022 - The “Cardiac Colonoscopy”: CT Scan That Finds Heart Attacks 20 Years Early | ClearCardio

So, hello and welcome everybody. We have a special guest today, a friend and a patient of mine. Interestingly, is also patient, but he actually is a gastroenterologist as well. I'm very excited to have him on our show today. And I think one of the things we'll do, I want to hear about his journey to Clear Cardio and how that went and how he found us. The other thing that I'm going to exploit as well is the fact that he is a gastroenterologist, and we're going to explore that concept that I use all the time for cardiac CT and AI and what we do to be able to identify the earliest plaque. So I always use the term cardiac colonoscopy. If you've listened to any of these videos, I'm sure you've heard me say that. So now we have a GI doc to actually take us through the concept of the cardiac colonoscopy, and maybe he'll say— I think that's a perfect model, or else he'll say I'm full of crap. So, I'm anxious to hear what he has to say because he actually is the guy that does these things. So, Paresh, I'll let you go ahead and introduce yourself if you don't mind.

No, thank you, Dr. Osborne. Cannot wait to get a little bit deeper around the cardiac colonoscopy and maybe some of the parallels with what we do as well. My background, Paresh Mehta, I am a gastroenterologist and I was practicing for almost 10 years down in San Antonio after finishing up all my training in Cleveland Clinic back in 2014. Had a very exciting career and also a lot of opportunities there to transition eventually over to more of the business side of both running our local practice, which grew to about 60 providers, and then of course a participant in a growth strategy that we had together with myself and, and many others led by Dr. Jim Weber, who's there in Dallas as well, to form the GI Alliance, which became a group of gastroenterologists really set on both establishing physician-led care And also at the same time saying, how can we do this together and collectively in the current healthcare environment? So it's been exciting, um, and be happy to talk to you about that. And of course, my journey at Clear Cardio, uh, both initially with meeting JD and then of course Dr. Osborne, us connecting in person.

Well, fantastic. I will say, you wouldn't know this, but I've known Jim for probably about 25 years. I met him shortly when I moved to Texas. I, after I did my training in Boston, met Jim and, and his group. I think at that point they had Maybe 6 people in this little group at Grapevine. And I know he's led the charge in the meantime. So tell us a little bit about, uh, cause I am interested about GI Alliance and where it started, how it grew, how big is it, uh, the geographic spread. I'd be very interested in knowing that too.

John, thanks for asking. And I would say just to start, you understand healthcare better than most. And at least from the perspective of private practice and led physician-owned care, there's been a lot of pressures for lots of different reasons, both hospital-related, payer-related, and just us trying to get some synergies of saying, hey, how can we collectively do these things together? So, you know, back in around 2018, I think the idea came together. And at that time, there was a lot of interest from other groups in saying, hey, how can we do this? But how do we actually have the capital to do it and do it the right way? So, you know, under Dr. Weber's leadership, and then ultimately, the growth of us both in Texas, Illinois, Arizona, and eventually up to 15+ states, and almost 1,000 doctors, the idea was really the same. How do we keep patients first? How do we provide the best care? And how do we do that under the guidance of both physician ownership and leadership with the help of some sponsors and us having some equity and capital to do that? So we thought we really did it well. And the shortest version of that story, Doc, is we grew and we had a recapitalization and eventually had a sale to Cardinal Health. But the idea behind it was simple, was us saying, how do we continue to establish that growth and became best in class and also just said, hey, Let's practice the best medicine we can. And we really think that we did that.

My GI provider is the group in Grapevine. So Steve Lacey was my doc for a long, long time. And of course he retired. Now his son has taken over as well, also a gastroenterologist. And I've also, of course, known Tim Ritter, who heads up all your research, which, I mean, you guys are now a powerhouse of GI research as well because of the scope and the numbers of, of docs you have involved. So it's really exciting to see all that evolve. And it's fun to know, I knew all these guys when They were just the GI docs down the road. So exciting about that. And I can tell you, not an ad, but all my docs are all the GI Alliance docs. And Jay Upuri is phenomenal. He's my guy and just a great organization. And even down to, you've even got the pharmacy part down. So, you know, you go through the colonoscopies and you got to do the prep and all that. And it's all under one big, cool umbrella. So very well organized, very impressive.

So, yeah, we were really blessed with a lot of great operational talent as well joined us and really just said, hey, how can we really streamline the process? And whether it's a cardiac colonoscopy or a standard one, the idea was just saying, how do we make something that may or may not be fun or may or may not be fully understood to be sure that it's easy and that we explain things and that it's straightforward, including the preparation the night before, all the way through the procedure and even postoperatively.

Very cool. Very cool. You know, one thing I, I didn't ask about, Paresh, as far as your clinical path within GI, because, you know, like so many other specialties, it gets subspecialized. And I know you're more on the business side of things, but just outta curiosity, did you have sort of a subspecialty within?

Yeah, I think most of the subspecialty work I did, I really enjoyed inflammatory bowel disease. And back then it was called NASH. Now they refer to it as MASH, but Really, we had a lot of patients coming forward with that, particularly in the South Texas area. So that became another area subspecialized within the liver world to be sure that we're finding out how do we actually treat the underlying causes. But other than that, as a general gastroenterologist, basically bread and butter stuff, both from acid reflux, ulcers, H. pylori, all the way down to functional disorders. And of course, you know, colon cancer prevention. And, you know, interestingly enough, Doc, as you may be aware of, you know, colon cancer is going up, not down in regards to finding it and finding it earlier. So— Our goal was to really be sure people got the best test, which is still optical colonoscopy, and that they get checked properly to be sure that we can be preventative even as the technology keeps moving forward.

It's exciting times in the world of GI. I think, you know, it might be fun maybe further down the road, we have another whole discussion talking about— we'll talk about the concept of the cardiac colonoscopy today because we already hooked people on that. It is interesting in the cardiometabolic space, maybe it's now the cardiometabolic GI space, But just in the last week or two, the ADA issued new recommendations, guidelines to really bring in screening for MASH, which is metabolic-associated steatohepatitis, which is a long-winded way of saying basically fatty liver that's begun to really take a toll on the liver. That's how I think of it. But it's extremely common amongst lots and lots of people, and most of the people who have it don't even know they have it. And particularly in our patients with diabetes or insulin resistance or metabolic syndrome, Or patients that I like to say in my practice, none of our patients at Clear Cardio are overweight, but alas, many are under height. So amongst our under height patients, fatty liver is very common. Again, most of the time undiagnosed, they have normal liver function tests. There are ways to be able to screen for this, et cetera. Maybe you can enlighten us a little bit about that. But it really is interesting that it's now being brought into the overarching concept of cardiac metabolic sort of diabetes, prediabetes, kidney or renal disease, you know, the liver is an active aspect, an active part of that too. And I think it's great that the ADA has begun to recognize that. And I think anybody dealing in this space, whether you're a cardiologist, a GI doc, a hepatologist, endocrinologist, you know, lots and lots of specialties, of course, primary care, I think we really need to do a better job identifying and screening for MASH and its cousin. Called MAFLD, metabolic-associated fatty liver disease. Yeah. So yeah, it is interesting. So yet again, cardiology and GI come together again.

Well, Doc, you really hit the nail on the head. I think sometimes we looked at these things as sort of independent things that we needed to work on as physicians. But we know a lot of the crossover is the same between both of those diseases and really focusing on the metabolic aspect, talked about insulin sensitivity. We talked about maybe some weight or height issues per se, dietary changes, lifestyle management, and really pushing that forward. But similar to the cardiac signs are very less and limited when there's not a lot of plaque or there's not a lot of fatty liver disease.

It's small.

And as I always told my patients, you don't feel any different. It's just somebody telling you, hey, here's some numbers and here's what you should do about it. I'm glad to hear a lot of the focus has shifted to saying, hey, How do we get in front of this and not just try to get behind it once it's already occurring? Lots of ways to do that, from fibro scans, which are non-invasive kind of ultrasound modalities to look at fatty liver, all the way up to, you know, MRI versions of that as well. So I think there's a lot of good options. And, you know, I tell people, if you start to see anything that looks abnormal on those liver tests, or you're not sure, your primary doctor hasn't quite gotten through to you, it's worth getting checked out both at the GI or hepatologist level if they'll let you do it. And also just in many other ways that you can get some data to understand really where's your liver at and thus what's your metabolic standpoint and possibly even cardiac as well.

Well, and I will say, this is a plug for cardiac CT. When we do the cardiac CT, we do get a good amount of liver, not all of it, but we're going to capture part of the liver on our scan as well. And even going back years and years ago when I first began to start it, I was always interested in this concept and finding fatty liver and looking for it. So, We have, I'll call it the poor man's way of looking for fatty liver on CT. We can measure the density of the liver, reasonable approximation whether there could be some fatty liver there or not. And again, not terribly surprising amongst the people that we look at, you know, we find lots and lots of fatty liver. And a lot of the people have normal liver function tests and it's a completely new diagnosis. So it's again, another little nice thing. It's the poor man's diagnosis of fatty liver, I like to say, 'cause the data's there and might as well extract it as well.

It is.

Fun how, uh, I always like to say I'm the guy below the neck and above the diaphragm. Now we're talking to the guy who actually is below the diaphragm. So exciting times. But it's very interesting to see how all these coalesce together, um, as far as fatty liver, diabetes, prediabetes, cardiovascular disease, atherosclerosis, plaque, etc. So, uh, that's a whole other story. I think probably would be worthwhile at some point to explore that further. And not only on the diagnostic side, ADA is now getting involved in this because of the high rates of fatty liver in our patients with diabetes. But also too, there's really a lot, a lot of excitement on the therapeutics for fatty liver, which again, interestingly, tend to overlap with therapeutics for heart disease too. So I think that's probably a longer story, but maybe we can put that on the books to review that. That'd be a lot of fun.

Let's do it.

All right. Well, again, we'll throw that out as a little hook. So come back later, we'll have another show with Paresh and talk about Fatty liver and what's going on with that, how that relates to cardiovascular risk, some of the ways to diagnose it more specifically. We kind of alluded to a few things, and then maybe also some of the excitement about a variety of new treatments, because that area of treating fatty liver had been just a desert for years, but now in the last couple years, it's really turned around. So a lot of excitement on the therapeutic side of things as well. Anyway, what I want to hear from you is tell me about your cardiac journey and how you ended up coming to see Clear Cardio.

Well, you know, thanks for that transition, Doc. I would just say for me, a couple reasons that I ended up at Clear Cardio, but just backing it up a little bit, uh, was really trying to understand some of the descriptions I'd had in my family history. My dad had had an intervention, so he'd had a stent placed in the heart when he had some plaque buildup. Brother had had bypass surgery. We thought there were some other people that we weren't—

How old were your dad and your uncle when they had these interventions?

They're in their 60s, both of them.

So pretty young.

Yeah, young. And also just kind of, I think, really, uh, the movement for many of us to become much more proactive than reactive, as we've seen sort of in standard medical care. And I say this just with somebody who's been in, in the game long enough to know that if we can catch things well before they become an issue, and we can work on things that may or may not be as obvious, including abnormal lab tests— we talked a little bit about other metabolic risk factors— then I really felt this was a big deal for me. And it brought out my want to really go further on understanding Do I have an issue and how can I catch that in my 40s versus having to catch it in my 60s? So as I started doing some of the work, you know, I kind of noticed that some of my blood work was a little bit abnormal. But you know, I was what I thought was healthy diet-wise in regards to sort of lifestyle exercise choices I was making. But the numbers weren't shifting. And initially, part of that I had said part of my longevity workup, I'd been at a different center, and they had actually provided a CT of my heart that was a CT NGO that had some of the same technology. And as we reviewed together, they had kind of said, hey, it looks like you at least have some cumulative plaque. And this was back when I was actually, I believe, 37 or 38. So definitely was, uh, continued to raise the red flags. And I looked at my options. I'd said, hey, do I want to start some pharmacological therapy or do I want to keep kind of push the lifestyle? Got busy with work, was really dialed into my lifestyle and said, hey, you know, I will follow up in a couple of years, usually the 2 to 3 years for the follow-up CT, depending on where you're at. Um, and see where I'm at at that point. And essentially, as I rechecked my labs, none of them shifted. And, and as we can get into some of the more advanced labs, when we're talking about the Lp or the ApoB, uh, those numbers really, as I learned more from people in the space, uh, listening to both friends of mine who were cardiologists, and then also people in the space who have become a little bit more influencer-like, Peter Attia comes to mind, just people who are really looking at pushing these numbers down, I realized, hey, there's some numbers here that might need some more. And I think no matter how much I push the lifestyle part on my end, it still won't do enough, particularly to save me from needing something in about 10 or 20 years. That's what brought me over to Clear Cardio, and I can get into that about how I landed there. But I, I was— lots of good things to say about it, and, and definitely excited about what the plan you helped me put together, and then think we're on the right track to hopefully preventing some of that stuff happening.

I think it's remarkable, and, and I really applaud and laud you for being proactive. I, I think many times Our parents are our pathfinders, right? They're pretty much similar to us genetically, right? We're half mom, half dad genetically. And the stuff that happens to them, unless there's really some extreme lifestyle stuff like you smoke 3 packs a day or crazy stuff like that, that's just sort of external stuff that if mom or dad develops cardiovascular disease, we'll say not just heart attacks, stents, balloons, bypass surgery, but also throw in strokes, mini strokes, also Peripheral arterial disease, blockages in the legs. If that happens to mom or dad, then there's a pretty good chance that we may be teed up for that as well, genetically. And it's also interesting too, particularly with your dad and your brother, or rather your uncle, rather. You know, one point about genetics and the genetics of cardiovascular disease is that obviously, if you have a mom or dad with cardiovascular disease, particularly if it's younger, particularly if they don't smoke, they're not overweight, Those kind of things. I would be, I'd be very afraid, if you will. I mean, there's no sense being afraid now that we can detect disease with tools like Clear Cardio and the AI we have. But, but definitely very motivated, I guess, is a better term. But clearly, having mom or dad have heart disease increases your risk genetically. Having both really increases your risk. But interestingly, with respect to your dad and your uncle, the greatest genetic risk factor for most disease, and cardiovascular disease is the same, is having a sibling with cardiovascular disease. So obviously, you know, your dad and your brother, or your uncle rather, both had cardiovascular disease because we are only half like mom, half like dad, but we are more like our siblings genetically than anybody else in the world. So if your sibling develops heart disease, or we detect heart disease, you definitely want to take a microscope to the rest of the siblings as well. So really appreciate, and I'm glad, and I think this hopefully in the future will be— this will be the future that people go, wait a minute, you know, I have some unusual risks here. I'm going to do all the right stuff. I'm going to eat right, exercise, stay, you know, height-weight proportionate, do all the right things. But sometimes genetics and those genetic hickeys still can take a toll. And it's great to have the ability now to very, very accurately and precisely detect this problem, literally, as you did, 20 years before it ever becomes a problem. Because with heart disease, you feel fine until you don't.

That's right.

And if we wait for symptoms, we wait till you have flunked a stress test, those kind of things, that really only detects really, really late disease. As I like to say, thinking of the oncology metaphor, if you wait for symptoms, you flunk a stress test, right? Which is typically how we diagnose heart disease. We're not diagnosing it at stage 1, like cancer. We're really diagnosing it at stage 4, and that's just no longer acceptable. Which then kind of gets us into the concept of that I use all the time, and I ripped this off you guys, is the cardiac colonoscopy. I would like to know, we'll get back to that in a minute, but what was your experience with the scan and all that, the process? How was the prep since we're talking about to a GI doc?

Oh, I'll tell you that. Well, you know, just before we go there though, I think the other thing I would add to that, and just to your point of being proactive, is we have so many potential things that we all look for. But when you look at the data of what's the most likely thing that could cause you a significant health risk, or even a risk of something as significant as passing away, Yeah. Heart disease always at the top of the list. And, and I tell people that sometimes we talk about it so much it gets forgotten. We start thinking about other things which are important. But really saying, if you look at it proactively or in a way that I like to look at things of saying, hey, what are the odds here of something like this happening? And then as I stack them together, hey, here's the general population risk, no matter with no family history, here's my family history, here's my labs, here's what I think is going on. I would just ask anyone who's, who's close or not sure, get checked. We know many people who don't, and, and unfortunately, as opposed to soft symptoms, they get more serious ones and particularly even life-threatening ones at the time of when things start. So, you know, just accolades to you. And to JD for stepping in front of this and making sure that we're getting these things out so people know they have access, because I think that's part of it, is the messaging is as important as getting the test.

I agree. I think in the future, this concept of looking for disease in the heart, we do it for cancers, obviously GI and colonoscopies, Pap smears, PSAs. We now do and are endorsed and paid for by Medicare and commercial players to do low-dose lung scanning, CT lung scanning to detect early lung cancers. And there's actually a mortality benefit associated with that as well. So we have a lot of things we've done recognizing that cancer just doesn't start as a big tumor. It starts off as a small tumor, and then we have a bunch of tools, again, colonoscopy, certainly Sentinel, to be able to find that early stuff, that early precursor, and then Take care of it. I will gloat for a moment versus my GI colleagues, Paresh, but when you do your colonoscopy, and we should, you know, I think we're really talking about preventable diseases, preventable deaths, right? I would hope that we make colon cancer, that we end colon cancer just like we did have smallpox with vaccination. I think if we find those polyps, take care of those polyps, use that analogy, that hopefully we'll have a huge impact down the road on— The incidence of colon cancer, and I think it is very much a preventable disease, particularly if detected early. But I will say, even if you get— have a— find a polyp, you guys just keep scraping them out, right? We don't have drugs or tools. I'll ignore the story on aspirin and NSAIDs, but basically I'll say we don't really have drugs or tools to treat or prevent polyps. There's actually some interesting data with aspirin, low-dose aspirin, and NSAIDs. out there as well. But for the most part, it's you just keep scraping it out, and hopefully we stay ahead of the process and you never develop the cancer. Whereas I will say, in my world of plaque and atherosclerosis, we have an incredible array of highly effective tools to stop it and reverse it as well. So I do have to gloat about that a little bit, so I apologize.

Yeah, well said, Doc. Agree with you. Hopefully eventually we'll have it in both worlds, but definitely lots of options for people. to hopefully prevent having that cardiac event or building up plaque silently without knowledge until you need something. So, prevention better than the cure sometimes, and most times is what I've seen in medicine. So, I would say, you know, it's a great thing. And yeah, I would love to dive into my story with my experience or any way you'd like to take this. But definitely. Yeah.

So, tell us your experience. I'd be really, particularly coming into it as a physician too. You know, I think it's always interesting and it's always a, I think it's a great experience to sort of Wear those moccasins and be a patient and, you know, kind of really have an experience of, is this really working well? Is it, you know what, I think that's very, very helpful. I think it makes physicians better docs, actually, or any healthcare provider better docs to kind of go through the experience.

Absolutely, Doc. And I would say, you know, my experience was 10 out of 10, both from the initial communication with your team And then also receiving anything that I needed preoperatively in order to be sure that I had everything ready to go. And then just really kind of the white glove service, you know, what I like, you know, high touch, high quality. And it really felt that way at Clear Cardio. For someone who's been through sort of a spectrum of different healthcare delivery systems and providers, I can tell you this was at the top of the list in regards to being able to get things done. Easy access and communication. And then I would say even during the day of the procedure, it was, you know, very straightforward and came in, got to the site, got checked in. We got going right away after getting some of the labs drawn and of course getting into the CT. The team was very friendly. And then, you know, I think the cherry on top, Doc, was getting to spend about 30 minutes, 45 minutes afterwards with you reviewing the images, going through things and really getting that understanding of Both that and again, that comparison that we were able to do on my old scan, which interestingly enough didn't quite have the clarity as the new one to provide some of the details that were important to make a medical decision. So I would tell you that. And then of course, our follow-up, I think you and I even ended up speaking on a day that you weren't even in the office just to go over some of the final results, which I really appreciated. I mean, I would tell you from sort of beginning to end, it's been fantastic and I'm really excited about my plan and how things might look on my next scan in about 18 to 24 months.

Absolutely. Well, you know, I say this to everybody as a preventative cardiologist, and there aren't many of us unfortunately working on early detection rather than late detection and where the real money is, the stents, balloons, and surgery, uh, where, you know, I, I love my interventional colleagues, I love my cardiothoracic surgeons, but honestly, I tell them very frankly, I want to put them out of business, right? I want to make what they do irrelevant because we find disease early, take care of it, it never ripens up to needing interventions and all of that. And the other worst thing about that is, unlike cancer, obviously we've touched on, for the most part, there's no such thing as sudden cancer death. But half of the people, their first symptom of heart disease will be sudden cardiac death. And then historically, we take those patients who, of course, have advanced disease, then they get stents and balloons because they've already survived that initial symptom. Which again, tedious, expensive. No one wants to do that. And then we say, oh geez, let's start treating the disease, which by the way, stents and balloons don't treat the disease. They treat the complication of disease, which is a blockage. What treats the disease is actually diet, exercise, lifestyle, medications, treating diabetes, high blood pressure if you have that. And really, of course, essential to that is cholesterol. But it really is incredibly exciting. And I was just actually, I just saw today, this is great. I didn't know this, but I was taking this This little medical trivia quiz that I, I, I hate, I hate, I hate-love those things. So it said there, and you can back me up on this or not, that the first kind of colonoscopies were done back in the '60s.

Is that somewhat correct? Yeah, I would say, uh, don't quote me on the exact decade, but it's been some time. And back then there obviously were, you know, there weren't a lot of LCD screens available or even built out. So most of that was—

Or the fiber optics, right?

Yeah, yeah. So Yeah, the fiber optics didn't come until a little bit later as well. So yes, sounds right. When they started to try to understand what it was, I think flexible sigmoidoscopies or a shorter version of the colonoscopy, and then eventually the full part. And, you know, a lot of people's work in both sides, both on the heart and, and for the colon, years of understanding and really getting to a place where we knew exactly, hey, how we can start preventing these things. And it's exciting to see the cardiac part catching up to that in some ways in regards to pushing prevention. Uh, over intervention, as you mentioned.

Right. Yeah, I remember, because I'm old enough now, back in the '90s in my training, there's a big debate about what we call fecal occult blood testing. So in other words, testing the stool for blood, right? You see blood, could be something, could be a hemorrhoid, could be a polyp, could be cancer, could be any number of things. But, you know, it would say, hey, there's something going on. Of course, it also would have a high rate of false negatives because you could have a cancer or polyp and not bleed. Be bleeding, at least at that moment. And then we talk about doing a sigmoidoscopy, which you mentioned, which is basically just looking at part of the colon, the far end of the colon, the distal part of the colon, but wouldn't cover the entire colon. And there was this whole debate about fecal occult blood testing, looking for blood in the stool and sigmoidoscopy and who should get it and all that. And then it all evolved to, well, no, we look at the whole colon every time at a given age and that's it. Which I think is much smarter because, I mean, you can't really look at somebody and go— you can certainly get a genetic history of polyps and colon cancer, et cetera, maybe even other cancers, and may go, yeah, you're probably at higher risk, but you just don't know until you look at their colon.

Right.

I mean, up until then, could be, maybe not. And I think there's a lot of parallels with what we've done in cardiology, looking at blood pressure, looking at cholesterol, going, Maybe could be, I don't know. All the while, never actually looking at the organ, looking at the heart, looking at the blood vessels. You know, now we start with looking at the heart, then we figure out if we need drugs for your cholesterol, as an example, right? So it's interesting, but, you know, if it's somewhat true that colonoscopy started in the '60s, we started doing calcium scores in the '80s. Cardiac CT really around 2000, 2005 or so. So I think that means we're probably about 30 years behind GI. Hopefully it won't take us 30 years till the concept of doing cardiac CT and AI and using all this technology allows us to really level up next to GI and go, wait a minute, no, let's find the polyps, take care of the polyps. You don't get the cancer. And I think that's— these are admirable goals. Um, and, uh, uh, I, I think, uh, you probably wouldn't mind saying something like you wouldn't mind putting the GI oncologists out of business, uh, because we never let people end up there. Uh, that's why I like to kid about my interventional colleagues, the ones that do stents and the surgeons, uh, that, uh, let's just find the disease, take care of the disease early, early on. Let's find the polyps, take care of the polyps, and we don't need, uh, people to redo your plumbing. Because we never let the plumbing get that bad. So. Right.

Right. Well said. Couldn't agree with you more, Doc, and excited to see where everything's going. And I think just a lot of great opportunities for people to really access this technology and this push forward for us to really get in front of it on the cardiac side. And just preventing things from occurring, particularly sudden cardiac death as, as being in the healthcare profession and, and just with friends have seen it even in particularly younger men and women. So just, just trying to get in front of that and make sure we prevent something that is truly preventable.

Absolutely. Well, that's why I love, love, love doing what I do. I've never worked a day in my life. I get paid to do my hobby, meet fantastic friends like you, like you, Paresh. And I really do want to thank you for sharing your story today. I think it's a powerful one, and it really underscores the fact that we really need to change. We have great tools to treat plaque. The problem is we wait until it's extremely advanced, where we've really failed patients. And in our population, our communities, is we just have never had in the world of cardiology, unlike GI and lots of oncologic screening tools, we've never had a tool to pick up the early disease. We wait until it's extremely advanced, which can be at a minimum rather unpleasant, expensive, and even not uncommonly, about every 40 seconds, can be deadly, and the first symptom would be death. So I think we really, really are in a fantastic position. I think we have all the tools available. Now we just need to get it out there, and it's very exciting. It's frustrating because you know the potential. You also know that we're only seeing a very small number of people right now relative to the burden of risk out there, but I think That we, we are definitely on the right track. And I think this is going to be a disruptive tool, disruptive technology that really is going to change how we think about patients, how we treat patients, and when we treat patients too. So thank you for helping me eliminate heart disease. And as always, I— my big ask for all my patients, Paresh, is please work to put me out of business. Okay? So that's my goal.

Thank you.

Just work to put me out of business.

And, you know, thank you and the team at Clear Cardio for really getting in front of this, providing value to patients and people that really may or may not even be aware that not only do they need to do this, or how to put together some of the dots that might be easier to see if you're coming from a healthcare background in their family, other things that could put you at risk, and really getting in front of that messaging of, hey, why is this important? Why you should do it. And what are the differences between all these tests, particularly in getting information that you can use to prevent something more serious happening? So, uh, really proud that you guys are doing this and, and happy to be a very small part of it by sharing my story.

Well, thank, thank you again. And I, I think we should come back again to talk about this whole above the diaphragm, below the diaphragm, cardiovascular disease, fatty liver. It's an extremely relevant topic, uh, extremely common issue. And I think we really need to shed some more light on it, and it would be great to, uh, maybe do a deep dive on that as well, particularly with the GI and the cardiologist, to talk about that and how we diagnose this, how we figure it out, and talk about some of the treatments that have really popped up in the last few years that are very, very exciting as well for that. So let's put that in the parking lot. Let's come back to that if we could, if we have some time in the future.

Yeah.

And also too, I do look forward— I'm already going to put on the calendar after your next scan, we're going to look at that, we're going to compare, And we're going to show, hopefully, I think we will see that with what we're doing, we'll literally show that plaque reversing, and that'll be a great day to enjoy that and celebrate that. And that's really what we want to do, early detection, take care of it, and just stop the epidemic of cardiovascular disease that we currently suffer from.

So, yeah, sounds good.

And any other final points you want to make?

No, I would just tell everybody that You know, make sure that you're helping drive some of your care as it comes in. I mean, you know, sometimes you're seeing providers and this is not a knock on anybody. Everybody's busy. Um, and you just want to be sure that you're understanding what all the information you're getting is. And sometimes you get a lot of information and some of it doesn't get clearly translated. Um, and just kind of being your own advocate in medicine was always what I saw was the most helpful of asking those questions of why and, you know, what can I do to be in front of these things and what might some of my risks be? And the other part I would say is where you get checked matters. And that's true for colonoscopy, and that's true for preventative cardiology. And I would say some of the technology you guys are bringing forward, just for people to understand, having the right scanners, having the right physicians involved that allow you to really understand this, being sort of hand in hand on that care, it's important. And the only thing I would add to that is, is, you know, as a patient, you're going to have to be that advocate and pick the right places and work with the right docs like Dr. Osborne. to figure out, hey, what's going on and how can I get to a point where I feel comfortable both with the plan and what I'm doing to prevent any sort of cardiac disease happening to you in the future?

Well, listen, kudos to you. I'm really excited to see the rapid and amazing, not surprising growth of GI Alliance and what you've done with that, see how far you've come with that, because you're about 20 years younger than I am. Obviously, you're going to have a phenomenal career There'll be lots of excitement, and already you've just been so incredibly successful. So, I really laud you and all your colleagues for, for doing that. And maybe down the road, uh, we can collaborate and there'll be, uh, the Clear Cardio Alliance too. So, we'll see. So, um, well, you know, as, as we work to eliminate our diseases, right?

Well, they got a wonderful team there at GI Alliance. One of the amazing things I got, um, out of the team there was also getting my business hat on, and, and now I'm pursuing some other things we can talk about on our next podcast that are inside and outside of healthcare, but so many good physicians there and so many good providers as well. I would say, you know, it just was an exciting time to be part of a great organization that really took GI care and physician-led care to the next level.

Well, it's exciting to reach across the aisle, so to speak, and involve my other in, you know, their efforts to eliminate their disease. And as it turns out, a lot of times there's a lot of significant overlap as well. Alluded to before. So thanks again, Priscilla. It was fantastic today. I really appreciate it. You're absolutely brilliant. Thanks again for taking some time today to talk about this. So this is John Osborne. Please be sure to subscribe to the channel. We have lots of podcasts and exciting podcasts that we'll be doing the next few weeks too. So there'll be a lot of new— I'll be back with my usual partner in crime, as I like to say, JD, whom we call Clear. And I'm Cardio, and we're gonna sign out. And again, thanks so much, Bresh, for your time today. And I think this really made it for a very, very special episode. So thanks again, and I look forward to bringing you back.

Thank you.

Really appreciate it. Again, thanks, thanks so much for doing this and taking the time. And I think we touched on a bunch of cool topics. I think we— I'd love to explore some more. So, yeah, yeah, absolutely.

Let's make sure we do it and we'll get something on there. And then, uh, just as an ask totally separate from this, I'll send a text to Now that everything's kind of panned out on the final documents and stuff, if I could just get some copies, I think I'll just send you a message or send the team a message just to have my files and compare because I really enjoyed that comparison you and I did. And yeah, it was incredible. So appreciate that.

We'll make sure we get all that to you. So, all right. Have a great day. Take care.