014 - Normal Cath, Major Heart Surgery: How a Virtual Autopsy Saved Him From the Operating Room

So you could have a completely normal heart cath and still have plaque, and then only late— and we're talking decades after you have plaque— will it begin to grow inward and cause blockages. We'll not have symptoms— chest pain, angina, any awareness of it— till we already have a 70% blockage. But the disease has been there literally decades, right, which we can now see with this technology. So you If we detect it early, heart disease or strokes too, as we know it, ceases to exist.

We're live from Cleer Cardio headquarters in Carrollton, Texas, with a very special episode of Prevention is Power podcast. Join David Leadbetter, world-renowned PGA coach, as he experiences the Cleer Cardio screening firsthand and shares his results with you in real time. Hosted by me, J.D. Enright, Cleer Cardio CEO and co-founder, And of course, featuring top cardiologist Dr. John Osborne. This episode dives into the power of prevention, peak performance, and living with intention. So join us on Power Is Prevention Podcast.

So I, I got a lot of stuff to show you, okay? Because we did your virtual autopsy, uh, emphasis on virtual, okay? Uh, so our main purpose here is look at all the blood vessels. We'll look at all the valve stuff as well, okay? But before we get that, get there, we get a lot of additional free data because we're really taking a high-resolution 3-dimensional scan, you know, from roughly your collarbone to your top of the belly. So there's a lot of other important stuff there. So we're gonna first of all look at all that stuff. We're gonna look at your lungs, your spine, your esophagus, your aorta, your spleen, your stomach, your liver, because we get all of that stuff in there too.

Right.

Okay, so we're gonna look at that, and then after that, then, then we'll switch over and we'll look at the The blood vessels and stuff like that. Okay, so stand back, relax. Let me walk take you through a tour of your body. So what we're looking at here, and to what if it if is that a good position for you to be in? Because again, we can turn this a little bit.

That'd be that perfect.

Yeah, is that better?

Yeah, that's great.

Okay, there we go. So this is you. So. There are your ribs. There's your spine. This is your scapula, your shoulder blades here. I can spin you around here. This is your breastbone right here. I can flip you around this way. This is the— your vertebral column. There's your vertebra. This is actually bone marrow in your vertebra here. Here, what I've done is I've removed your spine. There's your spinal cord. Where your spinal cord goes. I've removed your spine, and this is what it'll look like if we removed your spine and look straight through the middle of it. So that's always fun to do. Please don't try that at home. Here we are, speaking of the which side of the divot, we're looking at the bottom of the heart here. So there's the— your heart right here. This is your aorta going down to the belly here. This vessel right here is one of the first vessels that comes off the heart, that are off the aorta as it heads down the belly. That's the superior mesenteric artery. Here's your spine. So did you break your rib on the right?

You know, I had a—I'm trying to think what they called it. And they couldn't figure out how I did it.

Oh.

It's, uh, yeah, it was like a little— because I had a lot of pain here.

Right.

It was— that was only a few weeks ago too.

Oh, okay.

Yeah, so, um, yeah, Kelly will remember more about it. I mean, honestly, I've been to so many doctors the last month or so with all— It's just like a parade of doctors. Yeah, I mean, yeah, just for test this, test that, test this. And well, but anyway, I think that, yeah, there was a It was near— is it near the clavicle?

Well, yeah, so it'd be on the, the right side.

Yeah, I'm trying to think what it was called.

And it would be kind of basically—

Yeah, exactly, that's where it was. It was called the— there's a funny name for the, um, the bone. I'm trying to think what it was called. Anyway.

Just a rib fracture.

Yeah, I don't know. They don't know honestly how I did it.

No trauma?

Didn't bang anything? Uh-uh, because they thought it wasn't— they thought it was very unusual for it to Because I don't see it very often.

Yeah, so I can tell you one thing. So there it is right there, right on the right side. You can see what it looks like on this side too, right? It's still healing, but it looks like it's probably been there at least a few weeks, at least probably at least a month or so.

Really? Yeah, about a month.

4 to 6 weeks, yeah, my guess. The surgeon wasn't trying to get in there early?

No, no. I'm trying to think how it even came about because I was having— yeah, I was getting this pain. I thought, oh, what is that? And so anyway, they said, no, you've got a slight fracture in this whatever. Yeah, yeah. Anyway, they said, which doesn't appear very often.

But yeah, yeah, so there it is again. Nothing hides from this right there. Then this is what it looks like on the inside right there. Flip you upside That's interesting. Definitely see you fractured that.

That's healing, you say?

Yeah.

So anyway, but that's what you look like there. We can also begin to put back all the other stuff here. So there's your muscles there. There's your paraspinal muscles. There's your latissimus dorsi muscle. There's your pectoralis muscles here, right there. And there's your breastbone. This is the aorta coming out of the heart. There it is heading down to the belly. I took your spinal cord out.

That's amazing.

We can put it back in.

Clear it is, isn't it?

Oh yeah, it's incredible, isn't it? There's your spleen here. There's your liver. There's your stomach. So just nice little—

So essentially just doing this, even though you use the heart as the—

Right.

I mean, you're basically getting a full physical here.

Exactly, right?

Wow.

Yeah, exactly. So I like to extract every little bit of data from this because it's all here, right? Some of my colleagues, they just look at the heart and the blood vessels and like miss stuff, but I like to extract every little bit of data from this. In fact, We can actually go all the way out to your skin. So there's— there we are, all the way out to the skin. So, and this is where your right lung is. There's your left lung. These are all the different arteries and veins that go to and from the lungs.

Yeah, you asked me which lung was it. Can you tell on that which lung I might have had?

Yeah, it looks like from what I'm—

I can't remember.

Yeah.

Kelly will remember. I mean, she remembers all that stuff.

Yeah, it looks like— I'm going to say from what I'm seeing here— let me go back here.

I think it's the right lung. I'm just thinking now because I remember the—

Yeah. So the fracture is on the left. You know, it's it's you know I'm just trying to put this all together. You know, it's not uncommon after a fracture, a rib fracture, to get a pneumonia just because you're just not breathing deeply, right?

Yeah, I've been on this. I've been breathing on this spirometer for the last month. Got it. Yeah, just trying to expand the lungs. I had very bad asthma when I was a kid. Oh, did you? Yeah, and I remember when when I lived in England because we moved out to Africa. And I actually had, when I was a kid, I know, you know, I was probably 6 or 7 years old, I had double pneumonia.

Oh wow, wow. So you can see right here, this is the, the left lung here.

Yeah.

A little bit of scar right there.

Yeah, they said I had a patch on the lung. Yeah. What would that be? That's what—

And then there's a little bit here too, right? So this could be related to that pneumonia he had years and years and years ago, right?

Yeah.

But again, a couple little scars, we'll call them. Okay. No, nothing's a big deal. But looks like the pneumonia is pretty well resolved. There's also just a smidgen here. I'll show you. Right here, see that rib right here? And you can see the distance between the lung, which is the dark part, and the rib here. Is, is less here than it is here.

Yeah.

So there's still just a little bit of fluid there. So my guess—

Yeah, they took 4 liters of fluid off my lung. Ah, okay. Got it. I had these tubes, I had these tubes in here, you know, because then the guy actually had to scrape because—

Right.

So, yeah.

So, yeah, so I'm quite sure it was on the right side.

Yeah, I think I'm 99% sure it was the right lung.

Yeah, pretty sure. And you can see there's still a little bit of that fluid there, just a little tiny Yeah. Nothing that's important clinically, and you don't need to take any of the fluid out.

4 liters is quite a bit.

Yeah, that was a lot. So what did they find in the fluid? Was it infection, or—

Yeah, I guess, yeah, it was infection.

Got it.

And yeah, I mean, I was on antibiotics for like 3 weeks. I had a PICC line on where I had to— Have antibiotics 3 times a day.

So it is interesting. So the other side, the left side, was fine, right?

Yeah.

Yeah, so it is interesting. So there's the fracture right here, which looks like at this point is probably 4 to 6 weeks old, right, based on the healing. There's the fracture. And it is interesting that that's the side where all the— where they had to take the fluid out, right? And he had the pneumonia. It almost makes me wonder—

If they didn't do it.

Yeah, yeah, yeah, uh, yeah. So interesting. When they took the fluid out, was it bloody, or—

there was some bloody— yeah, there was a little bit of blood, red tinge. Yeah, a little red tinge to it.

Yeah, I, I almost wonder whether, you know, it's a bit of a chicken and the egg, right? Did— I mean, hard to imagine, you, you really wouldn't break a rib with a pneumonia, but you could definitely have a pneumonia after you broke your rib. So I almost wonder whether this was the whole beginning of it, which then teed you up for the pneumonia. Yeah, because you can definitely lose a lot of blood into that into that that chest cavity from from from bleeding and inflammation and all that kind of stuff. So yeah, interesting. Yeah, I mean, I I I I would bet that that may have been the genesis of it because again that. I can tell you how it's healing, that it's been there several weeks at a minimum.

Mm-hmm.

Anyway, so there's your lungs. They look good now. Again, just a little remnant of that pneumonia and that fluid there, but that's all healing nicely. There's your— and what we're doing right now, just to orient you here, there is your spleen. Yeah, pretty pictures.

So you could detect, for some people, with early cancers too, right?

Oh yeah, so if it's here, we'll see it, right? So it's a binary test. If it's here, we'll see it. So if you can see it on your autopsy, we can see it on this.

It sounds funny when you say that, on your autopsy.

Yeah, but we usually don't recommend an autopsy as the initial test. But virtuals are pretty cool. So there's your spleen, there's your stomach, your liver. One of the things we can also do with this is we can measure the liver density.

Yeah, I had, you know, I had a little nodule or whatever you want to call it on the liver, which is benign. And I mean, they found that when I had a kidney stone.

Sure.

And so, and Yeah. I went to have it removed. And the thing is, I had— when I went under anesthesia twice, twice I had this, I went into AFib.

Ah.

Okay. So then I had to— then I went to Mayo Clinic and they shocked me a couple of times to get back into rhythm.

Right.

And then actually I had to— I had an ablation.

Oh, you did?

Yeah.

Oh, wow.

So I went to a heart rhythm doctor and it's, it's been, it's been fine. That was 2 years ago.

2 years ago. Got it. Got it.

Although during this pneumonia period, there was the odd flutter, you know.

Right, right, which is pretty typical.

Yeah.

When you're kind of sick and stressed out.

Yeah.

Not uncommon for you to go into some AFib.

Yeah, exactly.

They keep you on any drugs for it, or?

Not really, no. I went on, um, I was on a blood thinner for a while. Alexithromycin. Yeah, for a little while. And, um, but no, I haven't, uh, no, I haven't had a real problem with it.

And never had a stroke or anything like that?

No.

No bleeding issues?

A few strokes on the golf course, but none—

Only those. Those are okay.

Yeah.

So not uncommon in the liver, we can get what are called cysts, just little fluid collections, very, very common. I suspect that's probably what they showed, what you had. But the other thing is, as we look at the liver, and as I said, I'm measuring the density of the liver. Whoops, as I'm measuring the density of the liver here. So that number in the middle, which is 39, that number quote unquote should be 60 or higher.

Really?

So if it's lower than 60, what it means is you probably have a little bit of fatty liver. Okay, so join the crowd, about 40% of US adults have Some fatty liver. Usually never shows up on a blood test or anything. You really just have to take pictures of liver. So a little bit of fatty liver, not a big deal. But the message here is that, you know, watch the carbs, right? Watch the carbs because the carbs, the white stuff, the sugar sweets— well, you mentioned gluten-free, so that's good.

Yeah, I mean, I do a lot of keto stuff.

Yeah, yeah.

So that's actually good for I fast every so often too.

Also too, this is your esophagus here, that's your food pipe there, heart's going to be in the middle. Also, by the way, with AFib, this structure right here called the left atrial appendage, this is in the chamber called the left atrium, it's literally just an appendage or a little Offshoot of it. This is where blood clots like to form. If you have AFib, they like to form in this spot right here, and I can tell you, you don't have any, so that's good. So here's another view of you. So we can cut you this way, I can cut you this way, or I can cut you front to back, right? So we just take, and we really have just a cylinder of you, right? In the middle of that cylinder is the heart, but I can look at all these other structures and cut you in any axis, right?

Yeah.

We call this coronal. So there's your right lung here, left lung, heart's in the middle. There's those ribs we talked about earlier. And we can cut you front to back. So there's your spine. And we'll measure your bone density here in a moment as well, because we can look at the bone density of the spine. And then here, there's your spine right there. There's the ribs coming out. There's that rib fracture I mentioned before. And then we can go all the way to the front. So there's your breastbone here. And by the way, except again, a little fluid on that one side, on the right side, some old scars, but other than that, the lungs look great. No tumors, masses, cancers, pneumonia. Emphysema, asbestosis, tuberculosis, fibrosis, or any other kind of -osis. So that looks good. And then here, I'm going to cut you with my magic machete straight down the middle. So you can actually see the lobes of the lung. This is the right lung. There's the right upper lobe, right middle lobe, left— or right lower lobe here. So we can see all those lobes very nicely. And here we're going to take a look at your spine. So there's your spine right here. We're also going to check that bone, the bone density there. So this number right here in the middle again is kind of the key number. So below 100 is really osteoporosis, right? Should be above 200, and between 100 to 200 is kind of the middle zone, right? We'll call that some osteo—

Normal.

osteopenia, right? So not osteoporosis where there's significant loss of calcium, but definitely some, some loss of calcium. So you see how this looks more gray? Usually it should look more, more bright, okay? That's because the calcium in the bones. So definitely something. Have you had a bone density scan by any chance? Does that sound familiar?

No, I don't believe I have.

Probably not. Yeah. Anything like that in the family, like hip fractures or Yeah, my mother had hip problems. Got it. Yeah, got it. So it's her fault.

Yeah, her fault. Exactly. Um, yeah, and I've got a bit of a hip issue too, but I think it's actually more from my foot than anything else. But anyway, um, oh, that's interesting.

Yeah. So as we, as we measure the density here, you know, there's some variability, uh, between the, the different bones here, but, you know, 113, 137, 158, 156. Here, this one's 90. So definitely then what I would do is—

What is that? What area is that?

So this is the lower thrust point.

Is that 90? Where's the 90?

Probably going to be about like T8, as we call it.

Okay.

In that range.

Yeah.

So definitely make sure we want to be all over that.

Is that something you can buy? You can fortify it or?

Oh yeah. I mean, there's a bunch of different—

I mean, they always talk about, you know, Calcium supplements don't usually do a whole lot for you.

Calcium and vitamin D really don't do that much. There are some very, very effective drugs now that really are really phenomenal at helping to improve that bone density. But I definitely would recommend, we call it DEXA scan. It's a scan, there's no prep, no IV. We put you on this table-like thing and it will give you very accurate measurements of the bone density. The problem is that, like heart disease, usually we find it after you break your hip, right? Or after you get a compression fracture.

Yeah.

And so you really don't want that to happen. So just make sure that we— and we'll go over this and all the little, you know, instructions, if you will, all the things we need to just check and make sure. Also, by the way, as we look at that, there's your spinal cord. You can see as we cut through the vertebra here, oops, a little bit of arthritis right there, tiny little bit right there, a little loss of some disc space here, right? So the discs literally just sit between the bones.

Yeah. So it's interesting. I don't know whether it's all part and parcel of this, but I have bone on bone in both shoulders. So, I mean, I was actually, prior to the pneumonia, was going to go and have a shoulder replacement out in Colorado because we spend time out there at the Steadman Clinic. And the surgeon I know is one of the leading shoulder surgeons in the world.

Sure.

And they were all ready to do it. I just put everything on hold. But I mean, I do have Quite a bit of arthritis and stuff in both shoulders. Funny, right? You know, well, you know, it's it's interesting.

So when you think about the bone aspect of it, you know, here right here in particular, you can see that disc. You know, normally it should be more like that, more like that. You can see it. It's that disc is largely gone, right? But also too, with that osteoporosis, right? So that rib fracture, right? You go. I don't remember hitting it, banging it, right? No trauma. But if you don't have good bone density, yeah, that can happen.

Yeah, yeah. Make it even like a bad coughing attack or something. Exactly right.

That shouldn't normally give you a rib fracture, but if you don't have good bone density— and it can really be systemic, not just in the, the back where we can get compression fractures, where basically the vertebra fails and collapses, which is Really painful, or of course in the hips. But you can get fractures anywhere, right? Wrists, ribs, etc. So that's why I say really want to have a good handle on on your bone density because that may be the thing that links all this. And it's not uncommon too when we don't have good bone density. The cartilage, which is part of the the the bony frack the bony network of our body, the cartilage which is but between the bones. Sometimes can wear out more quickly too. So there may be relationship between all those. And then lastly, let me show you, here is your esophagus. We can look at the esophagus, so if there's tumors, masses, cancers, hiatal hernias, varices, et cetera, all kinds of pathology we can see with that. So I always tell people, we talk about the virtual colonoscopy, this is the virtual EGD. So the EGD is where they take that scope and put it down there and look at your stomach and esophagus.

Yeah, that's what I had done the other day.

We get this for free. So, uh, maybe a tiny little bit of a hiatal hernia, but pretty small, which is very common. So why did you have the EGD? To look at the heart?

They want to look at the valves. Yeah, yeah, right. And they did— what do they do? They stuck something down my groin too, I think. Yeah, right.

Yeah, they probably did a heart cath or the angiogram, right? So, uh, So let's— I will show you one other little thing of note. So I'm going to go here. So here we are cutting you this way. So what we're looking at here, this is your aorta, that big vessel that's going to head down to the belly, right? So it's about that big around. It's quite big, right? That's going to supply all the blood to the belly and the legs and all that stuff. So as we fly down that I'll show you. See that little spot right here? Okay, so that's a little bit of plaque in the aorta, right? That's the same plaque that can be in the heart. Plaque always forms out in the wall of the vessel, okay? It'll always grow outwards early on, right? And so there's a little bit of baby plaque right there in the wall of the vessel. When that plaque initially is deposited, it'll be Full of cholesterol or lipid. We call it soft plaque. As it gets older, as we get older, our vessels get older, it'll begin to calcify. So it goes from, I call it the soft lipid-rich, cholesterol-rich is the lava, right? It'll then become an extinct volcano, a cinder cone, right? And as it becomes calcified or becomes an extinct volcano, it will then turn white because that's the hard calcium plaque. Okay, so a little bit of baby plaque there. Again, nothing that's important or relevant, right? It's never going to cause trouble. And but this is the same stuff, the same process that can form in the blood vessels of the heart. The difference is a 1 or 2 millimeter plaque in a 30 millimeter vessel, who cares, right? A 1 or 2 millimeter plaque in a 3 millimeter vessel is a whole different thing, but same process. But there is a little bit, bit of plaque right there.

Okay.

And then as we look at the heart here, actually, I'm going to switch. This is the low-resolution data, so now we're going to switch to the high-resolution data.

Okay.

All right, so this is actually the even higher-resolution data. And so, as we look at the heart here— This is the heart. This is your aortic valve, which looks good. No congenital abnormalities, rheumatic deformity. Holes in it, leakage, whatever. This is your mitral valve that we're gonna be looking at in detail. This is the anterior leaflet, there's the posterior leaflet, and we'll look at that valve in a couple different views. So during this phase, this valve should be shut and this valve should be open. Okay, so you can actually see—

So it's like a flap, right?

Exactly right. It's actually just 2 flaps just doing that 100,000 times a day. As we look at that valve, we can see it's open, right? So, there's the one flap open, the other flap open. So, that looks good. I really don't see on this any what we call prolapse, where basically prolapse just means that one of the flaps kind of gets loose, and when it should be closing, it sort of does that. And then you get all this leakage. Okay, so I don't see that, which is good. There's no calcification. There's no rheumatic deformity like rheumatic heart disease. There's no narrowing of that valve. And a lot of times too, when there's a lot of leakage, right, that we have to fix, you'll see the left atrium, which is this chamber right here, right, will actually get quite big. Right, because all that blood, it has to go somewhere. So if it's not going this way, and all these valves are just one-way valves, if it's not going this way and the valve's leaking, now we get all that blood leaking or regurgitating back up in the left atrium. So usually the left atrium's big and I don't see that.

Hmm.

So, which is good for you. Now, on the right side, this is the Pulmonary valve right here, so that looks good. There's 4 heart valves of the heart. And then over here will be the tricuspid valve. Now, as it turns out, the tricuspid valve is the— does the least work of the heart, right? You could have wide-open leakage, not cause you any trouble.

Hmm.

Also, if there were fluid around the heart or That kind of stuff called pericarditis or fluid, we can see that. If there have been old heart attacks or damage, we can see all that. If there's holes in the heart, congenital abnormalities, we can see all that stuff, and all that stuff looks good. And by the way, how young are you?

72.

72, okay. So anybody else in the family with atrial fibrillation or?

No, not that I know of at all.

Okay. All right, so now what we're going to do is we're going to do a deep dive and we're going to go take a look at the heart itself, the blood vessels.

Will Kelly see exactly the same thing I'm seeing here with her analysis?

100%. Everything you're seeing, Kelly will see.

That's great. Yeah, it's, it's, it's hard to be, um, a skeptic when you look.

Well, yeah, I love to say, you know, you go to a museum and you get a docent-guided tour, right? I'm just giving you the docent tour. Exactly. Why wouldn't you want to know? Exactly. And, and that way, you know, I don't have to convince you of anything. No, because we'll see it together. Yeah, yeah, yeah. Or we won't see it. Which is great as well. All right, so in the background, the computer is doing all kinds of calculations and all that stuff, and it's going to convert the data that we have, and it's going to identify—

How many millions of people's lives would you have saved if they'd actually— who died of heart issues?

Well, we lose about a million people a year in the US due to heart disease, so I'm going to say about a million a year.

And it's in many cases, it's probably fixable.

Oh yeah, oh yeah. I mean, or most cases, you know, I always think about this as, as I call it, this the cardiac colonoscopy, right? Because everybody gets that. Yeah, you find the polyps, you detect the polyps, you treat the polyps, you don't get the cancer, right? Well, what we're looking at here is really your cardiac colonoscopy, right? The difference is polyps are only there a few years before they turn into cancer. We can see plaque literally 20 to 30 years before you ever get in trouble.

Wow.

Before you have symptoms, chest pain, angina, need stents or balloons or surgery. And the other difference is, and I love to tease my GI colleagues, right? So we do colonoscopies. You want to find the polyp, take care of the polyp. You know what happened to your wife and her family, right? Well, guess what? My GI colleagues, The only way they have to treat polyps is to scrape them out. It's purely mechanical, right? And hopefully we keep ahead of the polyps enough that they never turn into cancer. But we do not have drugs or treatment or therapy to treat or prevent polyps, right? We just find them and scrape them out. In my world of plaque, we have an array of highly effective and proven tools that stop and reverse plaque. Which is the ultimate cause of strokes and heart attacks. So if we detect it early, heart disease or strokes too, as we know it, ceases to exist. The problem is historically we never look early.

Yeah.

Right.

Consequently, you get sort of great athletes. I mean, oh, absolutely. They talk about obviously post-COVID, right? I mean, whether that affected the whole issue or not, but.

Right.

I mean, these, you know, soccer players in the Premier League just keeling over dead and playing the rest. Exactly. And these guys are sort of at the peak of their fitness careers, you know, so to speak.

Right, no question. So let me show you where we're at now. So we can take you— there's your heart. What I've done, just so you can see all this, is I have removed everything except Your aorta and the blood vessels. So there's your heart right there. We can also create a little nice little movie there. It's always fun to see. That's what your heart looks like.

That's your heart.

And this is the left atrium, right atrium, right ventricle, left ventricle. So the 4 major chambers. There's the aorta coming out of the heart, that big, big vessel, about as big as a banana here, if you will. And then what we're going to look at here in a moment are the coronary arteries. These are the vessels that actually supply the blood flow to the heart. And this is where heart attacks and plaque and all that occur, are these little vessels right here. So that's what you look like, always cool to see.

Mm-hmm.

But I'm going to make all this disappear. And we're just going to put the coronary arteries back, we'll put your aorta back, and I'm going to make everything else disappear here. Also, by the way, there we are looking on the inside of your heart. So that's always fun to do. So if you ever wonder what it looks like on the inside of your left ventricle, that's what it looks like right there. So now what we're going to do is we're going to take each one of those coronary arteries, those blood vessels. I can click on this vessel here. This is the right coronary artery going to the back and the right side of the heart. Down here is that same vessel, but imagine I took that vessel and laid it all out in the same virtual plane. I took that vessel, cut it right down the middle, laid it all out in the same plane. Don't try this at home. And now we're looking on the inside of the vessel, but I can see not just the blood flow and if there's plaque or blockages, but I can also see what I call is the donut too.

Mm-hmm.

This is important because plaque always forms out in the donut, not the donut hole, right? It'll actually grow outwards, and then only late— and we're talking decades after you have plaque— will it begin to grow inward and cause blockages. Will not have symptoms— chest pain, angina— any awareness of it Till we already have a 70% blockage. But the disease has been there literally decades.

Right.

Which we can now see with this technology. So here we're looking on the inside of that vessel. We can turn ya, spin ya, rotate ya, all this high-resolution, 3-dimensional imaging. And then here, we're gonna take that vessel, and with the magic of computers, we're gonna straighten it out. So here we are, flying up and down your right coronary artery. Over here, these views, this is the cross-section of that blood vessel, so I'm looking right down the barrel of the vessel, if you will. And the arrows here show the cross-section, that's the cross-section there. And then there's 1, 2, 3, 4 millimeters upstream, 1, 2, 3, 4 millimeters downstream, and here we are flying up and down your right coronary artery. Now, the heart cath you have, the angiogram, That I stopped doing 20 years ago because this is so much more sensitive. 5% of the cost and none of the risk, right? And did they go through the groin or the arm?

Uh, the groin.

Really? Okay, we stopped doing that a long time ago.

But anyway, yeah, because they were good. They were going to do the wrist or the groin, and they did. Yeah, they went through the groin.

Okay, so on the heart cath Which has been, quote, the gold standard. Up until we had this technology, which evolved basically 20 years ago, there really was no way of actually looking at the blood vessels of the heart, right? We do a stress test, I don't see the blood vessels, right? I can see if there's what appears to be restriction in blood flow, but that doesn't start until you have a 70% blockage. Anything less than that? Your stress test is completely normal. So the heart cath, which was accidentally, as it turns out, invented in the 1950s, has really not changed for about 70 years. So the angiogram, the heart cath that you underwent, is a way for us to kind of get a handle. Are there blockages in the blood vessels? Okay, because I can see the donut hole. Now, here's the problem with a heart cath. I can see what's happening in the donut hole, but I can't see what's happening in the donut itself, because that's where always plaque starts. And early on, it'll actually grow outwards. So you could have a completely normal heart cath and still have plaque.

Hmm.

And that's the problem. And it's 20 times more costly and has a lot more complications than obviously what we did. Much bigger deal for you. They put you out in the hospital, put things in your groin, risk of bleeding, infection, strokes, heart attacks, et cetera. Well, we dismiss all that. So 20 years ago, I did my last heart cath, and now it's all been done with cardiac CT.

Okay.

So here is your right coronary artery. We can fly up and down that. Now, I will tell you, what we're looking at here, I'll call the raw data. Behind the scenes, we've already set up your data to do the AI analysis. So here's what's going to happen. When we look at this data, we call this grayscale, right? Because it's shades of gray, right? So from white to black and gray in the middle.

Gray's Anatomy.

Exactly. Yeah, precisely, right? So our eyes can see or delineate about 50 shades of gray. Like the movie. Okay. As it turns out though, all of these millions of pixels that make up this high-resolution 3-dimensional scan, every pixel— technically it's a voxel— but every pixel is actually encoded with over 2,000 shades of gray that we can't see. What the AI will do is it will look at every single one of the millions of pixels in the dataset that I showed you and then look at it not under 50 shades of gray, but over 2,000 shades of gray. So literally can see things that we cannot see. So kind of like what we can see with our eyes, you know, red, green, blue, imagine you could see ultraviolet and X-rays and infrared and all those other spectra that our eyes can't see. Well, that's what the AI can see. Then it will then quantify to a very, very precise level. Basically, think of the volume of a 10th of a period at the end of a sentence, right? It will be able to analyze down to that level of resolution if there's any plaque and be able to see the stuff that we can't see.

Hmm.

So that's what the AI is going to show us when we have that report as well. But I can tell you, having done about 20,000 of these over the last 25 years, I don't see any Plaque or buildup, but the AI is better than my eyes, okay? So that's the right coronary artery. Here we are looking at the left main, LAD. We call this the widowmaker, and all of that looks good. So I'm sorry we caught you on this end of the heart cath. Because again, I haven't done any of those for 20 years because, yeah, better data and more accurate data.

Right, right, right.

Yeah, with this. But it's okay. A lot of my colleagues use old-fashioned techniques, but they'll come around one of these days. This is the left circumflex. The vessel goes to the left side of the heart. And again, all of that looks good. And again, I will tell you, and it's very humbling, the AI is even better than my eyes, even though I've done a bunch of these. So we'll see. It might be able to— might show a couple little baby plaques or so that I don't see. But I would tell you, in the old ways we used to read these, this looks perfect. Okay, now a couple of other free things that we get from this too. is we can measure the size, the dimensions of the heart. So we're going to do that now. And your blood pressure's been good, no issues there?

The only thing— what, yeah, when I was— it hasn't got high, it's got very low.

Okay.

So that's when I say, but normally it's Pretty stable, sort of somewhere in the, you know, 100 to 120 over whatever.

Awesome.

Yeah.

Right? So from the age of 40, and one of these days you'll hit 40, from the age of 40, the lifetime risk of developing high blood pressure in the US is 90%.

Really?

Yeah. So I'm hoping and praying you stay in that 10%. Okay, so that's good. Okay, so here we can look at all the valves of the heart. Right, so this is the aortic valve. The aortic valve, I call this the surgeon's view. So we've taken your heart, I'm gonna slice through the aorta, we're looking straight down the aortic valve. This is what you'd look like. It has 3 leaflets or cusps, and this looks perfect, okay? So if there were congenital abnormalities, malformations, holes, leakage, narrowings, et cetera, we'd be able to see that, and all that looks perfect. And then we can also look at that aortic valve From all these other dimensions too. So there's your aortic valve in that view, cutting through it in this view, and that looks perfect. Okay. By the way, this is taking your heart, and this is why I asked about blood pressure. We've taken your heart, I've cut it up into 20 pieces, we've measured those thicknesses throughout the heart, and this looks pretty good, right? You can see a little bit of red here, but most of this is all blue and green. People with high blood pressure, they've had it for a long time, and for a while the heart, like any muscle, will bulk up. It'll get thicker, and we can very easily detect and see that here as well. But this all looks quite good. Okay, now we're going to look at that mitral valve, that culprit mitral valve.

So let's look at this. This is great because, I mean, obviously most people don't have a medical background, so For the layman, it's pretty easy to understand.

Well, exactly.

Which is great.

Exactly. Yeah, and that's the beautiful thing about this, right? I mean, I could sit there and tell you all this stuff.

Yeah, it doesn't mean anything.

But, but we're actually looking at your own—

Yeah.

Heart.

Exactly.

You got skin in the game, right? So this is the mitral valve right here.

Yep.

I'm cutting through that valve. That valve looks pretty normal. I mean, what causes leakage would be like rheumatic deformities, rheumatic disease, holes in the valve, prolapse. You can get calcifications, you get malformations, congenital issues. And I'm not, I'm not seeing that, so, which is good. And then here—

I wonder why. I mean, obviously they look at it and said, hey, I mean, the Yeah, cardiologist said, hey, you know.

We're gonna get to the bottom of this for you. Yeah, here again, we're just cutting it through different axes, so X, Y, and Z axis. So there's the mitral valve here, there's the anterior leaflet, the posterior leaflet. And again, if you notice this, so there's the left atrium. You can imagine if that valve is leaking, so the blood just goes in one direction from here, collecting from the lungs, And down into the left ventricle, the main pumping chamber. So if there's a lot of leakage, right, if there's a lot of volume where the blood is not just going in this direction, a lot of it is going this way, this chamber, the left atrium, will get bigger, right? Because it's— all that blood is coming right back up. And I really don't see much enlargement of that left atrium.

Wow.

Right? Again, there's that. Anterior leaflet, the posterior leaflet. So at least anatomically, that valve looks pretty good.

So when most doctors see this, because I mean, I had a virtual call because a friend of ours, he's a retired surgeon, and he put us in touch with the Cleveland Clinic, who are obviously supposedly one of the best heart facilities in the country, right? And so we had this virtual thing and yeah, I didn't follow up with it because I mean, I just, I mean, this is great that obviously I can do this because having a second opinion here is, uh, I mean, because I don't want to go through surgery unless I absolutely have to.

You know, I, I, I, I'm not going to give you my final last opinion. Yeah, but what I'm seeing thus far as we go through this, right, step by step, is I'm not seeing a whole lot wrong with that mitral valve.

Really?

Yeah.

How about the tricuspid valve? I mean, when you get—

Well, we're going to look at that too. Yeah, but the mitral valve looks pretty good. And I will say, on the tricuspid valve, everybody—

Yeah, everybody.

Everybody has some leakage. Yeah, everybody, right? If we, if we did echoes on everybody in this room, we'd all have some leakage through the tricuspid valve. And The tricuspid valve is the most, one of the most lenient valves. You could have what we call wide open leakage and be perfectly fine.

Right, right, so when you do, am I having the echo later?

Yes, we're gonna do that echo too.

And what would that tell you?

Well, so what the echo's gonna show me, this has better resolution, spatial resolution than echo. What echo's gonna show me is the flow of blood. Right, what I can't see on this is blood flow.

Right.

Echo's gonna give me the blood flow. So I can take the anatomical data in my head, overlay that with the blood flow data. It's literally Doppler, just like on Doppler on weather. So then that becomes very, very helpful for me to see if there's leakage or not.

Okay.

But this is not a valve. If you were to say, I think this valve is really leaky and needs to be fixed, This doesn't look like a valve that needs to be fixed.

Hmm.

And the other thing is with the tricuspid valve, right, the symptoms of that— so the symptoms of a mitral valve: shortness of breath, I can't work out, I can't do what I normally do, all of those things, right? Well, I'm not hearing that, right? Swelling the ankles, I'm waking up short of breath at night, I can't work out.

They did some testing on my lower Right.

So what's called probably an ABI.

Yeah.

So which is a crude, simple way of seeing if there's blockages. But yeah, you know, frankly, if you don't have blockages here, you're not going to have blockages in the legs.

Yeah. Right.

Um, so we'll look at that echo, but I'm just telling you, my gestalt way I'm seeing this is that valve looks pretty normal to me. Um, and again, on the tricuspid valve, so the Mitral valve, bad leakage, short of breath, I can't work out, I feel like I'm drowning, I got swelling in my ankles, I wake up short of breath at night, I'm using more pillows to sleep with, and I haven't heard any of that from you.

No, that's why it sort of surprised me.

And if the tricuspid valve is very, very leaky, 100% of them, you're gonna get refractory edema, swelling, all that stuff. Particularly in the legs, even the upper extremities. But it's, you know, these are the people that ends up with— we call it tree trunks, right?

Yeah, yeah.

Big swelling and all that. That's the symptom. That's what tricuspid valve leakage causes. And I'm not seeing that.

Yeah.

So, uh, let me just show you. I want to look at one other thing with you as well. We're gonna grab—

So now you— so when my wife comes in here, you might spend—

Oh, I'll give her that.

No, no, you spend 2 minutes telling her because she's always one, oh, you should have it done just in case. And I said, this is one of the main reasons that I obviously wanted to come to get a second opinion.

So the 2 chambers right there, the white one and the red one, are the, the atria. These are the upper chambers of the heart.

Okay.

The 2 bigger chambers in the bottom, this is the left ventricle, and that's the right ventricle.

Okay.

So all the blood flows back from the body into the right atrium, which is the red chamber up top.

Okay.

And then all the blood flows back from the lungs after being oxygenated into the left atrium, which is the white structure right there.

Okay.

And the big structure right there, tubular structure, is the aorta. That's the aorta that that carries all the blood out of the heart. It's really big. Do not bend, spindle, mutilate, rip, tear that vessel. That's a bad, very, very bad thing to do, okay?

Okay.

So that's the heart. And then the coronary arteries are these little vessels that run on the surface of that vessel. So with mitral valve leakage or regurgitation, right, same term, right, is, The blood in the chambers of the heart should only flow basically in one direction. Okay, let me— I'll use his heart as an illustration. So, and so this is the left ventricle. By the way, if he'd had old heart attacks, damage, enlargement, we could see all that. And all that looks good.

Amazing how they can detect everything.

There's the aortic valve, which is another one of the Heart valves, all that looks perfect as well. So all the blood flows from the left atrium out, coming back from the lungs oxygenated, flows through the mitral valve and into the left ventricle. And then the left ventricle really is important because that's going to pump all the blood out to the rest of our body.

Mm-hmm.

So this valve here, the mitral valve, really there should be flow only in one direction, from here to here, right, into the left ventricle. Now, what happens is, if there's leakage, particularly if there's a lot of leakage in that valve, right, so the valve basically just sits and does that all day long, right?

Okay.

If there's a lot of leakage, then what happens is, for any number of reasons, like rheumatic fever, rheumatic things can do that, but a number of things can do that. But if there's a lot of leakage, all that blood that should only be going this direction now begins to go back into that atria, into the larger chamber. And usually that left atrium will be quite large, right? Because it's getting all the blood flow coming in the right direction, back to the lungs, but then also whatever blood flow is now coming back through the valve that shouldn't be coming through, the leakage. So that left atrium, which is this structure, usually gets quite large, right? I mean—

Mm-hmm.

Because it's getting flow from both sides. And I don't see that. Okay. Now, I will admit, on the right side, this is the right ventricle. This is pumping the blood to the lungs. And the right atrium, which receives all the blood from the body, it looks a little generous, I'll say.

Size-wise?

Yeah, size-wise. So yeah, there could be some tricuspid valve regurgitation here. But here's the thing, tricuspid valve regurgitation, of all of the valves, probably the 2 most important are the mitral valve and the aortic valve. In other words, the valves on the left side of the heart. That's the high-pressure side of the heart.

Mm-hmm.

Think of this as the amplifier. The preamp, the low-pressure side, are the pulmonic valve that goes to the lungs, which Is located, I'm just scanning through it, is located right here, and then the tricuspid valve. But this is the low-pressure side of the heart. You can have massive amounts of leakage through the tricuspid valve and have no symptoms.

Do you have symptoms?

Well, and the symptoms, if you have a lot of, I mean, severe tricuspid valve regurgitation, all that blood that normally should be coming back from the body, Mm-hmm. Well, it starts not getting back to the heart. It starts backing up. So you get swelling in the legs, right? You get the tree trunks, right? I mean, really bad swelling in the legs. It can even back up into the liver, and your liver gets enlarged. Because again, all that blood is not going back to the heart, right? It's all going in the reverse direction. None of those things I'm hearing.

No, he had— I don't know, after you had that surgery, whatever. Do you know what it's called, the surgery he had where they scraped the inside of your lung out?

Yeah, so he had a— whatever it is. Yeah, sorry. His foot was kind of swollen that day. A pleurodesis is where they scrape it to— yeah, right. And then they do a tap. Yeah, so they basically put some chemicals into that tube so that they can basically get the—

And then they make it like cement here.

Exactly, so they basically cement the lining of the lung to the— It's really painful. Yeah, really painful.

And he detected that little broken—

So why would they do that if—

Well, you know, I'm gonna work— I'm gonna suggest something. So tell you what, let me just do one other thing while I have this down.

You saw the little broken bone? Yeah.

Oh, the one you broke?

Here, it was like here, remember? And it could have been from coughing even, because of my, uh— No, you mean my bone density. That's where they stuck the tube in though.

That's why it broke.

I didn't know. What I did here is I could also plot his ejection fraction. That's basically the squeeze of the heart, right? Yeah. And, and that looks good. I don't see any issues there either. Um, so let me go back a step because I showed this to him earlier.

So that they said— okay, well, I remember when they were talking about the mitral valve, and they said it was a— if it gets over 5, then you've got more of a severe mitral valve. Do you remember that?

The size of it?

Yeah, the size of it.

I can't remember. I don't know.

So what I was showing David earlier, and I think this may be very relevant, is, um, see this right here? Oh, that's a rib fracture. And I could tell—

So maybe when he was throwing a tube in there, he punctured them.

I think this is— my suspicion is, because I can tell how old that rib fracture is, that rib fracture has been healing a while, right? It's probably in the range of 6 to 8 weeks old, right?

Uh-huh.

My suspicion is, I think you had the rib fracture, then bleeding into the lung, and the pneumonia because of all that. Do you remember if you saw— I think that probably was what started—

I could have had one of my coughing fits or something.

Can you break a rib coughing?

You shouldn't be able to.

But he said my bone density is not great. But, right?

I mean, how would you break a rib without like me or you hammering on her, on him, right? Okay, and I assume you haven't been beating him. He might have fallen a little bit. Well, right. So you normally shouldn't break a rib like that.

If you fall on your rib, you're not—

you're gonna go— Exactly right. And kind of get So how could you break a rib and not realize it? Because you don't have good bone density. So again, free data here. Let me show you. So this, this is him, and you can very well see that fracture right there.

I wonder where the tubes were.

Can you see scar tissue where the tubes went? I can see some scar tissue. I'll show you that. So as we go here, So this, I'm cutting David right like that, right? Heart, ribs. And let me just adjust the colors here. So if you— I'll show you the normal side. See, this is the normal side, right? See the distance between the rib and the lung? The lung being the black part, right? You can see it, it— there's not much distance there.

Yeah.

Over on this side, If you look at it, there's the rib, and see how much thicker that is? So that's the scar tissue that they purposely did to stick that lung down so it wouldn't deflate and cause trouble. Okay? If you look at the lungs though, the lungs actually look pretty good. There's a few little scars here. I can show you as I scan through this. See this little, little bit right here?

Mm-hmm.

Right, you can see a little bit right here. So that's scar tissue, you know, not a big deal.

But do you ever, like, measure the openings of these mitral valves?

Oh, absolutely. Oh sure, all the time.

So, but, and you can't really see anything majorly horrible?

We're ready for his echo upstairs.

Okay, perfect. So perfect time. But, but let me show you just real quickly here, um, So what, what I was doing— and we get all this data for free, so I like to just, you know, extract every little bit of data. So there's his spinal column. I'm cutting him with my magic machete right there. There's his spinal column.

You can actually go through her pictures while he's doing his.

Yeah, we can do that. Anyway, what I found was his bone density is low, which may, you know, may not be a coincidence back to how do you break a rib and not know it.

So David, what a day, huh?

Yeah, it was a real eye-opener. I have to say that, JD, because I say, you know, obviously I, I've had, I've had a couple of health issues. I had pneumonia, and anyway, they, they said I had some, you know, some leaky heart valves. And coming here really, as I say, was a real opener because I really wanted a second opinion because For goodness sake, yeah, I mean, the average layman, I mean, does not understand all that goes on inside the body, and you just take somebody's word for it. And, and, uh, you know, this, this is incredible really what you, what you do here at ClearCardio because, you know, you see everything. I mean, it's like in, in the space of just a few minutes too. This is not like it's an invasive type of procedural thing. I mean, it's Really amazing where you've got the technology, you've got expert opinions, you know, you've got Dr. Osborne here and his colleagues. I mean, it's really pretty— it was, and I say, peace of mind from a standpoint of they don't feel that I need to do what, you know, our doctor recommended to do. So it's, you know, I'm really happy and I say you've got a great staff.

I mean, it's So let's talk about that for a minute. So we spoke for the first time because of David Frost, good friend of yours, lifelong friend of yours. He actually happens to be one of our patients as well. He said, he said, David, you gotta talk to JD. And so we jumped on a call, we spoke for probably an hour and a half or so. And, you know, you flew in this morning from Tampa with your lovely wife who also went through the Clear Cardio process with us.

Right.

And there was a lot of fun things that we did with her as well. And you had expressed to Dr. Osborne, who you spent most of the day with today, going through the Clear Cardio process, right? We did the blood work, we did the CT angiogram. How was that CT? How did you— how was that for you? Did you— is that any problems for you? Did you—

No, so easy. I mean, basically you lie there, they connect you up. I mean, there's no pain whatsoever. And You know, it's, uh, it's not even claustrophobic because, you mean, you're really not— your whole body's not really in the tube, so to speak, you know, like an MRI. So, uh—

We call it the donut of destiny.

Yeah, well, I mean, it was— the whole procedure is so easy, so simple. I mean, I'd recommend this to anybody, you know, especially as we get older and we don't know what really goes on inside our bodies. And unfortunately, Until it's too late in many cases, you know, and say, wow, if you'd only known. Well, now you do know. And it's obviously focusing mainly on the heart, but they see literally everything from here down to here.

Yeah.

Which is amazing.

And we show you.

Yeah.

Like you saw it.

And you'll see it. Yeah, you see it in 3D, which is like— and it's so, you know, they look at it from all these different angles. I mean, obviously being involved in golf now, we're into the technology and looking at things in 3D, and we're seeing things now we could never see before. So now you've got that also in conjunction with AI. So, you know, you obviously got the good eyes of your great doctors here, Dr. Osborne and co. But, you know, I've got AI to back it up. So, I mean, it's pretty much a foolproof situation.

So quite an eye-opener today, wasn't it?

Yeah, it really was.

So you were on the road of getting pretty major surgery, heart surgery, and this was a good way to get a second opinion. And you came in and you met with Dr. Osborne. You also met with Dr. Kazori. He's one of our doctors as well. And we did a thorough analysis on you— echocardiogram, we did the CT angiogram. And the next time we see you will be in a couple of days. It'll be remotely through Zoom, and you're going to get our full diagnosis and AI analysis along with, um, a really in-depth report. And effectively what we've done today is we have shown you that you do not need that open heart surgery.

Yeah, well, you know, it's not only just the surgery. First of all, it's the drama and the stress really thinking about it, and then you've got the recovery process, you know, and it's like, hey, I'm not getting any younger, and it's like, I really don't want to spend, you know, the rest of my years in recovery. I'd rather just get on and do my— You just got over pneumonia. I just got over pneumonia, yeah. I'm still pretty active in the golf world.

Well, you're a legend, let's just say that.

Well, thank you, thank you. But, you know, it's, you know, I've always believed, look, even in golf, I mean, if you want to get better, it's a holistic approach. And this is one part of the holistic process, which really, I think, I mean, if you if people just realized, you know what, prevention is better than cure, right? I mean, you know, and so this is a great way of, say, getting something before, you know, nipping it in the bud, so to speak.

We also determined what caused your pneumonia.

Yeah.

We are 99.9% sure that that broken rib Which you didn't know you had.

Yeah.

You felt the pain was what caused the pneumonia, not the other way around.

Yeah, that was also an amazing thing to think about too, because I was sketchy. I'm like, how did I catch pneumonia? Because I'm pretty fit. I mean, I work out.

Well, you look fantastic.

And I eat right. I mean, it's like, and I'm thinking, you know what, I think I'm just gonna go to McDonald's and just live at McDonald's, you know, because what's the point if I do all the stuff I do and yet I still get sick? and what have you. But, you know, we, you know, look, that's obviously just joking. But I mean, it's just sad really that, you know, when I look at, obviously heart disease is the biggest killer in the world, right?

Yeah.

I mean, add all the other illnesses and what have you together. And so you just wonder if, you know, how many people could have been saved if they'd actually gone through a process like this. I mean, obviously it's relatively new, but yeah, it's— I mean, this is obviously the wave of the future. You're on the cutting edge of it, so congratulations.

Well, thank you very much. I appreciate you coming down all the way from Tampa. No, no, it's not that far. I'm so happy and excited for you that your future is a lot brighter than you thought it was going to be with respect to surgeries and so on. You're going to have many, many more years of teaching people how to swing properly. That's for sure. And all of you out there are lucky to have him. And we're actually going to be talking in the coming weeks and months about some exciting things we're gonna be doing together.

Yeah, absolutely.

And so, well, thank you for coming out. And those of you who hung in there for the podcast, listen, you know, prevention is power. And we're so— I'm so happy that you came out to see us. And you're going off back to Tampa tonight, you're flying back tonight.

Yep.

Yeah, fantastic. And you're going back with a very different mindset, aren't you?

Very much so, yeah. I mean, you know, it's like a much more positive outlook. And as I say, I've always prided myself on good health. I thought, man, I'm definitely cracking up if I've got to go through all of this. And so, yeah, it's—

Would you recommend this to other people?

Oh, 100%, 100%, yeah. So if you have the opportunity, you know, Clear Cardio is the way to go.

Yeah, well, thank you very much. Appreciate you very much. Cheers. Wow, what an incredible journey today. A huge thank you to David Ledbetter for not only trusting us with his health but for sharing his Clear Cardio experience so openly. And of course, to Dr. John Osborne for guiding us through the science with clarity and his passion. You know, at Clear Cardio, we believe that knowledge is power and prevention You know, whether you're swinging a golf club, chasing your kids around the yard, or just trying to live your best life, your heart deserves the same level of care and attention as the rest of your goals. If today's episode inspired you like it did me, share it with someone you care about, and don't forget to subscribe so you never miss an inside look at how Clear Cardio is redefining the future of heart health.

Thanks, John.

of heart health. This Prevention is Power from our headquarters at Carrollton. I'm J.D. Enright. Stay well, stay proactive, and we'll see you next time.