah, so I went to a small school in Illinois.
44:54
SPEAKER_01: So we're Midwest, way different culture than down here in South Florida, because I'm from here originally.
44:58
SPEAKER_00: Yeah.
44:58
SPEAKER_01: Yeah.
44:59
SPEAKER_01: And I was like, as soon as I went there and experienced my first winter, I was like, oh, this is what people go.
45:05
SPEAKER_01: I had a lot of those epiphanies in my life.
45:07
SPEAKER_01: I feel like, oh, this is what this is like.
45:09
SPEAKER_02: That's why people come back down here.
45:11
SPEAKER_01: Exactly.
45:11
SPEAKER_01: And I'm like, I immediately know I want to move down to Florida when I when I grow up.
45:14
SPEAKER_01: You know, yeah.
45:15
SPEAKER_01: Um, just everything's so different, man.
45:17
SPEAKER_03: Like, but people are so nice there.
45:19
SPEAKER_01: Oh, super nice, so nice, super authentic, genuine, nice.
45:23
SPEAKER_03: That's how people in the south are.
45:24
SPEAKER_03: I mean, and yes, deep south.
45:26
SPEAKER_03: Florida is south, but it's not the south.
45:28
SPEAKER_01: It's not the south, yeah.
45:29
SPEAKER_01: Like Georgia, Alabama, South Carolina, Tennessee, Southern North Carolina, Tennessee, Mississippi, but that's a different draw over there.
45:39
SPEAKER_01: Um, and that's what we love Texas so much.
45:41
SPEAKER_01: So that's where I did my fellowship, was in Texas.
45:43
SPEAKER_01: Oh, okay.
45:43
SPEAKER_01: People are super warm and authentic and genuine.
45:46
SPEAKER_01: Like that's coming from University of Miami, where we went to PT school.
45:50
SPEAKER_01: I feel like the more south you go here, it's just not my thing, you know.
45:54
SPEAKER_01: Like the same people just attitudes, and I don't know.
45:57
SPEAKER_01: I just at a level of like they were nice to my face, but I'm not confident that they're not being talked about my back as soon as I leave.
46:06
SPEAKER_00: Yeah.
46:07
SPEAKER_01: Anyway, the opposite of that was in Texas that we had, our experience.
46:10
SPEAKER_01: People were just like super genuine and nice, you know.
46:12
SPEAKER_01: There's a huge family culture, and like people were very respectful, and people would honk at you when you're driving or walking.
46:20
SPEAKER_02: Oh, we just went to Georgia.
46:22
SPEAKER_02: Just oh, just to say hi.
46:23
SPEAKER_01: Yeah, and I'm like, oh, like, why are they oh you're like just so we don't even know.
46:27
SPEAKER_01: Just beep, just wave.
46:28
SPEAKER_03: I know.
46:29
SPEAKER_03: Everybody waves.
46:30
SPEAKER_03: Like, how's it going?
46:31
SPEAKER_03: Everybody says good morning.
46:32
SPEAKER_01: Yeah, good morning.
46:33
SPEAKER_01: We would have like conversations with people in the aisle of H E B, the looks like the publics over there at H E B.
46:39
SPEAKER_01: Loved H E B.
46:40
SPEAKER_01: You have a great experience there.
46:41
SPEAKER_01: Like it's like, yeah, anyway.
46:43
SPEAKER_01: Some people like, hey, can you reach that thing for me in the top shelf?
46:46
SPEAKER_01: Because I'm like tall guy, you know?
46:48
SPEAKER_01: And then I would have a conversation with the person.
46:50
SPEAKER_01: And before we leave, like a five-minute conversation, but never met the person before.
46:53
SPEAKER_02: Yeah.
46:53
SPEAKER_01: And they're like, tell your wife I said hi, like, oh, good luck to your daughter when she goes here.
46:58
SPEAKER_01: And uh, I'm like, I didn't even know that person.
47:00
SPEAKER_01: Yeah, I missed that.
47:02
SPEAKER_01: Yeah, I missed that, right?
47:03
SPEAKER_01: You know, that was so I was like, when we moved back to South Florida, we're like, we're gonna just as best as we can, we're gonna uh bring that culture and we're just gonna live it, you know, live it out.
47:13
SPEAKER_01: And if people aren't into that, then and if they are into it, then we'll just attract the right people, you know.
47:18
SPEAKER_03: Yeah, I mean, all you can do is teach your children the way that that you want them to be too exactly.
47:24
SPEAKER_01: Um shoot, what were you even on in the first place?
47:27
SPEAKER_01: Direction right now.
47:28
SPEAKER_03: Where did I where did I come from?
47:30
SPEAKER_01: Where you where'd you meet your husband?
47:31
SPEAKER_01: Oh, isn't okay, so he's yeah, and then you're Jack of all trades, he's a super niche specialist in cardiology.
47:36
SPEAKER_03: Yeah.
47:37
SPEAKER_01: Um, and then uh and then y'all moved together down to Boca.
47:41
SPEAKER_03: Uh we live in Boynton.
47:44
SPEAKER_03: He he started down here first because he was already finished.
47:47
SPEAKER_03: So he was down here for a couple years and I finished residency and then I came down.
47:51
SPEAKER_01: Oh, okay.
47:52
SPEAKER_01: Yeah.
47:52
SPEAKER_01: So y'all were split for a little while.
47:54
SPEAKER_01: Yes.
47:54
SPEAKER_01: Were you all married at the time or just dating?
47:56
SPEAKER_01: Just dating.
47:57
SPEAKER_01: Just dating.
47:57
SPEAKER_03: Yeah.
47:57
SPEAKER_01: Doing long distance thing.
47:59
SPEAKER_01: And then when you finished, you moved down to Boynton as well.
48:01
SPEAKER_01: Cool.
48:02
SPEAKER_03: And then y'all got we got married, three children later.
48:05
SPEAKER_01: Three kids.
48:05
SPEAKER_01: And how old are they?
48:06
SPEAKER_01: Five, eight, and ten.
48:08
SPEAKER_01: Five, eight, and ten.
48:09
SPEAKER_01: Wow.
48:10
SPEAKER_01: They're truly psychotic.
48:13
SPEAKER_01: We're not there yet.
48:14
SPEAKER_01: Mine are uh I think you're yeah, five years ahead of us with your oldest.
48:19
SPEAKER_01: My oldest is five.
48:20
SPEAKER_01: So we're five, three, and my little guy just turned 10 months tomorrow.
48:24
SPEAKER_03: Yeah.
48:24
SPEAKER_01: Five, three, and ten months old.
48:26
SPEAKER_01: Yeah.
48:26
SPEAKER_03: So it's a lot of fun.
48:27
SPEAKER_03: It gets easier, but then it also kind of gets harder.
48:30
SPEAKER_01: So in different ways is what I've heard.
48:32
SPEAKER_01: Yeah.
48:32
SPEAKER_01: You know.
48:33
SPEAKER_01: Um, but just trying to manage my own emotions and you know, day to day, just enjoying things, fatigue, tired.
48:42
SPEAKER_01: Yes.
48:43
SPEAKER_01: Yeah.
48:43
SPEAKER_03: Yeah, it's tough.
48:44
SPEAKER_03: It's really tough.
48:45
SPEAKER_03: I mean, especially when the the only time you spend with them is if you're working like in the evenings when they are full of energy and it's just pure chaos.
48:56
SPEAKER_03: Like my house is pure chaos.
48:59
SPEAKER_01: I believe it all the time.
49:00
SPEAKER_01: Usually, like one of the priorities we we just moved, we wanted to make sure our our backyard in our house was functional and not like just chaos with landscaping us all over the place.
49:10
SPEAKER_01: It's not it's not conducive to a three-year-old kid with a bunch of like landscape.
49:15
SPEAKER_01: So we got rid of all of our landscaping and turfed out the back.
49:18
SPEAKER_03: You did.
49:19
SPEAKER_01: Yeah.
49:19
SPEAKER_03: Isn't it so hot?
49:21
SPEAKER_01: It is hot.
49:21
SPEAKER_01: So here's my argument.
49:22
SPEAKER_01: All right.
49:24
SPEAKER_01: The benefits of not being dirty and itchy when you're rolling around the grass.
49:28
SPEAKER_01: Yeah.
49:29
SPEAKER_01: And then uh, yeah, just like dirty all the time, and then managing landscaping and stuff, it's just and then the for the benefit of open land, an open savannah to just gallop and run and wrestle.
49:41
SPEAKER_01: I sports, yeah, like 100% outweighs, I think, the negative of it being hot.
49:46
SPEAKER_00: Yeah.
49:47
SPEAKER_01: Where in Florida, I mean, from 11 a.m.
49:50
SPEAKER_01: till 4 p.m., you're not we're not gonna be outside anyway.
49:53
SPEAKER_01: True.
49:53
SPEAKER_01: We're not even gonna be out there.
49:55
SPEAKER_01: And by the time 4:30 hits, then we're good.
49:58
SPEAKER_01: It's gonna be it's warm, of course, it's hot, but it's not like you're not like losing your breath because it's like you know, strangling you.
50:05
SPEAKER_01: Yeah, we're not gonna be outside anyway.
50:06
SPEAKER_01: That was our argument.
50:07
SPEAKER_01: I was like, Yeah, you're right.
50:08
SPEAKER_01: We're not gonna be outside anyway.
50:09
SPEAKER_01: But anyway, either right before dinner or after dinner, unless I usually just like grab them and we're like, we're going outside.
50:15
SPEAKER_01: We got to get this energy out.
50:17
SPEAKER_01: And then we'll just like play games and I'll chase them around and stuff and wrestle.
50:20
SPEAKER_03: And yeah, yeah.
50:21
SPEAKER_03: You should make them do labs before school.
50:23
SPEAKER_03: That's what that's my new thing.
50:24
SPEAKER_01: Well, that's a good one.
50:25
SPEAKER_03: Yeah, like go run around the pool eight times.
50:27
SPEAKER_03: I bet you can't do it in three minutes.
50:28
SPEAKER_01: That's what we do.
50:29
SPEAKER_01: Like, hey, I want you to see that little like the fence post over there, touch that and come back and give me a high five five times in a row as fast as you can, and I'll time you.
50:36
SPEAKER_02: Yeah.
50:37
SPEAKER_02: Kids love a timer.
50:39
SPEAKER_01: And they're like racing each other, and then my daughter wins because she's bigger, and my son's crying.
50:43
SPEAKER_01: And I'm like, okay, try again.
50:44
SPEAKER_01: And I'll like hold my daughter down and let them get a head start.
50:47
SPEAKER_01: Yeah.
50:48
SPEAKER_01: Just run.
50:49
SPEAKER_01: Just get all the energy out.
50:51
SPEAKER_01: Um, yeah.
50:53
SPEAKER_01: So we uh yeah, it's the same.
50:55
SPEAKER_01: You know, I'm sure it's as they get older, just more chaos and energy.
50:59
SPEAKER_03: Yeah, it's really fun though.
51:00
SPEAKER_03: I mean, there's nothing more rewarding than having your kids run to you and when you get home and be a hug.
51:06
SPEAKER_01: I'm trying to like really ingrain that in my memory, you know, every time that it happens, you know, because there's some days where they're like, I don't want to hug you.
51:16
SPEAKER_01: And I'm not gonna make them, you know.
51:17
SPEAKER_03: Oh, I make them.
51:19
SPEAKER_01: I mean, yeah, because I'm like, when you're ready, I want to give you a hug.
51:24
SPEAKER_01: Um I don't know.
51:25
SPEAKER_01: I'm also probably maybe a little intimidating because I'm like, you know, I'm like a big dude and like I'm the dad.
51:30
SPEAKER_01: Yeah, I'm not the nurturing, soft talking mom.
51:33
SPEAKER_02: I'm like soft talking around here.
51:36
SPEAKER_02: Yeah, exactly.
51:37
SPEAKER_02: It's mostly yelling.
51:38
SPEAKER_01: Cool.
51:39
SPEAKER_01: I guess I'm just comparing my wife, you know, she's super nice and tenderhearted and nurturing, you know, soft talking usually.
51:47
SPEAKER_01: I'm like, hey, how you doing?
51:48
SPEAKER_01: Come give me a hug.
51:49
SPEAKER_01: You're like, ah, I'm not ready.
51:51
SPEAKER_01: I'm like, all right.
51:51
SPEAKER_01: Then usually five minutes later, then they jump on me and they're hugging me.
51:54
SPEAKER_01: So I'm like, let me give you a minute, acclimate to me being home.
51:58
SPEAKER_01: And then they're usually all over me, and it's totally fine.
52:01
SPEAKER_01: But um, yeah, it's amazing.
52:03
SPEAKER_01: Open the garage door, and they're like, Daddy, they like run out.
52:06
SPEAKER_01: That's really cool.
52:07
SPEAKER_01: So they still do their 10-year-olds still that with you?
52:10
SPEAKER_01: Oh, amazing.
52:11
SPEAKER_01: Yeah, that's what that's what I hope is.
52:12
SPEAKER_01: Yeah, as long as possible.
52:14
SPEAKER_01: Sweet.
52:15
SPEAKER_01: That's cool.
52:16
SPEAKER_01: Um, all right, so your practice, okay.
52:18
SPEAKER_01: Um, it's a concierge med internal medicine primary care practice here in West Palm.
52:23
SPEAKER_01: Yes.
52:24
SPEAKER_01: Um, people, you have members, yeah, right?
52:27
SPEAKER_01: And then you're on call with them 24 hours, 24-7.
52:31
SPEAKER_03: Yeah.
52:31
SPEAKER_03: So I mean, the the whole thing about concierge is that it gives you access to the physician, um, you know, texting me, calling me, emailing me.
52:40
SPEAKER_03: And my job is to be responsive, you know.
52:44
SPEAKER_03: Um and reachable.
52:45
SPEAKER_03: Yeah, reachable.
52:46
SPEAKER_03: And it takes away the need to have huge volumes of patients.
52:51
SPEAKER_03: And that for me is so refreshing to have a small panel of patients that I can take really good care of.
52:57
SPEAKER_03: Dive in.
52:58
SPEAKER_03: Yeah, as opposed to, you know, playing the volume game, which is unfortunately what you have to do.
53:04
SPEAKER_03: If you're accepting insurance, the more patients you see, the more money you make, you know, to be able to cover your overhead.
53:11
SPEAKER_03: And if you don't see enough patients, you you can't afford it.
53:15
SPEAKER_01: You have to, it's the same thing with PT.
53:17
SPEAKER_01: That's why we do the same thing, you know, because we're we're um out of pocket, right?
53:21
SPEAKER_01: We don't we're concierts, I guess you would say too.
53:24
SPEAKER_01: And um, for the right people that want that kind of exclusivity, they want the one-on-one attention and like actually dive into the matter, you know, they they they want that, you know.
53:37
SPEAKER_03: And it's worth it.
53:38
SPEAKER_03: I mean, it really is.
53:39
SPEAKER_03: I'm I mean, obviously there's different price points and you know what people can afford and can't, and it's unfortunate um that it's come to this, but you know, insurance has made the system that way, where you know they're ultimately in charge.
53:55
SPEAKER_03: Yeah.
53:56
SPEAKER_01: They're in charge.
53:57
SPEAKER_01: Like that's the bottom line.
53:58
SPEAKER_01: Where it's like, all right, well, F the system, I'm gonna do my own system, and we're outside the system.
54:01
SPEAKER_01: And if you want like super intensive, high quality attention and care.
54:06
SPEAKER_03: Yeah.
54:06
SPEAKER_03: Um it's just like anything.
54:08
SPEAKER_03: You get what you pay for.
54:09
SPEAKER_01: Right, totally.
54:10
SPEAKER_01: Yeah.
54:11
SPEAKER_01: So what what's your your main demographic?
54:14
SPEAKER_03: Um, I mean, mostly I would say uh probably 60% females, just because a lot of women want to see a female physician.
54:24
SPEAKER_03: And you know, anywhere from like 30s to 80s.
54:30
SPEAKER_01: Um so work active working adults, a little bit more majority women.
54:36
SPEAKER_03: Yeah.
54:37
SPEAKER_01: Cool.
54:38
SPEAKER_01: Um and what if like when people come on board and they like call you, say, hey, can I be a can I be a patient of yours?
54:45
SPEAKER_01: What do they usually ask?
54:46
SPEAKER_01: Like, what are they looking for?
54:48
SPEAKER_03: Well, I mean, I think they're looking for attention.
54:50
SPEAKER_03: A lot of people have been to concierge physicians before, and if they haven't, then I I kind of explain the whole process.
54:56
SPEAKER_03: And, you know, sometimes I'm so entrenched in the medical field that I forget how much people don't know.
55:05
SPEAKER_03: You know, like a normal layperson doesn't understand the intric intricacies of medicine and how to work the how to navigate the system.
55:14
SPEAKER_03: And I think a lot of it is doing that for them, um, you know, getting them to the right specialist or getting the testing done that needs to be done in an in a um, you know, expedited manner.
55:29
SPEAKER_03: Um, but at the end of the day, it's just having somebody that you trust that you can call.
55:35
SPEAKER_03: And, you know, whether it's an an emergency and it's come here now, you know, I fell or I'm going to the hospital.
55:43
SPEAKER_03: Or, you know, hey, let me, I heard about this, let me bounce this off of you and tell me what you think.
55:48
SPEAKER_01: Yeah.
55:49
SPEAKER_01: Yeah.
55:49
SPEAKER_01: I think it's interesting, like, well, going back to the thing you said of like a lot of people don't understand the late intricacies of medicine and like how the system works and the interplay of um medications and what their unique profile is like with like all the influencers on Instagram, social media and stuff.
56:07
SPEAKER_01: Man, I'm like, oh my god, like well, you're you're familiar with the Dunning Kruger effect, I assume, right?
56:12
SPEAKER_01: Like the the amount of stupidity and then like the competency versus confidence ratio.
56:17
SPEAKER_01: Yeah.
56:17
SPEAKER_01: I'm like, where does that come?
56:19
SPEAKER_01: I I I think it definitely I wish I had that confidence.
56:22
SPEAKER_01: I know, like, man, I wish I had your confidence to just say whatever you're saying, you know, as confidently as you do and not worry about um how you look, you know, or sound or the consequences.
56:34
SPEAKER_01: But um I mean the Dunning Kruger effect is like I've just experienced it a lot, you know.
56:39
SPEAKER_03: Yeah, yeah.
56:39
SPEAKER_03: I mean, it it's it's constantly changing too because people on social media are just um, you know, posting whatever, and it's amazing that all of my well-educated patients will believe anything and don't look at who the source is or you know what the person is saying.
57:00
SPEAKER_03: Is it reputable?
57:02
SPEAKER_03: Um, I mean, fortunately they can run it by me and I'll say, like, that dude's a moron.
57:08
SPEAKER_03: Please don't believe that.
57:09
SPEAKER_01: Yeah.
57:09
SPEAKER_01: Unfollow.
57:10
SPEAKER_01: Yeah, yeah.
57:11
SPEAKER_01: Um, but that's good though.
57:12
SPEAKER_01: You're that's a great resource, you know, for them.
57:15
SPEAKER_01: How do you navigate your own?
57:16
SPEAKER_01: I mean, because you're a healthy individual, like, how do you navigate your own health and wellness?
57:19
SPEAKER_03: Uh, probably not the way that I should.
57:22
SPEAKER_03: Um, I don't actually have a doctor, I just doctor myself.
57:25
SPEAKER_03: But, you know, it all comes back to the basics.
57:29
SPEAKER_03: I work out a lot.
57:30
SPEAKER_03: It's, you know, my way of getting rid of stress.
57:34
SPEAKER_03: And um I've I've seen that it really is important to show to my kids health.
57:41
SPEAKER_03: Yeah.
57:42
SPEAKER_03: You know, it feels good when I come home from the gym and they're like, oh, where were you, mommy?
57:46
SPEAKER_03: You were at the gym.
57:47
SPEAKER_03: Like, it's great for them to see that.
57:49
SPEAKER_03: 100%.
57:50
SPEAKER_03: Um, so I think that's super important.
57:52
SPEAKER_01: Yeah.
57:52
SPEAKER_01: We're very similar.
57:53
SPEAKER_01: Like my wife will go, I'll get home as early as I can, and then she sh shoots out and goes to the gym.
57:58
SPEAKER_01: It's like, they're like, they're in the still the phase.
58:00
SPEAKER_01: We're like, no, mommy, like, where are you going?
58:02
SPEAKER_01: And I'm like, she's exercising.
58:03
SPEAKER_01: You're like, did she exercise again?
58:05
SPEAKER_01: Is she going to exercise?
58:06
SPEAKER_01: And they're like, Oh, she's exercising.
58:07
SPEAKER_03: Yeah, yeah.
58:07
SPEAKER_03: So it becomes normal to them.
58:09
SPEAKER_03: It, you know, it becomes my habit um and kind of their habit too.
58:13
SPEAKER_03: So where do you work out?
58:15
SPEAKER_01: What do you do?
58:15
SPEAKER_03: Uh I do F 45.
58:17
SPEAKER_01: Oh, cool.
58:17
SPEAKER_01: Yeah.
58:18
SPEAKER_01: Good high intensity.
58:19
SPEAKER_03: Mm-hmm.
58:19
SPEAKER_01: The one here in is there one in West Palm?
58:21
SPEAKER_03: There's a lot of them, but yeah, I go to the one by my house in Boynton.
58:24
SPEAKER_01: Oh, okay, cool.
58:25
SPEAKER_01: 6 a.m.
58:26
SPEAKER_01: Super convenient.
58:26
SPEAKER_01: Every day.
58:27
SPEAKER_01: It's 6 a.m.
58:27
SPEAKER_01: Oh, it's your before work.
58:28
SPEAKER_01: I'm a before work.
58:29
SPEAKER_03: Yeah.
58:30
SPEAKER_03: It's the only way that I can fit it in.
58:31
SPEAKER_03: I mean, if I delay it to the afternoon, it's not happening.
58:34
SPEAKER_03: There's just too much going on.
58:36
SPEAKER_03: And, you know, I gotta go home and make dinner and make lunches and you know, yell at my kids, uh, make them do their homework.
58:43
SPEAKER_01: Right.
58:44
SPEAKER_01: Oh, that's not like we're not even there yet.
58:45
SPEAKER_03: Yeah.
58:46
SPEAKER_01: My kindergartner, she's a kindergartner first year.
58:48
SPEAKER_01: She has some homework now where it's like, get to finish this coloring page.
58:51
SPEAKER_03: Yeah.
58:52
SPEAKER_03: And they still think it's fun.
58:54
SPEAKER_03: In kindergarten, like my daughter thinks that her homework is fun and she's like, I gotta do it.
58:59
SPEAKER_03: And the and the boys are not into it.
59:01
SPEAKER_01: Yeah, yeah.
59:03
SPEAKER_01: Um, so you all right, so at 45, you 6 a.m.
59:05
SPEAKER_01: every day.
59:06
SPEAKER_03: Yeah.
59:06
SPEAKER_01: And then what about nutrition?
59:07
SPEAKER_01: Like, what do you do meal prep?
59:10
SPEAKER_01: Like, what do you do?
59:10
SPEAKER_03: Yeah, I mean, I so I grew up in the South not eating very healthy at all.
59:16
SPEAKER_03: I mean, it was like fried chicken and fried okra and white rice and occasionally some.
59:21
SPEAKER_03: Macorine and cheese.
59:22
SPEAKER_03: Yeah.
59:23
SPEAKER_03: Collard greens.
59:24
SPEAKER_01: Collard greens.
59:24
SPEAKER_01: I mean, I love American soul southern food.
59:28
SPEAKER_01: That was what we ate every day.
59:30
SPEAKER_01: So fried chicken is good.
59:32
SPEAKER_01: It is really good.
59:33
SPEAKER_01: It's just moderation.
59:34
SPEAKER_01: Yeah.
59:34
SPEAKER_03: I mean, so surprisingly, I I have I don't cook like that.
59:39
SPEAKER_03: I mean, occasionally I'll make something, but in general, I'm cooking for my kids and my husband every night.
59:45
SPEAKER_03: We eat at home.
59:46
SPEAKER_03: We don't we don't really go out a lot.
59:48
SPEAKER_03: So I just try and control, you know, as much as I can.
59:52
SPEAKER_03: And I won't say that everything, especially with the kids, is super healthy, but you know, there's always a protein, there's always a vegetable.
59:59
SPEAKER_03: Yeah.
1:00:00
SPEAKER_03: Regardless.
1:00:00
SPEAKER_03: And same.
1:00:02
SPEAKER_03: When I make it myself, I can control that kind of stuff.
1:00:05
SPEAKER_01: So it's another cool moment is like that we've had is more my daughter.
1:00:11
SPEAKER_01: My son's a little bit like this, the our middle son, but um, she's like, I'm hungry, I want a snack.
1:00:16
SPEAKER_01: Can I have some green beans and peas?
1:00:19
SPEAKER_01: She said she wants like, and they eat it frozen, just cold.
1:00:23
SPEAKER_02: That's funny.
1:00:23
SPEAKER_01: We'll get the frozen bag from Cosco or whatever, you know?
1:00:26
SPEAKER_01: So let's get a handful of peas and like throw it in a bowl.
1:00:28
SPEAKER_01: And then she just spoons it in.
1:00:29
SPEAKER_01: So it's kind of, I mean, it's cold, so it's a different texture and you know, temp.
1:00:32
SPEAKER_01: Yeah.
1:00:32
SPEAKER_01: But she'll like ask for vegetables for a snack.
1:00:35
SPEAKER_01: Hilarious.
1:00:35
SPEAKER_02: That's what my oldest says.
1:00:36
SPEAKER_01: Oh, that's good.
1:00:37
SPEAKER_01: Awesome.
1:00:38
SPEAKER_01: And I'm like, all right, we're trying to ingrain these normal and then the snack that literally yesterday my son went to the pantry and grabbed um the dried mango from Costco, same thing.
1:00:48
SPEAKER_03: Yeah.
1:00:48
SPEAKER_01: We're just buying in bulk right now.
1:00:49
SPEAKER_01: You know, like you have to.
1:00:51
SPEAKER_01: You have to got to.
1:00:52
SPEAKER_03: Yeah.
1:00:52
SPEAKER_01: And I'm like, love that, you know, um, to normalize, you know, to normalize that.
1:00:57
SPEAKER_01: What do you so you can cooking controlling stuff?
1:01:00
SPEAKER_01: What are you, what's on your list?
1:01:01
SPEAKER_01: We're like, no, we're not gonna eat that.
1:01:04
SPEAKER_03: I mean, I've I've been trying to really weed out a lot of the stuff that I was buying before.
1:01:11
SPEAKER_03: I mean, there's nothing that will make you feel more guilty than like looking at the ingredients on the stuff that you the crap that you can buy for your kids.
1:01:18
SPEAKER_03: Um you mean like fruit loops, like like Yeah.
1:01:21
SPEAKER_03: So like all of those cereals, we don't, I don't buy those.
1:01:26
SPEAKER_03: I try not to get anything with, you know, synthetic dyes in it.
1:01:29
SPEAKER_03: Both of my older kids have ADHD and you know, there is some correlation between the dyes that the FDA allows to be in our food.
1:01:38
SPEAKER_03: Um, so I try and minimize dyes for sure.
1:01:41
SPEAKER_03: I mean, I they they definitely eat some processed foods, but like what you know, crackers, there's chips, that kind of stuff.
1:01:50
SPEAKER_03: I try and make it as healthy as possible.
1:01:52
SPEAKER_03: And one time I did a Thrive order and they hated, you know, I spent like$400 and they hated every single thing they came.
1:01:59
SPEAKER_01: So like hey, hubby, guess what we're eating?
1:02:02
SPEAKER_03: Yeah.
1:02:03
SPEAKER_01: We're eating these Thrive crackers and stuff.
1:02:06
SPEAKER_01: Yeah.
1:02:06
SPEAKER_03: So I mean, I think when it comes to the kids, we have a hard time keeping weight on them.
1:02:10
SPEAKER_03: They're all very thin and active.
1:02:12
SPEAKER_03: And so it it's striking a balance between like letting a kid be a kid and and getting enough calories and you know, sometimes eating the crap, but overall instilling good, you know, a good relationship with food, number one, but also um, you know, modeling what what we eat and how they should be eating in the future.
1:02:34
SPEAKER_01: Yeah, totally love that.
1:02:35
SPEAKER_01: Um, I think one one thing I almost after all the the uh movements and bringing things to light, as an example, like dyes and processed stuff or whatever.
1:02:46
SPEAKER_01: Um, I think it was like recently Easter.
1:02:48
SPEAKER_01: I like went and I was like, I'm throwing away all the candy.
1:02:51
SPEAKER_01: Like we're not having candy anymore.
1:02:53
SPEAKER_01: I was like, wait, you know, it's just they don't have that much.
1:02:55
SPEAKER_01: Just you're you're gonna crush them, you know, like they are gonna be so devastated.
1:02:59
SPEAKER_01: I was like, all right.
1:03:00
SPEAKER_01: It's hard.
1:03:01
SPEAKER_01: It's hard because I feel like candy now, McDonald's, same thing.
1:03:06
SPEAKER_01: Like in the 70s, like it's not the same now as it was then.
1:03:10
SPEAKER_01: It's so much more, of course, corporate profit-driven.
1:03:13
SPEAKER_01: With like, how can you make this as cheap as possible and shelf life as long as possible?
1:03:18
SPEAKER_01: Look still good and still like be fluffy and look like and rise as it needs to.
1:03:23
SPEAKER_01: So like it's just like counteracting all these processes with poor processes and chemicals and stuff.
1:03:29
SPEAKER_03: I mean, the fact that they put red dye into children's Tylenol or children's ibuprofen, it drives me insane.
1:03:37
SPEAKER_03: Like, why does it need to be red?
1:03:40
SPEAKER_03: Why, what are you appealing to?
1:03:42
SPEAKER_03: And then when your kid spits it out all over their clothes, it stains them.
1:03:47
SPEAKER_00: Yeah.
1:03:47
SPEAKER_03: So it's stuff like that that really drives me crazy, especially when you're trying to make good, you know, make good decisions for your kids because you're the only one who is responsible for that.
1:03:59
SPEAKER_01: It's a I mean, I can't with little child like the systems are so vulnerable and sensitive, little bodies, you know what I mean?
1:04:09
SPEAKER_03: But they are so resilient too.
1:04:10
SPEAKER_01: Super resilient, yeah.
1:04:11
SPEAKER_01: No, totally good point.
1:04:12
SPEAKER_01: Because I don't want to, I don't want to, you know, freak people out or talk myself down in that hole.
1:04:17
SPEAKER_03: It takes a lot to mess up a kid.
1:04:18
SPEAKER_03: It really does.
1:04:19
SPEAKER_01: But I'm just saying, like considering like with childhood obesity, type 1 diabetes, it seems like things are getting more prevalent, right?
1:04:26
SPEAKER_01: Yeah.
1:04:27
SPEAKER_01: Type 1 DB is an example.
1:04:29
SPEAKER_01: Um, and child obesity hasn't been an it's not a new thing, but um with stuff like the diet, synthetic dyes, um, ultra-processed food, like hot dog buns, right?
1:04:41
SPEAKER_01: Like our hamburger, like it's not real bread.
1:04:44
SPEAKER_01: Yeah, but just eating that consistently, I'm like, man, no wonder.
1:04:47
SPEAKER_01: Um like, so where do we go?
1:04:49
SPEAKER_01: You know, like what do we do other than just and it's expensive to not eat like that?
1:04:54
SPEAKER_01: Really, really expensive.
1:04:56
SPEAKER_01: Just like what you know is super healthy um sources, yeah.
1:05:02
SPEAKER_01: Um, or buying organic, it's like, man, it's overwhelming, you know, and it's not super accessible.
1:05:08
SPEAKER_01: Yeah, um, it's just hard to do, you know.
1:05:11
SPEAKER_01: So my guard, then we're gonna have like just quinoa and chicken.
1:05:15
SPEAKER_01: Yeah, you know, organic chicken from Costco from Costco.
1:05:18
SPEAKER_01: That's what we're having again, you know.
1:05:19
SPEAKER_03: Yeah.
1:05:20
SPEAKER_01: Um, and then vegetables, which I hope are organic, you know.
1:05:23
SPEAKER_01: I think they are the ones we get from Costco, same thing.
1:05:26
SPEAKER_01: Yeah, but um, it's just challenging, you know.
1:05:28
SPEAKER_01: But anyway, so what I'm saying, like I can see why there's such a proliferation of systemic issues like that in children and adults, you know.
1:05:37
SPEAKER_03: Yeah, and it's sad, it's really sad to see children who are obese because again, it's not their decision, it's the parents' decision.
1:05:44
SPEAKER_01: And no, it's a bummer.
1:05:45
SPEAKER_01: Yeah, I hate that, but um we could talk forever.
1:05:50
SPEAKER_01: Um let's land the plane and uh we'll we'll have to get you back.
1:05:54
SPEAKER_01: We can talk more about maybe dive more into peptides, prescription meds, stem cells.
1:06:00
SPEAKER_01: Um yeah.
1:06:01
SPEAKER_01: Yeah, I have a lot to talk about with all of this.
1:06:04
SPEAKER_01: Cool.
1:06:05
SPEAKER_01: Well, we'll get you on again.
1:06:06
SPEAKER_01: Yeah, but tell people more uh like how can they reach you, how can they find you, how can they get in contact?
1:06:10
SPEAKER_03: Yeah, so my practice is called Chase Wellness, and I'm in West Palm, 1000 North Olive Avenue.
1:06:17
SPEAKER_03: Um email me, call me.
1:06:20
SPEAKER_03: You can look up the website, just um chasewellnessmd.com.
1:06:24
SPEAKER_01: ChaseWellnessMD.com.
1:06:26
SPEAKER_01: And then on there is all your info.
1:06:27
SPEAKER_01: Cool.
1:06:28
SPEAKER_01: Well, thanks for coming in.
1:06:29
SPEAKER_01: And uh if y'all ever have any questions, comments, concerns, conflicting opinions, like don't hesitate to reach out.
1:06:34
SPEAKER_01: We're always open to having a conversation and chatting.
1:06:36
SPEAKER_01: And if you have any pain that you feel like we could help you with, we're always we'd love to at least talk on the phone and see how we can help you, you know, get back to things you love to do and act uh active lifestyles that we help to enjoy people to live again.
1:06:47
SPEAKER_01: Um and we'll we'll catch y'all next time.