Health Series 6 Dr Golnosh Sharafsaleh / Dementia & Brain Care / Aging & Longevity / Beating Tragedy

0:01 Welcome to another episode of Come Together We're Live. Welcome to another episode with Doctor Sharif Saleh. Thank you so much for coming. Thanks so much for making this happen. I'm really excited to talk to you. Thanks Yuvram. And you said my name perfectly, so happy to be here. Yes, I kind of bailed them the first name Ghanoush. Ghanoush. Ghanoush close. OK, Where's it? Where's it? Where's it? Where? Where's where are you from? Where's your family from? It's like a traditional Persian name, you know, like Iran where all the conflict is going on now, but like a Persian kind of Zoroastrian, I guess.

0:51 I don't know. So. Cool. And tomorrow's like the new year, I guess, so we're going to eat fish, so that would be nice. Yeah, yeah. What's What's the celebration usually like for New Year? So gosh, I'm so ignorant. Well, let's see. So it's kind of I think originated from like this Zoroastrian holiday where it's spring. And so it's the beginning of like new comings and new beginnings. And you set up this table which is sort of like a Christmas tree, but it's not a Christmas tree. And there are different symbols on it. Like there's a mirror on there. And there's, there's greenery which represents like, is that fertility or is there's like coins, like gold coins on there, which represent like fortune and various things. And, and so my mom's very good at setting this up. And then my sister and I will go to her house with our kids and family.

1:48 And then my dad cooks because he's an excellent cook. And that's as far as I celebrate, you know? We. Celebrate like all the holidays. It's kind of interesting because you know my like Christmas and then my sisters like Russian Jewish husband. So we have like that whole thing. We just celebrate all the holidays. It's kind of fun that way. But yeah, tomorrow happens to be this one. It's nice. It's a yeah. I think it's cool. It's very cool. Yeah, we like it. We like it, you know so. So I'm so excited to talk to you about so many different things and you've got lots of, you've got a lot of fun things to say about a lot of different things.

2:32 So I'm excited to, to dive into the to to this with you And what kind of caught my eye originally when I found your profile on pod match was a combination of geriatric care, dementia and and then lifestyle health. And I thought that was really great because one thing that has been consistent, I think over the last few years, a lot of people have been talking about how lifestyle help less rather health helps you age more graciously and more, you know, and a little bit more forgivingly, I would say. And it's something actually, I had been arguing with my dad and bickering with him about my mom takes excellent care of herself. My dad is a little bit less so.

3:13 And so he's not thriving and. He's not thriving in his old age, is that no? No, no I don't. Not physically. Not physically, not physically, he's thrived more physically, he's been, he's been in better shape. But to be fair, he's almost 60. And you know, when you're, I mean, when you haven't exercised in a little while, it's hard to snap yourself into a new habit, I think. But that was really, you know, so that really caught my attention. And then and then when you and I spoke, we talked about some heavier things that I think that we should talk about too. And in your, in your book and, and I kind of want to just, you know, I'm, I'm more interested in learning from you and hear what you got to say. So I'll kind of just direct your thoughts and just I would love to dive into it.

3:55 Sounds great. OK, ask your first question. So let's hear about. I'm really curious about the early signs of, of, of dementia slash Alzheimer's and ways to recognize that in people and ways to recognize that in family. And I think it's and, and Alzheimer's and dementia in general, I believe is, is much more common now than it was twenty, 30-40 years ago. And you know, and if there's if there's anything that we kind of do to be preventative about it. Oh yeah, there are things. So here's the thing #1 risk factor for Alzheimer's is age. So there you go. And we're living longer. And I joke about this with my patients, but in reality, you know, if we think about evolution, like nature tries to kill us off as soon as we've like procreated and we've raised our young. But we, if we think about our, our lifespan, we think of it in like childhood, adulthood, and then our elder hood. And so that last third of our life shouldn't be where we're sick.

4:59 You know it. In our childhood, we're just learning to figure life out. In our adulthood, we're like taking care of everybody, trying to basically just survive life. And then in our elderhood, this should be a time of reflection. It should be a time where we have a good health span. We can see the world embrace like the things we didn't get to do because of all the things we had to do in our adulthood. And, and unfortunately, one of the things that happens is people develop chronic disease, like they have multi like more comorbidities and they end up losing their independence. And so I think as a geriatrician, so a Doctor Who, you know, pediatrician, geriatrician is a Doctor Who practices aging. My focus is always like, let's keep people independent and let's keep them cognitively sharp because I I truly believe that even if physiologically we develop deficits. Hey everyone real quick if you're enjoying the show, click subscribe and rate the show. 5 stars helps a ton. Thanks so much.

6:03 In older age, if we have our mental health then that will still keep us independent. We can still narrate our life versus if we don't have that, you know, the people who have dementia, these are the individuals who end up in nursing facilities. These are the individuals who end up being taken care of. And maybe their their goals and their wishes are not honored just because of like their care needs. And so that is constantly what I think about. And one of the emerging areas of medicine is to really try to detect signs early, you know, dementia and signs of cognitive loss. They start decades earlier than before we actually have cognitive disease. So around 10 years ago in my career, when I was first really treating people with dementia, family members would bring someone in who had some memory issues, but by then their disease was like in a moderate stage, so there wasn't much to do.

7:04 Unfortunately. Now people are coming to me themselves like earlier on. And they're like, hey, I'm noticing that I'm having trouble with words. I'm noticing that it's taking me longer to learn things. I'm noticing that I'm having trouble with names. And my first question is, always has this always been the case? Because if you're someone who's been bad with names forever, OK, that's fine. Like, hey, buddy, this has been your norm. That's not cognitive deficit. But if you are like, I was great with names and now I'm forgetting names, there's an issue there. Or if I walk into a room and I can't remember why I walked in there and this is not my baseline, then there's a problem here. And we need to think about it and we need to screen. And so this is where I I start screening people. And some of our common standardized tests are only standardized to like an 11th grade education. So then you have people who are who have a higher education than that and they can compensate for those and their primary care doc might just say, oh, you're fine.

8:04 There's nothing wrong with you when something is brewing. So really keeping track of those minute changes that occur that are not your baseline, I think that's where something needs to like happen. And, and one of the things you can do is if you don't have access to a geriatrician or a neurologist, you know, your primary care doc can refer you to a cognitive psychologist. They can do a battery of neurocognitive tests and, and try to weed out like, Hey, what areas of cognition do you have deficits in? And, and do we need to do something about it? The cool thing is you can actually work on your brain and different areas of cognition. I mean, I often send people to cognitive rehab so that they can work on areas that they're struggling in. They get better You didn't think of. That what's what's cognitive rehab look like or what's your date in that life?

8:56 You know, just like people get a prescription for physical therapy, like let's say you get a shoulder replacement or surgery or hips or knees, and you go to physical therapy and they lay out a plan for you. We're going to do this and this and this for this length of time, and these are your goals. Cognitive rehab is generally done by speech therapists. They have additional training and they will set up a goal. So they have initial cognitive assessments and then they're going to say we're going to improve on working memory and on delayed memory. And we're going to work on executive function and orientation and task management. And, and they will work with you and you improve and you meet your goals and then you you continue with those things.

9:41 So, you know, there's, there's opportunity there. And I think people don't even know about it. I mean, when I have patients in my office who come in for a cognitive assessment and I tell them, well, I think we should send you to cognitive rehab. Like they asked me the same point. Like, what is that? I've never heard of it. Not very many people who know it exists now. It's a shame, by the way, and there's a lot of different types of cool rehabs that that that exist that, you know, I think if not for a little bit of stigma that we could really take a lot of advantage of. I just did a episode yesterday with, with, with the neurologist and physiologist who part of what she researches is music in the brain and using music to, you know, for, to, to help with, you know, with different potential diseases.

10:26 As far as learning or as far as even I, I've read other accounts of, you know, playing music having a huge impact on neurodegenerative diseases like Ms. or Parkinson's or Tourette's or, you know, I mean, a whole, there's a whole library of, of potential neurodegenerative disord disorders that are really that, that could be helped with music. And how many people think to just play music as a, you know, when you're diagnosed with miss or Parkinson's, God forbid, you know? Right. And, and even like when we think about dementia and music therapy, sometimes what's fascinating is I'll have a patient who, you know, forgets everything, but you put them in front of their piano and they used to play piano forever and they will just like start playing.

11:10 And for a moment you have that person back, you know, and it's, it's pretty fascinating. It's. It's, it's amazing you say that I date. So I dated a girl, a girl for a bit, and her mother, while we're going out, had this disease. And I think it was very, very hesitantly diagnosed as Parkinson's because some of the symptoms matched up with Parkinson's, the freezing up. But there's certain things that didn't exist. She didn't really have the tremors quite in the same way as I've seen a lot of other Parkinson patients. They weren't sure really. But one thing that did happen was she did play piano and the accordion growing up. And so while we're going, yeah, I'd ever seen, if we'd ever go over and anyone is playing music or she decided to ever like pick up something, you could see the you could see that like her whole body would loosen up or we'd even play music and she would start dancing and she could dance even those moments moments ago really frozen up. It's crazy.

12:10 It's incredible. It's incredible. And sometimes like in, in terms of, I mean, you had this a whole episode, but this like neurodegenerative disorders, like with lasers and music, like how different parts of the brain will activate And then you, you stop that, that freezing and all of a sudden you have a fluid movement. It's, it's, you know, it's amazing because I'm like, what is our brain capable of? And even in the midst of disease, how can we, you know, retrain our brain And we're, we're not using every part of our brain that we need to use. And, you know, this whole concept of neuroplasticity is it's a new emerging concept, like when someone has a stroke or when someone has some type of an insult to their brain, How can we learn to rewire and rehone and learn the skills that we had and learn to move the way we used to?

13:02 So, you know, I think neurology is just a fascinating emerging field, especially as far as, you know, dementia goes. I think that's where I'm so interested because I'm like, if I can preserve the brain and preserve independence, that's all I want to do. Especially we, we have dementia in my family. So I'm like always like, you know, I, I have a personal investment in this. I tell patients like I am invested in you, you're my patient, I care about you, but I'm also personally invested in this. I want to figure out any new emerging therapies out there, and I want to be able to implement them if they're appropriate for you. Yeah, for sure. One of the one of the really incredible, you know, I, I've, I've spoken to this a lot of my podcast in different applications all across different like worlds. But one thing that everyone talks about recently is the fact that institutional trust has pretty much collapsed since COVID.

13:57 And there's a million different reasons why and a different million applications. And, you know, whatever it may be one way or the other, one of the, one of the benefits that I really strongly believe in is that it's kind of encourages more open mindedness and more play and more figuring new things out that like we were so set in our ways. You know, it felt like forever, even though I mean, again, in the, in the, in the concept of history, I mean, talk about being from, you know, Persian and like, Hey, I'm American 250 freaking years old. That's it. You know, I mean, like, you know, we, we figured everything out. And hey, there's a lot of, there's a lot of wisdom out there. There's a lot to learn and there's a lot to figure out. And sometimes it's good for institutions, institutional trust to break just for people to kind of feel like, like, hey, you know, what if I don't know what the doctor at Harvard said, then like, let me try this music therapy.

14:45 Oh, my God, it works. Like, that's incredible. Like, you know, like, OK, so then someone in Harvard will pick up their being, get into it. So I think that's really, it's I, I think that we're at exciting time. I'm really excited about what we could be accomplishing. Yeah. And you're totally right as far as I think just opening our mind to not just practicing medicine or living our life based on a set of beliefs or set of standards when it comes to even, you know, when it comes to health. I have a patient I recently, this is a funny story. Just this past week. I, I somebody I recommended they have acupuncture and they're like send that more of a placebo thing. As for the thing that they had. And I like sent them a bunch of papers and this person, you know, has a background where they understand research and paper and I'm like, actually not, there is a lot of data behind it. And here I am as a medical doctor and occasionally I'll send, I'm like, you should see a chiropractor for this or let's try this supplement for this in addition to this medicine for this.

15:49 And they're like, who are you? You have to kind of embrace all of it. You know, I am a medical doctor, but I think like if I just stuck to these standards, then I'm not going to give my patient the entire like pot, you know, of everything that they could possibly benefit from. So I am, I do take a very holistic approach when it comes to cognitive health, not only as far as thinking, OK, let's detect cognitive impairment, but then let's talk about what are these, what are these other factors that could be causing progression of your cognitive impairment?

16:30 For instance, like diet, you know, I work with people on their diet and really focus on like a diet that like kind of a mind diet, sort of a keto flex diet where that their brain is also benefiting from that and they're not having like glycemic index issues. I focus on blood pressure control, sleep apnea, exercise. I mean, exercise is like a huge part of what I do with my patients. And then in my office I use the scale called the in body scale. I don't know if have you heard of it tell. You about it? Talk about it. So I don't even want to talk about it because I'm a little bit like hurt. But like Peter Attia, you know, he was all over the Epstein files.

17:12 But his book was good. Outlive was a really good book, you know, but he talks. About, by the way, I. Mean, I was like, I was so sad. I read the book three times and I like preached about it and then all of a sudden my partner was like, did you hear what happened? Crap is that every man? Is that every single man? But anyways, it's still a very good book, you know, and but the the in body scale doesn't just look at your weight or your BMI. It actually looks at your skeletal muscle mass. It looks at your percent body fat. And for my patients, again, as you're aging, I don't want people to get frail. So I'm constantly like, all right, are you doing the exercises we're talking about?

17:53 Are you building muscle and all of those things? You know, managing the body holistically is protecting the brain essentially. So I do that, you know. It's awesome. It's I actually so it's funny you actually bring that up because I got AI sell medical equipment on the side. I actually not in the side as a living and, and one of the big things that have been very popular now or bone or bone density machines that people are buying for whole body composition and body fat composition. And someone calls me up in Austin, TX a couple of months ago, tells me, hey, you know, I want to buy this machine. I'm like, that's cool. And he goes, yeah, if you give me a good deal, like, you know, I'm buddies with this guy, you know, yeah, you heard of Doctor Peter Tia. And I'm like, yeah.

18:35 Then I'm like he's like, yeah, you know, and we were trying to base our our health model on him and. And by the way, you know, like. I know. So that to be like a case of separating the art from the artist. They're like, you know, like. So hard. Science and the dude and like, you know, like, what do you say? What do you do about that? Oh, my sister was said that about Kanye. She's like, you got to separate the artist. I was like, all right, all right. Yeah. It's, it's still very difficult, you know, because I think as a female, a physician, and it was like, I was just so disappointed, you know, and, and, and, and my partner was like, do we burn the books because we have a little library?

19:23 And she was like, but we're not book burners. Are we book burners? No, but yeah, but I do. I do think there was. Every book by every creep that was out there, then we would not have a lot of literature. Burning every book, yeah. But really the concept, you know, makes sense in that book. And I did, I think, develop a lot of my thoughts as far as and sort of I adapted a lot of things there, but it was only like in in one realm of, of mine, like health framework that I use. You know, when I, I see people in aging, I, I call it, you know, it's like, it's the art of health span. So health is this acronym where the HS like how we age and then the Ms. of a geriatrics which I think.

20:08 Are for not just the geriatric population, but they are relatable to everyone, which is like, So what matters to you? Before I even treat you like I shouldn't just to all this medicine, I should understand what actually matters to you. And then what your mindset is that you know, is it a mind disease or is it like your mindset, your multimorbidity, the medical problems that you have, the interactions between them, the medications and then your mobility keeping you upright. And then the E was the is energies from a cellular level to disease specific level that are energy dependent. And that's where like Peter Atilla was talking about, you know, some of the energy dependent diseases where you think about cardiovascular disease, cognitive disorder, cancer, metabolic disease.

20:51 Well, that's just like in the E. And then the A is for activity and how our bodies are like meant to be in motion and not like going to the gym, but what do we want to be able to do and our reserve and capacity. The L is the longevity piece. So then you know, those pillars of lifestyle medicine like social engagement, diet, sleep, you know, those pieces. And then the T is for transformation and how we do transform. So like, you know, these longevity people that I, I'm, I'm sort of, I think I stand outside of their realm is like, no, we are supposed to age and our life is not supposed to be forever. And so then how do we adapt to that transformation?

21:32 So our adaptation to change so that we can live fully and have the best quality of life possible. And the last age is habits and something I used to always say, and everyone was like, where did you get that? I'm like, I don't know, I pulled it out of somewhere, but I used to be like, what's the reset technique? So I guess nobody like had used it before because I ended up buying the domain. It's mine. I don't do anything with it, but anyway, but it's like these incremental changes, you know, our life moves along and our habits like you walk into a room, you flip on a light, that's your automatic habit. So how do we build our small habits in into our life, kind of like Atomic Habits.

22:15 That book is a fantastic book, but but then, you know, we can't maintain our habits all the time because life happens. So how do you have these like small incremental resets so that you can sort of pick up and just redefine yourself again so that you're not like giving up? You know, so I can, I kind of see health in that framework. And then that's my approach when I take care of a patient. And surprisingly, my patients are like super motivated. Like they come back and most of them are doing amazing. You know they do all the things and it works so when they do. I would, I would guess that part of the reason why they do so well is because I think that for a lot of people, if you're getting treated, you are receiving something and you expect, and your role is very passive and with a lot of lifestyle type of medicine, you're putting the person's decision making in their own hands and say, Hey, if you want to be healthy, you need to sit down and stand up three times a day.

23:18 You know, if you want to be healthy, walk up and down a flight of stairs and to say, Hey, this is in your hands. I can't force you to do it. And, and you will see that you'll feel better if you do it. But like, I think that I think that when you give people license to take care of themselves and you say, hey, there's a very tangible playbook that links your movement with your cut, with your cognition, let's be on top of that. Like they'll say, hey, if that's all it takes and that's all, and then I didn't realize that, then let me keep on doing it. That's awesome, you know. Yeah, I think in, in, in some senses, though, you know, like sometimes, because I do have elders. Most of my patients are elders. I have a few like in their 40s and 50s who came to me because I took care of their parents and they're like, they're doing better than me.

24:03 Will you take me on as a patient Now? I have like these young adults that I don't like, I'm like, Oh my God, that's amazing. You know, this is fascinating, like new area of exploration. But you know, sometimes my elder patients are like, oh, you don't, you don't know, like you, you don't know what having chronic pain is like. I'm like, oh, but I do, you know, and I tell them I'm like, you know, I had both my hips replaced like literally a year ago and they're like you did. I'm like, yes. And I was limping and I wasn't sleeping and it was like 3 years of no sleep and paint chronic pain. But I did what I needed to do, you know, and, and I was just unfortunately like born wrong, like a dog, you know, dysplasia, but you move on, you know, or they're just like, they don't get it. Like I share my personal stories with them, which I think help them to see that I'm also human.

24:57 So I, I sometimes do this very take this very non traditional approach to medicine, which I think we also need to think about as physicians. Like I, I made a house call the other day because the patient had had surgery and when I got there, the dogs needed walks. So I ended up like walking the dogs. There were these cute little puppies and I met the neighbors like, oh, I'm the doctor. But you know, you kind of meet your patients where they need to be. Like, I mean, that's like a very drastic example, but you need to meet your patients where they need to be. They need to see the human side of you, the imperfect side of you. So they can be like, all right, this person doesn't know, you know, or like, it's OK. Like they're not perfect either.

25:42 So I, I, I always remind them how abnormal and inadequate. And, you know, I tell them about my failures of like the night time. I get up and have a little piece of chocolate and then I have to reset again. Like what did you just do, you know? But I think that's the other part of medicine that's that's important. Just the human part that we don't, that will help our patients succeed. I for sure, for sure. It's very interesting because they bring that up because there's two things. So there's two responses. I'd love to hear your thoughts to the first part is I'm reading a book now called Empire of Pain and it's about the Sackler family and painkillers and to do pharma. And one thing that Arthur Sackler was who's the, I guess the leader of the clan and, you know, the the father of the family, so to speak, was famous for was he kind of linked advertising and the public's perception of MD's and doctors and associated and sold that as a package to the American public and said, hey, doctors are doctors are not wrong. Doctors are above people.

26:55 Doctors are always right. And we in our medical sense are only trying to achieve the highest truth, which is scientific truth and rigor and basically use that as a method to get away with selling, you know, incredibly, incredibly addictive painkillers as strong, stronger than heroin for for decades, right. And on the other hand, and on the other hand, my grandfather, who's a gastroenterologist for, you know, for 50-60 years in Miami Beach, he has lifelong patients. And he was lamenting to me how the new hospital systems that have taken over that are buying out private practices don't allow a doctor patient relationship, essentially. And that you're basically not encouraged to ever kind of like whoever you walk into the room is who you're dealing with. And then you walk out of the room and you never deal with them again.

27:47 And he's like, I used to check in on my patients on a daily basis and they would call me and they tell me I'd saved their lives just from being their doctor, not from there being their GI, from being the doctor. So like, you have two to the way that people could treat being a doctor. You have like the Sackler type of family that just, you know, holds themselves as above everyone and wants to take advantage of the rest of the mortals down here. And then you have the doctors that are doing the work of caring for people, you know, and, and part and again, you know, and I think that there's a misconception today or maybe a reconception of, of a doctor, someone that just tells you what's wrong with you. And the primary purpose is diagnosing not not as much preventative and not as much, you know, the building up and the lifestyle aspect that you're referring to. But I I hope that with with technology and AI, it's going to be easier for people to come become more. You have a personalized form of healthcare for sure. I think that's kind of what healthcare needs to be like. What, what is it that you want me to help you with? And that's really my question.

28:52 Every time they come, patients come in, I'm like, what can I help you with? What are you concerned about? You know, and, and that's sort of where the the approach starts. And then I and then I also tell them like, OK, well, I've detected this and this and, you know, I have patients who are like, I am not taking the statin drug. I'm like, OK, let's work on doing it another way and and we can try this, you know, and I really, I guess that's the reason I left at the corporate world. And yeah, I know we're going to talk about my book, but I always am like, if somebody in corporate medicine reads my book, they will never hire me in a hospital again because I slam the hospitals.

29:35 And, you know, I was getting involved with administrative care administration. I was, I was in a faculty, I was a teacher forever as a program director. And so I was getting involved in the with the C-Suite operations a little bit. And, and I think once with one of the execs, I kind of really got into it. And I got home and I got really mad. I was like, OK, I told my husband and he's a physician too. He's a critical care doc. And I said, Jace, what's his name? I like either. They don't know what they're talking about. I don't know or they're lying to me. But I've only learned medicine and I have to figure this out. So I'm going to go to Business School. And that's what we did.

30:16 The two of us went to back to Business School and got our MBAs. I was like for three years, you know, here were full time docs, full time parents and like our early morning study dates and our nighttime study dates. And you know what happens when a doctor goes to Business School, the OCD and type A personality comes out. So you still get like a four point O And I remember I'd been in Business School with these other students doing projects and they're like struggling. They were just out of their bachelor's and they're like, how are you? How are you not struggling? Because I'm like, I don't know, there's this like crazy comes out and I, and I have to like prove something to myself. But what it taught me, what it really reinforced in me was that I can, I can take my time with my patients, I can make money, I can be profitable.

31:04 And one day, you know, it was towards the end of business. So I walked into the clinic where I worked for this hospital. I turned on the lights and I think COVID had sort of jaded me anyways, you know, like I was just like this, something's got to give. This is not good. And I was doing a lot of palliative care consults. So I think emotionally I was just drained being with people as they were dying and, and I was like, I'm keeping these lights on, nobody else's. If I don't walk in here, like the nurse doesn't get paid, the front desk doesn't get paid. And and then the execs in the C-Suite don't get paid and they're taking my money. No one's going to take my money ever again.

31:46 So then I was like, OK, I'm going to come up with this whole plan. And, and I left, you know, and I called my one of my fellows, Kate, who's my partner now. And I was like, hey, we're going to do this. We're open this practice. And either it's going to work and it's going to be great or it's going to suck and we're going to just be employed physicians again. But either way, you know, it can't be any worse than this. And it and it works, you know, and it's like we're trying to, we're looking at adding another physician now and you know, who are five years into it, Like we're both at our capacity for patients and it's been wonderful. But I get to spend an hour with my patients. I get to go to the hospital and see them and I get to go to their home and I get to see them and I get to be like the doctor I wanted to be and I envisioned not like what they expected me to be, you know, and, and, and that's so valuable and I'm like, we need more doctors and I so now one of the, my motivations for having medical students is to show them, but like guys, there are other ways to practice.

32:47 You do not need to work for this institution. Unfortunately, that's the model. They they teach us to be a commodity and then the patient relationship goes away and then patients suffer, People suffer because of that. You know it's awful you. Know what you can't you can't count health without relationships because like the worst thing that you can do to a human being, the worst, the worst thing they do to you in prison is solitary confinement. And like, and the worst thing that you do, you could do to someone is to just take away their relationships and people, people that people will, God forbid, kill themselves over over relationships, You know, like you could have all the world, you could have all the comfort, you could have a house, you could have friends, you know, like if you don't have it, but the chances are actually like if like you probably don't have friends if that's the place you're at.

33:37 But the point is that relationships are everything and your health for sure. And, and it's funny because for a long time, you know, people have said, OK, well, emotions and like relationships and stuff, that's like one thing. But like we need to stick with the tangible. But they do have a tangible, tangible impact on, on for sure human beings. And definitely the, the, the old, the, I guess the people in the, the later stages in their lives. But I know, for example, that my my grandfather, my mom's dad. Sorry. Yeah, My mom's dad was off his nails his whole life and he was living by his own. My grandmother died 2530 years ago and he didn't even go on a date since the day she died.

34:19 Like he was like my wife, but he lived alone and he took care of the house and he was A and he was a professor. And then when he retired, he still kept, he'd come to our house to help take care of our house. And then he, I think went like 91 or 92, he had a stroke. And the second he stopped being able to help himself and the second he stopped being able to go to the supermarket and get his own girls, he used to walk 3 miles a day at 90 years old, you know? And the second that the relationships and the and the and the and the independence faded away, he was like, check me out, like, you know. I know this is I'm ready to. Yeah, exactly.

34:59 This is what I'm here for. And and you don't want to be a burden. That was the other thing. And like to feel like you're a burden is terrible. And the truth is that you said something really, really awesome at the beginning of the podcast, which is that we go through it like different stages in our lives. And the later stage of our life is to, you know, aside from enjoying is to be the wise people for our family and for the community and the world around us and to say, Hey, we've lived through a lot of this stuff. And you don't need to do this this way. And you don't need to go through this pain and this hurt. And you don't have to do this. And like, when you have that, like that gives you a reason to exist, that gives you a place in the world. My, my grandfather, when he was a doctor, he aged 10 years the year that he retired.

35:40 And it was, you know, it was heartbreaking, but that's, you know, the way that life is. Yeah, I was at a meeting tonight with a a couple of the older doctors in town and one's like 68, the other one's in the 70s and they're working. And like, we still love to work. My God, stay in it. And this is, you know, these old school docs that I'm like always just so inspired by. But again, that's kind of what I talk about in my book as well. It's all it's like this sort of I, I try to really honor my. Patients, let's talk about your book now. Well, OK, so I wrote this book called Life Love, and in between a geriatrician's journey through aging and the meaning of life. And it started out I was speaking at a women's conference in 2016 and, and it was a, you know, it was supposed to be like a motivational talk.

36:32 And I had just lost my son to a congenital heart defect a few months earlier. So I'm speaking at this conference and I kept thinking like, what am I going to talk about? Like, like I'm, I've come out on this other side, you know, of having a child who was in Hospice and which is, you know, I kind of like always think the universe like puts things in front of like, I kind of felt like our son James like had like we were meant to have him because we knew how to take care of him. You know, it's the things that we did and based on, you know, managing patients at the end of their life or doing the critical care things. But also it taught us like how to be better human beings Because for the first time when like I had to give him morphine when he was short of breath in Hospice, like I freaked out. I was having a hard time, yet I realized I so comfortably write these scripts for morphine for my Hospice patients. And then it it clicked like this is hard for people. So he helped me be a better human, I think a better doctor. But anyway, some of the talk was about my experience and how I went through that whole stage.

37:39 And what really got me through it was the lessons that my patients had taught me. And what I was talking about in the book was, you know, I get to sit with these people. I don't have like 1 mother and one father, one set of grandparents or whatever. I have many every day. And and I almost feel guilty because they pay me to take care of them, but I almost owe them more. But the book talks about, like, how fragile we are and how much we need to appreciate our lives. And each chapter has a theme and has stories from my elder patients and the lessons that I learned, you know, like about love and just the stories of how these people are meant to be together and how they're together for decades and finding the spaces in between and not taking advantage of the time that we have or, you know, at the thought of empathy and transparency.

38:31 And and so this is all of these themes and not, you know, really not, not, not lying to yourself, not lying to others. And the very last chapter of the book is called relevance. And I was sitting with a patient and this person, I mean, this person is like has been my hero. And they're very sick. I mean, almost dying. And they looked at me one day and I said, I no longer feel relevant. And I just, and I you know, I know these people like so intimately. I think I spent so much time with them and in my head I was like, I can't handle this anymore. So I started to like, I pulled like my Eckhart Tolle stuff out and I have things in there from like philosophers on failing, like Pima Chodrin.

39:19 And so there's a lot of, it's poetic, it's philosophical, but I thought about it. I thought, OK, So what happens when I'm no longer a doctor and I'm no longer a mother and I'm no longer a wife? Where do I find relevance when all of my labels have been torn away? And how do I sit with myself and I'm still relevant as this human being, you know? So the book, I think, I'm hoping it teaches people these wonderful lessons that I've learned from my elders. It tells a little bit of about my story and my upbringing and then the way I met my husband. And that was very special. But at the very end it says, you know, what? If you want to learn anything about this world and about. Surviving this world and living a better life. Just sit with your elders.

40:03 Just sit with them and they will teach you all the lessons you need to know. And it seems like you sort of have some of that in you. You know, you have your grandfather's stories, and you seem to. Old people. You love old people. I love them too. I love old people. I'm an old soul myself, so I, well, I used to, I used to visit the assisted living homes in college and organize, have students, you know, organize trips and you know, and I, and you know, I've always been an old soul as far as, you know, music and culture and stuff. So it's, you know, we'd say like Frank Sinatra and we'd sing some of the classics and you know, we'd hang out, we'd have birthday parties in the assisted living homes. And there's the sweetest woman named Ruth. And I remember her.

40:45 So she had, she's super, super, super short term memory loss, but was an incredible physical shape. Yeah. So she's always down to around looked great. And she would ask me, we would have the same conversations 30 times in half an hour. And I would tell, you know, I'd be like, So what do you study? And I'm like creative writing and just like, cool. It's just So what are you studying? And I'm like astrophysic writing. Oh, that's amazing. Yeah. Pretend like you had the first conversation every time, which is OK, you know. But so much you, you, you, you learn, listen, there, there, there's no, I, I, we always, I, I always grew up, I grew up Orthodox Jewish. And, you know, and one thing that that we always had was just like, you know, the, the, the, I guess the Jewish perspective is that the older the people are, the closer they are to the original source. And so the fact that they deserve, you know, so we didn't grow up looking at old people like they're relevant. We looked at them like, you know, they've. Got spiritual source.

41:45 Yeah, but the source to like, like this is where you get your enlightenment from, you know, you, you, you hang with, with them. Yeah. And I, you talk about some a friend of my best friend when I was 13, I, I talked about her. I had always wanted to write about her, about Alma. I was, she was 80 when I was 13. And I used to always go to her house. So I was never in trouble because I was always at Alma's house. And we used to watch Doctor Zhivago together. And she used to tell me she was like, she lived in Germany during World War 2. And so she told me all about just everything she had witnessed and experienced. And so I have stories of that and in my book too. And but she taught me about love. She was always like, you know, when and her husband had passed, but she was like, the love you have when you meet, like your husband is going to be so different than any other love. I mean, and it was just, again, I remember like when I first met my husband, I was like, oh, that's what she was talking about.

42:46 That's what Alma was talking about. You don't know until. Well, my my friend Mel she she's been reading my book. So I was telling you earlier she wrote this thing and said I was like, dear God, lady, I just finished chapter 2 in tears. This is so moving and then do not tell Jace, but I secretly like him as a human. Now is my husband comes across as this like very just stiff, like, you know, he does what he does, but I have the, I have these other parts of him that nobody else does, you know, and, and, and I think in the book, I show that, that this other human that nobody's used to seeing, you know, this other incredibly wonderful soft human. But yeah, so I hope, I hope people like the book. I really wrote it for, you know, caregivers. I wrote it for anyone who's struggling with aging. And, and I wasn't even sure like how it was going to go, but I just felt like I need to get these words out and, and I need to be as like poetic as I want to be in it because all I'm used to writing is like medical things. Yeah.

43:58 This was definitely a lot more fun. And it was heavy and it was also therapeutic too. So. And I thought, you know, what, if it, if it becomes a great book and becomes a great book, and if it it doesn't, that's OK too. You know, it was just my way of honoring the people that have given me so much. So. Yeah. I wanted to and this is please, you know, as as much as you feel comfortable with the talking about being measured that you lost your son James. Yeah. What can you. You said that he he that he had a heart condition. What how old is he? What happened as as much as they're comfortable with. Yeah, I know. I'm pretty comfortable talking about it now. It was 10 years ago. He would have just.

44:40 Yeah, sorry. It's. One of the it's one of the hardest things we could go through. It is, but you know, I think it was also one of those lessons that helped me see another side of medicine and it also helped me see another side of humanity because you know, I have always been super like pro-choice and doctor physician relationship. And you know, so when I was it was my third child. So I had Mila and Zoe and then we had it and then we had James. But we, I went to the hospital to get my ultrasound. I was so excited because I had the other two in medical training, so I didn't have a chance to like do all the fun pregnancy things that moms get to do. As I went there and all of a sudden the radiologist came and was like your baby's heart like the apex. So the the side of the heart is pointed to the right, it's supposed to be pointed to the left. I was like where are all the other organs and everything else was in the right place.

45:41 So anyways, he ended up having this very severe congenital heart defect called heterotaxy. And they said that he would he was fine as long as I carried him. But when he was born, he would have days to months to live. And then we could opt for some surgical procedures that were going to be palliative. You know, he would have been, he would have always been sick and and then if he lived to two, he could have had tried to have a heart transplant. Well, I think my husband and I had so much. We read a lot and we did a lot of research and I think a lot of like soul searching. But when we met with the cardiologist, they were sort of surprised when we said first they were like, well, you could terminate the pregnancy.

46:27 And so here's what's interesting. You know, here you're like, like, you know, it was like these decisions that people have to make about like life and termination of life and all this stuff sort of came into it. And I was like, what are you talking about? Like, why would I terminate my pregnancy? You know, they're like, it's not like, what the heck are you talking about? Like, so, you know, we carried him and then they thought because I was going to continue the pregnancy that I was going to do all these medical things. And then I was like, what are you talking about? It's like, I'm not going to let him suffer. I can't do that to him. And so we took him home. And you know, the only time I saw my husband cry was our pastor came to the hospital and baptized him there because we don't know how long we had that was that was really awesome.

47:18 And then we took him home and eight weeks. So he lived 8 weeks and he, he died at home. And, and then I, it just, I think I, I learned so much about myself and I learned so much about, you know, how I need to be sensitive in a different way just because I, I perceive things in a certain way as a physician. So I think he definitely changed the way I practice medicine. But then also, like I had said, my patients had sort of prepared me for all this, all the lessons they had taught me. And after he had died, sometimes I you, you question like, what did I do? Did I do the right thing?

48:03 Should he have done all these surgical procedures? And I ended up talking to a mom who had had a kid who had heterotoxy who passed away. And she's just sort of crying. And I said, are you OK? And we were just talking. Her son passed. My son passed. And she said, I, I did all the medical things and I spent so much time being his nurse that I never got a chance to be his mother. And you had every minute you spent with him, you were his mother. And we did, we took him on hay rides to see the Easter Bunny to the bar with his cousins, little 4 LB baby and her like, you know, I'm like, you're going to live it up. I don't know how long you're going to live, but you're going to live your life up, kid. And it was, it was really cool.

48:46 It was incredible. And then, yeah, you know, and you also learn how much like, like I learned how much my husband loves me because we were at the doctor and they were like, we shouldn't have another pregnancy because you have these complications. And I'm like, well, you know, we could probably have another baby after James. And, and he was like, she will never have another pregnant. You know, when he thinks like he thought my life was at risk and I was like, wow, he really loves me. That's so sweet. And you know, but then we got involved with foster care and after that and we were doing respite foster care and somehow again, like life works out the way that works out. You know, we, we ended up with Peyton in our life and, and we were able to adopt her.

49:31 And so I ended up somehow with three anyways. And you know, you just kind of like, I think that's the other part that I I talk about in my book too, is like I had just planned my entire lifeout since I was 6, like I'm going to do this by this time and this by this time. And even if things didn't work out a little bit, I still figured it out and everything still stuck to my calendar until like the the world God and everything that all the powers that be were like, no, no, life doesn't work out that way. You go with the flow like you have to you know, you you can't do that. And and that was, you know, it takes, it takes like 37 years for me to have that lesson, which was pretty incredible. I'm kind of thankful for it.

50:21 But but even now, you know, and I think that it just changed who I am. And yeah, I don't sometimes I'm like so inappropriate because I was in a patient's room the other day in the hospital and I'm wearing jeans because they end up in the hospital. I just went because I didn't know. And I have my head be on the bed, like my legs were up. And the nurse came in like, who are you? And I showed him my doctor badge. Like they thought I was the patient's daughter. I was like, well, I kind of am. I'm their advocate. I'm. I was taking the charts, seeing what was going on, you know, and and then, yeah, he helped me, I think be more human than anything any other time in my life. So I just let things go now. It's incredible that you can, that you, I mean, you know, I mean, I, I don't know what the alternative is. And I know the alternative is, but I mean it's incredible that you like that you, you're able to, you're able to turn it into, meaning you're able to turn it into, into something tangible that you take with you.

51:21 You know, I, I did, I, you know, I guess I, I did a breath work class. My wife had encouraged me to try 1 and it was more of that like and I breathe out until you, you know, I was in and exhale and I wanted to and I've done psychedelics before. So I was a little familiar with, with, you know, the kind of place that I was supposed to end up at. And, and I at this point, I've been a father, this is probably a year ago now. And I've been a father for two years. And I was still struggling with the idea of me being a father. And I was not, I don't think I was still, I still, I still thought of myself and I'm still transitioning in my head from thinking myself as like a kid and a teenager to being like a dad that's responsible for, you know, for two kids right now and, and a home and a wife and a family and, and my grandfather and my grandfather had just passed away, you know, a couple months earlier. And I was doing this deep breathing and I, I, I swear to God, I felt his soul.

52:25 And he was like the father figure kind of role of my life. My dad, who I work with, I'm very, very close with, is always more of like a friend. Yeah. And he didn't, like, he wasn't the authoritative father figure that, like, you look up and say, like, this is a dad. You'd be like, oh, this is like, this is my dad. Love him. He's funny. Yeah, he's cute. My grandfather was like, you know, like this Holocaust survivor and like, you know, strict, strict but loving and has priority set straight. So, you know, I'm doing this breathing. And like he came to me and like, and I was just like sitting with his presence. And it just helped me process for a minute like, hey, like he was scared and he made it and you were scared and like your life is a total breeze and like you're going to be fine. And like he's with you.

53:15 And like, like, you know, like you have the direction and you have the people and like, and, and almost felt like it almost came to a little bit of some kind of resolution, some kind of spiritual resolution that I really, really felt like, and I felt like, you know, he had to be acknowledged that like he behaved a lot of the way that he did a lot of time because he was afraid and frustrated. And, you know, I and I had to come to the conclusion like I, it was a fearful kid. And I don't have to be a fearful kid anymore. I could just be a dad now that like learns from his grandfather how to be a dad and like you learns and like, and what's incredible is what's you've taken that lesson from, you know, the elderly community and applied it to your life and a child and, and child like, you know, like, which you would imagine is the total opposite. But I feel like they, the wisdom is so deep that and, and they, they, they have to cross, you know, like they, they definitely, you know, they, they, they, they, they flow into one another.

54:09 And, and if you're willing to if and you look and it sounds like you're, you've been able to accept it from either end, you know, from learning from the youth and learning from the elderly. And it's, it's extremely, extremely admirable and it's really, really beautiful to be able to just even listen about and hear about. So I really, really, I give you so much credit for for choosing to handle things in the way that you do. Which, you know, it's really interesting being on this podcast with you because like you're, you know, looking at you're like, you're obviously like younger, yes, young family and, but like, and culturally, like after having this conversation with you, like wow, we are like a lot alike, you know, as far which like, I think we've, I think like we've, we've lost that. Do you know what I mean?

55:01 Like I, I wish we would have more of that. And, and, and I, and I love that you can talk about this because I do think like you being younger, you can definitely be like this amazing role model for your peers, you know, because I'm like, I know how. Role model. I've encouraged them. To you know, it's. I am, you know, I'm just a regular dude. I, I don't think, I don't think myself very highly at all. I think a lot of people are working. Like, you know, it's like you're when you're some someone who's like relatable. Like if you, you know someone who's like, OK, no, like I, I can relate to you in this sense. You know, just like, I think I'm like mid career women are struggling with some of the same things I'm struggling with.

55:45 Can like relate to me, you know, and it's like, so, you know, but but what's cool is every stage is like beautiful and every stage is just like, embrace it because you're going to lose it even with your babies. Like, Oh my gosh, like I, I keep looking at Mila's pictures when she was a baby and I'm like, Oh my gosh, I've got this like big teenager that's taller than me and like, where did that go? So I don't, I don't know. I feel like our life is so, is so short and we're so lucky to be alive, you know, and, and we're so lucky to, to get to experience life. And I think we shouldn't take it for granted. I think that's what elders teach us. Yeah, and I think it goes hand in hand with everything we've been talking about.

56:34 When you love your life, you want to take care of it, you want to, you want to cherish it. And like, I mean, I, I've had, I had friends that just came over and they're a little bit helicopter parents either first times and they are, you know, and like, you know, we, we, we understand, like I like, you don't want that person to get hurt. You like you don't want it and you know, you want to protect them. But at a certain point, like, you know, there's a great book, The Anxious Generation by Jonathan Haidt. Shot a great book, yes. It's the most important book I've read other than any religious book I've read. I like that book is like. It's transformational. It's a fantastic book, yes. I read. Everyone should read it. I mean, he's, he's an incredible social psychologist.

57:16 But what was the other book he wrote that I read first? But he's, he's incredible, yeah. Another favorite He wrote a book, The Coddling of the American Mind, too. That wasn't the one I was thinking about something. I mean, I was thinking about the Dan Ariely book and it was like, it's it's hard to remember which one, but he's so smart and he's so right on. You know, like 10 years ago I was like telling my in laws like, don't let don't let Mila on this phone. It's going to give her ADD. And now you're like up. Sia told you all the studies are up too late now. Yeah, that's it. It's gone. It's gone. I have it too. I have it too. I've been hit, I've been hit. I'm addicted.

57:57 I'm addicted for sure. I wanted, I wanted to, I wanted to ask you because my wife was really excited when I was preparing for this. I was, I was talking through, I was going through your website with her and we're talking a little bit about de prescribing because I think that, you know, we talked about the American pharmaceutical treadmill that people are on where you always on it and it just keeps on. It keeps on chugging along and like no matter what you're doing, it's just always tagging more on it's. Never taken more. Yeah, exactly. And so how do you go? I'd like to hear how you go about de prescribing. And I think that a lot of this stuff does not just exist in a vacuum. If it applies for geriatric, I'm sure it applies for, you know, young adults. I'm sure it applies for middle-aged people, I'm sure it applies for youthe.

58:43 So what are some things that you've learned about the process of de prescribing people and what replaces that? So when people this is how I am, I, I see medicine, you know, you're like in your 40s, your blood pressure goes a little high, you start to get a little blood pressure medication. Do you know? And then cholesterol goes up and you get a little bit of a my little my middle child just wanted, but you're you're you're Hey, Zoe, you're you're. Well, good, yes. OK, so in your 40s, you take a little bit of medication, another one for cholesterol, and then your blood sugar goes up, they give you something else and then you have a side effect from the cholesterol medication or the blood pressure medication. So you get on something else.

59:31 You know that we call that the the prescribing cascade where they, you know, you end up on another medication for the side effect. So like on a nausea medicine now because you have nausea from another medication, he's like the time you're like 60, you're all of a sudden I'm like 6 to 10 medications. And we consider polypharmacy is when you take a lot of medications and then and there's like over 110 definitions of polypharmacy, but the most common one is 5 or more medications. And, you know, as we age, the way we take a medication and the way that medication is distributed, the way it's metabolized and eliminated from our body changes because our body changes, You know, our skin changes, our kidney changes, our liver changes. And, and, and so we have to, as a geriatrician, we have to think about, well, is this medication still appropriate? And so when I see a patient, is this medication still appropriate for their kidney function? Is this medication still appropriate for like primary prevention?

1:00:29 Is the risk of prescribing it, you know, is the benefit outweigh that risk? And, and thinking about side effects that they were, they're experiencing. And I kid you not, I had a patient in my office who came in who I was testing in like the moderate dementia stage. I took her off of half her medications over a six month period and she tested in the normal cognitive range. So she was and, and I mean, this was like the classic, I cannot believe they. So she was able to drive again and she was about to move in with her son and she was able to go back home. I mean this is I mean I. Prescribing. Yes, and I think, you know, and then these some of these are like extreme cases, but you know, we, we have to really be as a, as a good doctor, we think about prescribing, but we have to equally think about de prescribing. Now when we think about younger people. So if that young person before they were placed on their blood pressure medication, what was the reason for their blood pressure issue?

1:01:34 Was it because of their weight? Do we need to think about weight management? Is it because of, you know, stressors and they're like cortisol at all levels? Is it because of hormone levels? Like you have to kind of think about this person holistically, You know, is it a genetic? Is it a genetic factor? Is it a kidney factor? So really I'm thinking about that. And then if we can sort of address the underlying issue before we prescribe that medication and see if we can get and achieve the goal that we need without the prescription medication. And sometimes we need the prescription medication. I mean, medicine is cool. It's we've created all sorts of awesome things, but sometimes we go overboard. So, you know, if the cholesterol example, you know, can we lower the cholesterol by by thinking about a more plant based diet? And every time people are like, why can't I can't be a vegan, you know, or I don't ever tell them you need a ketogenic diet And they're like, I can't just eat meat. And I'm like, no, my husband is a vegan and he eats a ketogenic diet.

1:02:34 Like it's not about meat and it's not about, you know, he gets plenty of protein. I can't. I eat what is. Different protein. What is what does he, what does he get for? What food does he eat for that? So lots of soy, like I would say tempeh and, and like lots of beans, you know, and I make like these alternative common foods, like I'll make like a falafel, but it has like walnuts in it and nutritional yeast and you know, and I'll, it's, it's baked and not fried. And, and then we eat like very good, like like good oils, you know, not seed oils. Those are inflammatory.

1:03:16 But yeah, like great. Like good olive. Like it's so it's, yeah, I mean, that's, that's a lot of a lot of lots of nuts. And, and you know, sometimes I'll make stews and mix a lot of nuts in there or it's and my, my elder patients that they're like, I'm going to go vegan. Like you are not going to go vegan because you are going to get sick. We haven't been sick many years to, you know, to get to a place where you're meeting your macro micronutrients, but I can help you get more plant based, you know, and and still maintain that and lots, you know, lots of vegetables and you know, it's it's not hard it, but it is hard, you know it. You have to have like someone who's patient with you. And so like I had a guy kind of leave you with this big one, but came to me depressed because wife had died, didn't know how to cook was like 304 lbs.

1:04:09 The sweet man. So didn't like had gained all this weight, diabetes was out of control, blood pressure was out of control. And, and I had, I told them, I said, listen, we're going to make some changes. But for the next three weeks, every time you go to the grocery store, I need you to call me. I'm going to show you how to read food labels. So we did. I showed him how to read food labels, how to prep food, how to make food. So over 2 years he went from 304 lbs to 240 lbs. And that was, do you have that, do you have this process on your blog? Like, do you have this like in a commonly available, accessible way that like anyone could like take a look at this because like we care about, I think young, the young, young, the generation cares about health nowadays. They really.

1:04:51 Do I know I love that too. So I'm I'm writing this book because all this stuff is like kind of mish mashed in my blog post because and in the blog post come from a patient asks me a question and I'm like, oh, I need to write about this. You know, I got to I got to make sure they have access to this information. And then I'm in the office and I'm like, oh, hey, you need your Omega threes. Here are your plant based Omega threes and here are your animal mice Omega threes. Print out the thing. Here's the blog post. But I'm writing this book now. I'm actually on the very last part, the H the habit. So I try to like package it all. So it is in this like sequence. But you can find like all this information on jerryacademy.com and and the blogs not for old people.

1:05:33 It's for everybody, you know, who's who thinks about their aging and we should think about our aging and like our second, third decade of life, not just like when we're 50 and 60. We've lost all that time, you know, So I, I love how younger people are thinking about it. I mean, my 15 year old measures her food and kind of obsessively, but in a really healthy way. She makes her lunch every day, but make sure she has like, she measures everything that she puts in there, you know, and I'm like, this is, this is kind of good. OK, Maybe like the OCD parents, the Type A parents have, you know, done that to her. But it's OK, you know it. But you know, yeah, all of this stuff, you could kind of, you can find it in the blog.

1:06:16 There's like healthy things and I and I keep adding more to it. But, yeah, I'm hoping I have to find, like, a literary agent first for this book to see if I can get, like, what as far as, like, publication goes. But I just was like, I got to start writing this. And. But all the information is like, in bits and pieces in the blog. You just, like, look for the thing you want to look up. But yeah, he got a dog. He ended up walking. He ended up moving closer to his daughters. Like, this was all transformative, you know, after losing 60 lbs and he was continuing to lose weight. But, you know, it was, it wasn't hard. Somebody just needed to teach him what to do.

1:06:57 Yeah, I I totally agree. I, I have AI have a group of dad friends around here and you know where I live and you know, I and when I have one particular friend who since I've met him a couple of years ago, probably lost 150 lbs without exaggerating. And no one ever like told him that he was overweight And like he never had, like he told me he had a, you know, a doctor was like, Hey, you got to be careful. But what happened, I think was he became, he became friends with me and a couple other guys that do exercise a lot and just talk about it. You know, we just talk about like, we like really talk about how good we feel and how it's part of our everyday schedule. And then, and then, and then, you know, we have a group chat and he's, you know, and then he started sending like, you know, the videos of, of people jogging and like, you know, so one day I got a random Tuesday, someone's in the video of them jogging.

1:07:44 And then within the next hour or two, everyone else in the video of them, Hey, you know what, I have 20 minutes now. Let me get up and let me work out for a little bit. And like, I think that he's also such such an integral part of, of health as far as building habits and encouraging healthy habits, because a habit, you know, it's hard to build when you're kind of swimming against the stream. But when it's your, when it's your norm, then it's like, hey, you almost want to do it. Like, I mean, you know, all the, and you could talk about the motivation and the value or not and how much intent matters or not. At the end of the day, if someone's losing 150 lbs at 35 years old, that's awesome. You know, like, I don't, you know, if, if you're doing it with your friends, you're doing it, you guys are laughing, you're doing it, you guys, you know, agree that, you know, cutting back on drinking for, you know, drinking X amount XY and Z is probably beneficial.

1:08:30 You know, the way you eat, probably beneficial. Stop eating at a, you know, particular restaurants or particular types of food. And like we just, everyone is just doing better now than they, they had before and their lives are crazier. They're, you know, it really helps with balance for sure. Yeah, like we love craft beers and it's really cool that there's all these like non alcoholic craft. Beers. Every time we go somewhere, you know, like now we are like, let's try the non alcoholic craft beer. Oh, Asheville's like the best beer place ever. Have you been to burial? Oh, yes, burial's close to me.

1:09:11 Yeah, it's. Incredible. I get beer shipped from them down to South Florida and make I make my dad go there to pick to pick up for me. Here's a log cabin right near there and I make him go to burial and ship me beer. Oh my gosh. Yeah. No, we we love it. I mean, we, we love, we love craft beer, but that's kind of really cool because the whole like shift, because it's just kind of like an experience. And now they they make all these like, yes, amazing. Like Sierra Nevada has a whole bunch of really yummy, you know, non alcoholic beers, but a lot of. You guys right? Voodoo Rangers Sierra Nevada to the same company. Yeah, and then who? Like Hillman Brown?

1:09:52 I mean, there are so many. Such a. Cool. Like, you know, and then that's like our, our weekend. We're at a brewery with our kids and there's like music and we just chill out and it's good. That's the culture's good. But again, like, there are ways to, to live healthy now, you know, They're just like, you know, if I have one beer a week, OK. But then if I want something else, yeah. Like my husband only drinks some alcoholic beers now. He's just kind of giving up alcohol completely. I still do like a glass of wine a week or a beer once a week or something. Just that's good. You know, what do you do? We have our vices and then we reset again, right? Yeah, definitely, definitely.

1:10:35 You guys have great music there too. You guys have an awesome music scene there. Billy Strange just played three nights there. I know my nurse went every night. She thought it was there. She got tickets every night. And then what did I just do? Oh, I just bought tickets to Lollapalooza to take my two daughters. And she saw that. Yeah, I was on the like on the website today trying to get the tickets. And then my oldest was like, I can't go. I have volleyball tryouts. Like, OK, I already bought the tickets, so I'll sell it when I get there. Like, really? Wow so cool, it's a great place to live. How long you been in Asheville for? We've been in Asheville, let's see, like since 2020, but I was only an hour away and then we've been in North Carolina since 2013, so.

1:11:22 So my dad has a log cabin about half an hour from Burnsville, which is Tennessee from you guys. Yeah, city to him is Johnson City, TN. It's only like an hour from us. Yeah, it's close. It's not. Far Yeah, yeah, totally, totally. And we and, and when I was yeah, during COVID in 2020, you know, I my, my, my there was this log cabin no one's around it's the middle of nowhere. And I used to go with my, and I was like, I'm sick and tired of being locked up. So I, I would take a group of friends and, you know, we'd take 5 or 6 of us. We'd go to like in the cabin and going to Asheville during the day and then, and then go back to the mountain at night. It's awesome. I love that part of the.

1:12:02 It's such a fun, different place and like anything goes, you know, you go downtown and somebody's just doing yoga and everybody else walking. It is just like a wild just and people are just so, I don't know, like everyone is so helpful and kind and and I think. That was affected by the by all the flooding. Yeah, it was. That was hard. That was awful. Luckily, like our house was fine, but we didn't have water or electricity for many, many, many weeks. And I had to close my office because we had no running water. And eventually I, we, we opened and we were like, we'll just bring water in.

1:12:47 And you know, it made house calls and it made, I mean, it was, it was, it was crazy. And then our virtual assistant, she lives in the Philippines, you know, we made international news. She called us. And I was like, are you guys OK? We were trapped in our house for like, we like on our street, we couldn't get out for like 3 days. And then we're every, nobody was helping, you know, because nobody could get to anybody. And finally all the night everyone took their like chainsaws and cleared the roads so you could get out. And by the time we got out, we didn't know there was like everything was shut down and it was crazy. And we ended up getting our kids out of town so that they could go. And, and then we ended up coming back to help, you know, do whatever we needed to do.

1:13:32 But it was, that was wild. I can't believe we went through that. Hopefully the last one And Asheville's just perfect now because I, I really do love it here. It's like my favorite place I've ever lived. That's awesome. I love. Yeah, I'm happy to hear that. Yeah. That. So we've we've gotten stuck there, if you want to. The truth is that as far as like America goes, if you want to kind of have trouble in America, like, you know, like natural trouble and stuff like that, like N Carolinans treat each other so well and like the people like gone. You know, we've got stuck in the mud so many times or you know, like we've broken down or something's happened. And like the people are just good people. They just, they just have that, like they just have that goodness in their heart. I really like, I really, I really being around there. Before you wrap up, I want to ask your advice and final thoughts on things for people to avoid as far as their brain health and development as they age, and things for people, A couple of things to avoid, a couple of things to proactively take care of and do.

1:14:35 OK, so processed food, like avoid it. It is a killer. No, that's a tough one, but it's a it's a killer and everything is now processed, you know, like just anything that comes out of a box, try to avoid it. Eat fresh foods. I would, I would say it's probably the big thing, but avoid processed food, avoid not sleeping. That's really, really bad. Make sure you get at least 7 hours of sleep because lack of sleep, you know, and I, I struggle with not getting enough sleep, but insomnia can increase your risk of dementia. Make sure that you know, don't, don't smoke smoking is bad. Don't, don't vape. We don't know all the data yet, but bad things are happening like we're finding bad things.

1:15:15 So don't don't put anything in your body that's harmful. Just like treat your body like it's a temple, you know, try to really know alcohol is the best thing, but a little, you know, try to don't drink daily because that's not good for you either. So those are the things that I would say exercise almost daily, not just cardiovascular. You know, you should probably do weight training. I hardly ever do like cardiovascular stuff. It's like I'm basically doing weight training. And most of the time when you're weight training, you're hitting that zone too. So you're getting your cardiovascular needs met anyways. But yeah, I'm strength training. I think like almost everyday you should be doing something to stay active. And then, you know, I think there's some good stuff about fasting that's going to that's.

1:16:02 We're. Still figuring all that out, but I don't I don't not into this like these big long fast. I'm still trying to figure that. I know David Sinclair talks about these fast. You know, he wrote the book Lifespan. He's like so smart. But I, I'm, I'm more of a, hey, let your body do a natural fast. So don't eat late at night. Finish your dinner at 6:00 PM. Don't eat anything else. Just have some water until the next day before you want to eat. Eat when you're hungry. Don't don't suffer, but eat something good. I mean, those are like the basic things I tell. People, that's really cool. So avoid smoking, avoid vaping, processed foods, a lot of alcohol.

1:16:42 And what was the last thing to use? I think the top. Three, sleep. Make sure you're getting plenty of sleep. You know, sleep. Right. Project to. Get enough sleep, exercise, and potentially stretches of fasting in whatever capacity that might be. So from from dinner time to breakfast time, breakfast time to dinner time. Whatever. Yeah, just kind of, you know, these natural fast eat when you're. Hungry. Does that include water? Does that include water or no? Oh, yeah, yeah. I think like you should just drink as much water as you want. Like water is key. Do you know, even like you can even stay hydrated with some coffee and tea if you're like going throughout the day. You know, I mean, as a doctor, like people are like, oh, when do you take lunch?

1:17:23 I'm like, I don't take a lunch. So all I do is I have, you know, my breakfast, which is sometimes like couple of eggs or like a protein ball or something. But then that somebody from the gym makes and some coffee. But then the rest of the day, like if I'm hungry, I'll have like a handful of nuts and then I get home and I eat. But doctor, diets are perfect. You don't. We don't worry too much about weight gain. We just don't really have an opportunity to sit down and chow down just fine. Busy enough to not get unhealthy? Basically is this is the answer? Yeah, and I'll, I'll put up some more blog posts on like specific like diet things.

1:18:04 I think that that would be a fun, you know, a good thing to, to put up. And I always tell people like don't like follow all my vitamin supplement. It's not advice. It's just information so that you can advocate for yourself, you know, and, and you can talk to your healthcare professional. And that's the other piece of it before my Internet knocks out. But you know, if there are only only 13% of people have access to a geriatrician, we are, we need 30,000 by 2029 when the last of the baby room returns 65. And we only have a like close to 7000. We have those retiring. We only train 250 a year. And so I think healthcare really needs to become like your own, like you have to own it.

1:18:47 And yeah, I do think AI and tech is going to help us achieve some of that where they're going to be a little bit of a lack in healthcare. And then people should advocate for themselves and seek, seek truths other than some of the weird, like weird stuff, you know, that that's out there like. You mean like to live forever, be like a lizard person kind of thing? Like drink something you're in or I don't know. Yeah, yeah, yeah, yeah, yeah, yeah. All the Epstein popular stuff. Avoid all the Epstein. Falls no. Avoid all that, yeah. Seriously doctor, this is such a fun conversation and honestly I had such a blast. This was a emotional roller coaster, but so informative and so much fun and quite frankly, this was awesome and you killed it, so thank you so much.

1:19:36 For taking. Popping on. Thank you. And then yeah, I'm going to connect with you because I do want one of those like bone density machines. I was looking. At Oh, definitely. Yeah. Like maybe we can connect. Definitely. Definitely. I'll do what I can for you, Doctor. Thank you. Of course. Thank you. Thank you. We said goodbye, but before we go, how do we find you? OK, so you could check out jerryacademy.com, geriacademy.com it has a link to my book if you're interested. And then the book again is called Life, Love and the In between, a geriatricians journey through aging and the meaning of life. So. And I'll put that link on the website and on the on the episode page.

1:20:17 So I want to be able to find it very easily. That sounds great. Thank you. OK.