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Oct. 18, 2019 - Freedomain Radio - Stefan Molyneux
38:26
Bernie Sanders Heart Attack!
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Hi, everybody. Stefan Molyneux from Free Domain here with a good friend, Dr.
Kevin Wakasi. This is, of course, the kind of show where I will regularly be turning my head and coughing.
Dr. Wakasi has been an ER doc for 25 years.
And tell us a little bit about your history, your blog, and how people can find you on the web.
Well, thanks for having me on, Steph.
I've been practicing emergency medicine for 25 years, like you said.
But I also do now what's called direct patient care.
I have a cadre of patients that pay me per year.
I don't accept any health insurance in that practice, and they pay me, and I'm on call for them 24-7.
It's really wonderful. Direct patient care or direct primary care, as it's being called these days, is the wave of the future, I think, where people just get away from using health insurance for their routine health care.
I also have written a couple of books.
The first one is The Guide to Buying Health Insurance and Health Care.
And the second one is, oddly enough, it's called Healthcareonomics, 1,000 Crazy Ways the American Health Insurance Industry Controls American Health Care.
And those are both available on Amazon, iTunes, and Nook if you'd like to check those out.
I also have an app called Dr.
W's Equation that helps people buy health insurance, make smarter health insurance choices.
And I have a blog at healthcareonomics.com.
And how we found each other was on Twitter with HConomics.
You can follow me there. Right.
So we're going to talk a little bit about what, for those of us who are anti-socialist, looks like the closing credit scene in a horror movie, you know, where they think they've put the vampire to rest, but the hand comes out and grabs the ankle like a ball and chain, which is Bernie Sanders seems to have had a pretty close flyby with the deep dark hereafter.
And now he's back and claims, I think he's continuing to run.
The squad has endorsed him.
And boy, you know, heart attacks, you know, there's a reason they say it's as serious as a heart attack.
So what happened in your view?
And again, all the caveats, you haven't examined him personally.
We're just theorizing and this is not any kind of medical advice.
We're all certain of that. But what do you think has happened and what are his chances of being able to go through the rigorous and grueling nature of a presidential campaign?
Well, you know, I tweeted out the other day that it's time for Bernie now that, especially since he's had a heart attack, you know, I think everybody reaches a point in their life where it's just time to sit back and enjoy what you've got.
And I plan on doing that.
I'd like to do that pretty soon.
Yes, it's like when they had that John McCain with that weird grapefruit tumor and he's staggering around Congress and it's like, dude, go home, spend time with your family, like make your peace.
Like, what are you doing?
Yeah, I think this goes to what you've said quite a bit in the past about, you know, most of these politicians and political types are addicted to power.
And it's probably what gives them their being.
And so they're not going to see anything come between them and the pursuit of power and pursuit of more fame and what have you.
You know, good for Bernie. I'm glad he survived the heart attack, but it's time for him to hang him up and go home and rest and relax.
I sure would. But he had a heart attack.
Now, pardon me.
It's allergy season here in Texas.
It's always good when the doctor can make it through the interview without keeling over.
I feel that's a good endorsement of self-care.
Well, physician, heal thyself.
If I could cure allergies, I doubt you and I would have ever met, Steph.
I'd be a very rich man.
But in any case...
Let's talk about heart attacks.
And in order to understand heart attacks, you have to understand that when we say heart attack, there is a lot of different meanings that can potentially go into that.
And the reason why is because the heart is an extremely complex, yet simple organ.
Everybody understands that it pumps blood.
Well, in order to do that, you have to have several systems.
Ask any carpenter or engineer, and they'll understand exactly what we're about to talk about.
The heart is composed of three different Major systems, really.
It's like a house. It has a mechanical system like the doors and the walls and the structure of your house.
The heart is made up of different muscles and valves.
These things have to work in conjunction with each other and timed perfectly in order to pump the blood.
But in order to do that, in order to get that to happen, in order to get the structure to move, the heart has to have an electrical system that tells it what to do.
And that's the wiring diagram of the heart that provides for the normal beating, the chambers that beat and sequence so that the blood actually gets pumped through the heart.
And when people die from heart disease, they can die from mechanical problems.
Like valve problems, as we'll talk about here in a little bit with Elijah Cummings.
They can die or they can have heart issues with the electrical part of the heart, and that's where you see a lot of sudden death on school grounds.
What's the number one cause of death on school grounds around America these days?
It's not shootings. Not yet.
But it's a sudden cardiac arrest and these children that you read about and hear about where they die of sudden cardiac failure, those are almost always electrical in nature.
That's where their wiring gets crisscrossed and they don't beat their hearts effectively and it stops beating, stops pumping the blood, they die.
But then the classic heart attack involves the third major system of the heart and that's the plumbing system.
That's the arteries that actually surround the heart and provide it with blood.
And there's three arteries in everybody.
There's the right coronary artery, the left anterior descending artery, and the circumflex artery.
Now, without getting too bogged down in the weeds on the anatomy of these things, any one of these three, or all three of these arteries, can become clogged.
They can become blocked with plaque.
And that's what most people are familiar with when it comes to the idea of a heart attack.
It's the idea of a blockage that causes a problem with the plumbing, stops the blood flow to a particular area of the heart.
Now, depending on where the blockage is and where the stoppage of the blood flow occurs, that creates the severity of a heart attack.
In other words, imagine when the artery first takes off, and all three of these heart arteries come from the aorta, the major artery of the body.
And they all take off from the aorta right after it exits the heart.
Now, imagine when the artery takes off from the aorta, it's a very, very large, like the Thames River, or like the Mississippi River.
But then if you go upstream, instead of going upstream up a river, as it gets smaller, you go upstream, you encounter creeks and streams and brooks and things like that.
In the arteries, as you go downstream, the artery narrows and it gets smaller and smaller and smaller.
So, depending again where the blockage is in an artery, if it's close to the aorta, if it's right there at the main takeoff, that's going to affect a lot of heart tissue.
And what constitutes a heart attack, like what I think Senator Sanders had, is when the heart artery gets blocked, Stop the blood flow and actually causes damage to the heart tissue.
Okay, so just a sec here.
So this is something I've never really understood.
It's great having this house call here.
So you got the plumbing, right?
You got the artery. Now the plaque builds up slowly.
So shouldn't it just kind of slowly pinch it off?
Like where does the attack part come along?
That's a great question. So what's theorized is that you have a blockage.
In fact, you can find significant blockage in arteries of people who have no symptoms whatsoever.
They don't even have heart attacks.
So what happens is for some reason, and we're not really sure why, if it's inflammation or if it's stress that happens or if it's smoking can do this, for some reason the platelets in the blood vessels of the body, the platelets They get sticky and they stick together.
Now, I like to say this to patients.
I'm going to digress a little bit, but I think you'll find it interesting.
Blood is the most complicated liquid on the planet.
Do you know why? Because it likes to clock.
Yeah, it likes to clot, and thank goodness it clots, or else every time we cut ourselves shaving, we'd slowly bleed to death over about a two-week period.
So the blood clots, but it shouldn't be clotting inside the blood vessels, inside the arteries.
If it does, that's bad.
That's when we get heart attacks and strokes.
So then it treats the arteries like a hole in the skin and tries to seal it up as quickly as humanly possible, thus resulting in a severe non-continuation of life.
Yes, exactly.
For some reason, and nobody knows why.
If we figured this out, we would eliminate heart attacks.
For some reason, you can have a very small part of the artery that's blocked.
In other words, 50% of it's blocked.
You can have 90% of the artery that's blocked, and people will do just fine.
And then for some reason, out of the blue, bam, the platelets get sticky.
They stick to that surface, to that plaque, that cholesterol buildup.
They form a clot inside the blood vessel, and then at that point, as we say in the emergency room, when people come in with a heart attack, time is muscle.
You've only got a certain amount of time.
So how quickly does this clotting occur?
Like, is it hours? Are we talking like days?
No. How quick? Instantaneous.
I mean, almost instantaneous.
When the clot decides to form on the plaque, on the blockage inside the vessel, The clot forms almost instantaneously.
I mean, within a few seconds.
So the danger is that the clot will block it quicker if you already have existing plaque in there.
Is that right? Yes.
I'm unaware that the vessels are so large.
The blood vessels, microscopically, of course, we're talking about.
Again, I'll go into a little bit of physics here.
The only physics formula that I really remember has to do with the flow through a tube.
And the flow through any tube, including the blood vessels in your body, is proportional to the fourth power of the radius of that tube.
Let me explain. Fourth power means you multiply the radius times radius times radius times radius.
Well, when you're talking about multiplying something times the fourth power, the radius is, you know, half the diameter of a tube.
And if you're talking about the fourth power, a little bit of a shrinkage or a little bit of an expansion of the radius of that tube leads to a significant amount of change in the flow.
So in other words, just a little bit of change in the radius downwards with blockage Leads to a significant decrease in flow.
Or you think of like putting your thumb over the end of a hose, right?
I mean, if the water flow appears constant, that's when you play with your kids and you can send it like 50 feet, right?
You close it off a little bit and it can really jet.
Right, exactly.
Because the flow is trying to maintain the same velocity, but it can't with the obstruction there.
So the pressure gets higher, and there's all kinds of physics and dynamics involved.
We won't go into that.
But basically, when you have a blockage, in arteries that don't have blockages, I don't know.
Now, if it's a smaller artery, I guess you could form a clot in there.
It depends if you have what's called a hypercoagulation disease.
Some kind of blood disorder where your blood clots internally inside the blood vessels when it shouldn't.
These are genetic disorders. As far as I know, Bernie Sanders didn't have any of that.
He probably just had unchecked coronary artery disease where he had blockage around the coronary arteries or in the coronary arteries.
And, you know, and we need to get into that a little bit too in a bit.
But bottom line is that he most likely had a blockage that a clot formed on caused a heart attack.
Now, getting back to where the heart attack occurs, where the blockage occurs within the artery, the closer the artery, the closer the blockage occurs to where the artery takes off, in other words, the larger section of that, the more damage gets done.
So this is the difference between heart attacks that kill people just outright, Like my uncle at 53, or heart attacks that are just mild and people survive them and they do okay afterwards.
There's in the middle where people will have a heart attack and they survive it, but they have significant damage to their heart.
They need to have artificial valves put in.
They are not artificial valves, but artificial balloon pumps put in.
They may need a heart transplant, etc.
So you get all kinds of varying degrees of damage depending on where the blockage occurs.
I don't know where the blockage was.
I do know that That from the news reports, Bernie Sanders received two stents.
And what a stent is, it's literally a little piece of plastic, of rigid plastic, or sometimes they're metal, but most of the time they're plastic.
I believe they're plastic. A cardiologist can correct me on that.
But they take a little stent, a rigid piece of tubing, and they slide it in to bypass the clot.
In other words, they just kind of slide it over where that blockage is, and they re-enlarge the artery.
So there's lots of people walking around with these stents.
They're a fantastic invention.
They've made a huge difference, you know.
Wait, sorry. I'm just trying to – so there's a blockage.
They open up the artery and do they use this – they clean out the blockage and then put the stent in so it doesn't reform or how does that work?
Yes, they can clean out the blockage, but most of the time what they do is they insert a balloon into the artery and they just inflate the balloon and kind of squish the blockage a little bit against the arterial walls and then slide a stent over that.
Should we have mentioned that you probably should not be eating a ham sandwich while we're having this conversation?
No meatballs! Anyway, go ahead.
You shouldn't eat a ham sandwich. No, I have a ham sandwich.
I like ham sandwiches.
I don't know. The red meat thing.
We'll do a whole other show on the rise and fall of the fortunes of red meat, according to the hysterical nutritionists.
But anyway, go on. Right, right.
Yeah, in moderation, folks.
But the bottom line is that stents are a miraculous treatment or a miraculous intervention in the treatment of heart attacks.
In fact, 40 years ago, if somebody came into the ER having a heart attack, and I don't know, I wasn't practicing then, but 40 years ago, my understanding is that we would just put them in the corner and turn the lights off and say, shh.
You know, Steph's over there, whoever's over there having a heart attack, be quiet.
Don't upset them, and let's hope for the best.
Cross our fingers. Every heart attack comes with its own priest, right?
That's right. There wasn't a whole lot we could do.
Nowadays, there's a lot that can be done for heart attacks, both to prevent them, as we should talk about, as well as when they're happening.
It sounds like this is what happened to Bernie Sanders.
He had some chest discomfort, went to the ER. They probably found out that he was having a heart attack, sent him straight up to the catheter lab, Where he had these two stents placed and relieved his heart attack.
It looks like the damage, if any, was done was very minor because he's back on the campaign trail.
So it looks like Bernie has slipped the grasp of anything bad at this point.
Let's just do a tiny rewind, of course, and we can get to this later if that works better for your narrative.
Shouldn't this all have been known ahead of time?
Like, isn't this preventive stuff?
I mean, these guys are supposed to get the gold-plated best care on the planet, and America's fantastic for healthcare if you could pay, or someone pays for you in their case.
So shouldn't this all have been mapped down in obsessive tiny Dungeons& Dragons detail so that there wouldn't be these kinds of oopsies suddenly appearing?
Well... Yeah.
Bottom line is that heart disease is something that doesn't just creep up on you.
And by heart disease, what I'm talking about specifically is coronary artery disease, blockage of the plumbing, of that plumbing system, the coronary arteries that feed the heart that Bernie Sanders had.
This does not just develop overnight.
It is something that we can screen for.
There are many tests available, stress tests, stress tests with radioactive dye, Not significant radioactive dye, not dangerously radioactive dye.
You can do a nuclear scan.
You can do a stress nuclear scan.
You can do a cardiac catheterization.
Nowadays, they have MRI machines that are totally non-invasive, use no radiation, and are so fast and so powerful that they can pick up blockages within the coronary arteries themselves.
I've got a book in the works called Your Money and Your Life, and this book is going to be about how the American health insurance industry has really kept wonderful technology away from people, away from Americans for decades, because we have wonderful ways of screening for disease that we should be using.
We really should be doing these things just to check and see if there's anything going wrong with people before it becomes a problem.
I don't want to digress too much, but we've got a very reactionary healthcare system in America Instead of a proactive healthcare system, which is what we need.
We have the technology to be able to do this.
We certainly have the technology to be able to find coronary artery disease, these heart blockages, before they become problematic, before they become heart attack givers, like in Bernie Sanders' case.
So I'm questioning, I'm wondering why it is that Bernie Sanders had a heart attack.
I mean, to me, These, him and every other member of Congress ought to be getting rigorously screened for all kinds of things every year.
In fact, if they were to make me the Congress physician, I'd put those folks through the ringer.
I mean, every year, some more than others.
No, I wouldn't do that. I would treat everybody the same.
But I would absolutely put people through the ringer and do all kinds of testing on them.
You know, they made a big deal out of President Trump's physical exam.
If you remember, he had that hippie-looking physician who gave him the one-page report that cleared him for running for president or what have you.
Oh, this guy. I love this guy.
Tell me if I remember this rightly, because he said...
People were like, but Trump eats McDonald's, and like, why?
And he's like, hey, genetics, man, what can I tell you?
You know, it's just the way he is.
I think he's a genetics dude.
I think that's what he wrote on his report.
I'm not sure. Genetics dude, and I can sell you some weed in the VW outback.
Something like that, if I remember rightly.
All right, all right, all right.
Yeah, I think that was all, you know, as President Trump is wont to do, I think that was all a feint.
I think that he probably is getting rigorously checked out.
I know he is now with the Surgeon General and being in the office of the President.
I am certain that he was checked stem to sternum, head to toe, if not that particular physician, by many different physicians.
And if he's not, he ought to be.
As should every member of Congress and every member of the judiciary, every member of the federal government at that level.
Our leaders, our leadership class, this is one thing I will say about our leadership class, is we need them.
They're important. We've taken the trouble to elect and appoint them.
They really ought to be getting checked out and be insured in the best possible health.
And I just, you know, Bernie Sanders, as far as I can tell from the news reports, he had some kind of a deal in 2016 where the, I think it was the Congress, the Congressional Physician said that, you know, all they released, and I'm not sure what all they did, okay, as far as testing goes, I'm certain they did more than this, but he said, his report said something to the effect of, well, Senator Sanders has a good heart rate, a good blood pressure, and an excellent blood count.
So what? And your point is, what about all the other things that can go wrong?
What about cancer screenings?
What about looking for coronary artery disease?
Plus, if this is the last one that he had in 2016, then I would say that Bernie shouldn't be up there screaming about what a terrible healthcare system we have.
Well, I can also imagine Bernie being the kind of crotchety old stub-my-toe uncle who's like, I'm fine, you know, I'm going to go back to combing my hair with a Van de Graaff generator instead of going to get my heart checked.
You know, like, just because you get good advice, you know, this is a doctor, right?
How many times have you said to people, you know, maybe you should lose weight a little, maybe you should cut back on the smoking and drinking, maybe get a little exercise, and they're like, yeah, I'll get right on that, right after I don't.
Never. All my patients do exactly what I tell them to do.
Right. I once asked a criminal defense attorney who happened to be a patient of mine.
I said, what about all your clients who've been guilty?
He said, oh, none of my clients have ever been guilty.
And I thought, well, that's how they do it.
That's how they sleep at night. But anyway, yeah, I don't know.
I think that it's more than likely that Bernie Sanders has been cursorily checked.
I could be wrong about this.
Again, I haven't reviewed any of his records, and I'm going to get lambasted for saying this, but...
Bottom line is I think that you're probably right.
He's probably somebody who has the power of Bernie inside of him and he doesn't need to get checked, etc.
He is 78 years old, which in medical terms we would say is old.
And that's really, you know, things start falling apart.
I mean... Hey, you know, your heart beats several billion times during your lifetime, especially by the time you've reached 78.
Try opening your car door a few billion times and shutting it and see how it looks.
Well, you know, with Bernie, I mean, I assumed that in the middle of his chest was a frozen bust of Stalin.
So the fact that he actually does have a heart is quite a shocker to me.
We shouldn't be laughing about an old guy getting a heart attack, but he is pro-communist in many ways.
So I'm going to give myself this tiny bit of latitude, but we'll pretend you didn't laugh at all because it's cruel.
Now, how are things looking for him if this was caught, I guess, in process, if he's got the stents, if he's got the procedures?
I mean, can he do it in your opinion?
Well, okay, so let me go back to what I was saying earlier about the stents.
I'm not sure if they placed two stents in one artery, you know, which they sometimes will do, one in the more distant part, one in the more proximal, we call it, the closer part to the aorta, where the artery is larger.
Maybe he had more than one blood vessel affected.
You've got three, and they split off into innumerable branches, so there's all kinds of places where you can put a stent in to alleviate blockage in the heart vessels, in the heart arteries, I should say.
So, I don't know if more than one artery was affected, in which case that would be a bigger deal than if a single artery was affected.
In fact, I think a great question to ask would be, well, at what point do we need to consider doing a bypass?
You know, the old rip the chest open, pull it apart, do all the artery, take the vein out of the leg and...
And recreate arteries in the heart.
Well, it's clear that he didn't need that, which would indicate if he did need that, that would indicate that he had significant, like three vessels or two of his vessels were blocked and his heart function wasn't normal.
So the fact that he got out of there with just two stents and bounced back onto the campaign trail so quickly tells me that if he had a heart attack, which it sounds like he did, it was a pretty mild one.
It didn't cause any lasting damage that's causing him to be short of breath or not be able to pursue his normal activities of daily living, those kinds of things.
So can he make it?
Well, you know, I think that they're going to watch him a lot closer now because these stents aren't a cure-all.
Sometimes the stents can block up themselves.
We've really decreased that by putting medications or drugs into these stents.
That at the very localized level, they leach out a drug that prevents clotting, prevents platelets from sticking together.
It's fascinating technology.
And I'm sure he got those.
I'm sure he got what are called drug-eluting stents.
So the chances of him having a recurrence of this in the near term, yeah, pretty slim, I would imagine.
And if he does, they're going to be on him like stink on you-know-what.
But stink on Bernie, let's say.
But the bottom line is...
Because Crowder, I think, called him a piece of whatever.
But anyway, the bottom line of what I'm saying is I can't make a prognostic factor or I can't make a prognostic prediction based upon what has happened.
I will say that I wouldn't vote for him and not because – I mean I wouldn't vote for him anyway because he's a stinking socialist like you said, a communist wannabe.
But even if he were President Trump, who I plan to vote for again, I would be very leery of voting for somebody with that level of sickness.
I mean, he's 78 years old.
If you're going to vote for Bernie, you better make sure you're voting for a really damn good vice president.
Well, and just by the by, the thought crossed my mind, and I am pretty happy with my life choices.
It's a lot of fun doing what it is that I do.
But if there is one regret I have in life, it's that in running a philosophy show, I'm never, ever going to legitimately utter the words, we're going to have to crack his chest.
You know, like, other people get to do that, and I envy that very much.
It's such a dramatic thing to say, as opposed to, oh, my recording seems to be a little pixelated, which is not quite as dramatic as, we're going to have to crack his chest, Jim.
Anyway. All right, so I've done it a few times, and it's not nearly as fun as you would think.
It doesn't come with a zipper.
And now, and I'll say this, none of the three that I can name off my head, none of those patients survived.
Oh, a neighbor of mine showed me his Franken-chest once, and it's just like, wow, they really did turn you inside out, and then just assemble you back together with some sort of cosmic stardust, because that's really quite impressive.
Well, I'm talking about from the emergency standpoint.
Now, to be, let's I'll finish that discussion a little bit, though.
My father, who has passed away now, he passed away about almost 10 years ago, but he was almost 85 when he died.
At 67, he had severe heart disease.
He had severe coronary artery disease, hadn't taken care of himself, hadn't been checked out.
Like I'm saying, they ought to check out members of Congress.
And when he finally started having symptoms and did get checked out, this is in the early 90s, they found that he had severe blockages involving all three vessels around his heart.
So what did they do? They couldn't do stents.
Even if they had the stent technology that we have today, they would have said, nope, we got to crack your chest.
We got to do a bypass surgery.
Now, the interesting thing is that, you know, all the toil and trouble that entailed, and I mean, this was bad news.
I mean, my father's a very active guy.
He was mowing his lawn at 82.
But I mean, he bounced back after a few months from that dilemma and did great.
For the rest of his life. And then he died at 85 from non-heart-related disease.
And just by the by, like this staying active stuff, like I remember when I was going through treatments for cancer, I said, you know, gosh, you know, it seems weird, you know, like I exercise a lot, I eat pretty well, I weigh the same as I did when I was 18.
And they're like, well, that's going to help you bounce back.
But no guarantee that that means nothing bad is ever going to happen.
But if it does happen, it's much more of a trampoline.
Well, that's right.
That's right. I put my seatbelt on every time I get in my car, even though I might have a car accident and have a wreck.
But, you know, precaution is, you know, an ounce of...
What did I... I came up with a thing.
An ounce of... Prevention is worth a coffin full of cure.
So, yeah. So, for preventing this kind of stuff, and, you know, I guess like you, I sort of yearn for the days when a heart attack was just something you read about, but, you know, Bernie's only a quarter century on for me, so it becomes a little bit more relevant.
Basic things that people can do for heart health.
I know it's a huge topic, but let's just do the 101 or the elevator pitch of, you know, here's how not to have your heart do a supernova in your chest.
Yeah. Yeah. Well, the thing that affects more Americans than ever is obesity.
Being overweight is a big, big deal.
I mean, the more body weight you have, the more body mass you have, the harder your heart has to work.
The more difficult it is for your heart to push the blood around all that blubber.
So get rid of the obesity.
Get rid of all the fat. You want to get down to your ideal weight.
Not everybody needs to be walking around with a six-pack.
I have a 12-pack, maybe half a keg.
But the bottom line is not everybody needs to have a six-pack look like Mark Wahlberg, but we definitely need to shed those pounds that we don't need.
And you've said it on your show.
I heard you say that, you know, the average human needs around 800 calories a day to survive.
That's a shocking, shockingly little amount of food, especially given the American diet where we can eat 24 hours a day.
So obesity, lowering your weight is number one because lowering the weight affects High blood pressure, it prevents diabetes from forming.
And diabetes is a huge risk factor for developing plaque.
It makes the arteries, let's say, sticky, if you will.
It makes them suck up this cholesterol that much more quickly.
So being diabetic and having high blood pressure is a very bad thing.
So obesity is number one.
Number two risk factor that is modifiable that people can do something about is smoking.
And that is nicotine in all its flavors and forms, even vaping, which, you know, we should do a show on the vaping crisis.
Which I think is ridiculous.
But nicotine, although I'm against smoking, I'm against vaping, but nicotine is really a bad news thing because It's theorized that it actually makes the heart arteries, it causes low level of inflammation and causes the heart arteries and other arteries inside the brain, for instance, and the aorta to build plaque much quicker than normal.
I did not know that, man. Nicotine is a creative little gremlin.
Like, it really has figured out a lot of different ways to kill you.
Everyone thinks that the lung cancer emphysema is like, no, no, no, that's just one of its many arrays of weapons against your continued survival.
Right, yeah, no, the vaping thing.
I've often said vaping, I think, is going to...
Well, I won't get into that in this show.
But the bottom line is that nicotine is still bad for you.
No matter what. It causes a high blood pressure.
It causes, you know, all kinds of stuff to happen.
So cutting out nicotine in all its forms is another biggie.
Watching processed foods.
Watching your sugar intake.
And not just your sugar, but your carbohydrate intake.
You know, you can wear out your pancreas.
You can be non...
How should I say this? I have several patients of mine who are not obese and they're type 2 diabetic.
Their pancreas doesn't work right.
Their insulin is... They have insulin resistance, and I don't know if it's because of sugar intake.
I don't know if it's because of the American diet.
Apparently, these folks were never obese, so there may be some genetics involved, but I do know that the more refined, the more processed foods that you eat, the high carbohydrates Boy, that just leads to mayhem.
You can have the genetics that means you don't keep the weight, but you can still keep the ill effects, right?
They call it skinny fat or something like that.
So just because somebody isn't overweight doesn't mean that they're necessarily healthy.
That's, you know, you're only as old as your arteries, as they say, right?
Absolutely. Absolutely.
The arteries. And you know what's really sad?
What really stinks? Is that, you know, when you work out and you bulge those muscles and you get them all worked up and everything and they get sore, they're building up lactic acid.
Why are they building up lactic acid?
Because they're not getting the oxygen that they need.
So your skeletal muscle is wonderful.
There's two areas of the body that cannot do that.
They have to have oxygen second by second or else those cells start to die.
And it just so happens that they're the two most important organs for keeping us alive, the brain and the heart.
So anytime you have blockage of the arteries inside the brain or the heart, it's a big, big deal.
It's a bad deal. So you can have heart attacks and strokes.
These are very closely related entities.
You know, I wanted to talk about Elijah Cummings also, who just died today.
I think he died today or maybe yesterday.
But in any case, you know, he had some heart issues.
And he had a... I'm not clear why he died exactly, but I was reading that back in 2017, he underwent an aortic valve replacement.
Now, what's really fascinating, and again, let's talk about technology and technological advancements.
An aortic valve is the valve that is responsible for opening up and spurting the blood from the heart into the body.
It's a tough cookie.
I mean, it's got to be Really tough to take that blood pressure.
Think about the average blood pressure.
The desirable blood pressure is about 120 over 80 or below that, a little bit below that.
I mean, that's a huge amount of pressure.
That aortic valve opens and shuts billions, billions of times throughout your lifetime.
And it takes a beating.
So when it goes bad, it tends to go very bad indeed.
But the way they used to do this was they'd have to crack the chest, like you say, go in there, open up the heart, literally open up.
It's called open heart surgery.
Where they open up the heart, take the old valve out, and replace it with a pig valve or a mechanical valve.
You know, nowadays, and I just worked the other night with a nurse who had this procedure done last month.
She had her aortic valve replaced through her vein in her leg.
It's intravenous now.
They can do this. It's technology that's awesome.
It's done by a specialist called an interventional radiologist or sometimes cardiologists do it.
Man, it is fascinating what they can do these days, the technological improvements.
She was back up on her feet.
She said she didn't take one pain pill after this procedure.
It was totally painless because they went in and they fixed this.
It sounds like this is what Elijah Cummings had back in 2017 because I read one report where they described a minimally invasive heart procedure where he had an aortic valve replaced.
Well, that's not minimally invasive unless you have this This intravenously or intravascular procedure that I'm talking about.
The problem is he developed an infection after that back in 2017.
I think he had the aortic valve replaced in May and I think in September of 2017 he developed an infection.
Now an infection of the heart...
And these infections, they can get pretty Genghis Khan on your ass because a lot of them of course are antibiotic resistant and drug resistant and then it's just like we're back to like the 12th century cross your fingers stuff.
Yes. Let me go into the detail in the anatomy a little bit.
Where they put this valve, it's got to be anchored into the heart, right?
Well, anytime you get an infection around an artificial valve, it tends to involve that margin where the heart valve is attached to the heart tissue.
Well, if that turns into an abscess, into liquefied pus, I mean, you're in trouble big because, you know, that valve is going to come loose and it's not going to function properly.
So the fact that, and let me say this too, that heart infections are notoriously difficult, very difficult to pick up on.
Now, in somebody that has an artificial valve, we'd probably pick up on it a lot sooner.
But the fact that they were on this, that they treated it successfully, and I didn't even know about it until today, not that I've followed Elijah Cummings' health that stringently, but I didn't even know about it.
I think that Congressman Cummings was getting a lot of, he was taking advantage of the health services in the healthcare system like we should be, like a congressman certainly should be.
He had a knee infection again also in 2017, or maybe that was last year, I forget what, And then it's unclear what he absolutely died from, but there was some kind of complication.
How do you just pop up with a knee infection?
I mean, that just seems like an odd place to get an infection to me.
They do happen. I'm not sure if he had a knee replacement or if he had any kind of knee surgery that would predispose him to this.
Well, yeah, that would do it. I'm just, you know, it seems a bit protected, you know.
But they could talk about, I don't know, maybe it was an infection involving the skin overlying his knee or something.
I have no idea. But sometimes we do see these random joint infections, a knee or a shoulder infection or a hip infection that will just pop up out of nowhere.
And they're bad. They're bad news too.
So I'm not sure of his health history, if he was diabetic or what have you.
But it certainly sounds like he'd been through a lot and unclear as to why he died.
But I'm sorry that he died and he'll be missed and what have you.
And so anyway.
Well, and this is something that, again, is really, really important.
Like, people don't often think about the last sort of third or, in particular, quarter of your life.
Because I remember reading years ago a guy, he was a smoker, a lifelong smoker, and he kind of quit in his 50s.
And his doctor said, you know, hey, if you want to quit, that's great.
It's not going to do you a whole lot of good at this point.
And, you know, that's what the guy said.
Now, what's interesting is that the last quarter of your life in particular, you know, it's actually kind of a long time.
You know, it's like 20 years.
Think of your first 20 years.
That's a long time. Man, it's coming up fast, though.
But that, you know, this is why, you know, you kind of have to do those annoying things.
You know, get your checkups, get your scans, get an EKG, just whatever you need to do.
Eat well, exercise.
I know it's a drag, and I know it gets progressively more creaky.
Like, I keep having to modify my workout routine, just, oh, my tendon, this kind of stuff, right?
But you kind of got to do it, because that quality of life, In the last quarter, so much depends on all the stuff you do for the first three quarters.
And by the time you get to Bernie's age, like I'm sure people are saying, oh, do this, do that or the other.
But he clearly is not taking the advice of maybe get a little bit less stress because he's hammering on a presidential campaign.
So I don't know how much lifestyle changes really matter when you're over 70.
I'm sure they help a little bit, but it really is the foundation in the first three quarters of your life that matters the most, in my humble opinion.
Well, I'm thinking from the standpoint of quality of life, as far as Bernie Sanders goes, I mean, this probably is his quality of life.
Wake up every day and be told, you know, where he's got to go and what he's got to do and who he's got to say things to and, you know, who he can control today.
That's very important to him.
That's less an invitation and more of a possession.
My nipples went inwards with fear, hearing that raspy voice.
But go on. Well, I could give a shit about controlling anybody else.
But, you know, to people like that, they're, you know, I mean, that's what they live for.
So, you know, I mean, you know, what's it going to do?
I mean, it's a desperation struggle at this point for him.
I mean, I think that any voter who votes for him with his health history is a crank.
I would have thought that anybody who voted for him anyway is a crank or on the take.
But now you've really got to, like I said, vote for a damn good vice president.
I'll say this, that what you're saying about paying attention to the last part of life, if you really want to do yourself, and if you're really kind, you can do other people a favor, is every once in a while, a few times a year, go to a local nursing home and go up there and take some flowers, take some candy, take some, you know, just go say hi and sit and talk with people and stuff.
And you will see some very, very, just any old nursing home will do.
You'll see some great people who are having a good experience.
You'll see some terrible people who, you know, in their 40s and 50s who are on long-term care, nonverbal, vegetative, etc.
So, yeah, you've got one shot at this life.
You better do your best to take care of yourself because nobody else is.
And if you hit the unlucky bucket, boy, you're in for a long, long ride.
All right. So, well, thanks a lot for the analysis and the updates.
Just give people a reminder of your website and the books.
I'll link to all of these below.
Highly recommended. Go for it.
Healthcareonomics.com is my blog.
I have a YouTube channel. It's Healthcareonomics as well.
And I've written a couple of books.
The first one is The Guide to Buying Health Insurance in Healthcare.
And that's really, I mean, people can save a lot of money on their health insurance and their healthcare if they pay attention to what I'm saying.
And I've also written a funny book called Healthcareonomics, A Thousand Crazy Ways American Health Insurance.
Controls American health care.
So give those a look-see. I appreciate it.
Thanks. And as always, after we have these conversations, I'm going to spend the rest of the day saying, does my heart feel funny?
Does it feel okay?
I'm going to run up and down these stairs and just make sure I don't see any black spots.
So I appreciate the paranoia.
All right. Thanks. Thanks, Dr.
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