016 - ER Doctor + Preventive Cardiologist: The Ugly Truth About ‘Sudden’ Heart Attacks | ClearCardio

'Cause we always ask our patients, if something comes up, let us know. We wanna know what's going on. So he checked himself into the emergency room thinking he was having a heart attack. While he was in the ER, I called him. He was in the hospital bed. He was having chest pains. And I said, I'm telling you right now, I've spoken to Dr. Osborne, I've spoken to the team. We've looked, we've personally, I personally looked, you have no blockages. And when I told him that, he started to cry on the phone. What if I told you that 1 in 4 people who show up at the emergency room with a heart attack never make it out alive? And the rest, for the most of them, never saw it coming. You know, in the US alone, over 800,000 people have a heart attack every year. That's 1 every 40 seconds. But here's what's even more shocking. Roughly 200,000 of those are are silent heart attacks. They hit without warning. Nearly 50% of all heart attack deaths occur before the person ever reaches the hospital, and for many, their first symptom is death. Today, we're going behind the scenes from the emergency room to the cardiologist's chair with 2 doctors who are done staying quiet. Joining us, Dr. Kevin White. An emergency room physician who sees firsthand the chaos and loss caused by a system that waits until it's too late. And Dr. John Osborne, a Harvard-trained cardiologist, chief medical officer of Cleer Cardio, a leader in preventive cardiology who's helping people detect heart disease years before symptoms strike. You see, today's conversation is about the ugly truth— why so many cardiologists are still reactive, why prevention isn't standard practice, and how we can flip the system. One scan, one patient, and one life at a time. This is the Power of Prevention podcast, and this episode could literally save your life. So welcome, Dr. White.

Thanks.

How are you?

Thanks for having me. And Dr. Osborne, how are you today?

Fantastic.

Yeah, fantastic.

Absolutely.

What a great— I, I, guys, I have a privilege of sitting here with 2 doctors. Um, one was a former ER doctor who is now— why don't you tell everybody what you're doing now, which is really exciting. I'm really excited to hear what you're doing now.

Yeah, we do a concierge-type practice based on focusing on longevity, healthspan, and lifespan. And you can't really have a conversation on longevity if you don't discuss, you know, the number one killer in men and women. So that's kind of what brought me to you guys.

Heart attacks and strokes.

Yeah.

Yeah. Cardiovascular disease.

What's the name of your practice?

Prime Health Associates.

Prime Health Associates. Where are you guys located?

We're in Edmond, just part of Oklahoma City.

Oklahoma City. Okay. So all of you folks who are tuning in from Oklahoma City, You know where to go and talk to Dr. White here about longevity. And so what does that mean? What is longevity for those who are watching?

It's just about focusing on healthspan and lifespan. And what are those things I'm sure you guys have discussed is that, you know, lifespan is how long you live, but healthspan is really how, how active you are in those years, last 10 years of your life. If you're really, you know, doing what you want to do, if you're, you know, hiking, skiing, doing the things you want to do, or if you're spending time in doctors' offices with chronic disease. So, um, so really—

So not just the quantity, not the, like, the length of your life, but the quality of your life during that time.

Yeah, and I'd say more importantly so, the latter there.

Yeah, yeah, fair enough. Well, that's great. So what are some of the things you do in your practice?

Uh, we focus primarily— cardiovascular disease is the number one thing, uh, but then we look at, uh, neurodegenerative disease, we look at, uh, things contributing to cancer. We do some genomic testing and all that, and we get what we call the fingerprint of the patient.

So, okay, interesting.

And it takes a lot of time, and you get all that, all that data so you can treat them in a more personalized way.

Got it. And you have a lot of patients nowadays? You're doing well on that?

Yeah, yeah, we're doing okay.

Fantastic.

Good.

Yeah, well, we, we are so thankful. Um, I know I'm very thankful that you came all the way from Oklahoma Yeah. To meet with us here in the Prevention is Power podcast.

In IRL, as they say.

IRL.

In real life.

In real life.

Yes, in real life.

Yes, exactly. And so you guys are meeting each other for the first time today?

Yeah, we've talked and et cetera and bonded medically.

You guys have something in common that I don't know.

It's just always great to know that there are other people out there who know, see this world the way you do, and it's very refreshing.

Exactly.

You know, hopefully it'll be down the road everyone, but unfortunately people of our mind are still a rarity, you know, but we're working to change that.

Well, I'm excited for the conversation today, and I'm just gonna sit back in awe, and every once in a while I'm just gonna chime in when I can, but I have some things that we definitely would like to get through today. So with that, we'll go ahead and get started. So, Dr. White, so I understand. So we know what you're doing now. But I also understand that if you saw it during the intro, you used to be an ER doctor. Yes.

Yeah. Yeah, I still am. But I've kind of stepped away from that.

Got it.

The last few years.

Got it. So what was the driving— what was that like being an ER doctor as it relates to cardiovascular disease, heart attacks and strokes? Can you give us a little insight into that?

And we discussed this a little bit before, but yeah, it's all over the place. It's just you don't go in a day without seeing some sort of degree of cardiovascular disease. And the one thing is, as you'll get ready to go on a shift, you just think— later in my career, I would start to think, some guy's out having coffee or some woman is out just hanging out with her kids and her life is going to change probably about 4 or 5 hours. And, and it just happens like that because there's no— they just don't see it coming. So that was a common story that replayed and replayed itself. And then, you know, as I started getting into my 40s, you know, you start seeing people close to your age and there's just some really heartbreaking stories around there. And it just changes the way you think.

Mm-hmm.

It's like we've got to get ahead of this. And, you know, initially it started kind of for me, and then later it developed into what we do now, is, you know, bringing my patients, my, my people along with me to, uh, to try to avoid these things.

So it was really the seed— seeding ground for why you do what you do now, right?

You, you—

if I understand you correctly, you know, you, you went to medical school and decided that you were going to end up, you know, Treating people, you saw, right? You could really do some real positive influence and impact going into the emergency room. Dr. Osborne, our goal is to never have anybody in the future go to the hospital in an emergency situation due to a heart attack or stroke. That is our goal.

There should be no emergencies.

No emergencies.

No emergencies.

According to, yeah, for heart attacks and strokes. So preventive, that's what it's all about, preventive, right? And heart disease is very unique, right? You had said it before, nobody just drops dead of sudden cancer.

Right. There's no such thing as sudden cancer death.

You're like, you know, any kind of sudden death.

But there definitely is sudden cardiac death.

Yeah. And nobody—

Strokes or heart attacks, right? Right. I mean, you're dead.

We talk about colonoscopies all the time, right? The preventive approach to colonoscopy. It's like the most— like, I remember, again, our viewers have heard me say this before, I'll say it again. I remember when I was 30, I turned 30 years old, My father leaned over to me and said, in 20 years, guess what? You're gonna have something up your butt. And I'm like, what are you talking about, Dad? He's like, yes. He goes, you're gonna have a colonoscopy.

Am I gonna be moving?

Yes. And this was, this was, this was 27 years ago. I'm 57 years old. 27 years ago, I was being programmed to get a colonoscopy as a preventive measure to prevent colon cancer. Okay, colon cancer, how many people does it kill a year? Percentage-wise, from a cancer perspective.

Yeah, it's about 2%.

2%, okay.

2 to 3%.

Now, nobody should die of cancer. Everybody should get, you know, their tests and things like that. That's not what I'm saying. But what I am saying is it kills roughly 2% of the population. Heart attack, and nobody dies of sudden colon cancer.

Right.

Or any cancer suddenly. versus what kills half the population on the planet, men and women alike, and does come out of nowhere with no symptoms, drop dead. We have got to be proactive on this. And so it's a perfect segue into what you did previously was exactly what we don't do here at Clear Cardio.

Mm-hmm.

We are not reactive, right? We are proactive. We determine, we define the disease, and then we treat you so you don't end up in the emergency room. But it's really interesting, and it's really interesting to hear your perspective, having been an ER doctor. Like, what are some of the stories that you see?

Yeah, so I gotta ask you, Kevin. So I want you to, if you could, I wanna see the face of this, right?

The personal face.

Was there a particular event, or maybe series of events, that go, there's gotta be a better way?

Yeah. Oh yeah, there's, um, there's a lot of them, as you know. And, and in the traditional side of medicine that's so reactive, it's, you know, and I wanted to go into emergency medicine because I wanted to take care of people on death's door, that kind of thing.

Yeah.

I wanted to do something, and I was, you know, chose, you know, you choose these specialties when you're young and energetic and everything, and then, you know, I kind of changed my thinking. So one of the things that came about, there was a guy who was, you could tell he was just out on a jog in the afternoon on a Saturday, and the thing that struck me was he was a week to the day older than I was.

How old were you at the time?

I was like 43.

So this guy's young.

Yeah.

Yeah.

It's always scary when you see the date of birth and go, ooh.

Oh yeah, yeah.

That's me.

Same year and everything, and it was the month, so kind of, I don't know. But so he was out running, and you could tell he was probably just a guy trying to get in shape, and he He wasn't, you know, morbidly obese or anything, and he just—

A little dad bod, maybe?

Maybe, yeah, a little bit of that. And he just went down, and he came in, he was having a cardiac event, and he was unconscious, and we were just, you know, he was, you know, we just ran the whole code. He was in, he was in V-fib, and then he was in asystole, and you play around with all these things, and you just try to You know, we have a great team. Everybody's doing exactly what they should.

Triage-ing and they're—

Oh yeah, it's all the—

Paddling and they're injecting and all of that stuff, yeah.

Yeah, it's all the things you see on TV, you know, and, and then it just came to a point there was nothing more we could do. We just couldn't get any perfusion back.

So he flatlined?

Yeah, so he was— and, and we had to declare him dead, right? Just a really sad deal.

Wow.

And he didn't have any ID on him, so—

Oh wow.

So we had his phone, And back then, you know, they didn't have the face. It was just, you know, his finger went on it and it, and it popped on his iPhone.

So you had to take his dead hand?

Yeah.

Oh, wow. And use his cold thumb to open up his phone.

Right. Wow.

Wow.

And it showed his picture of his, you know, beautiful wife and 2 beautiful young blonde girls. And the whole room just kind of went, you know, down. And now you think, okay, now I have to go talk to these people. And, you know, their life's gonna change right now, and you have to present that in such a way that— and it's just one of those stories. They were probably hanging out and having breakfast and doing whatever, and then—

I'll be back shortly.

Yeah, and that's it.

Wow.

And it was weird. I thought about that whole week afterwards because he was a week younger than me— or older than me— and I thought, what if this is my last week? And I kind of— you know how you just get going in your head?

The Twilight Zone episode, right?

Spiral down the rabbit hole. I've been there.

Yeah, but it was just a sad deal. It just really put a face on it, and there's stories like that all over.

So it shows you the ER is the last stop. It's not the first line of defense. It's the last resort, right? Ideally, you need to be doing something proactively.

Yeah.

And so that was the genesis. We've had a lot of stories like this, John.

Yeah.

We had a We have a new patient coming in, I think Friday. Very well-known man in the sports world who was just going to Puerto Vallarta. A friend of his has a clinic down there. American man has a clinic down there, a friend of his, and said, come on down, we're gonna do some stem cell injections. I guess you can do it down there. I don't know if you can do it here. I don't know that business, but But he was down there and he just said, hey, you know, you have a CT machine, let me do a CT machine. And they did. He did a CT machine, and before you know it, he was rushed into a hospital in Mexico to have a heart cath, and he ended up having, what, 2 stents put in?

Yeah.

We found this out after the fact, and he was introduced to us through a good friend of mine. Who's also a well-known athlete for many, many years, championship guy, who called me immediately and said, JD, this is my good friend, so-and-so. You need to talk to him right away, because he went down there to get some stem cells and some IVs, you know, and he's got heart catheterizations and stents. How does that happen? Like, how do we allow that to happen? And so he's coming up on Friday, but— You know, it's just insane what's going on out there right now. And so, you know, having your perspective from an emergency room, an ER perspective, you know, you're on the front lines.

Yeah.

You know, so, you know, you're seeing these stories every day of tragedies, and you started to think what? These could be avoided. There's a better way of doing this.

Oh yeah. Uh, like for instance, this guy's disease started when he was probably in his late 20s.

I mean, there's been teenager.

There's some book around there where they took autopsy, right? And they They found, I mean, kids who died from other diseases in their early 20s. You might know this.

Well, yeah, so yeah, these are studies. So what they did is they took kids, right, who died in Korea and Vietnam, right? Average age was like 18, 19.

Oh, wow.

Right, and then they did autopsies on them.

Wow.

Specifically look at the heart and coronary arteries and all that.

Yeah.

Yeah, about 85% had plaque.

No kidding.

Yeah.

Wow.

Yeah.

I was not aware of that. I know that it takes years, it's like a glacial process, but getting it early enough, we always talk about prevention is power.

Yes, I didn't realize that early. So 85% had evidence of plaque in their coronary arteries at 18 and 19. So the disease had already started.

Yeah, okay. So, wow, so you get these people, they're being rushed in, you're in the emergency room, you're on shift, They're having an event or they're having symptoms, right? So what is the typical process? Walk us through the typical process of today's medicine on cardiovascular events.

Well, so if you're talking about an acute MI or an acute event—

For those of us who don't know that, what's an MI?

It's a— well, we've got a cardiologist in the room, but I will play a cardiologist.

Well, everybody who's watching the podcast who's not a cardiologist.

This is not a quiz.

Is that a myocardial infraction?

It's infarction, so.

Infarction, guys. It's an infarction.

Infraction is like a parking ticket.

Sounds like a swear word. Go infarct yourself.

But infarction, yeah, myocardial infarction. Okay, that's a fancy 10-cent word.

Yes, okay.

So the bottom line is you're not getting blood flow to a particular part of the heart, so you're losing, you know, you're getting necrosis of muscle essentially, because you're not oxygenating that piece of the muscle, right?

Ischemia?

Yeah, ischemia.

Okay, ischemia.

Okay, I understand that. So, you know, hospital prides itself, and they should, And I'm not disparaging any of that, because cardiologists, we know great cardiologists, cardiovascular surgeons doing a fantastic job, and this will always be needed, but pride themselves in door-to-balloon time, or door-to— that's really important. Time is muscle.

So what happens?

So you need to have the EKG before they get there, or whenever they arrive. They're not comfortable, they're not happy, A lot of times they're having symptoms, sometimes they're not. Sometimes I've seen a woman who just had nausea and I just did an EKG and she had an anterior STEMI. I mean, it can be tricky. Not everyone follows the rules.

Yeah, so a lot of people, you think of the classical clutching your chest and pressure, burning, ache, whatever, radiating to my neck, back, shoulders, shortness of breath, whatever. Some people, particularly women, just, they feel nauseated, or flu-like symptoms, or just fatigue, and they can be having a massive heart attack.

No way.

And so the problem is that because they're not really diagnosed up front, maybe no one did an EKG, and then really bad things happen. So, you know, be careful, 'cause, you know, there's the classic Hollywood heart attack, right? That's, yeah, right, that's maybe 50% of the time. The other times, it's a whole different, can be a whole different set of symptoms, or no symptoms.

Wow.

Right.

Wow, so how does an EKG tell you if you're having a heart attack?

Oh, that can be tricky as well, 'cause not everyone follows the rules.

Right, right. Yeah, you know, EKGs can be helpful, right? What gets me is a lot of times you go to the doctor, for whatever reason, they'll do an EKG.

Mm-hmm.

The value of that is pretty limited. Now, in the setting of someone having symptoms that could be suspicious for a heart attack, then it could be helpful, but just also appreciate, you could have a completely normal EKG and still have a heart attack. Conversely, and I see these people, particularly in the outpatient world, you could have a really funky-looking EKG, and your vessels be perfectly normal. So it is a tool, it's quick, it's simple, it's relatively inexpensive, et cetera, but don't take it to the bank, right?

Yeah.

'Cause it could either be a false negative where you are having a heart attack and it'd be normal, right? And then drive you to the wrong decision, you're fine, see you later, or it can also work the other way where it can look really abnormal and funky and you're worried they're having a heart attack, and then sometimes those people even go to the cath lab, and then we're putting catheters in their heart or tubes in their heart and injecting dye and all this invasive stuff, and then find out you're fine.

Yeah.

Yeah.

So it's just a piece of the puzzle.

It's a piece of the puzzle. And then there's other tests we do to help confirm whether this is going on, depending upon, you know, that, that, you know, you, you're familiar with, like troponin levels and things like that, which, you know, if, if you have symptoms and you have an EKG that looks like this is a heart attack, Then, nowadays, a lot of times, I'm sure it is up in Oak City and Edmond, that they would do a 12-lead EKG in the ambulance, so you'd already have a heads up. Okay, this is a, we call it STEMI, that's an ST-segment elevation MI, but that's the real deal MI, right?

Yeah.

Which is actually a pretty small number of MIs, but that's the real deal, and those patients need to go right to the cath lab immediately. A lot of times, they don't even hit the ER, they go immediately to the cath lab, so that we can open that vessel up, Because otherwise, that heart muscle is dying.

It's dying because of lack of oxygen.

Exactly. So a lot of times, sometimes, depending on the scenarios and all that, we may make that diagnosis in the ambulance, and then they get directly headed to the cath lab.

So how long do you have? I mean, on average, I know everybody's physiology is different, but from the time you have, like, 'cause you could have a heart attack for, like, I've read stories, and we've heard conversations and had conversations, with people about— they were having a heart attack for like a day and a half. They didn't even know it.

Sure, absolutely.

Like they felt nauseous, dizzy, whatever, they laid down, they wake up, whatever, and then they go to the hospital. So obviously they're still getting enough blood to keep things flowing, but then it gets to the point where it isn't, and then they end up in the emergency room, right? How long before that there's no blood going into— Where they're going to— and they have the catheterization, the relief of the— open up the artery and all that before they start to see real permanent damage to their heart?

It's extremely variable, right? Because you could have just one vessel that goes down, right, and have pretty normal blood flow one moment, and the next moment you rupture a plaque, those lipid-rich soft plaques, and then form a blood clot so that you go from a pretty good Channel, hole, to having a blood clot in seconds and minutes. So that can occur very, very quickly, and heart muscle will begin to die within minutes after losing blood flow.

Mm-hmm.

So that's why the clock really starts, and that's why we pride— hospitals pride themselves on the door-to-balloon, naturally, door-to-stent time. Initially, that was 90 minutes, right? But a lot of hospitals these days, I mean, can be 20 minutes. I mean, it could be really remarkably fast. Yeah.

Which means you get there on time. You're lucky enough.

If the symptoms are recognized, if they're directed and shunted to the right place. Now, you can also have, particularly in older people, people with lots of disease, they've had this slow, progressive narrowing of the vessels, right? has time to adapt to sort of reshift the blood flow, right? So take it from areas that don't have blockages and put it in the areas that it is, in which case, those patients certainly can have heart attacks too, but those are the ones that the EKGs may be, eh, not pointing in the right direction, equivocal, or whatever. So they're harder to make the diagnosis, right?

Mm-hmm.

'Cause again, you could have a normal EKG and have a heart attack, and then have an abnormal EKG and be perfectly fine. So it's hard. Another tool we use, particularly if we're not having what we call a STEMI, that's 100% absolute heart attack, get to the cath lab. These things called non— the opposite of that is a non-STEMI, a non-ST-segment elevation MI. Those people might have symptoms, might be a little, maybe, could be, possibly. EKGs are kind of, eh, don't know. And so there, we sort of have to— we have them in the ER, and then we get some blood tests done. And so you could talk about the blood tests.

Oh yeah, well, the easy ones are the STEMIs, because you know they're—

Definitively they're having a heart attack.

Yeah, there's no question, everybody's in agreement, we're moving along, but the non-STEMIs, these funny people who aren't quite following the rules, those can be the scary ones.

Help me understand what a STEMI is. Define it.

So STEMI stands for ST-segment elevation MI, which is the pattern that we see on the EKG.

Okay.

Which different, you know, jiggles and stuff like that, but that's a STEMI.

So guys, that's what a STEMI is. I still don't know what it is, but it sounds good.

When you see it, it's like, got it. Boom, done. We know where you're going. End of story.

So if you end up in the ER, guys, and you hear one of the ER doctors say, you've got a STEMI, you've got a heart attack.

Nowadays, STEMIs are a lot rarer than they were.

Okay.

Most of the heart attacks that occur these days, where it's still heart damage, you're still losing heart cells, and they're dying off and all that, are really non-STEMIs. So because of that, STEMI's pretty easy to diagnose. Now, STEMI is much more likely to kill you up front. So remember, the EKGs showing a STEMI are people who've lived for the ambulance people to arrive.

Got it.

Right?

Fair enough.

Yeah, 'cause that STEMI may have started, and they died, and the next person was the, Yeah. Coroner, not the ambulance, right? But if the system works well and promptly, you see the STEMI, they go right to the emergency room. Easy peasy, done, right?

Yeah.

Non-STEMIs can be a lot, lot more variable. Symptoms, finding on the EKGs, sometimes we have to then just sort of say, well, I'm suspicious, I can't clear you, you're having some symptoms, EKG looks a little funky, That's the technical term. In which case, we're gonna sit on you here a little bit and kind of see where things go. And so we use some blood tests, which are highly sensitive and highly, what we call, use the term specific. There's some proteins, enzymes technically, that are only given off, only present and only given off from heart-damaged heart muscle. So if you see any of these, even very low levels, that tells you, hey, this is a heart issue. It's not heartburn, it's not a gallbladder issue, or any number of— It's not angina. Any number of other different kinds of things can cause chest pain, but these troponin markers, or as we call them, troponins, are very, very helpful. If it's not clear upon the outset with symptoms or EKGs, we basically then do some monitoring of these blood tests over the next few hours.

Got it.

That say, oh, okay, if they're negative, that makes you feel better. Wasn't a heart attack. It could be something else. Although, it still doesn't mean it's not the heart, right? Because you could have a narrowing and cause symptoms, but if no muscles die, your troponin levels would be fine.

Yeah.

Right? So it's a tricky business, as Dr. Kevin can elucidate.

So what I'm hearing is, is that they're in the ER, you guys are treating the symptoms of years of disease buildup.

Sure.

It took years for those men and women to get to the point where now, from a cardiovascular perspective, they're in trouble and they're coming to see you. Yeah, and you're having to deal with that. And oftentimes, I'm hearing, a good percentage of the time, they don't survive it.

Sure.

Even though they survived to the ER, they're not necessarily surviving the heart attack. And when they are, there's interventional things going on there.

Right. And yeah, we're seeing the really— if you want to think of that cancer analogy, we're seeing just stage 4 cancer that went through stage 1 or precancer that went through stage 1, stage 2, stage 3, no symptoms, No one was aware of it.

Yeah.

And then we're only being signaled when it's kind of the stage 4 equivalent of it, right? And you know it's been there a long, long time.

So—

Yeah. So, you know, what are some of the, um, early warning signs for those people who, um, who are watching the show, the podcast? What are some of the early warning signs that they should be looking out for, either on them, in themselves Or in their loved ones, family members, friends, whatever. We've had conversations about guys being out on the golf course with their buddies and all of a sudden their buddy's not doing so well. What are some of those things that— I'd like to hear from both of you. You, from having been in the ER, having seen the triage and what's going on there, and you from just a preventive cardiology perspective and the physiology side of things. what you see, what you've heard in the past. So if we could start with you, if you don't mind.

Sure. Yeah, you know, it really is all over the map. It can be nausea, shortness of breath. It can, it can be chest pain or just kind of weakness. So everyone's, everyone's a special snowflake here. And but primarily, I would say just dyspnea on exertion. You try to get up and walk from point A to point B and you feel Like you just don't have the energy anymore. You might have some chest pain, sure, or you might have some shortness of breath, but you just have that general fatigue and weakness. That could be something that doesn't want to— you don't want to overlook.

Like I'm just feeling really— like I normally feel pretty good, out of nowhere and all of a sudden you just start to feel like, I just don't have any energy. It's not because you've stayed up all night or whatever. You just don't have the energy and you're labored and that kind of thing. Yeah.

Or one thing, as you're interviewing the patient, getting the history, they say, well, yeah, I could mow the lawn 3 months ago fine, but over the last several weeks, I mean, doing it, I'm just dying. I'm short of breath, right? Whether or not they have chest pain, but just what I could do 3 months ago, I can't do now. And that says something concerning is going on.

Yeah, it's not just allergies.

Right.

I mean, it could be, but it's most likely something else.

The sad thing is there's a lot of people minimize, you know, especially guys will minimize their stuff.

Oh God, I'm so bad at that.

I mean, I had to go in and tell one lady that her husband had died who we coded, you know, it was a sad deal, and she was— he was just up all night with nausea, and she said that, you know, I just thought it was the baked beans I made. I made him baked beans for dinner.

Oh yeah, didn't sit right with him.

Yeah, so it was just kind of minimized, and then by that time, by we saw him, Time had passed, a lot of ischemia, a lot of dead muscle tissue of the heart.

And it just wasn't recoverable.

No, no, it was just a sad deal.

So he had been suffering all night from this, from this nausea, thought it was the baked beans from his wife.

Yeah.

And then he decided that it wasn't that, and that's what brought him to the ER?

Like, oh, it just gone on and on, and then he became unresponsive in the morning. So he came down.

Oh, so he actually had a massive heart attack in the middle of the night and he was unresponsive in the morning. And was he DOA?

No.

So he was still alive.

Correct.

But unresponsive, unconscious.

Yeah.

Into the ER. And then you guys did what you could and that didn't— nothing worked.

No.

And eventually he just passed.

Wow. Yeah.

And that's not rare, I guess.

No.

Yeah, wow.

No.

But the flip side of this is, right, and Kevin is very aware of this, the flip side of that is, right, you want to diagnose these people, take care of them, hopefully get them to cath lab or whatever, and sometimes these symptoms have been dragging on for weeks or months, and finally they show up. But the flip side of that, 90% of the time, people come in worried, are having symptoms, or chest pain, or worried they're having a heart attack, maybe a stroke, and they're perfectly fine.

Yeah, that's true. So you've got to weed through all that stuff.

So there's a massive amount of weeding through the wheat and the chaff, right?

Yeah, we actually had a patient—

And that becomes— I mean, it's a massive cost. It's kind of a pain in the butt for everybody. And we don't want to miss anyone. On the other hand, odds are that patient, quote, with chest pain, just walking in the door, 90% chance, right, knowing nothing else about them, 90% chance it won't be heart-related. And that's a massive, you know, cost, hassle, time for the patient, you know. So, uh, that also is a major, uh, just, uh, medical issue too, right?

Yeah.

So the more you know, if you got it, you got it, and if you don't, you don't, right?

So that I'll tell you, it's scary, because the more I'm listening to you, the 2 doctors here, the more difficult it is for me to really— just me personally thinking about my own selfishness. If I have a symptom or something— we had a patient, for example, like, what do I— like, is it a heart attack? Is it stress? Is it— did I push too much weight and I maybe tore a muscle or stressed my neck or— Or is it anxiety? 'Cause people have anxiety and that creates heart palpitations and all kinds of crazy stuff that goes out there, right? We had a patient this past weekend who we were communicating with very actively, who was being proactive about their heart health, who checked themselves into the emergency room. This is a really important thing to discuss. I'm really glad I remembered to bring this up. This gentleman, he's in his 50s, mid-50s, and was concerned, had a family history of heart disease, siblings, parents, and such, and then came to see us proactively, and we took him— through the process. We hadn't yet given him his results yet, 'cause he was brand new, like brand new patient.

Mm-hmm.

And didn't have time to sit with us the same day to get through the— we were still waiting for some blood work. But literally like 48 hours after we had initially met him, he reached out to us, 'cause we always ask our patients, if something comes up, let us know. We wanna know what's going on. So he checked himself into the emergency room thinking he was having a heart attack. He was having chest pains, and they got worse over a 24-hour period. Checked himself into the emergency room. They kept him for 2 days in the emergency room. They did EKGs, an echocardiogram. They did blood work. They did a number of other things in the ER, and while he was in the ER, he was communicating. I called him and reached out to him. I had reached out to you, Dr. Osborne, if you recall.

Mm-hmm.

This is just a couple of days ago, over Easter weekend, and he was scared. He was really scared that he was having a heart attack, and they couldn't weed it out. For some reason, they couldn't tell him he wasn't having a heart attack. And so he was— and I said, please, whatever you do, before— you know, obviously you've got to trust the doctors, emergency room, whatever, but reach out to Dr. Osborne if they decide they're going to rush you to a cath lab for whatever reason. let us know so that Dr. Osborne can be involved. And so I said, in the meantime, I'm going to talk to Dr. Osborne and to Kenton, one of our associates, patient coordinators, and I'm gonna get your results and we're gonna take a look at your results right now. 'Cause we looked under the hood, we did the CT, we did the blood work, we did the AI analysis.

Mm-hmm.

And it turns out that He was in the clear.

There was nothing there.

There was nothing there. He had no blockages. We had the proof. We could show, and so I call him up. He was in the hospital bed, in the ICU, getting ready to have another thing, and I said, I'm telling you right now, right? I've spoken to Dr. Osborne. I've spoken to the team. We've looked. I personally looked. You have no blockages. You have very little plaque. I think he had something like—

Oh, trivial.

Trivial.

I mean, stuff, stuff you couldn't even see by eye.

Yes.

Right?

The AI could pick it up.

Only the AI could see it.

But by eye—

So we knew he wasn't having a heart attack associated with plaque rupture, blockages, any of that stuff. And when I told him that, he started to cry on the phone. And he said— and I'm getting emotional just thinking about it. Um, because I imagine myself in his position, right? Many of you who are watching the podcast are empathetic people.

He could have been that 43-year-old guy.

Yes, right? Could have been that 43-year-old guy that wasn't that lucky. Um, so I was able to— immediately he went, oh, I could hear him go, oh, and he started to cry on the phone. And he's like, I'm so thankful for that information. If he hadn't done that, who knows what road he would have gone down, right? Maybe In the prior podcast we did earlier today with Mark Cozart, where he was perfectly fine, wasn't showing any symptoms, didn't check himself into the emergency room at all.

The opposite.

Right? And within 90 days, they were telling him— he was just going for a regular checkup— they're telling him he has major bypass surgery requirements, and they're going to cut open his chest and all of that stuff. And he was lucky enough to find us. And we found out he didn't need any of that stuff. We have a number of stories like that. David Leadbetter, championship golf coach, same issue with him. We prevented him from having a major double bypass surgery.

Open heart surgery.

Open heart surgery, valve replacement, because we were able to look under the hood. So because I was able to— he was fortunate enough, this patient over the weekend, to have seen us prior to these issues.

Yeah.

It turns out that he had overexerted himself. He was having some anxiety for not knowing, 'cause he didn't have the results yet back, and he had been long-term thinking about his genetic history, his life, and I think I'm having a heart attack. He was convinced he was having a heart attack.

Sure.

We were able to show him, you're not having a heart attack associated with this. Now, could be AFib or something else associated with it, we don't know, right?

But—

So I gotta tell Kevin this. I don't know if you've ever heard this, right? This is what I tell people, and this is something that only dawned on me, I mean, 10 years ago, right? I'm 30 years into this now. And I realized one day, we talk about chest pain, which is critical, right? There's chest pain can kill you and chest pain that's a hassle. Most of it is a hassle, as it turns out. But as it turns out, this is what I tell people when we talk about chest pain. I tell them it's actually really, really simple because there's only 2 kinds of chest pain. That's it. Just 2 kinds of chest pain. The stuff that can kill you. and everything else, right? And I'm gonna tell you, and this is why I love cardiac CT, right? Cardiac CT can find the plaque that could be coronary artery disease, blockages that can cause heart attacks. It can find pericarditis, 'cause that can cause chest pain. It's not related to blood vessels, but another kind of chest pain that could even be fatal. It can find aortic aneurysms, where your aorta splits open, rips open, never a good thing. Mortality's about 10% per hour if that happens, but we can see that. even more, even better perhaps, is we can see aneurysms that have not ruptured, and we can find all that data. We can even see pulmonary embolisms, things that, blood clots that go to the lungs. All of those things cause chest pain, and all of those need to be diagnosed very quickly and taken care of very rapidly. And all of that is figured out with cardiac CT.

Hmm.

And if I do not see it, if I do not see one of those things on cardiac CT, Guess what? Whatever your chest pain is, and there's a very long list of things that can cause chest pain and mimic heart disease, whatever that chest pain is, we've now taken it from the lethal, life-threatening, into the annoying but benign category. 100%, zeros and ones, binary.

And that peace of mind is invaluable.

I sleep better. Forget my patients, I sleep better, 'cause I know, right? Done. You know, and you've seen people come in with chest pain, they get admitted, you know, whatever, and then they stick around for a couple days, and, you know, that electric meter is running, and the bill is doing this, and then they get stress tests, and, you know, sometimes the stress test looks funky, and then they go to the cath lab, and they find out they're fine after a couple of days and $70,000, and it's just crazy.

The meter is running.

Yeah, the meter is—

Right?

Cardiac CT, it's all clarity.

Yeah.

It's a beautiful thing.

It is a beautiful thing. Yeah, it just goes to show you how important prevention is, you know.

And just knowing.

Yeah.

You've got a problem, no problem, we take care of it.

Yeah, exactly. I mean, you spent your— a good portion— how long were you in the ER area?

Uh, 23 years, 24 years.

So you were in the ER for 23 years?

I mean, I think in 2000, and then we moved, got out of residency in '04, and been there ever since.

Wow.

That was one shift?

It's just one long shift, 23 years long.

Yeah, he got out for good behavior.

Yes, he's actually only 23 years old. He's been there his whole life, born into it.

That's right, that's right.

So, wow. Yeah, and I'll give— I just rough Not perfect, but rough estimate on during that incredible 23-year stint in the ER, how many of those are really, in your opinion, cardiovascular stroke-related, heart attack stroke stuff?

Well, like you said, the majority of people coming in don't have disease, so you're kind of filled up with a bunch of— there's that degree of nonsense that comes in that, I mean, people, they think something is going on and You know, not to discredit that. So a lot of it is giving them peace of mind whenever you weed through all that stuff. So, um, so that's important. I'm not— um, so I mean, a huge amount though. I mean, that's where—

Thousands and thousands.

Yeah.

I mean, of the deaths, I guess deaths, serious events, like, like you get gunshots, you get car crashes, you get, you know, DUIs, you get, you know, all of that stuff. But, you know, would you say like how many— a large portion of it is heart attack and stroke-related?

Of the deaths that occurred.

Of the deaths, yeah.

Yeah.

Wow. So we don't want that to happen. We want to have you who are, people watching the podcast today, we don't want you in the emergency room and having to go through that process at all. And so you decided, I'm done with that.

Yeah, and then whenever we started the practice getting into focusing on proactive care, and then I came across CLEARLY, I don't even know how I came across it, but then we started, Using it, and I talked to the Clearly guys, and I said, I want to speak to a cardiologist that's not on your payroll that I can just visit with. And he knew, he just rattled off your name right off the bat. He's like, he'll talk to you, just talk to him. Because I think we're doing this all wrong. We're just doing these markers that aren't really directed, and we're looking—

Stress tests, calcium scores, running up and down, blood tests, things like that.

Yeah, by proxy is how we're doing it. I just— so it's been a great addition to our practice. And then I looked at one you were doing on a podcast, and I think— I mean, we're using something like a Porsche, but you're using like a spaceship because how you were—

We're very, very fortunate. Yeah, we don't know what— access to some phenomenal equipment.

And we only use the best here at Clear Cardio.

Well, you said like virtual autopsies, and I thought, what do you— I mean, I know what you're saying, but then I saw the images and I was like, oh, It really is.

I mean, it's, you know, as I mentioned before, it is the test. Forget stress testing, even heart cath, right? Because remember, even on a heart cath, right, you could have a normal heart cath, but still have a lot of plaque in the doughnut, right, in the wall of the vessel.

That's funny. We had people, we had a case, a guy in room 21 died. He had a normal cath like 3 months prior. Same kind of thing. Because they still have the plaque, Just because they— and probably soft plaque in retrospect.

Oh, absolutely, right? It was all out here, impossible to see. There's only way you can see it is with either cardiac CT, and particularly with AI to really enhance your vision, basically, or an autopsy. And most people choose cardiac CT when given the choice.

Yeah, autopsy, or some people say, well, you know, 'cause we don't take insurance, 'cause we're— unfortunately, insurance company doesn't, they're not proactive, they're not preventative, They they they literally they're pay for services, so they you have to have a heart attack or stroke, and assuming you survive the heart attack or stroke, then they'll pay for our heart cath or bypass surgery or whatever. Or you know, assuming you don't have a a large deductible like most of us do, right? When you end up paying a fortune out of your own going into debt, even though you have an insurance company supporting you, right? So we don't do that because they don't see us as being. You know, the proactive. They're not there yet. They're gonna get there. They will get there. I promise you they're gonna get there, but they're not there yet.

We call it the clear cardio or the casket.

Yeah, yeah, so when they say, hey, you know, we have to pay for this. Yes, you have to pay for this, but guess what? The cost of our entire process, our system, of all the analysis, the disease detection and the treatment, is about the same cost as a casket. So you could choose. You could actually—

That doesn't include the burial or the flowers.

Or the flowers.

We're just talking the casket.

And suffering and all that stuff, right?

All those things too.

Exactly, or the headstone, or the plot, which is another $20,000.

I know, we're a great deal.

So we're just the cost of the castle.

And I'm gonna say too, I gotta say this, that being the preventative guy, I do not cath people. I stopped that 20 years ago when I found cardiac CT, and I don't stand, and I don't do cardiac surgery. The people we see, like Mark, right? I don't have a foot on the interventional side, on the stenting or surgery side, right? So if you need stents or surgery, I will send you to colleagues of mine that are really, really good at doing that.

The best in the world at it, yeah.

But I don't get paid more, and I don't make money, and my organization, right, 'cause most cardiologists are part Employed by hospitals. I don't get paid more to have you have stents, balloons, or surgery, right?

There's no conflict of interest with us.

So I have no conflict of interest, which is really the place I like to be.

Yeah, that's right.

If you need it, I will make sure you see the best in the world. But if you don't need it, you don't need it. So I'm really just advocating for our patients, which is a wonderful place to be as a doc.

Yeah, and it sounds like you're the same way. It sounds like in your practice in Oklahoma, Um, you know, you've, you've come full circle. You're like, listen, I don't want to see people dying, dropping dead all the time, right? After 23 years of seeing, you know, most deaths caused by heart attack and strokes. By that time, by the time they're seeing you, that disease has progressed for decades and decades, right? All preventative, by the way. All preventable.

Mm-hmm.

And we know that now.

Mm-hmm.

And reversible. But it's often too late by the time— and you're saying, no more of that. I want to go and start being Productive, proactive, and preventative, which makes you, just like Dr. Osborne and us at Clear Cardio, collectively pretty rare birds in the world. Yeah.

Well, I love it, 'cause we're both dedicated to early detection. Ultimately, that translates to the prevention of, by far, the number one killer in the US and globally. And whoever is out there that gets and understands is proactive in prevention. I mean, I, you know, it just— that's— I love it. It's just great. It's fantastic. It's the way it should be.

It's very rare that we get a chance to speak to other cardiologists, and I know they're out there, but again, they're like hen's teeth.

Well, and I'm going to say, as a preventative cardiologist, right, I mean, most of this is brain. You know, I'm not twirling catheters or slicing things up and suturing them and all that. So it's really just, you know, knowledge, experience, training, all that stuff. And I love to say that a preventive cardiologist, you know, they got anyone else who's not, quote, trained as cardiologist. Well, guess what? You got the same pen and the same prescription pad I do, right? So I think it's wonderful to see the democratization of prevention because frankly, if you got access to cardiac CT and AI, Mm-hmm. Right? And you can figure out what's going on with that, and you can write the rosuvastatin, the aspirin, or whatever might be appropriate for them. Yahoo, right? I mean, I want to put— I'm sorry, my colleagues, but I want to put interventional colleagues and cardiac surgeons out of business. I'm sorry.

Yeah, and it can be done with preventive. And it's a conflict of interest.

So I love meeting other preventive cardiologists. There aren't many of us doing it.

Well, he's not a cardiologist. He's a general doctor, yeah. He can be.

He is, whether he knows it or not.

Right, exactly, yeah.

If you're using clearly cardiac CT and all that, he is a preventive cardiologist, right?

It is like—

So welcome to the club.

Yes, welcome to the club. Well, thank you.

Good to have you.

Yeah, it's great to be here. But I was driving here and I thought, it's like driving without any gauges on the car. I'm sure you've heard that analogy. It's like if we changed our oil whenever we saw it smoking a bit, that would not be a good thing. So yeah, I did not know how many of you had your cheeses up.

Sounds like my daughter, by the way.

That's what my daughter does.

She just runs the car out of gas, no oil, whatever. We have to remind her, otherwise she'll just, why is the car seized up? Well, because you haven't put oil in it in like 7 years.

Yeah, hopefully it runs.

Yeah, exactly.

But, uh, yeah, I actually had my ClearLee 3 weeks ago.

Oh yeah?

Yeah.

Good.

It was quite an easy experience.

Good.

No big deal.

Awesome. How was it? Good? Was it— were the results good? Like what you see or not?

Uh, yeah, it was weird. I thought it was a mistake. But I have zero of anything.

Wow, congratulations.

So I was— I don't know if you heard earlier, but, uh, and this is actually also talking to the Cleerly people who have access to hundreds of thousands of these exams. As it turns out, 1% are zero.

Really?

Which tells you that is the penetrance of atherosclerosis, of plaque, In our society.

99%.

99% of us who are getting Clearlys will have plaque, whether a little bit or a lot. 1% have no evidence of plaque by Clearly. So God bless you, you're going to live forever. No, you're going to die of cancer because you can't live forever, but it won't be heart disease, right? The other flip side of that is, so only 1%, so you're in the— if you took the SAT, you're in the 99th percentile.

Yeah.

Right? The flip side of that is, again, in asymptomatic people, no symptoms, I feel fine, normal stress test last week, I love to say, a third of our patients, and this is true clearly nationally, a third of our patients will have stage 3 atherosclerosis.

I believe it, yeah.

Yeah.

That's remarkable.

I feel fine, no symptoms, I feel fine.

Yeah.

Normal stress test, right?

Exactly.

So it's those 2 statistics, I think, are really kind of mind-blowing when you think of it.

Yeah. Wow. So how would you— so what would you say to our, to our listeners today, the people that are watching the podcast or listening to the podcast? Um, what would you say to them about, you know, the proactive— being proactive in their cardiovascular health?

Um, it's really a no-brainer. I mean, it's, it's— I mean, The stories go on and on and on. We've all known somebody who died well before their time, and it's just something that can be taken off the table, and it's not hard to do. It just takes a little bit of time. We pay more attention to our cars than we do, you know, our cardiovascular health until it's too late. So, so it just needs to get done. It's so easy. I mean, I did it myself, and it was—

Yeah.

It's like, and if it comes out totally great and negative, it really gives you some real peace of mind. And if not, you can do something about it, like with that—

It's treatable.

Staging process, you know, 0, 1, 2, 3, and the action plans and everything laid out really well there. And then you follow it and everything. So it's actionable.

And if we do find plaque, guess what? 99% chance we will, right? The wonderful thing is, We're in the situation right now, as it stands right now, we have an incredible array of proven therapies that can stop and reverse plaque. And the stuff that's in the pipeline is mind-blowing. Maybe we'll have a whole segment on what's in the pipeline.

We should. We should do a podcast on that, yeah. It's amazing.

But the great thing is, if you don't have it, yahoo, that's phenomenal, that's great. But if you have it, it's completely actionable, right? We're gonna basically save your life from the disease that kills about 44% of everybody else.

Yeah.

You know, and the other thing is we found that by doing this and reviewing it with the patient, they are more likely to eat right, exercise, lose weight, take their medications, you know, do all those important things that treat plaque than people where you go, well, your cholesterol's high, here's a pill.

Yeah.

You're gonna go, yeah, well, whatever, and I'm paying for money, I got a side effect, what am I taking it for? You have no idea.

Yeah.

But when you show someone and review the images with them and say, you got plaque, guess what? You got their attention.

They've got their why right there.

Absolutely. There's the why, which is— I mean, that's a really important part of the therapeutic process is saying, yes, you have the issue. Not maybe, could be, possibly, statistically, you're at risk. In fact, I hate risk. Risk means I don't know. I like knowing you're either okay or you're not.

Yeah, the binary approach.

Binary.

Yeah, it's either you do or you don't. And then, and if you do— if you don't, great, keep doing what you're doing, right? And then it just becomes about, you know, quality at that point. And if you do, okay, okay, let's understand it. Let's— and then let's resolve it. And that's why I think what you're doing out in Oklahoma With, um, really it's quality of life, not just quantity, quality of life, um, as well is, you know, folks like us at Clear Cardio, we're in, you know, detecting the disease similar to what you're doing, uh, and then we're treating the disease so that, you know, practices like yourself who then take it to the next level and say, okay, we're, you know, Clear Cardio and, and Dr. Osborne, those folks, um, we've identified the disease, we're treating the disease. We're gonna make sure they never have a heart attack or stroke and that they don't die from that. But then, you know, where you pick up from there as well is, now let's really make those years wonderful. Let's make that skin better. Let's make your physiology better, the muscles stronger. Let's give you this new lease on life. Let's get that weight down. Let's do all of those things that are necessary.

Mm-hmm.

And so it's a nice relationship. And really, that's a great segue into an announcement we'd like to make here at Clear Cardio. So Clear Cardio and its team here, along with Dr. Osborne, we are announcing an affiliate program. So we are reaching out to— we've gotten to the point where we've been so successful. It's a good thing. Uh, here in Texas, uh, in, in our location in Carrollton, um, that, uh, it's time to expand and time to grow. And so we're reaching out to those of you who are watching this who are, are cardiologists, uh, regardless of your interventional or claim yourself as a Yeah. uh, preventional cardiologist, uh, or if you're just a general MD doctor who wants to be involved like yourself. right, who's in that space, um, reach out to us if you'd like to be an affiliate of Clear Cardio, to work in our program, to work alongside Dr. Osborne. Uh, he does— we've got a whole training program associated with that and the Clear Cardio process, um, and how we can work together to, um, bring, um, our, uh, Clear Cardio program process to your practice, um, and consistency across, across the board. for, for, for, for new patients coming to you who want to be proactive. Uh, and I know we're, we're in discussions about that, uh, you and I already. So I'm excited about having those conversations moving forward. Uh, I bet there's a lot of people in Oklahoma who, uh, who, who would love to be proactive and, and take that prevention is power approach. Yeah.

Oh yeah, absolutely.

Fantastic. Well, um, thank you, gentlemen, for What a wonderful, good conversation here. Anything you'd like to say in closing?

No, I think we wrapped it up. I think you guys are doing a great job here. I think that it just— it needs to change. It's 2024, for crying out loud. 2025. Geez.

2025.

So we need to kind of get after it a little bit better.

Where are you located in Oklahoma? For those people that are in Oklahoma area?

Yeah. Visit you? Yeah. So we're in Oklahoma City, just on the north edge of town is a It's Edmond area, so that's kind of the region.

Do you have a website?

Yeah, primehealthassociates.com.

primehealthassociates.com. You heard it here.

And do you have other— who else works with you?

Well, we've actually been collaborating with Optispan, Matt Chamberlain, and some of those guys over there in Seattle. We see patients from all over the country.

Great.

Excellent.

So yeah.

Well, again, it's always wonderful to meet and hang out with and chat with another Preventative cardiologist.

Likewise. Yeah.

Yeah. Dr. Osborne, any last words?

No, you know, I hope— I think these are— our podcasts, I think, are full of gems and pearls, and I hope you got some of those today. There'll be more to come, and it's just always a pleasure meeting new friends and colleagues.

Yes, it's great to not feel so alone in the wilderness with preventive cardiology. So thank you for what you do. Yeah. And then for all of you who hung in there with us, we appreciate you hanging in there and enjoying and participating in the Prevention is Power podcast brought to you by Clear Cardio. I'm G. Dan Wright, the host. I'm Clear.

I'm Cardio.

Thanks for watching. Cheers. Until next time.