Dr. Joel Wussow | On the Homefront with Jeff Dudan #47

There's just this huge disparity between what people know and what the doctors know and what the doctors are not teaching the patients. Doctors are guilty too. You look at most doctors, they're not healthy people. It's not that they don't know the information. They do know the information. But are they actually practicing what they're preaching? Most doctors aren't. I wanted to change that. As far as anti aging is concerned, we can do all the biohacks under the sun, but if you're not dialed in with all of your lifestyle habits, all this other crap is a drop in the bucket. Fatty liver disease not from alcohol has an now surpass fatty liver from alcohol as the cause of fatty liver.

What other good news do you have for us today? Dr. J. Welcome to another enlightening episode of on the Home Front. I'm your host Jeff Duden. You can't turn back time, but you can buy the time back when you get serious about your health. Today we are dialing in our health habits with longevity medicine. Dr. Joe Wuso. The doctor gets right into why he shifted from emergency medicine to longevity practice and how he lives to encourage, counsel and educate his patients on how to optimize their health. Dr. Joel is at the forefront of personalized medicine and doesn't hold back on any life changing health advice. Stay tuned. This episode is full of guidance on how to improve your lifestyle to reach your healthiest potential. If you like what you hear today, leave a like comment or subscribe to see all the content we have coming your way. If you have any questions regarding business franchising or just about the show, use the links in the description and we'll get right back to you. Thanks for listening. Welcome everybody to on the Home Front. I'm your host Jeff Dutton here with Dr. Joel Wusow. Is that how you say it, sir?

Wu. So.

I usually get close.

I usually get butchered a lot more than that. So that was pretty good.

All right man. Well I'm. Can we go with Dr. J?

Dr. J. Sounds good. All right.

Does it? Does has a ring to it. Somebody should go by that. I think somebody has. But anyway, man, well, welcome to the show. I'm excited because you are building a business around things that I'm particularly interested in preventative care, longevity and really interested to unpack that. Love to learn a little bit about you, Joel. Can you tell us a little bit about how you grew up and what your journey was?

Of course. Well, thank you for having me on the show, Jeff. I really appreciate it. So I Am born and raised in Plano, Texas. It's not a town anymore. Pretty big city outside of Dallas. I went to high school there and then from. So I've always been kind of a science geek and I think maybe it stems from my dad. My dad's a botanist by trade. He did a PhD in botany and we did like fossil digs together in West Texas and we have all that stuff in the house and just always gravitated towards stuff related to science. I did science fair projects ever since I was in kindergarten. Always been very curious, very excited about scientific method and how that works. It's really windy out here, but so originally I thought actually I didn't do the best in high school. I kind of just didn't. I wasn't as focused. I mean, I always enjoyed science. But then something happened whenever I went to college. I went to University of Arizona for undergrad and then I just really turned things on and got very studious and I didn't know what I wanted to do per se, but I ended up majoring in biochemistry and then I minored in business. And the reason why that's relevant is because I, I had a. Some experience doing some sales in college. I worked for a company called Cutco. I don't know if you guys have heard of that before.

Cutco Knives, dude, I just, I just did a solo on an Uber driver that I met that took me from West Palm beach down to Miami. And he was, he's from Haiti, he's got four kids and he's trying to break out of the employment cycle. And I told him, I gave him three recommendations, I gave him books to read. I told him to see if you could sign up for Cutco Knives to get sales training because you can sell your way into a better future. And then I, he was trying. I gave him a model to buy a business that he'd been talking to a guy about a lawn mowing business to buy it on a royalty. But so funny you bring that up, man. Cutco Knives is. I use them for high end gifts, like monogram gifts and stuff like that.

But man, somebody sold you on that, huh?

Yeah, well every, you know, all my kids, friends, they would go away to college and then they'd come back that first summer. Ms. Mr. Duden, can we have 30 minutes of your time for an opportunity that you won't want to pass up? So we got a ton of. We got a lot of knives, man. I'm telling you. From Cutco.

Excellent. I love that. So with the. I mean, I Had some sales experience and then I just decided to go to a career fair. Whenever I was a senior in college, I had every plant intention of going to medical school. I did all the prerequisites for that. And then I got sucked in by the pharmaceutical companies. And this was back in the day when there was very little regulation back in 2005. So I did pharmaceutical sales for a little while. And you know, while I was doing it, I just, you know, interacting with doctors and you know, I was just envious. I was like, I know I can do this, I can do what you're doing. I want to be interacting with patients on a daily basis and helping them. So that was relatively short lived. I did that for two years and then I went to medical school at Jefferson Medical College in Philadelphia. And I've always had this passion for preventative care. I've always been a super healthy person. I've worked out almost every day of my life since I was 12 years old and I'm 41 years old now. It's just, I love it. It's just exercising and a healthy lifestyle is just in my veins and no one's ever taught me that. No one around me like kind of kept that lifestyle going other than me. Like no one in my family does that. So I don't know where it came from, but I love that. So medical school at Jefferson and then I went to residency. I did emergency medicine residency at New York Presbyterian Hospital, which is a dual program at Cornell and Columbia. I don't know if you're familiar with Manhattan, but Cornell's on the Upper east and then Washington Heights for Columbia. And I chose emergency medicine. I think it kind of just goes along with my lifestyle. I'm a little bit of an adrenaline junkie. I like to dabble with, you know, all aspects of medicine. Be quick on your your toes, quick decision making, lots of procedures. So. And also from what I thought it was more of a lifestyle type of a profession. Because what was appealing to me is you can kind of clock in and you can clock out, you do shift work and you don't have to take any of the work home with you. But as you know, we'll probably talk about a little bit that's it's a very, very demanding profession. And the shelf life is actually on average about 10 years. I didn't know that going into it. I'm going on 11 years now.

So I'm trying to make ER specifically.

ER specifically specifically is like the shelf life is around 10 years. And I read somewhere recently I don't know where the study came from and I don't know if it's validated or not, but. And one of my colleagues told me about this, he said that the average life expectancy for an emergency medicine physician is 58 years old.

Okay, so is it mental or physical that wears you out? Because man, you're dealing with kids and gunshots and car accidents. I mean, just day after day after day, right?

Yeah, I mean, depending on where you work and where I work now in West Texas and Odessa, there's a lot of trauma, you know, from high speed motor vehicle incidents. There's a good amount of violence too, so lots of trauma. And yeah, that's very high pressure stuff. And just a lot of really sick people. A lot of people with chronic disease have unfortunately have very poor insight into their own health. So they keep coming back over and over again. And it's a very sad process because you have a lot of repeat patients that you see and you just see them decline over the years. And really no intervention is being done to help kind of reverse this process. Very little education and unfortunately in the er, I don't have time to do much education in terms of prevention. It's more. So this is what you got. This is what we need to do to treat it. And you, you know, patch them up and get them on their way. Either you admit them or you send them home.

Hey, was there a particular case, Was there a particular case that you had? There's this great book called Change or Die. I don't know if you've ever read it, man, but it's, it's about how like, even faced with our own mortality, we won't change our habits. So you're talking about people that just, you know, had throat cancer and they had their voice box cut out and you know, they wheel themselves outside and they, they stick a cigarette in their tray. Coal, you know, just cause they got it, you know, they're like, well, these cigarettes are killing me, but I've got to, I just, I really want another one. Or you know, people not taking their meds just because they're just too lazy to do it. And it's, it's the stuff that's keeping them alive. So is there, is there any case where you had a repeat person come back in and you're just like, man, if you would just, if you would just do this, you wouldn't have to come back here?

Unfortunately, that's probably 85 to 90% of the population that I see. It's people that Come in to have very poor insight. A lot of the ones that really upset me more are not people that are end stage with. End stage with chronic disease because they've lived a life of this. It's more so the ones that keep coming back that are relatively young and when I say young between 20s and 40s and I'm seeing signs of severe chronic disease already and I talked to them, one of them is, that's extremely common is called or fatty liver disease. And fatty liver disease now it used to be, we used to call it non alcoholic fatty liver disease because the way that you, we thought that you got fatty liver was from drinking a bunch of alcohol. But now based on the standard American diet and through people's behaviors and being obese, fatty liver from non alcoholic processes, just being overweight and having a lot of what we call visceral fat or fat in your organs has surpassed fatty liver secondary to alcohol. And what fatty liver does is it.

Essentially we're number one. We're number one. Obesity.

Fatty liver is, is a, is actually a very. It's. It's so common and it's a really scary process because fat literally deposits in the tissue of the liver and it makes it not function. And that's, yeah, that's part of how you develop insulin resistance and diabetes.

And you're, it's a cycle. It just, it is. And now, now it just cycles you down, swirls you right down the drain and you're fighting everything, Fighting everything.

I mean it's essentially your, your liver is like the general in your body to, to help keep your metabolism in check. And it, and it makes sure that your sugar stays at a nice level and whenever fat deposits in there, it doesn't work. And it's this unregulated on switch. If it's not working, that sugar just gets pumped into your bloodstream and then your pancreas has to spit out a bunch of insulin to keep up. And then, then it's this vicious cycle. So. But what I was going to say.

Well, where are we with liver replacements these days? I mean, can they, that's not one that they can, they can't do a liver transplant, can they?

Oh yeah. I mean, I mean, are you talking about people that have non alcoholic fatty liver? Do they get on the transplant list? Is that what you're asking?

Yeah, yeah. I mean they do. I know we do. We know we do hearts and kidneys and those types of things regularly. Right. But liver was, My understanding was that it wasn't as common or it was More difficult or we weren't quite there yet with it.

It's definitely the nice thing. I mean I'm not a transplant expert, but the liver is a different organ and that has the ability to regenerate itself. And if you just give a very small piece of healthy liver, it can regenerate. But as far as the transparent list, I don't know a ton about that. But the nice thing about fatty liver, and I'm probably going to be doing a lot of talks on this and reels with my social media, I order ultrasounds all the time for just various things, people that come in for gallbladder issues, etc. But it's so alarming how many young people I see that we do an ultrasound and then it's called an incidental finding. You're looking for one thing, but you find something else and you can see the marbling and the fat of the liver of someone, an 18 year old, 17 year old, 19 year old, 22 year old already you know they're on the path for having because this progresses to liver cirrhosis just like you would get drinking alcohol every day of your life. So this is skyrocketing in our country and it has now surpassed now fatty liver disease not from alcohol has now surpassed fatty liver from alcohol as the cause of fatty liver. So I imagine more and more people as they get older, we're going to see a much higher prevalence of liver cirrhosis as we continue to keep the weight on that we are in this country.

Well, what other good news do you have for us today, doctor?

Oh man. So, I mean, so back let me I wanted to talk about like more about the how taxing emergency medicine is. And I think a lot of people don't quite understand like you come in, you see an ER doc, but we all work as a team. You know, I work in a group and we all have to work different hours. Right. So we'll talk about like in my business now, I run a longevity medical practice. It's a telemedicine based practice and my biggest thing is to encourage, counsel, educate the patient on lifestyle optimization to improve your overall health. As far as anti aging is concerned, we can do all the biohacks under the sun, but if you're not dialed in with all of your lifestyle habits and have those core lifestyle habits functioning properly, all this other crap is a drop in the bucket. And what I mean by that is exercising regularly, getting good quality sleep, tracking it regularly, having good mental and emotional health. So some outlet to help de stress Yourself, finding purpose, meditation, journaling things of that nature, and then eating clean, getting plenty of protein. Those are just the simple core values for lifestyle optimization that I make sure that all of my patients are participating in. Because I'm not going to go through this whole process with you if you're not willing to do that, because that's where we're going to see most bang for our buck. But back to emergency medicine. And now I'm coming to the point. Now I don't do night shifts anymore, but most ER docs, they work days, afternoons, nights, and they switch back and forth, forth. It's so awful for your health. I think that's part of the reason why you see this average age of death that's so much younger than the average population, in addition to the stress that you have while at work. But your sleep cycles are awful. And then with crappy sleep cycles, we know there's evidence that shows that if you don't sleep well, you're encouraged. Your body, your mind wants you eat more crap. Have you noticed, like, if you, you don't get good quality sleep or you're staying up late at night, or if you, if you, for. If you stay up overnight, you eat like crap. A lot of people do that. And I.

100 or. Or if you have like two cocktails or something like that, you know, even, you know, had a nice evening with my wife on Saturday and you know, we decided to have, you know, we don't drink at home usually, you know, but like, like, oh, you know, a couple of cocktails a week here. So we had a couple of cocktails and the next morning I was. I couldn't wait to get corned beef and hash and toast and all of that stuff. And I think it's also too, because even like one glass of wine for me, it, I can tell it disrupts my sleep. I just, I do not sleep soundly if I've had any alcohol whatsoever. And. And then I wake up and it's just, I, it's one bad habit after another. I, I lose, you know, so I'm interested to know why that is. I know that it is. I just don't know why it is.

Well, it's, it's interesting that you, that you talk about. Do you use a sleep tracker? Have you used one before? Just, Just to assess the quality of your sleep?

I have an aura ring.

Okay. So, yeah, that's. That's great.

So, yeah, I don't know where it is, but I have it. No, I got it. I gotta, I need to break it out and then break it out again.

And then, I mean, are you just saying, just subjectively that your sleep is poor after alcohol? Definitely attractive.

Okay. No, I'm saying subjectively. I mean, I'll wake up early, I'll wake up through the night. I just be restless and tired in the morning. Yeah.

Okay, so what alcohol does. And you know, I've tracked this with the Oura ring. So it, this disrupts the amount of deep sleep and REM sleep that you get. Some people are more sensitive than others, but for me, exactly one drink, I don't get good quality sleep. And actually what happens, you don't realize it because you're in light. It puts you back in more into light sleep and you have more awakening in the middle of the night that you don't remember. So it disrupts your sleep in that regard. So you're actually waking up in the middle night and you can see it on your aura ring. It'll see that you actually wake up, but you don't remember that it's a sleep happening. So, you know, I'm not going to go that down the whole alcohol path. I mean, but if anything, we know that alcohol disrupts your sleep and we know that sleep in itself, if you're not getting regular sleep, it wreaks havoc on your body. It, it messes up your, your insulin sensitivity. I mean, if you, if you are getting poor quality sleep during the day or at night, the next day, I do for my patients, I prescribe them a continuous glucose monitor so they can monitor their sugar throughout the day. But just watch, just watch. If you get, you know, half the night's sleep that you normally would get, doesn't matter what you're eating, your, your resting blood glucose is going to be higher and you're going to have much higher spikes than you normally would if you had restored sleep. So there is a reason why sleep has been preserved throughout time for the human species. It's obviously very important. Right. If we didn't require sleep, we would, genetically, we would have evolved to get rid of it. So there's a, there's a reason for that.

Right, so you, you prescribe a glucose monitor even if your patients are not pre diabetic?

100%, because. Go ahead.

And what is that, Is that like a patch that's hooked into a phone or something?

I've got one right now, actually. So, yeah, there you go. I do it. I would, I don't do it regularly, but I do it probably maybe two or three times a year. And the nice thing about it is you wear it for a month and you get all the data that you need. You don't have to wear it forever. And the reason this One is the Dexcom 7, it's really, really tiny. Okay, this one's a, it's a 10 day, 10 day per patch. Doesn't hurt. It's got a tiny little needle in it and it gives you your sugar readings in real time every five minutes. It's spitting out your blood glucose.

Yeah, well, amazing information. Matter of time before we're all just plugged right into the matrix, isn't it?

And I'll tell you this with this, if anything, what I have found with my patients, if you know in real time what your sugar is doing, it's so powerful in terms of changing your habits. So we have learned that if you eat like a carb rich meal and you're sedentary, your blood sugar is going to spike. But if you pair it with, you know, around the time of exercise, it really blunts that sugar response. So you can set alarms on this. You see your sugar go up? Oh, it went up to 160. Okay, it's time to get up and go walk around a little bit. Or you have all of this learned behavior because now not only do you don't have a snapshot in time, you have a movie of what's going on inside your body. It's very interesting how your body reacts to that.

Fascinating. What a great idea.

What else do you want to talk about?

So you, you're still doing the ER work and now you are doing your ER work and you're splitting time between Texas and Miami and your business is based in Miami. So why don't you tell us a little bit about your business, what it is and who you serve.

Sure. So this has been kind of a long time coming. Like I said, I've always been very passionate about health and preventative medicine. And in my medical training there really hasn't been a space for this. Unfortunately, medical training, or at least when I went to medical school back in 2008, the preventative medical aspect of training did not really even exist. We are all focused on disease pathology and treating the disease itself, which I think is great. And we have great medical advancement. And I'm not going to knock conventional medicine because we have done some amazing things. But I think we're looking, we need to be looking at things from the other end of the spectrum. And I think part of what's going on in our conventional medical society today is Doctors are obviously, they're busier than ever. Their reimbursement's getting lower and lower, and they're asked to see more and more patients. But when it comes to them actually getting paid, there are no ICD10 codes for preventative medicine. So if you, an ICD10 code is what you put in for a diagnosis to get paid to get reimbursed. So if you're seeing all of these patients and the only way you're going to get paid is by showing that you're treating a disease, then what are you going to spend more time on? Right. You don't have time to do counseling to help prevent the person from getting disease, which is a very sad story. Right. So I think a lot of this stuff can be prevented. And I see it time and time again in the emergency department. There's just this huge disparity between the knowledge what people know and what the, what the doctors know and what the doctors are not teaching the patients. And I think a lot of it's, I mean, doctors are, are guilty too. I mean, if you look at most doctors, they're not healthy people. So it's not that they don't know the information. They do know the information. But are they actually practicing what they're preaching? Most doctors aren't. So I, I wanted to change that. So I, I split time between Texas. I stack all my shifts in a row right now so that I can focus on this business I'm starting. It's called healthspan by design. And what I'm doing is taking a tailored medical approach for each individual patient. And it's kind of like it's a, all of it right now is virtual via telehealth. And I'm, it's a concierge longevity medical practice where I'm tailor making a package, a program for each individual patient. And how I'm doing that is by we, we order blood work with biomarkers on a quarterly patient for the patient. So you can see what's going on at a cellular level underneath the hood at all times. And it only makes sense, right? If you're, I mean, do you, whatever it is that you care about in your life, are you only like the, the, the, the standard of care right now is getting an annual checkup, 30 minutes with your doctor, blood work, and then you come back next year. Do you think that that's gonna, that's, there's, there's no way that's gonna optimize your health? And just thinking about that in other aspects of Life like car maintenance. I mean, do you, do you only look at your car once a year? I mean check. I mean, no. I mean the car will break down, it'll deteriorate. So if you want to maintain that, you have to know what's going on at all times. So we do blood work with biomarkers on a quarterly basis. And then I do it, I pair that with a one time genetic test that looks at all of your genetic deficiencies, your vitamin mineral deficiencies. And then between the blood work and biomarkers and the genetic testing, I have a very tight blueprint of what's going on inside your body and I can tailor, make a plan just for you. And then with that, you know, I'm doing, you know, traditional prescription medications on some regard because I, there are certain aspects of health that I feel like pharmaceuticals are the best option to aggressively prevent certain disease. Like one of them being your, your lipids and your cholesterol. I think most patients should be on a lipid lowering agents because the name of the game is driving down this molecule called apob to prevent cardiovascular disease. And if you can do that, this is a progressive process. And the longer this is floating around in your bloodstream, the more opportunity it has to build up into your artery wall. So we want to drive that down as low as possible to, to actually prevent you from getting clogged heart arteries.

Is that.

Is one approach. I do a statins on, on a lot of patients and there's some controversy around statins and I understand that there are some side effects, but I do a very low dose statin on the majority of my patients because the most recent studies show that at a very low dose of statin, you're getting 85% of the effectiveness of the reduction of APOB, which is the, the, the molecule that we're looking at to, to help prevent.

Got it.

Cardiovascular disease. So statin would be one, another one would be azitimibe, which is Zetia. That's a, a different type of cholesterol lowering medicine. It helps your body from reabsorbing cholesterol as opposed to a statin helps block the actual synthesis of cholesterol. But there are, there are tests that I can look at that can tell you, hey Jeff, you are a high reabsorber of cholesterol versus you're a high synthesizer of cholesterol. So I can I custom make it based off of your genetics? More likely than not, most people do, they either do one or the other a combination. But regardless. So we do the Genetic testing once, blood work with biomarkers on a quarterly basis. I prescribe prescription medications, hormone optimization, and also. What am I blanking on right now? Different supplementation. Sorry. And this is all based on your blood work with biomarkers, genetic testing, and then we reassess, we do your blood work again on the next quarter and then we see how the interventions have improved things. And then I pair that with lifestyle optimization. I can get you paired up with a personal trainer, high nutritionist, mental health coach if you need. But that's essentially the process and it's custom made for you.

Yeah. This is crazy. And so I was. So I'm in franchising. I came up with a concept called 45 plus, and it never got off the ground. But now you're seeing some Men's Health franchises out there that basically have an offering of nearly all of these types of things. Right. It's all about men's. Now, do you do men and women in your practice?

Men and women, yes.

Okay. You do men and women. So let's talk a little bit about the genetic testing for just a moment. I had a. We did a podcast with, who was the founder of the DNA company out of Toronto and his name was Kashif Khan. And probably one of the most listened to episodes that we have people that just go back and just listen to it because it was fascinating where they did a, they did a 7,000 patient study to figure out, okay, once we map, I guess they map the genome, now they, now they do the DNA test and then they're able to say, all right, a combination of these five different gene things says that you will, you will absorb this, you won't clear this. And so that makes you predisposed to Alzheimer's or that makes you predisposed to other degenerative diseases and things like that. So based on that combination, if you do this, you will be reacting uniquely to the needs of your body in this particular area. And the thing about it is, so I ordered the kits for my entire family and we've swabbed and sent off and we're going to get it back. But the interpretation of the data seems to be complex.

It's.

It's not. It, it seems, it seems like it's a relatively new field. It seems the. It seems like you really need somebody who knows how to read the tea leaves inside of that. And then, you know, and then you actually need to do the things that, you know, your genetics are telling you that you're predisposed to. To do. You need to do those things. So when you do the genetic testing, is that something that you reference back to or is it like a one and done thing? You got it. Okay, I see these, I see these things. This is what you're predisposed to. These are the challenges that you're going to have. Here's what's good about your genetic makeup. And now we're going to use that as a fundamental baseline of treatment. Or you know, explain to me a little bit about how you use that one time genetic test, if you don't mind.

Sure. So a lot of these genetic tests are very similar though. I use a company called Self Decode. I like it because it does a really good job of packaging the data into specific disease processes. And what people have to understand is so the genes that we look at, so there are variances and they're called single nucleotide polymorphisms, genetic SNPs. And that's how I'll refer to them. We have these genetic SNPs. So everybody has, it's the same gene, but there's a variant on that particular gene itself that codes for whatever protein that does whatever it's going to do in the body. Let's say for example. So for me, and I learned this through the genetic testing which has been invaluable. Like I've always been kind of radical with diets just to trying things out to see if they work. You know, I was vegan for, for many years. I'm no longer vegan. But you know, I have or at least a very strong family history for cardiovascular disease. My grandfather had his first heart attack at age 38. My, my, he was actually at the time the youngest living heart transplant recipient. I'm sorry, the oldest at age, I think 69 or 70. At the time this was like 25, 30 years ago. But not the best genes. My mom, high blood pressure at age 30. I had high blood pressure in age 30. And you know, I was checking my, you know, cholesterol through the traditional ways that we checked it through LDL cholesterol, which we now know is, is not, it's still there is correlation but it's not as accurate measure for cardiovascular disease as looking at your apob levels. My cholesterol levels were poor. They were high. Why, why is this? I'm in really good shape. You know, I have very minimal body fat, I've got good muscle mass, I'm exercising regularly, I'm eating clean. I went over to a vegan diet thinking oh well, there's some studies that show this and that. And again, studies that talk about food more often than that are pretty bad because there's a lot of confounding factors that go into that. So when I say that there's just a lot of other variables that can skew the results. So you can't say that you can actually prove causation for the, for the metric that you're trying to actually show is happening. It's very hard to prove that in food studies because there's a ton of confounding factors that go along with that that may skew your results. So was vegan looked at my blood values, my cholesterol had gone down, my blood pressure had gone down. I was like, this is the answer. And then I got off of doing veganism just because I was looking at some genetic testing and I wanted to do some experiments. And I found out whenever I looked at my genetic SNPs, that, so when you look at these SNPs, it's not just one, like it'll give you. Whenever I look at this site, it'll say, oh, well, you have, you don't tolerate fat very well. And for me specifically, I didn't tolerate, I don't tolerate saturated fats very well. And because of my genetic SNPs, it shows, because of this intolerance for saturated fat, it's going to drive up my cholesterol levels. So for me, like I use this analogy, I could just look at bacon or smell bacon and my, my cholesterol's through the roof. You, for example, you may tolerate saturated fats very well and your APOB levels may not go up because you're eating a significant amount of saturated fat. But it's not one single nucleotide polymorphism. It's a number of them, 15, 20 that come into account that they put this formula together. So you can't just look at one particular gene and say, oh, I have this gene for this. Or like, for example, the APOE4 gene for Alzheimer's disease? Well, yes, that's one of the big influences for genetically predisposing you to early predetermination of Alzheimer's disease. But there are a number of other genetic SNPs that are involved that put you at higher risk. You can't just look at one. You have to look at a collection. And what this site does, I mean, I'm not a genetic geneticist, but it puts together a collection of these single nucleotide polymorphisms and comes up with a formula and puts you Puts a risk score together for you and tells you, hey, you're more genetically predisposed for not tolerating saturated fats. And the thing that I like about it is it actually puts together, like a diet plan for you. So for me, I don't eat a ton of saturated fats. Or, I mean, it does it more on a macro level, but it also tell you some food. Food intolerances as well. So it gives you a lot of. A lot of really cool information, and it takes the guessing game out of it. So I don't need, you know, I don't have to struggle and I don't have to be vegan to optimize my health. I can, you know, just. I have to be very conscious about saturated fats. My numbers are exactly the same as they were before whenever I was vegan. But now that I know that saturated fat is my trigger to raising my cholesterol, I minimize that. So that's the power of genetics. I mean, we're looking at these. These. All of these genetic single nucleotide polymorphisms, and we come up with a formula they can tailor, make a plan for a patient, rather than just saying, you know, oh, everybody should be having curecumin or theracumin or this supplement or that supplement. Well, some people don't tolerate this, the supplement or that supplement. And some people may not need this because they are not genetically predisposed for high risk for this or that. So genetics helps guide that. And then the blood work with biomarkers is looking at things in real time so you can assess your progress.

What I found fascinating in the conversation we had about this is that if you have a family of five and everybody has slight variations inside of their genetic SNPs, and yet you grow up and for better part of 18 years, you eat exactly the same. You eat the same exact meals, or some of it's regional. If you're in the south, you're going to grow up eating certain things. Texas, you know, whatever, and there's no variation on it. Now, the other. The other side of it is, is you could genetic test everybody, and if people aren't willing to make the lifestyle choices, then it doesn't matter at all. Let's talk a little bit about hormone therapy. And so is there any male over 50 that should not be on TRT?

Yeah, I'd say yes. And I have a little bit more of an unconventional approach whenever it comes to hormone optimization, because I don't know that when we're specifically talking about testosterone, then the Numbers don't matter so much. And I know you're going to hear, you're going to hear otherwise. I mean, I think when, when you, I think if you have. There. There are a couple scenarios with this. I drive my therapy based off of symptoms. Okay. Because if you're, if you are looking at the numbers themselves, what are we treating? If we're strictly going at the numbers, I know plenty of people that, their numbers for testosterone. So let's go with the numbers. So anywhere between 400 to 1,000 nanograms per deciliter for total testosterone, and you want to be between 2 and 3% of your total testosterone for your free testosterone levels. I mean, those, those are like the, the rule of thumb numbers. But yeah, that's great and all. But if you're not having symptoms, what are we, what are we treating? I know plenty of men, they're at the lower end of normal for testosterone levels, 400 nanograms per deciliter. And their free T is 2 to 3%. But. And they're doing great. They don't have decreased muscle mass. They have maintained libido. They don't have erectile dysfunction. They're not moody. They don't have a bunch of central or adiposity, a bunch of weight in their gut. You know, it does, you know, testosterone does decline as we age. But I go off of one, the symptoms of low testosterone and then also the metabolic markers. So I am very aggressive with trt more so from a metabolic marker standpoint, oftentimes men do have some of these symptoms too. But testosterone is going to help your lipid profile. Okay. So if you have crappy lipids, you probably need to be on TRT as you age. Okay. If, if you're not, I mean, in addition to lifestyle modification. Right. And we're honing in on your APOB levels, you're eating clean. We've done your genetic testing. We've figured out what potentially your triggers are, but you still have high levels. And then I potentially have you on some medications to drive down your cholesterol, but we're still not at optimal levels. Then I'll start you on some trt. Even if this is a scenario where you got great energy, everything else is great from the commercial use of what you think people should be on TRT for. I will prescribe TRT for that patient. The other thing with TRT is it helps with insulin resistance too, so. That's right, it's going to help. It also helps with blood pressure. So a lot of these, these metabolic markers that we're looking at. You don't see them right away. It takes upwards of a year, but yes, tr, testosterone. I'm more excited about testosterone for more of what's going on inside your body. And it is a, a longevity drug and you do want to have your testosterone optimal. Yeah, but I don't think about it the same way that you think about it of why a man wants to use it. I think about it more from a metabolic standpoint.

Got it. Well, hey, you know, if we're motivated a certain way and it helps us in other ways, then, you know, God bless us. All right, are you, are you a pellet guy or a shot guy or what's your. I take a supplement that's got three different testosterone boosting, you know, just an over the counter bought it from an Amazon and you know, I take that supplement for testosterone. Are you, what do you prescribe pellets or shots or how do you do it?

So, I mean, I leave it up to the patient. I primarily choose actually an HRT cream. And okay, guys are going to be going to love this because you don't need the injections. Actually you can get much higher levels and much tighter ranges with an HRT based cream. Okay. This is not an androgel, this is a cream. And you apply it to the scrotum twice a day and your levels will get higher. And so if you think about. So testosterone sipionate, which is the injection, oftentimes that's injected either on a weekly or I like to do it on a, on a bi weekly basis. But you start up here and then you go back down here, you get injected, you go back up here. Okay. With the cream, you're here.

Okay.

Much tighter plasma or blood level and way less hassle. You know, you can travel with it. I mean, I'm not exactly sure. I mean, because these HRT creams are relatively new. But there, there is no advantage for the injection. There really isn't. So I'd say 95 of the clients that I see are, are on the cream and they're seeing amazing results and their levels are getting higher and they're feeling much better because they're not having these fluctuations in their T levels that they would see through a pellet or same thing with the pellet. It lasts for a while but then it, it's a, it's a much slower drop off. But it's like this as opposed to. Yeah, man, like that with the, with the injection.

So yeah, that arc of the pellets, it's Got to be just like a big, you know, like a big downward arc. Right, Because.

Yeah, you know. Exactly. Yeah. And not to mention it's, it's, it's uncomfortable. I mean, you can feel it. I mean, with men, I think women tolerate them a little bit. Women tolerate things a lot better than men anyway. But these guys have a hard time with, hard time with pellets. But I don't think that there's a right or wrong answer. It just to me it makes much more sense from a compliance standpoint and then from a much tighter level and even you get a much higher level with the cream also.

It's like sunscreen, right? Apply, literally apply twice a day with the injection.

You also have negative effects of HDL cholesterol, which you don't see with the, with the cream. So I can't really think of one reason not to use a cream. It's cheaper, it's more convenient, it's tighter levels, you get higher levels.

So is that prescription or can you get that over, can you get that over the counter?

I wish it was over the counter. You got to come see me or your, your functional medicine doctor to get the cream and, but make sure that you get it when you do it. It's, you get it, you get it compounded from like a compound pharmacy. But yeah. So what else, what else with the tip? Oh, one other thing that I prescribe regularly in tandem with TRT for men specifically is dhea. I don't know if you've heard of this, but this is a precursor to testosterone. And this is often, whenever I check it in, the blood levels is not optimal, not even close to optimal in most people. It does convert a little bit over in males to testosterone, but that's not the effect that we're looking for. This is a, what I call a zero protective molecule or an anti aging molecule because it helps with everything. It helps with cognitive function, it helps with insulin sensitivity, it helps you to build muscle paired with, heavy with, with exercise. So this is truly a longevity drug. And oftentimes I'm not seeing people, men in the ranges that they need to be. So I prescribe that pretty regularly. Almost all my, all my male patients are on DHEA at a minimum, even at a younger age. So I'm 41, I take DHEA. I even, I have some of my younger clients, their levels aren't optimal. I don't have them on trt. And as you know, with trt, some of the negative effects of TRT are sterilization. So you want to make sure that you're, you know, you're not wanting to have children or you're on TRT a short enough period of time that it's not going to have that effect, less than a year. Right. So those are some of the down downsides of that. But dhea, you don't have to worry about that.

Okay. And that's an over the counter supplement.

So you can get it over the counter. I just don't really trust, I mean, supplementation when it comes to that because you don't know the potency, the quality. It's just not quality control. Third party tests, it'll oftentimes. So again, I go through a compound pharmacy so I know exactly what I'm getting. It's third party tested for potency, quality, chemical composition, and I prescribe that for my patient.

Dr. Joel, what have you learned about your customer? You've got, there's age ranges for me, I started thinking about longevity concierge type medicine when I was in my early mid-40s and I realized that, you know, things were starting to slow down. I think the day I turned 40, I think I needed readers. I mean it seemed like at 40, like three or four things just broke all at once. And you know, you're starting to really feel that, that downward trend of, you know, how you're feeling about things. And so I think people probably start thinking about it when they get into their 40s. And then at some point I would imagine that the patient base, as people get up into their 60s and 70s, I would think that like there are. All right, well, I mean they probably start caring a little bit less about stuff like this. I would think maybe when they retire, things like that. So from a demographic perspective, I'm interested for you to share what you've learned about who your clients are and who you think they will be going forward with your practice.

Jeff, I think you're, you're dead on in terms of at least like the low hanging fruit of who I'm seeing Contact me. You have like that eight, eight, that sweet spot age range of, of men and women that realize that, you know, they're not going to live forever and they're, they're starting to see signs that they're breaking down and they're, they're gaining some weight, they're slowing down a little bit. So they want to be aggressive in optimizing what they have left and maybe even reverse some of the damage that they've had from being a little bit cavalier and not paying attention. And then as you get older and you've had this neglect some. I'd say that client that really hasn't done much. And as they get in their 60s and 70s, it's more of like, oh, it's the give up mode. I just, I. Things are going to be the way they're going to be.

But yeah, I does Matlock doesn't care what I look like.

But yeah, I'd say that age range is probably late 30s to mid-50s, early 60s. Right now I have more men than women. But I love taking care of female patients as well. I mean, there's so much that I can do to help a patient, a female patient, especially as they're, they're going through menopause and hormone optimization. Hormone optimization is key for men and women. And I'm very aggressive with that, extremely aggressive. Because I feel like your testosterone, estrogen, thyroid, all that stuff needs to be optimized for your body to function the way that you want it to. And I just don't think we do a really good job of doing that in conventional medicine right now. We just have this acceptance. It's okay for it to decline. No, let's get those levels back to where they were. Whenever you're in your 20s, when you're feeling good, it's not bad for you to get, keep those levels there. So let's get them back there. And that will slow down the aging process and see all these things. But back to your question about the sweet spot. It's the man and woman probably in their mid-40s, who realizes that things are starting to decline. What can I do to slow that down? And unfortunately, I mean, at least right now, all of what I do is preventative. It's preventative medicine. Okay? So insurance is not going to cover this. So you're going to have to have, you're going to have to buy in the fact that in order to be an optimal health, it costs, it's going to cost some money to do that. Just like you're investing, you know, for retirement, you should be investing in your health, on the, in the forefront when it matters, when you can get the most bang for your buck. And you're planting the seeds for the future so that you are, you're decreasing that time, sandwiching that time of morbidity that you have later in life. That's what we, that's the goal, right, is we want to sandwich that time of morbidity so that you essentially fall off the cliff when you die. You're highly functioning until the day that you die. That's, that's what I want. I mean, and I think that's, that meets the demographic of most of my patients. They want to continue to do all the things that they enjoy doing for as long as possible. And just this slow decline, rotting away, you know, I see that all the time, just people riding away in a nursing home. It's so sad. I mean, I don't want that for anybody. And that doesn't have to happen. I think we can age gracefully and we can really, what we do in modern medicine, we've extended lifespan just a little bit. We have. But as far as morbidity, in terms of improving our health span, which is our quality of life, we have not done a good job of that at all. Between the ages of 65 and 80 years old, you know, when, when people start to slow down, down and they pass away, we've done a really bad job. The, that level, that halfway point is what of your health span is that hasn't improved. Like we, we decline very, very quickly between the last two decades of our life. And we can prevent that. We really can. And I think if you think about it, even if you're only living to be 80 years old, which is around the average life expectancy now, wouldn't you want to be, if you could. If I told you, if you just put in a little bit of work and effort for, you know, every day in your life, you're going to be highly functioning into your late 70s, as opposed to your mid-60s. If I can buy you another 10 years of really high functioning quality life, wouldn't you want that? I mean, because the one finite resource is time, right? That's the one finite resource that we have. So I was talking with Ryan Alford about this. He had a podcast talking about the one finite resource is time. And we can't turn back the clock, right? We can't buy time. But essentially, if you invest in your health, you kind of can. You can do that because if you're investing now, you're buying time for the future. And that's what I like to express to all of my clients. While you're young and you have mobility, be aggressive with it now because it's going to pay dividends in your future life. Because if you start now, you're going to build this huge reservoir that's going to deplete much, much slower as you, as you, you know, get older.

Well, that's, I mean, that's the thesis when. So I had really bad knees. I was an athlete, but it was Just genetics and, you know, really bow legs and bad knee structure and over time. And I probably should have had knee replacements in my 40s, which they say, don't do it till you're 60. Well, I had them at 52, and by that time my lower body had atrophied to the point to where I mean, I couldn't walk a hundred yards, man. I mean, it was. That's how bad they hurt. And I mean, I, we. I went for a walk. The day I decided to do it, I was visiting my daughter at school and we were up on this dam type thing where we were just going for a walk where they, you know, around this lake and whatever. And I got back in the car and I was pale white, I was sweating. I was about to pass out just because my knees hurt so bad, bad. And I said, I don't care if I'm 52, I'm going to have them both replaced. So I did that. And that's been three years. And I've also done trt. I've also started. I was. It enabled me to start going to a trainer, which I do three days a week. I do infrared sauna four days a week, which is a different share of wallet, right? So you've got all these. And I'm paying for all of this and you know, I can, can afford it. So, like, you've got, you've got to have a patient that's willing to look at the different areas of their wallet and say, I'm willing to invest in supplements. I'm willing to invest in medical. I'm willing to invest in the genetic testing. I'm willing to invest in infrared sauna. And I've done all this and, you know, I'm about 25 or 30 pounds down. I'm in the best shape of my life. I, I literally, since college, I mean, I got down to 226, which, you know, was a, was my probably freshman in college, you know, playing weight. And I hadn't, I'd been floating around between 245 and 260 most of my adult life and man. But it took an investment of time and energy and money and education. And the reason that I looked at that concept was putting it all together because all of these things you listed 10 years ago, you couldn't find all in one place. So I, you know, I went to concierge medicine and I went to this program and, you know, they did all the strength testing and the ears and the eyes and the blood work and all of that stuff. And you know, and I had a meeting with him. It's okay, well, you're pre diabetic. Your, you know, here's, here's some information about it. But there wasn't a program for me that had accountability that included all of these things like that. What they wanted to do was they wanted to get the seven grand for me and then they wanted to sell me the testing. But then the follow up, but I didn't, There was no accountability to the follow up and maybe that was on me. So, you know, taking what you're doing and, and looking holistically at longevity and incorporating all of these things along with, you know, coaching, accounting, accountability, like that's, that's literally what you need to do. And to your extent, to your, to your point, do you want to be 68 years old? Because I've seen them. I mean, you know, my father being an example who was diabetic and then he had, you know, bad circulation, so he was off of his feet. And man, you know, by the time he was that age, I mean, he was bedridden and there was no coming back. Like, there was no, there was nothing he was going to be able to do to re. At once. It, once it goes past a certain point to rebuild the muscle mass. So now it's just eat as well as you can manage your blood sugar, have, you know, get a little bit of exercise and where you can be comfortable, you know, and that's it. Maybe it could have been different for him, maybe it couldn't. But I know for me, I just said, you know what? I'm just gonna roll. I'm gonna roll at this as hard as I can. I'm not gonna worry about the expense of it and, and then I'm going to find a way to be, be account, you know, to put some accountability in there for myself. Not perfect by any means. I mean, I still struggle with diet a little bit and those types of things. But as far as getting the working out going, doing the supplementation, doing the hormone therapy, doing the infrared sauna, I mean, it's, it's really, I mean, I'm am investing every day in, you know, my, hopefully 60 to 72, that it'll be, it'll be productive and comfortable.

I love that. I love hearing these stories. It makes me so happy. I'm just curious. So I think I know the answer to this, but I want to hear you tell me what, what was the trigger for you? What was like we're gonna do? Because it sounds like you got really aggressive and you got aggressive quickly. So some, there was some switch. What was it for you?

So I've always been motivated to, I mean, I mean, do whatever. And I, I got in. I've been in the fitness, health and wellness industry from a franchise perspective, so I've been involved there. I've always been motivated to work out. I've, I've continued to work out during my life and it just, my, my fit, my. I was so incapacitated with my knees that there was just so, so it was so limited of what I could do. And when I got now knee replacements, I think, you know, somebody told me they're the most traumatic elective surgery that you can have because of the amount of tissue injury. And I gotta tell you, you know, like the first three weeks after a knee replacement, it's. Those aren't good times. However, you know that like, it's all, it's kind of like all construction in there. There's nothing. It's not like an ACL where you got to be really careful because you can tear it there. It's just tissue, it's just tissue injury. So like my second one, I didn't even, I just walked in the house saying, you know, the same day, next day, whatever it was, I just walked in the house and I'm like, okay, this is going to hurt for about three weeks, but we're going to start rehab tomorrow because you can't break them. Like, there's, it's, it's construction, man. It's, it's nuts and bolts and it's all screwed together and anything that could tear is gone. And so you just do it. And after two to three months, I, I realized that like, okay, I really can't sprint like I used to, but I can do the ladders, man. I can, I do squats. I do. I hadn't been able to do single leg things for years, so now I can do single leg exercises of all types. I, I got, you know, I got my rear end back. Like, you know, I was a football player, right? So like we, you know, we had functional strength, you know, kind of between your mid torso and between above your knees. Like that's, that's where football happens, man. It's your functional strength. It's your core, it's your hips, it's your glutes, it's your quad, all of that stuff. And I had completely lost the ability to train that for a good 15 years, maybe 20. And so what triggered is just the ability to get back into it and to do it and then now, yeah, I've been with my trainer probably 18 months and man, I can, I can go to a. You know, we got our annual conference coming up for the industry and it's five days. I can walk all day. I can, you know, we, I'll take my dogs for a four mile walk. You know, I can, I can do anything now. So for me, it was, it was making a decision to just to do something that would then put me in a position to be successful and then coming out of that saying, all right, now if I looked at this, all of this list of, you know, I independently found my way to all of this stuff. Blood work, concierge medicine, genetic testing, supplementation, trt. I said I'm going to, these are all. I'm going to put these all into one wallet and say this is an investment in my future and, you know, whatever it takes, I'm willing. I'm not gonna, I'm gonna, I'm gonna be smart, but I'm gonna invest in these things and see if I can't, like, finish impeccably.

Amazing. I love that.

And you provide that all in one door. Walk to your door, Dr. Joel. And you get it, right?

I mean, that we only, we've only talked about a couple of the things that we do, but.

Well, what's the experience like? What's your patient experience like if they take advantage of all of the things that you have?

I mean, I think it's a, I kind of gear it towards what the patient wants. And I mean, I have different tiers in terms of how much interaction time you have with me. So if you need for me to really hold your hand, I will. But it's all about, you know, providing that tight knit blueprint up front and, you know, setting the expectation that this is not a quick fix. So if you are a someone that wants to biohack, I don't know that you're the client for me. Um, we are going to, I'm going to really push you to make sure that you are honing in on all of these lifestyle buckets and make sure that they're optimized. And then you're going to see just through that alone that the markers that we're looking at are going to improve without any medicine. I mean, granted, we are going to be doing some medicine, so it's, it's going to be hard to see the chicken or the egg, but they are going to work synergistically. But I will know if you're not, you know, holding yourself Accountable and quite frankly, we're wasting each other's time. I don't want to take your money if you're not putting in the effort to maximize your choices that you can make to optimize your lifestyle. So it's that. Go ahead.

I was going to ask it. You know, I'm not going to ask you what you charge because I'm sure that it's different based on the needs. But do you do a retainer or is it an a la carte thing? And you put a customized program together for a client.

So just very quickly, the way that it works is I have. So they're all six month memberships. We can stretch it out into 12 months. And then, you know, the first tier is a certain amount of time with me. Then second tier, some additional. And then the third tier even more. Everybody gets blood work with biomarkers and genetic testing. Everybody gets a food sensitivity test. Everybody gets a DEXA scan, which we do. I like to do it every six months. DEXA scans are great because I can see in real time how much organ fat is melting away based on our interventions. And that's the important fat that I'm worried about. Not the fat that you're carrying around your gut that you can see, it's the fat around your organs. That's what wreaks havoc. So that's why a DEXA scan is important. In addition to looking at your bone mineral density and how much muscle mass you have, because muscle is very powerful. It is a very, very powerful organ and we want to maximize muscle mass. So DEXA scan is included. What am I missing? And then everybody has access to prescription medication supplementation and hormone optimization. Then in the next tier, we get a little bit more aggressive with cancer screening. I do a liquid biopsy test that screens for over 50 different types of cancer that are not regularly screened for, like breast cancer or colon cancer that we routinely screen for, that's done with a liquid biopsy. And then the final tier is even more diagnostic testing. And this is if you want to be very aggressive with looking at your heart arteries, I do a clearly coronary scan, which is a 3D image of your heart arteries. That's integrated with artificial intelligence. So coupled with looking at your, you know, aggressively managing your APOB levels, driving that down to as low as I possibly can, and then looking at your heart arteries, managing your, your blood pressure and make sure you're not smoking. That's, that's as tight of a blueprint as you can get for, for looking at your cardiovascular Health in terms of your heart. And then I also do a, offer a full body mri. So the full body mri, this is in the, in the, in the upper tier. That's, so that's also looking for the smallest signs of, of cancer as well as other things. You know, we can. Like looking at mine like I've got severe chronic sinus disease. So because of that I'm a little bit more aggressive in the solutions that I put in my nose. I'm doing neti pots and saline rinses to help prevent infection. You know, like you, I've, you know, I put some wear and tear on my body. My spine doesn't look the best, the best. But you know, you can see degenerative changes in your spine and just looking for this, the slightest irregularity, any tumor, any mass, all of that is under surveillance. And having that blueprint from day one, we can monitor that over time. You get an annual or a, every other year you get an mri. We're were under close surveillance. So the name of the game for cancer prevention. We've done a good, a decent job with some cancer, but once cancer has progressed beyond its early stages, we, we still have not done a very good job yet in terms of the cancer world. But if you're extremely aggressive in cancer surveillance, like doing a liquid biopsy before what a liquid biopsy does, it looks for cell free DNA that the cancer expresses. And through this technology you can actually, not only can you assess for cancer at a really early stage, you can assess the origin of the cancer as well. The name of the game is not getting cancer at all. But if you have it, detecting it so early that the agents that we have out there are that much more successful in treating the cancer if you get it super, super early. So that's why I recommend, especially if you have a strong family history of cancer, to consider getting a liquid biopsy on an annual basis. It's one blood test and then a full body MRI on an annual or every other year. I have some of my clients that are doing that as well.

Well, that's an incredible comprehensive list of everything that I've ever heard of that people have recommended that you need. So hats off to you for, for pulling it all together. Dr. Joel, is there anything else you want to cover today before we take this, take this horse and head it towards the barn?

No, I mean, I, I just, I really appreciate you having me on the show. I just, I really encourage your guests that, you know, whatever avenue they take to take charge of their own health, the Sooner the better, because the sooner you do this, the sooner you realize that optimizing your health, it should be at the forefront of your goals. I've transformed my whole outlook on life now. I mean, being an emergency medicine doctor, it's very easy to have your health take the backseat. You can eat like crap, poor sleeping habits, not managing your stress well. But now I just made it a priority. I told my team I'm not working nights anymore, you know, and, you know, I'm getting good quality sleep, I'm eating well, I'm meditating on a regular basis, regardless of what's going on. You know, however, how, how busy I am, if I'm not physically and mentally healthy, I'm not going to be able to perform the tasks that I will perform the level that I potentially could. So if you put your health first, everything else falls into place. Your job, your relationships, everything. But you have to put your. Just like the analogy of you're in a crashing plane, right? You want to put on your oxygen mask first so that you can help other people. So if you're optimizing your health, you're going to be a better contributor to society. So I don't think it's selfish at all to put yourself first in that regard because you're going to just be a much better person overall if you do that 100%.

Dr. Joel, if you had one sentence to make an impact in someone's life, what might that be?

I think going back to the one finite resource we have is time. And what a better way to extend the amount of time you have on this earth. It's by optimizing your health, because you will get time. You will get time in the back end whenever things potentially start to decline for someone that's not doing that. So put your health first. It'll buy you some time.

Yeah, man, time is like oxygen. You don't know how bad you want it until you don't have any.

Exactly.

Where can people reach you?

So my website is accepting a waiting list right now. It should be up in a week or so. So it's Health Span by Design Company. You can put your, your name, your information down and your email address. I'm holding a waiting list. And then the website should be live. And then in about a month from now, I will be starting to see patients in Florida. I have licenses in Texas and New York as well. So I will be expanding to those states here in the next couple months, and then after that, hopefully nationwide. But we'll see how things go to start off all right.

Dr. Joel Wusso, is that correct?

Yes, sir.

Dr. Joel Wusso, thank you for joining us today on the home front. It's been a pleasure, and everybody out there, thank you for listening.

Thank you, Jeff.