Why Do Full-Body Imaging? with Dr. Anthony Oraha

Foreign. This is Dr. Araha, and we're meeting for the first time today. But I had an experience where I was getting a CT calcium score in a CT angiogram called Clery because I have some minor atherosclerosis. I've got the heart attack gene, so I've only been watching that. And across the way, was there a synergies, sort of a concierge medical practice. And I'm really interested in that because we have a lot of patients that come to us to look better on the outside, and they're also wanting to look better on the inside. We've done certain things to help people, help people's health. We're also looking for doctors in our community that can manage the patients that have unique things from anything from cardiovascular concerns or to worry about neurocognitive decline, to worry about detecting cancer early. They want to have a better sleep, better longevity. And interesting too is we came from a similar background. We're both ER doctors by trade. So I trained in the er, where we were used to taking care of people when they were either about to die or they had some injury or they were sick. But they were never really. We were never really focused on their overall health. We were focused on this, managing the immediacy. So just tell us a little bit about yourself and your background, how you kind of started forming your synergy clinic. Sure.

So, as you mentioned, my background is in emergency medicine, and the er, by nature, is reactive. You know, we're reacting to chronic diseases that have an acute state. So, for example, atherosclerotic cardiovascular disease will lead to a heart attack. And then people come into the emergency department with chest pain, shortness of breath, et cetera. I just saw that repetitive nature of treating things reactively, and I wanted to turn the page and focus on a proactive nature of treating disease, really, you know, focusing on prevention instead of treating something after it happens. And so being in the emergency department was a big sway for me to start Synergy. The second part to that was I had an uncle who unfortunately passed away from a brain tumor and found out he had a brain tumor after he had a seizure in his sleep. And I was just thinking back to myself, like, we have to have a better way of detecting diseases, detecting cancers early on. And it was around that time that technologies like the whole body, mri, liquid biopsy tests, these things were coming together. And I said, let's bring a place to the Midwest that offers all of this under one roof where we can focus on keeping people healthy, detecting disease very early on and preventing any disease that we can. And with my partner, Dr. Zielinski, we came up with synergy and that's where we're at today in focusing on prevention and early detection of disease.

So getting back into that point and digging this a little bit more is that health care is really disease insurance. And just like your house insurance doesn't kick in unless your house burns down, you have a flood, it's not paying for your smoke detectors or for your roof fungus, your car insurance is not paying for your hair, tires, your tire inflation or your windshield wipers. And prior to 2010, prior to the so called Affordable Health Care act or the Obamacare act, screening tests such as colonoscopies and mammograms were not required to become covered by insurance. There would have to be something you have to pay out of pocket or subject to deductible. And Congress wrote, I think something like 72 screening tests and preventative disease, such as preventive things such as a vaccine, to be covered by insurance. But that was only 15 years ago. Prior to that, the idea of preventing disease wasn't entering into the health care framework. And doctors feel bound by doing what health insurance companies will pay for. And it's an interesting model that, you know, we think about, let's say people smoking, they spend roughly $3,500 a year smoking. How much out pocket costs are people willing to spend for their health? The large portion of population, it's zero. And we're having a shift in society where we are having less children, we are living longer, we're maybe delaying having children so we have a little bit more affluence. And then the idea of just aging and getting old and dying is not so desirable. People are putting off retirement and then we must realize that probably our health insurance is not going to pay for extending your lifespan because then they're stuck with you longer. And if you look at it from say Blue Cross's standpoint, they want you to sit bumble along until you get Medicare, when your big expenses occur, then they're off the hook. So when I hear patients talk about unique things to extend their life and they're like, well, my insurance doesn't cover it, I don't think I should do it. That's because they love their money or their possessions more than themselves. And we're finding there's a growing segment of population that prefers life over their possessions and they can actually afford both, just like you could with smoking. And you said something else regarding, you know, picking things up while in advance. Now, the liquid vibes, we talk about that a little bit. That's certainly got limitations, but it's the first foray into cancer detection with screening. I think stuff would be much better in the future. But that probably is the only FDA approved one. I don't think it's FDA approved. It's more clear approved. There's only widespread one now, and there's ones in other countries you can get done that might be a little bit better. That will be here in a few years. The full body MRI you talked about for picking up cancer, we briefly touched on screening for cardiovascular disease.

Yeah. Just to highlight, you know, the whole body MRI to create our protocol took us about 14 months because we really wanted to optimize it as a screening tool. You know, when the mammogram came out is like 50s or I think early 60s. It really took 10 years for the medical community to accept it as a screening tool. And so we look at whole body mri. I mean, this is a pretty new technology in the last two to three years where it's really grown in popularity. And I think that hopefully in the next five years or so it's going to be accepted as a cancer screening tool. When we use whole body mri, really, when we use the current United States preventative task force guidelines, and that's, you know, PSA for prostate mammogram, colonoscopy, low dose, long CT and Pap sMears, those are five tests right now that are approved to screen for cancer. Those tests only pick up 14% of cancers. That number is. When I read that, I was shocked because what if you flip it? What it's telling you is that 86% of cancers, you wait until symptoms develop, until that seizure that you have, you know, belly pain that people come into the emergency department for. I mean, you may remember in your, in your ER days, people come in, you know, I've had this really bad belly pain or I've been, you know, urinating blood or whatever, and it's cancer. Right. And so you're making that diagnosis correct. Correct. You're making that diagnosis at an advanced stage when symptoms have already developed. And we know time and time again the earlier that something is detected, the easier it is to treat. You know, and we want to optimize health span, which is the amount of healthy years that people live. You know, common myth is people will come to synergy, say, oh, doc, how are you going to get me living to 120? I'm like, well, I don't know that I Can right now. But what I can tell you is we're going to get you living as healthy as possible for as long as possible. And so I just wanted to highlight kind of the. What we have right now for cancer screening, which is those five tests and then what we can do with a whole body MRI so we can look at brain cancer, you know, the scary cancers. Brain cancer, pancreatic for women, ovarian cancer, which is often overlooked for months. Right. Because the symptoms are very generic, very, very vague. Bloating, little abdominal pain, maybe, maybe some bowel habits that change and it gets written off. Written off, Written off until it's at stage three or stage four. And so we're able to detect these at stage one, making a drastic impact on people's lives.

Let's talk about that a little bit because a lot of people might not know what that means. And so we're talking about stage of the cancer, which each cancer has its own stages. But the. And you basically said you did, your protocol, took in 14 months. The idea is like public's idea. If you went to the hospital, went to Beaumont Hospital, said, I want a full body mri. Probably take you a day and a half, cost you 40, $50,000. We're really talking about with a full body MRI is actually a lower quality MRI. We're trying to find things the size of a peanut rather than the size of a millimeter. So to get a full body mri, we're actually degrading the image a little bit to be able to get it done an hour. But still, when you have an image that shows something abnormal, let's say in your pancreas, now we can do the more extensive test. Right. I want to go back just to kind of talk about like maybe put this in three different categories. We discuss those more, more in length. So we've got the things that are going to. When you say somebody wants to live longer, let's just not die now. And that's not die something stupid. Number one is cardiovascular disease. That's going to kill most of us and that comes on first. So if you're going to die in your 40s, that's probably the most likely culprit. And we're going to exclude, you know, accidents and that sort of thing.

Correct.

Number two is cancer. That's going to be 60s and 70s. Number three is neurocognitive client. 70s and 80s. We're getting back to. We'll stick on the cancer one a little bit. Talk about the full body mri. And it not only picks up Cancer, but also aneurysms, other anomalies, and what we call incidental comas, which is a abnormality. It means nothing. I got a cyst on my liver and if I wasn't smart about this and didn't have the right doctor, they're taking that thing out. Well, I can live with it. I'm not getting taken out. That's actually the biggest criticism to full body MRI is you're going to find a cyst somewhere. If you take it to a general surgeon, that thing's coming out and we might have a complication. You want to go into that a little bit?

Yeah, absolutely. So I'd like to kind of classify our findings in a few different categories. And I think incidentaloma is a funny and great way to describe, you know, an incidental finding that you need to do nothing about. And it's just if you had not had this scan, you would have had no idea. You would have lived your entire life and had no idea that you had a cyst in your liver. Right. The second is a finding that maybe requires follow up in 6 months, 12 months, and sometimes we'll see a slightly enlarged thoracic aorta or maybe something in the kidney that, you know, the radiologist will call me and say, hey, you know, doc, I don't think this is concerning right now. Let's track it, make sure it doesn't grow in 6, 12 months, etc. Then we have more urgent findings. Get a call, say, hey, there's a suspicious mass at the tail of the pancreas. Let's get them in. And you know, let's get that follow up test sooner than later. So, you know, a few things to kind of, to touch on that. One is that you don't get handed a report from Synergy. All of our patients get my cell phone number and get my email and I am very accessible to all of our patients. And what that does is it alleviates one. After getting that kind of raw report, you know, going to Google is what everybody does. And I'll tell people, do not go to Google. Call me, email me, let's go through this. So when we do our results appointment, we go line by line through the raw data. And then I also give what I call the English translation of that raw data so people can read and say, okay, these were my results. This is what Dr. Raha thought was important for me to know. This is what I can take. And for next year, whatever it may be, when we have any kind of follow up, we also have expedited scheduling for all of our patients. So that's, you know, another nice touch point from that, that separates us, I think, from other people who are doing full body MRIs. And the third and most important thing is that people are able to get their results in less than 24 hours. These kind of nationwide companies, sometimes it takes two to three weeks and you're not following up with any physician and you just kind of get a report and say, hey, good luck with whatever it is. We are helping people set up, follow up. You know, like I said, everybody has access to me. So I just wanted to kind of highlight that in terms of the results that we get. So going back to incidentalomas, we find incidentalomas all the time. And it's really important for you to have somebody who you can go to because like you said, you go to a general surgeon with this, you're signed up for, you know, you're out, you're on the schedule for the or, it's coming out. Right? But if you have somebody who can say, no, I don't think this needs to come out. This is something that we're going to keep an eye on, or this is something that is totally benign, I think it's really important. It gives people peace of mind. It lets people know that there's a doctor in their corner, there's a team in their corner that is there to support, you know, whatever questions, concerns that they have. One other thing that you mentioned, and I think it's really important to highlight is you mentioned the quality of image, and you're right, it's a different type of quality of image that we do for whole body MRI versus, for example, if somebody's getting a shoulder mri. When we do a whole body mri, we're looking for cancer signs and symptoms of cancer being present in somebody's body. So, you know, people will come to us and say, oh, you know, are you. My shoulder also hurts. Are you able to, you know, look at that on the mri and we can look at the. Your shoulder, we'll see kind of bigger issues, but we're not going to see it as a dedicated shoulder.

Partial tear.

Exactly. That's exactly right. And so, you know, I think it's really important to know that we are looking for cancer. We do find these other kind of incidental findings and some things, like I said, no follow up. Maybe follow up in six to 12 months. And then that third category of, hey, you know, we need urgent follow up, this person's got to come in. We had a patient who needed A pretty urgent finding. When they were calling other places to get scheduled for that follow up test, they were looking at at six to eight weeks out. And when they came through us, they were like, hey, can you help us get this scheduled? I said, absolutely. We got them in, in three days. Yeah. So it just changes, you know, our approach with patient care, with really being in the corner, supporting people throughout this process is much more than just getting an MRI and getting your results. So I think you brought up some really great points in terms of what to look out for for MRIs. We can even kind of touch on some of the risks. Right. So there's no radiation, which is great. You're not exposing yourself to radiation like you are with a ct. But there is the risk of maybe finding something that warrants further testing. It's rare, but it's something that people should be aware of. You know, nothing is perfect and nothing comes without risks and benefits. But I would say far the benefits that you're getting by detecting or doing a screening for early cancer detection far outweigh the risks of, of any kind of further follow up tests that you may need.

So that brings up a good point of what does it miss? So it's not good for skin cancer.

Right.

The way we're doing it now is not good for breast cancer, it's not good for prostate cancer, not good for colon cancer. That being said, we don't want people to think this is an alternative to routine screening. It's in addition to. So you still get your skin check, still your colonoscopy, still get your mammogram, still get your PSA blood test. We can argue about PRSA blood tests. It is only helpful in certain settings, but it's something that should still be done. There's something called a 3D MRI at the prostate that does, is better for picking up prostate cancer. So if you have a specific genetic risk, it's actually a separate test.

Correct.

Just dig deeply. I don't want to get too deep superficially into the liquid biopsy because I think that's going to. Right now the test is called the gallery grail. It came out and it's, it's, there's a big splash because it picks up fragments of DNA from cancer. The problem has been it's not good at picking up cancer in early stages. But the price is coming down. It's also going to lead to other technologies. Give me an example. What, how would you explain this to patients about whether or not you're going to spend close to $1,000 for a grail test.

Yeah. So, you know, one of the reasons I came up with the name Synergy is that none of our tests are meant to stand independently. And so, you know, all the time I get the question, doc, what's the best test that I can get? And my answer is all of them, because it depends. So one thing that we do is that we'll sit down and have a conversation half hour to an hour long, where we get to know your own personal history, your family history, etc. And then we come up with, with the tests that will optimize your longevity and highlight what, what are your goals here. One thing I do want to go back to, and I think it's really important that you said this, is that no matter if you do all the tests that we have at Synergy, we still encourage you to follow up with your primary, still encourage you to do all the United States preventive task force guidelines. Nothing replaces the current tests that are out right now. These are meant to be an adjunct to those tests. So I just wanted to highlight that point and then go back to the question that she asked about gallery liquid biopsies. So the tests are meant to work synergistically together, meaning you did a whole body mri. You do the multi cancer detection test, that if there was something that was too small to be seen on whole body mri. So depending on the tissue, we can see things between 5 and 10 millimeters. I mean, that is tiny, right? Very tiny. It's a phenomenal test, but it might be too early. And that's where a test like the liquid biopsy test can come into play. As you mentioned, whole body mri. MRI can miss skin cancers, it can miss cancers of the blood and cancers that are too small. And that's where we then use the liquid biopsy test to kind of fill in. And you had mentioned this before and on a previous podcast. That test isn't perfect, still has a lot of room for growth. And we're here for that growth process. It's great for a lot of tests, head and neck cancers, certain GI hepatobiliary cancers. It's good on detecting. And then it doesn't detect certain tests, certain cancers that. Well, so that's kind of how I break it down to patients, is that we use these tests together to make sure that we're leaving as few stones unturned as possible. We actually have an additional. It's a stool test that looks for microscopic signs of cancer, similar to your cologuard test. And that way we're really trying to not miss any small signs or symptoms of cancer.

Yeah. So the, I guess the, the price point is if it's negative, do you really feel like you're wasting your money?

It's a great. That's such a, that's such a point. And you know, we'll get that sometimes that question and I'm like, okay, if it was all negative, what did you benefit from? It really it. Right. And the benefit is peace of mind. I think everybody has seen this and you don't really need to be a statistician to see that younger and younger people are getting diagnosed with cancer. And that is scary. It's just a scary statistic. I mean it's becoming more and more common. A loved one who is, I mean you talk to them like, oh, they really only 42, they're only 38. How did this happen? You know, and so right now, ours, I feel like our screening tools are catching up to this lower and lower diagnosis age. We have tools that are available to us and we brought all those tools under one roof at Synergy to allow people. No, please.

The great question is, my staff ask me this all the time. What age should I start? Now, obviously we can say at any age, but what from realistically, if you had the US Preventive Healthcare Task Force looking at, they'd say never because it would not be worth the money.

Money.

But from an individual standpoint, because we can think about, you know, you can do some genetic testing, see if you're at risk for cancer, you look at family history. How are you counseling somebody? What age do you pull the trigger and start testing?

That's a, that's a great question. We actually had somebody reach out to our clinic for testing for their 7 and 8 year old and I had to kindly say it was out of the scope of practice for Synergy. We treat adults currently.

Are you doing the myriad screening we do?

Yep.

Would that be reasonable in a kid and child?

Yeah, I think that's actually a reasonable test because it, it looks at your DNA and short of epigenetic changes which don't change necessarily your risk factors for cancer, your DNA is not going to.

Change, but they don't even know it at 7 or 8 Corrections. Or an adult like a 17 year old. Correct. I would think that that's a test that I may want my kids to have done just to know while you're at risk. Pancreatic cancer. Let's kind of just kind of watch that. Yeah, I'm sorry, go ahead.

No, no, I think that that's, that's a great point that you, that you bring up and actually punched out on the question that you had asked me before.

So the person comes in age, should I start spending this? Because we're talking about $3,000.

Right.

For cancer detection.

Correct.

And we're not sure how often to do it. So let's talk about what age should you consider doing it based on average risk versus high risk and how often should you do it?

Yeah, and I think that boils down to the importance of that initial 30 to 60 minute conversation that I have with every single one of my patients. Because if somebody comes in and says I'm healthy, zero family history, you know, my, my lab work looks great, I feel phenomenal, I work out five days a week, I eat healthy, etc. I don't smoke, et cetera. Looking at very, very low risk individual. And so what I would encourage is let's get a baseline and then let's determine after we get that baseline where.

We'Re at, let's say the 30 year old versus the 50 year old. Yeah, we're probably having a slightly different conversation.

Correct.

30 year old comes in perfectly healthy. I reckon they get a baseline. A 50 year old comes in perfectly healthy, you recommend they get a baseline.

Yeah. So both people get a baseline. And based on what that baseline looks like and what their risk factors are, are, we will have recommendations. So currently for whole body mri, our recommendation is yearly, but we're collecting data points to say, okay, for low risk, yearly is maybe too much. Maybe it should be every two years. For high risk, yearly seems to be suffice. It's really too early to tell. We don't have enough data points to tell us that. But we are collecting that actively to come down to a good, a good point. For cardiovascular disease, which I'm sure we'll get into in a second, there are a little bit, little bit more guidelines for that. So for example, somebody doesn't need a CTA yearly, you know, clearly analysis yearly, that could be done every two to three years or every three to five years on that. Sure.

Talked about the cancer liquid biopsy. We're both like, that's, that's helpful. Routine screening. Absolutely. Mri, body, full body mri. And I do mine every, every two years. Now I did some genetic testing below very low genetic risk. And the only reason I'm doing every two, two years. It's not a matter of the cost. Even I can tolerate the hourly in the machine. Sometimes it's getting around it and you forget for a While next one is cardiovascular disease, we might be the first one. So we look at, you know, I've talked before, there's really three ways to screen for this. One's a coronary calcium score and that's a cat scan, about 100 bucks. And I think that's really good for young people just for a basic screening test because it doesn't pick up soft plaque and other things. Then there's a cimt, which we like doing because we have ultrasounds here, non invasive, no ionas and radiation. And it looks at your carotid arteries in your neck, which is a good marker for your heart arteries. And then the CT angiogram with Clery, which is a spelled C L E E R L Y is. I spelled it right.

Yep.

Yeah. So that's a test that they actually basically use AI to straighten the arteries out. They look at all your individual arteries and you're going to compare the amount of soft and hard plaque, just like a cimt. So it's like a ultrasound of your neck, but of your heart vessels. And our protocol had been to. We generally, most of our patients are 40s and older, so we're doing a CIMP and based on that, it's perfectly clean. We're not ordering a clear cleary if it's not perfectly clean. We are ordering a Clery. Do you want to take kind of your approach to that?

Yeah, I think the, the CIMT test is a, is a great test as kind of a baseline screening tool and we use the coronary calcium scan for that. Again, just kind of jumping back to that initial conversation that I have with people. If somebody is low risk, I think the coronary calcium scan is a great place to start and understand where, where has your body been in, you know, is your body forming plaque despite you having a good cholesterol? Is your body already forming this process of atherosclerosis? For people that are medium to high risk, I really think the coronary calcium scan is kind of useless.

But almost like the flip side would be it's so cheap. Correct. You just might just do it to like persuade them to spend the. Whatever it is for the. That's my approach. I agree with you totally.

Yeah.

But for the $99, 30 seconds in the scanner, you got a score of 200. It's like, okay, now spend some money on this. Because if they are at high risk, it's not going be negative.

Correct? Yeah, correct. So that's a, that's a great point. You know, and so when people have that medium to High risk. I really send them right. For the cta and the cta, especially.

When it's just, let's just say the CTA and Clery, it is the same thing, clearly is a brand name of a company that straightens it out. And CTA is. The test we're talking about is that's CAT scan angiom. So it's equivalent kind of to a heart can.

Yeah, so that's a, that's a great point. And, and I'll, I'll tell people that, you know, you're really looking into your coronary arteries with a cta. So, yeah, like, I guess let's kind of take a step back and define these tests. The coronary calcium scan is a quick CT scan. So there's a, you know, slight small dose of, of radiation there. Does not use IV contrast and looks at calcified plaque plaque. So that's plaque that has already kind of gone through its, its process and the body has, has hardened it up. Everybody's telling you I'm forming more plaque, FYI, but this is what you can see that we've already created. The next step is a coronary CT angiogram that uses IV contrast, has a slightly higher dose of radiation, but the contrast goes into the coronary arteries, which are the arteries that supply blood to your, to your, your heart. And give us an idea on any hardening of those arteries, hard plaque and soft plaque. We can take that coronary CTA and run it through the clearly AI analysis. And that, as you mentioned, is a phenomenal tool. It uses AI to take your coronary artery, which is usually very curved and, you know, all over the place, lines it up and we get a millimeter by millimeter interpretation of what kind of plaque you have and your plaque burden. And, and it gives us numbers. So, you know, I'm a numbers guy. I like to see numbers and how we can change those numbers. So you'll see, you know, 26 cubic millimeters of hard plaque in your left main. When we repeat this test in two or three years, we can see if the interventions that we've taken have made an effect on that. I mean, it's, it's just such a good test and the value that you get, the amount of information that you get is incredible. So I just wanted to kind of define those few different tests so that people understand exactly what we're talking about. So for those medium to high risk people, we get a coronary calcium score when we do the coronary cta. So you already kind of get that embedded into the test. But then you additionally get the essentially perfect view. Like you said, it's essentially a calf of your heart. You're looking inside of the coronary vessels and getting a very, very good picture of what your heart health looks like.

And arguably a little bit better than a heart cath because even differentiate differentiates. How soft is the plaque? Soft and growing or soft and remodeling into hard plaque?

Yes.

And to be clear, a calcium score is. The calcium is actually healthy. It's kind of like having buck teeth. That doesn't hurt you.

Right.

So if you have a, you know, your basically what happens with your arteries, they get inflammation, they get thicker, then they start looking a little bit pregnant. And then that pregnancy is the soft plaque and it can rupture and kill you, or it can get fixed and turn into a little piece of like, basically like a filling. On an X ray. We've probably seen your X, actually your teeth. You see a little white spot on there. That's. That's a calcium score. And one of the limitations of the calcium score, if you go and get a calcium score and it's medium risk and you fix it, your number actually gets worse because your soft plaque turned hard, which is actually better. So we really just do that one time, right. Because it's very misleading to. People think, oh my God, I'm doing all this stuff and it's getting worse. I really want to have all this soft plaque back. We don't want that. So soft plaque, really soft plaque that's growing is very bad. Soft plaque that's remodeling, a hard plaque is, is. Is kind of moderate risk. And then hard plaque is actually, you fixed it. You fix the problem. Your body can live with that. You can go to your grave with that hard plaque. It's a soft plaque we want to watch.

Yeah, that's a thank you for defining that. Because a lot of people think, well, the hard plaque is the one that's going to cause a problem. And it's not. It's that soft plaque that you're not able to see on the coronary calcium scan that is at highest risk for rupturing. And that, that clearly assessment is able to, to even kind of separate that soft plaque into high risk soft plaque versus low risk, which you can't do with an angiogram.

Correct.

You cannot do it.

You cannot do that. They're guessing at it and they're trying to do it, you know, maybe do an intervention. So don't talk about too much about intervention because, you know, I could probably talk for a day on that. We're really trying to figure out what that individual has got going on that's causing their plaque. And if we look at how American healthcare has been set up to detect heart disease, disease is basically, we check cholesterol, which is not useless, but close to useless. Maybe some other LDLs and triglycerides, which have some utility, but there's not a strong correlation between those numbers and presence or absence of heart disease. In fact, the strongest correlation between having atherosclerosis on a, on a, on an angiogram or CTA is actually hemoglobin A1C uric acid oxidized APOB.

Homocysteine.

Homocysteine level. Right, homocysteine. So there's all these other factors that you're. Your doctor's probably not really checking a lot of margin checking apob, let alone oxidized apob. And when we're doing hemoglobin would see we're mostly worried about, you know, basically putting people on medication that doesn't really improve their insulin sensitivity, which is an absolute must do. So when you get these things done and your doctor looks, your lipids are not that bad. Well, we do have to manage that even better than they are now. So if your LDL is in the range of 100 and you have a lot of soft plaque, we probably need to get that down around 25 or so. And there's other things that do more aggressively. But if you're a cholesterol. Cholesterol is 200 and the Aldi has 130 and you're clearly perfectly normal. This stuff's not hurting you. So it's not a great test.

So you actually, I mean, just kind of going back to why not one test is meant to stand independently. You know, I, I look at these things and they're meant to work synergistically because. Exactly that. If your cholesterol is borderline and you have a whistle clean cta, I'm not jumping to crash that down. It doesn't make sense. Right. But if your cholesterol is borderline and your body's already forming plaques, we have to, you know, we have to figure out what is causing this underlying. And a lot of people, when they go to their primary doctor or they'll come and tell me, you know, my primary doctor got blood work. It looks great. They're not ordering these tests.

It's interesting you say that. So I had a guy that Mark, who, he's a, he's an accountant for us. And he's giving me permission to talk about his story. But he came here and he's overweight and he was a consultant for me and helping us grow our vein business and did a great job for us. And he's overweight and not taking care of himself. So just working with me, me personally, as my, my, my coach on business. I started coaching him on living a better life. And he had about a 25 occlusion on his, on his, on his blood vessels, which is not bad. But I said, hey, Mark, you know, go back to your cardiologist, give us some lipid LOR and stuff, get the hemoglobin A1C down. Let's change your diet a little bit, do all these things. So he's all into it. He gets back and his cardiologist said, 25, that's nothing. I won't have to see you for like five years. Oh, his cardiologist thinking, I don't have to see until you have a heart attack, because I know exactly how to manage that. I get a 25,000 heart cath, an angioplasty, perhaps. You get a bypass surgery, about $176,000. But right now, let's not worry about that. And it's just, it's almost like sickening. But this is actually the way. I mean, he told him not to worry about it.

Reactive health care versus proactive.

So Mark did the opposite. When saw Joel Khan, he actually did the vegan diet that Joe pushes down everybody's throat. Don't put down everybody, Dr. Khan. So, I mean, he's spot on. That's not for everybody. Yep, he did that. He started exercising, did a VO2 max. Was horrible. I got that up. He went on hormone replacement therapy. He. We treated his sleep apnea. We reversed it with, with this night lays procedure. He did some hyperbaric oxygen. His plaque regressed to no soft plaque. None. A little bit of hardened plaque. His CIMT age went backwards about 15 years. His glycolic age went back glycan age went back like 30 years. His vision got better. He's healthier, lost the fat. But he's told by his cardiologist, don't worry about it. And unfortunately, he push past that concept and don't worry about it because you're not going to have a heart attack this year. It's only 25.

Right.

Come and see me when it's 50. I'll take it out.

Yeah, that's. That is the, the huge problem. And we can probably have another podcast on days about the issues with our current healthcare system. But that is exactly one of them. Come back when you have symptoms. Right.

Because it is a disease care system.

Correct.

Point being is cardiology spot on. A 25 occlusion is not. That is not a life threatening disease. It will be and then your insurance will actually pay for it then. Right, right now you've actually got to do this on your own. So yeah, that's, that's really a sick.

Care system, not a health care system. Right.

And really, I mean we can criticize it. We really have to accept that's what it is.

Correct.

Because your healthcare insurance is not going to pay for your gym membership or your, your healthy eating or your meditation or your saunas and that sort of thing. So let's move on to neurocognitive decline. And I know this subject we haven't really talked about outside of this. I'm really bullish on picking this up as soon as possible as well. Well and then there's interventions you can do to get your brain is plastic, it still has the ability to grow back because that is the third cause of, you know, undesirable death is your brain shrinking, getting, getting Alzheimer's. And I, the clinic that I went to, they got the clear yet they're not doing the neuro quantitative imaging yet. But the neuro quantitative imaging, the idea is that you're doing an MRI and it looks at the volume of your say your material, the material in your brain and the bottom volume of the water or the csf. What happens over time? Our brain mass declines and it gets filled up with liquids and the people that are in the lower 10 percentile are definitely going to get Alzheimer's if they live long enough. The people in the upper 10 percentile probably won't get it for you know, 50 years. This is an imaging test as well and there's things that you can do. Are you working with this at all?

So when we first started at Synergy, we were offering that neuroquant test and when you had come in, so you know, we do the CTA and clearly through, through Synergy, I think you're referred by Dr. Khan to you know, our clinic to get that done. So we, when we initially started we were offering that, that neuroquant test and it wasn't, you know, very widely available and wasn't super popular for people to, to want or to, to know about. And so our imaging partner, we decided to not continue that test. But I think it's a really great test to have an idea of where you're at right now and kind of like you said, being very proactive with your, with your brain health. So, you know, the number itself is important, but not as important as the change in that number. And so when you get that percentage, you know, if you're getting 60%, if you go from 60 to 40, that's a red flag. You know, why are we reducing it? I think it also looks at hippocampal volume, right? Why are we looking, you know, why. Why is there a decrease, that drastic of a decrease? Whereas if you're, you know, 45, 45, 45 on each of your tests, you're probably not experiencing that mental decline as, you know, as somebody else who has that kind of drastic decrease. So unfortunately, it's not a test that we're offering right now with synergy. It's something that we are definitely consider bringing back. Especially, you know, in this kind of, like you said, this is kind of the third thing that people are worried about as, as you're getting older. And a lot of our patients who are, you know, between 35 and 55 have their parents going through, you know, similar kind of neurocognitive decline. And they're like one. I don't want that to happen to me and what can I do to prevent this?

So back to the story about Mark, when his main concern was his mother had Alzheimer's at 60, 70 or 62.

Wow.

And we measured his brain. He went down the floor to get it done. And we measured his brain. He was in the bottom 15% down hippocampal volume. And after one year, really aggressive lifestyle intervention, he went to the 50% down. That was pretty massive improvement. His brain to brain is plastic. And there's certain things he did. He did the fasting, mimicking diet and a Prolon diet and made changes in his, in his lifestyle. But this, your brain is plastic. And once you have Alzheimer's, those steps you need to do to recover your brain, people, they don't do them. This does not work. So it's best to get this before you have mild cognitive impairment. That's really key. Once you have mild cognitive impairment, the road goes downwards pretty fast. It's a slippery slope. But if you're say, in your 50s or early 60s, you're not likely to have neurocognitive symptoms, but you might have decreased your brain size fair amount. In this case, Mark was 62 and his brain was more like an 70 or 80 year old. And he took, took intervention and he was motivated to do it because, you know, he saw his mother and he was in extremely good health. Because when your brain is in the bottom 10 percentile, it still works pretty damn good.

I think a really important point to, to take from that is anything that you are doing for your heart health will also then improve your brain health. Right. When we are eating, right when we are working out, when we are taking care of our emotional health, et cetera, all of these things will factor into improving our brain health. And so, you know, I think I. I don't want people to think, wow, you know, they're throwing so much. Throwing so much at me. I got to do all these different things. Well, it's really not.

It's.

It's taking baby steps in the right direction. And any baby step in the right direction that's going to improve your heart health is also going to improve all these other aspects of your life. So it's. It's really important for people to know, like, you know, we're not telling you to change everything tomorrow. You know, I rarely will tell people to make these drastic changes in their life. One, because they. They don't stick. And two, I wouldn't tell myself to do that. I tell my patients to, like, let's sit down and say, what changes can we make in your diet that you'll actually stick to? You know, for people who have McDonald's every day for breakfast Monday through Friday, because that's the easiest thing that they can get on their way to work, I'm like, okay, for the first two weeks, Mondays, you're not doing McDonald's, right? And then after that, Mondays and Tuesdays, you're not doing it. And then if you're slowly kind of making those habits, that's what's going to stick with you, and that's what's going to actually make a real change in your life. So I just wanted to kind of highlight that correlation between our heart health and our brain health and, you know, our entire bodies is that we're taking steps to care for our heart health. We're also taking steps to care for our brain health.

So you just described James Clear's Atomic Habits.

Yeah, it's a great book. Great book.

Yeah. You can stay there one little step at a time. The title, Atomic Habits, almost sound like it's like an atom bomb, but it was actually atomic. Little, tiny, little, tiny micro changes.

Yeah, I think he made that little play on words on purpose, you know, because it. It ends up being this nuclear change, you know, slight pun intended, ends up being this Big change in your life that start from tiny, tiny, tiny steps.

Yeah. So it's a great podcast. We'll do a follow up one. I guess what I like to talk to you about next is, is more about the gut health, about micronutrient testing. These are things that I think generally are not done in healthcare. There's a handful of functional medicine, doctor and concierge doctors are doing that. They're pretty much everything we talked about, just the full disclosure. None of the stuff's covered by insurance now. Some of the treatments might be. So for example, if you're have a. I have an abnormal Clery score. When I was, I was very healthy. And then When I was 55, I had a big health issue that caused me to have a little high blood pressure afib atherosclerosis. And it's not much, but it's a little bit. I don't want to have any many and I take in repatha, which is an injection in a, in a statin. And my goal is to get those plaques all hardened up, which they're going in that direction. And then once they're hardened up, I'm in good shape and I'll, I'll just decide what to do and do that. But the, there's interventions that are going to be based a little bit on doing some macronutrient testing, micronutrient testing. You know, you talked about SIBO basically before, before the meeting. Most people don't know what that is. Most doctors don't even know what that is. And about microbiome, which I was unrelated to this today. I was just kind of thinking back to when I was a ER doctor and I was training the res. I was really trying to get them not to prescribe so many antibiotics to these kids with ear infections because they basically don't work. And they did a study in New England Journal of Medicine. I'm sorry, in general, American Medical association in 2003 published a study showing that six weeks of antibiotics other than minocyclines, six weeks of antibiotics in women in their childhood led to a 30% increase in breast cancer rates. Right. We don't think about this. The kids are young. They're not really thinking about their future health. Did we really need to give the mother the placebo of the amoxicillin? That does nothing for ear infections in most cases to just to placate the fear. I think whole generations change. We're not so much into the antibiotics and stuff, but the microbiome is so impactful on our Health, it's just extraordinary. We do a lot of stem cell therapy and I wrote a book on how we treat Ms. With stem cells. And a big part of it is working on the gut health too. That's not the only part of it. We do. We do other things as well, but there's links to your gut health and every other autoimmune condition for sure, and probably most conditions. So we have so many other things going on besides. Today's talk was about basically almost like we'd say X ray imaging being the X ray department, what we call radiology department, even though they weren't really X rays. So I appreciate your time.

Yeah, no, I really appreciate being here. Like you mentioned, for gut health, it's very overlooked, right? We do not realize the importance of our guts in our immune health, in, you know, how we absorb nutrients. I mean, when we're eating food is medicine, right? So when we're eating constantly poison. Yeah, absolutely. Well, most of the stuff that we're eating, unfortunately, you know, ultra processed foods are poison. But if we're eating good whole foods, that that food is medicine. And our bodies have to be able to absorb that medicine and, and bring it to, you know, the, the rest of our bodies. So, so our guts are extremely, extremely important. My partner, Dr. Zelinski, was a family med doc, grandfathered into emergency medicine and did functional medicine as well. And really he kind of leads the way with our gut health and taking care of patients who are interested in that, in that gut health protocol that we have. So, you know, super, super important part. You mentioned antibiotics. I mean, it's like dropping a nuclear bomb into your, you know, your gut. It just clears out all the really good bacteria that we have that can, you know, break down these nutrients and our natural bacteria that are producing the GLP1 agon that people are using. You. Right? We have bacteria that we can promote their growth to do that naturally. And so it's just so important to not ignore the gut health. And that's been a really great part of our practice because it's so overlooked in kind of modern day medicine. But thank you so much for having me. This is great.

Thank you.

All right.