Tag Archives for " stroke "
July 19, 2021
- in guest/interview , health by allan
How to recover from a massive stroke with Vivian King
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When Vivian King collapsed at a benefit breakfast, she had no prior warning that she was about to suffer from a massive stroke. On episode 495 of the 40+ Fitness, we discuss warning signs, being prepared, and recovering from a stroke.
Sponsor
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Transcript
Let's Say Hello
[00:02:26.270] – AllanHey Raz, how are you? [00:02:27.920] – Rachel
Good, Allan. How are you today? [00:02:30.320] – Allan
Doing all right. It's been kind of busy here. My wife is getting Lula's kind of ready, you know, finishing up some of the final touches and we had a professional photographer come in to take some pictures. And it was kind of a scary moment because I walk in and I go into the living room and it's warm and all I see is a tripod sitting outside. So I'm like, OK, she's doing something somewhere else in the house. [00:02:53.720] – Allan
So cool. I start opening things back up and she comes downstairs and says, Do you have somewhere to be? [00:02:59.640] – Rachel
Oh no. [00:03:01.820] – Allan
Oh. And then she says, you know, we need to close those windows and turn off those lights. And I'm like, OK, so I just went back into our little, we have an owner suite. I just went back there, shut the door, just stayed in there. So I knew she was gone. So I've dealt with some scary people, scary things before, but just her just, OK, I'm out of here, you know. [00:03:25.980] – Allan
Do you. And I'm out. But they were some really nice pictures. And if you're on the Facebook group, I went to post a few of those out there so you can kind of get an idea of what this Lula's place I've been talking, complaining about. It is beautiful. It is beautiful, but it's been a handful to go through this major renovation of it. And but we're almost there. [00:03:49.520] – Rachel
Yeah, it does look beautiful. The pictures came out just lovely. It looks like a wonderful place to relax for a nice vacation. [00:03:57.560] – Allan
And live [00:03:58.220] – Rachel
and live. You're lucky you can live on vacation. [00:04:01.730] – Allan
Well, not exactly when I'm there. I'm not on vacation. I have to leave there and come to the gym to feel like I'm on vacation. [00:04:09.560] – Rachel
It's beautiful, though. That's very exciting. [00:04:11.990] – Allan
So how are things up there? [00:04:13.610] – Rachel
Good, good. We have a mulberry tree on our property that produced a bumper crop this year. So we have jars of mulberry sitting in vodka, which we will turn into a liqueur after they set for a while and then we've got a couple of pounds in the freezer that will turn into jelly. And just after that was done, our black raspberries are coming to fruit right now. And so we've been picking blackberries. My fingers will be permanently purple, but we'll be doing the same thing. [00:04:48.230] – Rachel
I think we'll make something to liqueur because we have so many and then we'll put some into some jelly. So it's been fun. [00:04:55.370] – Allan
OK, good. Yeah, we don't have much space in the growing space on the property, so there's none of that for us. You know, my wife had an avocado that she had grown up and it was about three feet tall and then Buster decided to tear it out of the ground and so it died. But it looks like it's trying to reroot. It's just I don't think it's getting enough sun where so I think I'm going to have to move it. [00:05:18.650] – Allan
But, yeah, we're not in a place where we can really grow our own food or liqueur or, you know. [00:05:26.390] – Rachel
It's tough. Yeah. We've got a lot of space here, so but maybe some potted tomatoes or something, or at least herbs would be nice. [00:05:33.950] – Allan
Yeah. Something, you know, we do have it's funny, we have this, it's called a Katuk plant. It's called katuk plant. Hold on, let me check it out. Yeah, it's called a katuk plant, and so friends of ours brought them over, they were staying with us while they were in town and they went over to their property and it was all over the place. And so they picked some and brought us some sprigs. And so we've been growing this katuk. [00:05:57.800] – Allan
And it's basically kind of a nutty spinach flavor. [00:06:01.580] – Rachel
Oh, neat. [00:06:02.870] – Allan
And so we like we'll mix it in with eggs or something like that. Similar to spinach. You just don't wanna eat a whole lot of it because there's actually there have been some studies that, you know, if you get like a too much of it, you can get sick, and so this is kind of one of those things where it's a, you know, really good it tastes really good. It mixes well with eggs and, you know, works similar to spinach, which just don't want to overdo it, you know. [00:06:27.270] – Allan
So obviously, whenever there's something that's good, more of something good is not always really good. [00:06:33.770] – Rachel
No, not usually. [00:06:36.410] – Allan
So we are growing katuk. So I guess I take that back. We do have a plant that we pick a few sprigs from and put into our eggs. [00:06:44.940] – Rachel
Fun. That's awesome. [00:06:46.790] – Allan
All right. So you ready to have a conversation with Vivian? [00:06:49.400] – Rachel
Sure.
Interview
[00:07:32.030] – AllanVivian, welcome to 40+ Fitness. [00:07:34.520] – Vivian
Thank you so much, Allan. It's so great to be here. [00:07:37.730] – Allan
Now, I have a connection with you that I didn't share with you before we got on this call. But I was a part, I joined the author academy. I didn't do the elite, but I did do that. I've been to a couple of their conferences and whatnot over, of course, covid came and there weren't the live things. So I don't know that I'm gonna get back to their next one when they do the next live one. [00:08:01.790] – Allan
But it was just, you know, I saw that your book was from them. And interestingly enough, and I'll tell you, you tell anybody that's publishing their own book because you are self published with them is that if you don't make it easy for me to find you, I can't ask you to be a guest on the podcast. So when someone has a book and, you know, I'm going to say independently, you work with a group that helps you, but you get the book published and so many people will be published that way. [00:08:25.850] – Allan
And then I start searching for them all over the Internet and I can't find anything. But you made it easy for me to find you. And I'm really happy and glad because this topic we're going to talk about today, your book is called When the Words Suddenly Stopped: Finding My Voice Again After a Massive Stroke. I've actually had feedback from listeners asking me to have this topic, and so I've been looking for a book on stroke and recovering from stroke. [00:08:54.360] – Allan
And that's your story, which is awesome. Now, can you tell us, just real quickly, you know, just an encapsulation of what happened to you. And this is eight years ago or so. Right? [00:09:10.660] – Vivian
Yes, eight years ago, it was in 2013, it was a Friday morning I woke up, I felt fine. The only thing I had a rough week. Right. It was really busy. And I thought, oh, I have to get up and go to this Girl Scouts breakfast. And then I said, maybe I'll cancel. But at that time, I was just becoming the vice president of community relations at the health care system here in Milwaukee. [00:09:38.410] – Vivian
And I would fill tables and I would hate when people canceled at the last minute. And of course, in my heart, I knew this was really not a good reason. So I said, I've got to get up and go. So I got up, got dressed. I didn't put on my makeup, which is not totally unusual if I'm resting, I'll do it on the way at stoplights, not driving, but at stoplights and but I will even [00:10:03.640] – Vivian
If I don't finish, I'll finish when I get to my destination. Well, I completely forgot to do that. I think in hindsight, I think the episode was starting. But I got to the breakfast, basically got in and sat down at my table. Someone asked me if I was OK and I said yes, but they said, you need something to eat probably. They gave me something to eat. And that's the last thing I remember for 10 days, nearly because I collapsed from a seizure. [00:10:33.730] – Vivian
I was rushed to the hospital. Then they decided that I needed to go to our hospital that specializes in stroke care. I was in neurological ICU for 10 days and in the hospital for a total of 32 days. And I basically had a stroke. I had a blood clot on the left side of my brain over the part that manages your speech. It bled out, killed all those brain cells, which is why I had aphasia and couldn't talk literally for about three and a half weeks. [00:11:02.200] – Vivian
And I wrote this book because nobody looking at me would think that I had a stroke or was in danger of having a stroke. And then I found out the cause was birth control pills over the age of 40 that caused the blood clot in my brain. And I just did not realize that that was a risk. Half the women don't realize that either, because they say, oh, I'm still over 40 and on birth control pills, the other half say, yes, [00:11:32.020] – Vivian
My doctor told me when I was in my thirties and plus it's in the fine print. But how many of us read the fine print? I didn't. And so shame on me. But we need to obviously have this talk because doctors don't readily necessarily say that, especially if you haven't had issues with birth control pills. [00:11:51.430] – Allan
Yeah. And we're going to get into some of the risk factors that would include this. We'll do that in a minute. But I want to start with one thing that I think was really important in your case. And you've acknowledged this a dozen or more times in the book is you had your sisters with you. You had people there at the event that you were really, really close to that immediately stepped in and did big sister stuff for you and got things moving and kept you on track and kept things working for you. [00:12:19.510] – Allan
You had these really dear friends that then identified themselves as sisters at the hospital so they could come see you and do the things they wanted to do. And you also referred to as your posse. I think it's really important for us to have that in our lives, but a lot of people don't have that kind of support. And when you have an event like this, you've got to kind of be ready for it. And in your case, you had developed these wonderful relationships, but had a nurse said, no, I need to see that you're actually her sister. [00:12:49.390] – Allan
Some of those things might not have happened. So can you talk a little bit about the sisters stepping in and then, you know. What that looked like from you, from a support perspective? And then so we can kind of think in terms of, OK, well, something like that were to happen to me today, how would it play out and do I have the right things in place to manage that? [00:13:13.810] – Vivian
Absolutely, I am originally from St. Louis, Missouri. I lived in Milwaukee now more than twenty five years and I don't have fam, I'm not married, I don't have kids. And so my sorority sisters are really close to me. My sorority is Delta Sigma Theta and we have chapters all over the world. And so I'm in the Milwaukee alumni chapter. I also have other close friends as well. But because I was at this breakfast and people, I was pretty well known. [00:13:46.600] – Vivian
I used to be on television here in Milwaukee. And so I have friends here that in television I had friends who were members of Delta Sigma Theta. And so people in this Girl Scouts breakfast knew that. And so they started calling my friends who were my sorority sisters. And so when they got to the hospital, the nurse said only immediate family are allowed in there with her. And so one of my quote unquote sisters said I'm her sister. [00:14:19.030] – Vivian
And they told everybody else who was in my close circle to tell them that you're her sister. And you're right. They if they had said, give us an I.D., or some kind of proof, they probably would not have been able, of course, to do that. But I'm glad that they were able to be there with me because what they wanted to do was to make sure that they got down all of the information that we needed to give to my mother when she arrived to town that night. [00:14:55.780] – Vivian
And so they wanted to make sure that I was getting my care. They wanted to make sure they got down any of the information that my mother would need. And so it was just very important for them to be there. And from this book, my friends who are single like me, they are designating people to call in there, not only in their living wills, if you want, but also in their advanced directives that health care systems give you. [00:15:28.930] – Vivian
And so here with Aurora health care at the time, they have five well wishes. And so you list all of your wishes so that they know call this person if something happens. And of course, my mother is listed, but then also one of my sisters is now listed as well. And it's just important because, you know, we're living by ourselves and we're home most of the time by ourselves. And if somebody needs to know what's happening also since that book, one of my friends who was listed as my sister, Tracy, she's not in my sorority, but we're really good friends and went to the same church. [00:16:16.060] – Vivian
And so now what we do is we make sure we touch base with each other in the morning and then in the evening. So we'll say good morning. We'll say good night, because in a stroke, time is brain. And so the faster they can get to you, the more positive your prognosis will be. And they have a chance to reverse things. And so it's just so important that you are just letting people in. And I know sometimes we get into our own lives and we don't let people in. [00:16:53.530] – Vivian
We need to let somebody in so that they know what's going on with us.
Sponsor
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[00:19:11.290] – AllanYeah, and, you know, when you went into this that you were 49 years old, you were healthy, vibrant, doing some great things, having all kinds of fun and moving forward in your career. Things were humming and they were just going well. [00:19:27.730] – Allan
And then boom and had this happen 15 minutes earlier, you would have been in a car. Had it happened earlier in the morning, you would have been at home. And so having that preparation just to know, OK, if something happens, this is what we do and this is who we contact. And, you know, making sure that's lined up I think is really, really important, even if you feel like you're in the best of health because you just never know. [00:19:54.420] – Allan
Now, you had some you had a couple of stroke risk factors, but they weren't stroke risk factors that you would have just readily known. One of them was your race, and then one of them was taking birth control when you're over 40 years old. Could you go through some of the risk factors that are out there? And just so people know, OK, if if this then at least something to keep top of mind and if there's something that's reversible, which a lot of these are, I mean, you obviously can't reverse your age, but there are other things in your health you can. [00:20:31.290] – Allan
Could you go through a few of the risk factors? And I mean, just briefly talk about them a little bit. [00:20:36.420] – Vivian
Right. Yeah. You know, high blood pressure, which is very prevalent in African-Americans, high blood pressure is one of the risk factors. So you really want to keep your blood pressure regulated. I don't have high blood pressure, and I didn't then and still don't. And so everybody would ask me, oh, you have high blood pressure. And I said, no, I don't. So high blood pressure is huge. And, you know, a lot of people have to take medication, but you can lower your blood pressure with exercise, etc. [00:21:14.340] – Vivian
If you have a history of high blood pressure in your family, you probably do have to go to medication. But a lot of these things can be mitigated with exercise and eating healthy and that sort of thing. [00:21:26.500] – Vivian
The history of a stroke in your family is something that you need to watch. And if you do have a history of stroke, a lot of times we don't talk about what is happening in our families. A lot of people are so closed mouthed when it comes to their health. They don't either want to know or they don't want to go to the doctor. So they may not know. Bottom line is, we're not talking about our health and we need to talk about our health. [00:21:52.950] – Vivian
You need to find out what your history is with your health. You know, if you're smoking is a problem. It exacerbates your ability or your incidence of having a stroke. And with the birth control pills, that would be an issue as well. But I've never smoked. But this birth control pills is kind of lower on the list. And really, it was like on the third list. And but I found out that the estrogen levels in birth control pills can cause these blood clots, clots after a certain age. [00:22:32.310] – Vivian
And so you really do have to pay attention to that because birth control pills are used for various things and they are a lower risk. A lot of times doctors don't readily talk about it. And so I think that's where I got I got caught in this conundrum, if you will. I had never had an issue with my birth control pills. I moved a lot. And so probably from one state to the next that didn't transfer. [00:23:07.110] – Vivian
But maybe doctors weren't really thinking that I was have I haven't had any issues. And so maybe they felt that it wasn't I didn't need to know about this or maybe they didn't know. So, you know, I'm not quite sure. I don't want to indict anyone. But I just know that this is an issue that we need to talk about. And even if you don't know what's in the fine print, always ask, what are the risk factors? [00:23:39.750] – Vivian
Are there any risk factors to whatever kind of medication you're taking into your body? [00:23:45.360] – Allan
And I think one thing you put together there is, there's things you don't know. But then you find out if you ask the question, what's the risk of this? And then knowing the other risk factors, you can kind of look at them in tandem and say, OK, what does this mean for me? So if you're looking at a medication that you might be taking, you say, OK, am I overweight, am I inactive? [00:24:08.700] – Allan
You know, do I smoke or do I have high blood pressure? How old am I? What is my race? And you start putting those together and you say and then put something low risk on top of all of that, it could be bad. For you, it was really you know, you were in decent shape and you said a little maybe a little overweight, but not anything exceptional. You were very active. You're moving around doing a lot of things. [00:24:32.130] – Allan
You didn't smoke. You weren't a binge drinker, just an occasional social drink. You didn't do drugs, but you added this small thing on top of race and those risk factors that came around. And at forty nine, that's relatively early. I could see why someone in their 40s would be on birth control because you still haven't necessarily transitioned into menopause. So you're still, as far as your body's concerned, capable and a lot of people also take the like you said, they'll take the birth control pills to manage their periods, to manage, you know, just their cycles, to have a little bit more control over their lives and not thinking about or not knowing about these additional side effects. [00:25:14.110] – Allan
So if you are going to go on any medication, get the pamphlet out. It's long. It's boring. It'll probably take a few nights to read it. You'll fall asleep a few times, but ask your doctor and then, you know, just do a little bit of basic research. It's not that you're going to be Dr. Google or anything, but just get out there and say my doctor's prescribing something that I'm going to put in my body. [00:25:37.050] – Allan
I need to know what this does, not just what it's going to do for me, but what it could do to me. [00:25:43.090] – Vivian
Absolutely, absolutely, and one of my friends also said to maybe even talk to a pharmacist or pharmacologist, because a lot of times doctors know their specialty, but they don't always necessarily know how medications interact with other medications. And so a pharmacist and a pharmacologist is really more in tune with those things. And so don't be afraid to talk to the pharmacist or the pharmacologist. [00:26:15.430] – Allan
They actually have a little booth in most pharmacies. If you go in there, there's a little consultation little booth. You can go over there and they'll stop what they're doing and come over and have that conversation with you. So good tip there. Now, there are different kinds of stroke. And I guess as an individual that hasn't had a stroke or had a family member with a stroke, I guess my grandmother had one. [00:26:38.140] – Allan
She's relatively young and she had hers. I wasn't even around yet. But there are different types of stroke. Could you talk a little bit about the different strokes and then kind of how yours was a unique? [00:26:50.900] – Vivian
Right. So there are three kinds, there's in a ischematic stroke, there's the hemorrhagic stroke, and then there's the transient ischemic attack, which is called a TIA. And so a lot of people have had those types of strokes. And they are you know, I don't want to say the symptoms are mild, but they're milder compared to two mine. So they may have something and they may be able to walk around for a few days and sometimes they may have two or three. [00:27:28.400] – Vivian
But those are all kind of warning signs that a major stroke is coming along. The hemorrhagic stroke, that's just excessive bleeding that happens. And then the ischemic stroke is when you have a clot that really blocks the artery. And that's what I had. And it was a major block. But this is what was really interesting. My doctor, Dr. Akram Shhadeh he said that it's called a C V T cervical or cerebral I'm sorry, cerebral venous thrombosis. [00:28:07.460] – Vivian
And it's when the blood stays or stagnation causes pressure and then it starts to bleed in the vein. And so it's kind of inward instead of outward. And I know this kind of technical, but it was just a rare kind of stroke. And that's why it happened so quickly. And I had the see, it's characterized by a seizure. And so I had that seizure. I had never had a seizure before in my life. [00:28:42.680] – Vivian
I had two on that day. One at this breakfast. And then they had to stabilize me because I had another one once they put me into the ambulance. So I had to in one day. And when you have a seizure, you can't drive for 90 days legally. And so I had to after 90 days, I had to take work with my occupational therapist. And we know we're going to talk about them in a few minutes. But I had to work with my occupational therapist. [00:29:16.260] – Vivian
So they do a driving test that really looks at your peripheral vision. If you could see certain things, your reaction and they have to sign off on whether or not you are able to do that before you send it to the state and the state signs off for you to rescind your or to give you your license back, basically. [00:29:42.110] – Allan
Yeah. Anyone that's listen to the show for any time at all knows that physical therapists are like my favorite people on Earth. I just thought if you enjoy yourself, find a good physical therapist, it's going to mean the world to you as far as how much that can improve your life. But you also then had to go to occupational therapy and speech therapy. Can you kind of talk about how they're different and why each of them was important specifically for you coming back from your stroke? [00:30:13.520] – Vivian
So physical therapy is very important because when you have a stroke, sometimes you're one side gets weak and so this, my right side got weak and so they would wheel me around in a wheelchair because I had to strengthen that right side. So I had to go to physical therapy every day and do exercises to basically strengthen those muscles. And, you know, it's you know, when something is weak, you just have to exercise the muscle to get it back strong. [00:30:54.020] – Vivian
And so physical therapy is so key. And we take I think we take our therapists and we take what we do every day for granted. And I just learned through my experience in the hospital that therapists are angels. My nurses and my therapists in particular were angels, because every day we would work on something. And if I wasn't doing well, they would say, well, work on that tomorrow. Let's work on something else. They're just extremely positive, just so positive. [00:31:31.280] – Vivian
And so physical therapy just strengthens your muscles back so you can use what you've always used in the future. And then occupational therapy is really the therapy that helps you do your everyday activities, that allows you to cook, that allows you to, you know, get dressed in the morning. And so because I was out of it for nearly 10 days, I needed to shower. I needed to brush my teeth, I needed to cook. I needed to get organized. [00:32:09.320] – Vivian
And so all of those things come in to the help that of an occupational therapist gives you. I remember being in the hospital and she take the occupational therapist, took me to this stall, shower stall to help me get dressed and showered. And then when we came back, she says, OK, go in and brush your teeth. I tried to brush my teeth. I was doing what I normally do. And then when it was time for me to spit the contents out. [00:32:44.860] – Vivian
I didn't know what to do. I open my mouth, but I didn't know the function of actually spitting it out and she said, Vivian, you have to spit it out. You have to spit it out. And I thought to myself at that time that, oh, I probably should have known this, but I went ahead and spit it out. But just the damage that the stroke had done had taken away my ability to remember all of the actions and functions that my body had done up until that point my whole life. [00:33:18.370] – Vivian
And so occupational therapists help you get back into your normal routine of life, whatever that may be. And then, of course, there was the speech. That was the most impacted of my abilities. And so I had to do that twice a day. And so I had to learn how to write again. I had to learn how to speak. I had to learn organization. The speech therapist also kind of gives you exercises to do. To say, what would you do first? [00:33:51.700] – Vivian
What would you do second? What do you remember from this from this sheet with these pictures on it? And so all of that kind of works together to get your mind back into the organizational habit that it's been in for your entire life. So I too love them, just like you look at therapists. [00:34:15.070] – Allan
And you did your work. And I think that's the core of this. You did it. You kept doing it. And even when you were out, you went back to your appointments, you got your work done, and as the result, you were able to go back to work. [00:34:28.900] – Allan
And after going back to work and work your way in, now, I guess as of 2015, you are I don't think you'd call it stroke free, but fully recovered. [00:34:40.920] – Vivian
Absolutely. Yes. My doctor told me that my chances of having another stroke point one percent. So I think that's pretty good. [00:34:51.520] – Allan
I would, I would put some money on that one. Yeah. [00:34:56.140] – Vivian
And I'm not on any prescribed medications but I do still take a baby aspirin each day. But it's not prescribed. But that's what they want me to do just to regulate my blood and the thickness of my blood. [00:35:12.460] – Allan
Vivian, I define wellness as being the healthiest, fittest and happiest you can be. What are three strategies or tactics to get and stay well? [00:35:21.220] – Vivian
exercise, movement. And I know sometimes I have a lot of friends who joke about, oh, you won't find me on the treadmill. It doesn't have to be the treadmill. You know, walk outside. I'm in Wisconsin. And so, you know, it's kind of cold in the winter, but it's a little spring and summer. Get out there. You know, I'm right on Lake Michigan. I like to walk along Lake Michigan, you know, instead of saying, hey, let's go out for drinks. [00:35:49.960] – Vivian
Hey, let's go for a walk. We get one with nature and we're getting some exercise in and chit chatting with our friends. And so it could be dancing. I was in this dance competition and I actually we danced like every day for hours when I was getting ready for the competition and I lost like fifteen pounds leading up to that competition. Now I've gotten a few pounds back, but it's still, you know, you can do dancing, you can do walking, you can do just whatever. Biking. [00:36:24.310] – Vivian
A lot of people like biking, swimming, anything that gets you moving and that's fun. You want it to be fun. Just do that. Just have taken a walk. We all can take a walk and if we keep taking a walk and walk a little farther, we could walk farther the next time it's building up those muscles. So that's one thing. I think one thing that I do, I chat with my creator every morning and so I wake up and I just want to make sure that I'm grateful for the things that are in my life. [00:37:03.490] – Vivian
And so just to me, thanking God for all of the blessings that I have, number one sparing me on October 25th, 2013 so that I can be here and tell this story and share this information, because he gave me the gift of communication. You know, I just thank him for that. I thank him for my friends. I thank him just for all of the blessings that all of the positive things that are in my life. [00:37:31.930] – Vivian
You know, you need to be connected to your core. And I would say also having friends, you know, some people may not be as social as I am. I'm not a socialist. Some other people that I know, but if you have someone that you can call, whether it's a family member or a friend, connect with people because you'll find things to be grateful for just with that relationship. So those are just three things that I think you just need to have in your life so that you can live a happy, healthy existence. [00:38:15.260] – Allan
Thank you, Vivian. If someone wanted to learn more about you and your book, When the Words Suddenly Stopped, where would you like for me to send them? [00:38:23.390] – Vivian
Send them to VivianLking.com. If you go there, you can connect with me on my social media. You'll be able to just click and follow me either on Facebook, Instagram, Twitter or LinkedIn. You can also learn about the book there. I also have a link where if you would like to get the book, you can link to Amazon, you can link to Audible, and so you can just find anything at vivianlking.com. You can also email me and we can have personal conversations and you'll be able to find whatever I'm doing on vivianlking.com. [00:39:07.280] – Allan
OK, you can go to 40plusfitnesspodcast.com/495 and I'll be sure to have those links there. Vivian, thank you so much for being a part of 40+ Fitness. [00:39:17.690] – Vivian
Thank you so much for having me. It's just been a pleasure and I'm glad I made it easy for you to find me. Carry over with you. Really excited about that. And you know what? You talked about the conference. The next conference is coming up this October, so I would love for you to see it. I'm going. So I hope you'll be able to go too Allan. [00:39:34.910] – Allan
I'll see what I can do.
Post Show/Recap
[00:39:41.000] – AllanHey Raz, welcome back. [00:39:42.290] – Rachel
Hey, Allan, you know, it was really wonderful to listen to Vivian share her story and, you know, stroke is a scary illness. It's something definitely everybody should watch. And just like health, disease and cancer, you know, almost everybody has some sort of a tie. I've got a family member who suffered a stroke. I've got a friend who's a young lady, suffered a stroke. And her story was very close to Vivian's with having lost her speech and learning how to walk. [00:40:10.400] – Rachel
And it's been a long road to recovery. It's a scary situation. [00:40:14.990] – Allan
Yeah. My grandmother on my mother's side had one when she was relatively young. And so it was just things I remember is that her left side was just really not really strong. And so she had to be careful with her balance. And then she had this thing on the steering wheel handle grip thing so she could turn the car more effectively because she just didn't have the dexterity of her left side to do that thing. But she lived well into her 60s. [00:40:42.500] – Allan
So the care that she got must have been top notch. And she did recover, you know, again. To me, the big thing is, A avoid this, you know, avoid it. In the first you know, we had Dr. Raza on last week and he was talking about cardiovascular disease being on the increase because so many people were more sedentary and gaining weight. And so we know that that's a risk factor. You know, having excess body fat, having, you know, our blood lipid numbers not look well. [00:41:14.630] – Allan
Those are big cardiovascular risks. But, you know, if you're in a high stress environment or you're hitting some of those other risk factors, like smoking or drinking too much or those types of things, you're setting yourself up. [00:41:29.060] – Rachel
That's right. That's a good way to look at it. Instead of setting yourself up for success, you're essentially setting yourself up for failure or some sort of an illness. And stroke is one of the many diseases that we do know so many things about. I mean, it's been researched like crazy. And so if we know these risk factors, then why not discuss them with your doctor and see what we could do to reverse that? [00:41:52.190] – Allan
Well, you know, in a lot of the books that I've read on longevity, you know, today and then it was the Blue Zones and all that type of stuff. They always talk about, you know, being active, having good social connections, all these different things that can help you live longer. And she was checking off the boxes. You know, she she was living the life that she wanted to live and then, boom, it could have been gone in an instant. [00:42:20.570] – Allan
And she was just very fortunate to have been around friends and people that can take care of her, get her the help she needed quickly. So that's a big part of this. Is one A avoid it if you can. B have some have some plans, have some contingencies. So something happens, you know, you have people that know to look out for you. And then the final bit is. The stronger you are before it happens, the better your opportunity of coming out of this, and I truly believe that that's a big part of why Vivian was able to write this book, was because she was pretty active, pretty healthy, you know, checking off the boxes beforehand. [00:43:00.780] – Allan
And that just made it easier for her to recover. But then on the back side, she did the work. But, yeah, she went to the physical therapist and she got all the therapy. She went to the occupational therapist and did all the therapy. She went to the speech. Even when she couldn't talk, she was still going to speech therapy. So she didn't wait and she didn't put it off and she didn't quit midstream. And a lot of times people will do that. [00:43:26.760] – Allan
They'll say, OK, I've got the homework and they're not doing the homework. And they go to a few physical therapy sessions and are like, OK, this is kind of silly. You know, I got this little Pully thing and they're making me pull my arm up and back and do that thing like, OK, that's great, I can do this at home. Why would I pay this guy this kind of money to do the pully thing in front of him when I can do it at home? [00:43:48.810] – Allan
But the reality is that that is the necessary action to get your body back where it's supposed to be. And whether it's the physical therapy, the occupational therapy or the speech therapy, it's just you want to recover. If you want to get back what you lost, you've got to go. You've got to do well. [00:44:05.760] – Rachel
It's so important. And these people are all experts in their different fields, and especially with the occupational therapy, like Vivian had mentioned, was that you need to learn how to do things, how to get in and out of a car again. How does put your seatbelt on and off again. And it's not that you're learning it like a child who learns to walk from the first time. It's that your muscles are learning how those actions work. Again, it's a little different and it's kind of hard to explain. [00:44:31.320] – Rachel
But but the faster you get into these programs, the faster your brain synapses come back together and can process this information. And like she had also mentioned, time is of the essence. If you wait too long, then you might lose some of this and make the process even harder to regain and how to heal from. And yeah, timing is so important. [00:44:53.400] – Allan
Yeah. And I know a lot of people would be shocked at this, but she had to learn how to shop. I mean, quite literally, they took her to a store, a grocery store and I think maybe a Wal-Mart as a part of her occupational therapy so she could mock shop. So she could relearn how to shop. And you just think that's just those automatic things like spinning when you brush your teeth. And she talked about, well, you know, it's like she just forgot what she was supposed to do next, because even though it had been become so automatic in our lives suddenly now. [00:45:26.070] – Allan
There was a missing gap, something was not there, and she had to be told to do something that she knew she needed, she knew afterwards. They said it's like, of course, that's what I would do. She had actually physically, not just mentally or remember how to what to do, when to do it, but actually physically go through the action because she had forgotten how. [00:45:44.250] – Rachel
That's such a mystery. The brain is so mysterious that way. [00:45:48.180] – Rachel
And it just depends on what part of the brain suffers that damage. And, who knows, it is like literally you forget things and then you forget how to do things. And it's just those random things like learning how to shop. And thank goodness for occupational therapists who could ask you the right questions and see if you know how to do these things during your recovery. It's really amazing. [00:46:10.140] – Allan
And the last thing I want to leave this with is, OK, maybe you're not concerned about yourself having a stroke, but there are people around you that I know you love and care about. So learning what are the symptoms of a heart attack? What are the symptoms of a stroke? What are the symptoms of heat exhaustion and heat stroke by just by knowing those symptoms and you see something out of place, you know, a drooping of the face slurring of the words when they've obviously not been drinking those just different little things that are happening that if you catch it early and they get the medical care that they need, it can mean a world of difference over how much damage actually gets done. [00:46:50.850] – Allan
And so it's just really important for you to know some of those things so that when you see it, you can react to it. And if nothing else, it's going to say to you she couldn't have done that for herself because she was too far gone before she even realized what was going on with the people around her. Saw it. You saw it happening to her. Everything was normal. But they could see it and say, no, this is not normal.
Note: The power went out in Bocastown while we were recording.
[00:47:16.170] – AllanAll right, looks like our power went out. So I think I'm still recording, but I think Rachel has fallen off because my power went out. But so thank you guys for being part of the 40+ Fitness Podcast. Will talk to you next week.
Patreons
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Thank you!
Another episode you may enjoy
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January 27, 2020
- in guest/interview , health by allan
Heart health with Dr. Jignesh Shah
At some point in our lives, we're all going to deal with heart disease in one way or another. In his book, Hearth Health, Dr. Jignesh Shah explains the various tests and treatments and when they're the right thing to do.
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Allan: 01:00 Dr. Shah, welcome to 40+ Fitness.
Dr. Shah: 01:04 Thank you. Thank you for having me on the show.
Allan: 01:06 Now I really enjoyed reading your book, the book we're going to talk about today, Heart Health: a Guide to the Tests and Treatments You Really Need. Part of the reason is, you know, being in my fifties, this is kind of the time when a lot of the conditions that have us thinking about our heart start popping up, you know, heart attacks, and all the other things that can go wrong with your heart, stokes and things like that. We're reaching that age where we're seeing it happened to our friends and family that were right around this age. And in some cases people lost their parents around this age. So we start to think about, well, how healthy am I? You know, you would just think, well, I'll just go in and get these tests done every once in a while and then I'll know I'm good. But that isn't always the case.
Dr. Shah: 01:53 Absolutely. And that is one of the key points of the book that just because we get a test done and the test says you're fine, doesn't necessarily mean that nothing will go wrong. We have progressed quite a lot in that understanding of heart diseases. However, there are things that we can predict and things that we cannot and even after a normal test, people can have problems. And on the other side I would say just because you have a normal test doesn't mean that you are looking at an impending doom and gloom. You have a lot more control, you have lots more time and you've got to use it effectively to gather all the information before reacting to it.
Allan: 02:49 Yeah. I think that's really kind of where that when you start talking about heart disease and particularly when it's happening in the moment, it is really hard to kind of take that step back and think about it objective. Because everybody just knows when the last beat of your heart is the last beat maybe. And so people tend to want to fix it now versus taking that step back and thinking about it. And that's what's really cool about the book. As you had stories in there of individuals that were, we're going through different things and then different protocols were promoted and they either did it or they didn't. But some of them were rushed into decisions and some, you know, had the wherewithal to get the second opinion. So if I go into the doctor and the doctor tells me there's some problems and they want to do a procedure, it could be, you know, putting in a stent or do even a bypass, we should get a second opinion. Right.
Dr. Shah: 03:45 So you started off really good you said you go into a doctor's office and that is a critical thing to remember. You went walking into the doctor's office, that's a different scenario and he pointed out to be a good place that you have enough time to get a second opinion. Now if you went into the emergency with chest pain and the EKG show or showed that you have, you're having an active heart attack, that is not a time for us. So that's the book tries to give you the new one's version of it, but you're absolutely right. You go to the doctor's office, tell them, you know, I've been having chest pain when I walk but I'm under a lot of stress and the doctor says, let's go ahead and do a stress test it's a noninvasive test. They're not going to poke inside your body. They're not going to put gas.
Dr. Shah: 04:49 Very good test to start. However, even in this situation, we're trying to get a second opinion and slow down the crane. In some cases, you know, I have known 40-year-olds who have been running five, seven miles a day, no problems at all, and then they started a different exercise and now they're having chesting pain the rest to a stress test and that patient the same stress test may not be necessary. However, somebody who does not exercise that much and starts exercising and starts noticing chest pain with exercise stress test may be necessary so in either case you have enough time to get a second opinion.
Allan: 05:38 Yeah. One of the things I think that was was really important as I started going through the book and you stress this time and time again is if, if a procedure is recommended, you really want, you want one or two things to happen as a result of that procedure. You either want to know that because of this procedure I'm going to live or and or that I'm going to have a better quality of life. Can you talk a little bit about that?
Dr. Shah: 06:03 Yes. Thank you for giving me these two very critical things. As a doctor, there are only two things that we can do for you. We can either prolong your life or make the quality of life of your life better. So no matter how bad the pictures are how fabulous the technology is. As a patient, you really have to know does it need one of these two end goods live longer or live better? Then so if you went into the doctor for what I would call a well baby checkup, annual physical or a wellness check, meaning thereby you do not have any symptoms, any tests that is being recommended you really have to ask, is this going to make me live longer? Because remember, if you do not have symptoms so the patient can, the physician cannot make the quality of your life better, but if we can improve the quantity of your life, meaning that they are longevity, then you don't want to undergo that test.
Dr. Shah: 07:18 That test is not going to make a difference. You really have to question, no matter how fabulous the technology is, how convincing the logic is. If you do this, then this happens, then this happens and this happened. All of that becomes more and more farfetched at the bottom of the day. You want to know does this make me live longer and if you are having symptoms, will this take away my symptoms? Is it likely, particularly my symptoms and only then you want to undergo that and you know, I would say even with that, you do want to ask the physician is there a simpler way to accomplish the same thing and you would be surprised how often a more simpler approach can sometimes accomplish exactly the same thing. We know from studies of the studies now that in majority of the cases, medications accomplish exactly the same as a bypass surgery with medication. You know, so you always will, ask the physician, is there a simpler way to accomplish the same group?
Allan: 08:28 Right. So, you know, being older, you know, I do go in for wellness checks and if my doctor had recommended to me, Hey, you know, you're over 50 now, let's, let's do a stress test. And no, I haven't had any symptoms. I haven't had any problems. I only had one incident where I thought I had a problem, but it turned out to be basically my sodium got too low and I went into the emergency room with chest pains. And that was really because I had had an episode of a seizure. And then during that seizure kind of strained my chest. And so to me it was, you know, I was feeling really bad because my sodium was low and as soon as I went in and you say the word chest pains, it leads to a whole, a whole set of protocols.
Allan: 09:11 You're taken straight to the back. You're given a nitroglycerin and they're putting you on a drip there. They're checking your heart rate. They've got you on a machine like that. And so it turned out it was just, it was dehydration and low sodium combined was what mine was. Now had they told me after that you probably should go do a stress test. I wouldn't have known any different. I would just said, okay, well my doctor said I need to do a stress test. So I think it's important to know that, you know, do you have symptoms that are okay? There are some of the heart attack symptoms, but if I have to agree, okay. The doctor says, okay, you should go get a stress test. And I agree. Tell me about what, what does a stress test entail? You know, what does it like and what's it going to tell us in the end?
Dr. Shah: 09:52 Right. So a stress test is performed to increase the activity of the heart, so as to increase the oxygen requirement of the heart itself. And under that stressful situation, if the heart muscles which are now requiring increased oxygenation do not hold up, then it indicates to us that there are some blockages to the blood flow. To the heart itself and the way to accomplish that is ideally to walk the patient on the treadmill, well connected to the EKG machine and look at how the EKG or ECG changes take place. And if there are some changes then that is concerning. However, if the patient is able to walk 10, 11 minutes and has no chest pain whatsoever, the EKG does not show any abnormality. Then they know that their heart is able to work under this stressful situation. Beach indirectly tells us that there are no blockages.
Dr. Shah: 11:05 So the idea of stress test is where you would maybe walk on the treadmill with EKG connected to you and somebody's observing the EKG or blood pressure and your heart rate. Sometimes there are additional testing added on to it where you get injected with radio active dye which is injected when you are at the peak of your exercise and then you're put under a camera where the emission from the radioactive dye is picked up and it hurts us. Understand if there are parts of the heart that are not receiving blood supply. Once again, that indirectly tells us that may be blockages in the heart artery. That's the typical stress that is performed and it is performed to figure out if there is a chance that you have blockages in the heart artery.
Allan: 12:02 A lot of times if someone's had an issue in the past or a doctor just feels uncomfortable and you're going to go in for a surgery for something entirely unrelated, they may make you required once you to do a stress test. Should you try to get a second opinion, should you try to talk them out of it if you've had no symptoms or is this something that maybe you just want to go ahead and do?
Dr. Shah: 12:21 No, I think I'm American college of cardiology and American heart association is very clear about the fact that in rare high-risk surgery you need a cardiac clearance and a stress test prior to that. Outside of those rare surgeries for 90 to 95% of surgeries, you do not need a stress test, to undergo orthopedic surgery or a back surgery or what have you. And so for majority of the cases you do not need a stress test. And I would strongly urge you to get a second opinion before you undergo that stress test because the chances of that stress test veering you away from what you really require, which is that surgery, it will just point to a different direction. And as you've read in the book, it will lead you down a path that you will not want to go. And that is why American college of cardiology is very clear about the fact that majority, I mean the overwhelming majority, 90 to 95% of surgeries do not require a stress test prior to undergoing the surgery.
Allan: 13:37 Yeah. You had a story in the book where a woman had torn a ligament in her knee and as a result, she wasn't able to be active like she wanted to be. And obviously if you're not active, you a trophy and, and so she couldn't, she couldn't walk with her friends. So she was missing the social aspects and the fitness aspects of it because she failed a stress test.
Allan: 13:58 Then they were like, okay, well, you know, I think she went on for other procedures and, but she had to wait a year before she could come get that surgery. That's, you know, a year of, of inactivity. Scary. And so that was definitely not going to extend her life or improve the quality of her life. It was really of cause the exact opposite.
Dr. Shah: 14:17 Exactly. I mean, she been for a stress test that was not acquired then she had, she was asked to undergo this cardiac catheterization and she had complications from that. And from that point forward it just went into this cascade of negative events where she was not able to get surgery that she required for almost a year and had she not gone through stress test like it is recommended by the American college of cardiology. She would have gotten the ligament surgery and went on to be active back again, which would have done more good than all this additional testing.
Allan: 15:01 Yeah, so if I go through as far as stress test and the doctor finds something abnormal and they say, okay, we need to do this next procedure. As the cardiac catheterization you spoke about, can you talk about what that is and how they do it and what we can find out from it?
Dr. Shah: 15:15 Yes. A catherization test is an invasive procedure, meaning that the doctor is going to get inside the body, they will number the area around the groin where one of the major artery is, sometimes they can use the major artery in the arm. And once they get access into the artery, they put a catheter, a small, tiny long plastic tube that goes into the heart artery and they inject dye into it by taking pictures of the flow of the dye under the camera. And by getting several pictures we understand where the blockages in the heart arteries, based on where the blockages are we can further prescribe the right type of medicine or discuss the possibility of stints or discuss the possibility by-pass surgery, depending on the pump or not the blockages it tells us a lot about the blockages in the heart.
Allan: 16:25 And again, it's one of the things I really like about your book is after you've had that, you know, that initial test or you know, then the second follow up the catheterization test, your book goes on to say, okay, here are some of the options that you might be presented. There's medication, sometimes there's bypass with medication and it gives you the questions to ask your doctor. So as you're facing these things, I think your book's an awesome resource for someone because it answers a lot of questions very, very easily. And then you can ask your doctor the right questions, you can get your second opinions and you can make sure you're doing the right thing to increase your longevity and quality of life.
Dr. Shah: 17:02 Absolutely. And thank you for bringing that up because on the web, what I notice is that there are a lot of generic questions which may or may not apply to your specific situation. So I have wanted to equip my readers with very specific questions for that particular procedure, which is pertinent so that the patient in the position exists, that willing to be an active process. You are willing to be part of the healthcare team and not just a passive sit here.
Allan: 17:36 And let's hope, again that's your physician is a, is a main role to you having that and being a part of that team. Cause if that physician is not you, you might need to find that another physician.
Dr. Shah: 17:47 Absolutely. I agree with you completely.
Allan: 17:49 Now you, you, you kind of mentioned Dr. Google, you know, people love to go on dr Google and self-diagnose. We also love, love, love to wear these tools to measure everything. You know, so the Apple watch and some of the other things that are out there, you can know how well you sleep. You can know how many steps you take in a day. You can know your heart rate every single day, including, now I guess Apple watch does an EKG for you. If someone has one of these watches on and they start noticing and an abnormal rhythm or you know, something going on and their watch is kind of, is that something they just definitely need to walk into the doctor and start having some conversations or is it something that they should just sorta say, okay, I get it. I don't have any other symptoms but the watch is telling me there's something amiss.
Dr. Shah: 18:38 Yes. So there are a few aspects to it. I will mention. So if you are having symptoms and it correlates with the EKG section or the heart rate section of your wearable device showing abnormality, if those two concur, then there is good reason to go to the doctor and get checked out. Secondly, there is a condition called atrial fibrillation. Unfortunately, as we age, a lot of us become familiar with that term atrial fibrillation. And what we know is that people who have atrial fibrillation have an increased risk of stroke. And so if the Apple watch is talking about the possibility of atrial fibrillation based on the EKG, then you do need to get checked by a physician. Maybe get another monitoring gadget that they can look at and figure out if it is indeed interpolation. And if so, how does it need to be treated because of the increased risk of stroke.
Dr. Shah: 19:54 There are things that we can do to decrease your risk of stroke. So from that standpoint of is critical. However, the other aspect I would also say is that people don't need, to me these variable devices, the source of their anxiety. Please know that nature has given you one of the best gadgets to assess how your body's feeling and that is your own self, your own understanding of your body. If you notice that every day you've been able to walk five months and for the past two weeks at two miles, you're just getting by tells you're huffing and puffing. That is enough reason. That is more of reason to be concerned well and beyond what the Apple watch tells you. I think we understand some of the technology, we understand some aspects of how the heart functions and how our body functions, but it is all in combination.
Dr. Shah: 21:05 Just the heart rate by itself doesn't tell you the complete story. Just the EKG by itself doesn't tell you the story. That is where physicians can put things together for you and say, is this critical or is this not critical to be addressed. And sometimes the treatment can be worse than the disease itself. And I want the listeners and the readers to be open to a conversation that isn't something that is so bad that the treatment will make it better. Is if six or one and a half dozen of another well was treatment as well.
Allan: 21:46 You know another interesting thing that comes out of these wearables, it's a conversation I've had with one of my clients. He has a resting heart rate in the low 50s and I have a resting heart rate in the high 70s. And so, you know, if we go and we look at that formula where our bodies, and our watches are saying, you know, stay in this zone. He can't, he can't get to the zone. He can go 100%. His perceived effort level is 100% and his heart rate just will not get up to pass one 41 50. It just, just won't mine, I could get my heart rate up pretty quickly, but I also don't feel full exertion at 177 or 180. I can actually exert past that for a sustained period of time. And, and I try to, you know, I try to explain to folks, it's like, okay, this is a formula that works for a lot of people, but not everybody. So can you talk about where this max heart rate thing came from and how it kind of blew up into this,fitness craze of people thinking that they have to be in this magical zone all the time?
Dr. Shah: 22:48 Absolutely. so that is a very interesting story. You know, in the 1930s and 40s, doctors have promoted this idea that any kind of activity is bad for your heart. Patients with heart condition used to be told you need to rest. You can't exert yourself too much. You can't have too much stress. You can't argue with people and so on. And then as time went on in the 50s, the people started realizing that people are actually doing better when they're exercising. So the world promotion of exercise came into be a jogging was promoted and so on. And at that point in time, burning question in the physician community and cardiologist community specifically was what other heart patients who have had surgery for the heart condition, what kind of exercise can be recommend safely. So that was a burning question that was brought up time and time again.
Dr. Shah: 23:54 And the health services department knew that they would be asked this question during a certain meeting. And so at that point in time, what they did was the junior colleague was asked to collect some data regarding that. So he took into consideration 10 papers written about cardiac patients, young heart patients who had undergone heart surgery and what was the safe level of exercise and when they assessed this data in a very preliminary manner. They said, you know, there is this easy formula that we can come up with. It is 220 minus the age,based on what they observed. And so they went and spoke at the conference and when they were as expected as how much exercise can somebody do. Yeah. After having had heart surgery after having had heart disease, they said it seems that the safe level is to get to a heart rate of 220 minus age.
Dr. Shah: 25:00 Now even the people who were recommending this knew that even among the heart patients, people who had undergone heart surgery, this was a wide range. This was just a general guidance given. Just like what is an average human height. And we would say in the US it is 5'9″ or 5'8″. That doesn't mean that if I'm 5'7″ I need to get looked up about it. We immediately recognize that. And so then the experts assume that this would be recognized that this is not hard. And it's true. And this was the data only for patients who had a hand be at a young age. Father had significant heart disease. But as it happens, numbers are attractive. You know? So it just took a life of its own. So people put up posters in the fitness centers and gymnasiums and so on.
Dr. Shah: 26:07 And then there was wearable device made and show enough that industry has just exploded. So the drum beats of measurement and quantifying has just taken on a life of its own. Though this was never meant specifically for, this was never meant for the general population. So it is good to have a general guidance. However, do not let yourself be restricted just because of this. As I mentioned, nature has given us a much parameter, which is how do you feel? Are you feeling alright? Then go for it. Exert yourself a little more. If you're not feeling alright, it doesn't matter at what heart rate you are. That's body's way, nature's way of telling you that maybe there's something amiss and you need to stop.
Allan: 27:01 I define wellness as being the healthiest fittest and happiest you can be. What are three strategies or tactics to get and stay, well?
Dr. Shah: 27:11 Number one I would say look at home care more than healthcare to make you healthier. And what I mean by that is regular exercise, quitting smoking, and eating a healthy diet. That would be the first and foremost thing that you can do at home to get the most bang for the buck. Now step number two would be to get a good assessment and control of your blood pressure and if you're a diabetic, of your blood sugar. That would be my step two. And step three would be to practice optimism, mindfulness and graditude. And I see all these three based on solid research evidence, which has shown that all these three things, to give you a much healthier heart, much healthier heart than otherwise. There has been tremendous research on optimism, gratitude and mindfulness and then to live 5 to 10 years longer and happier life compared to the pessimists. So I would strongly recommend your audience to consider these home care steps before approaching the healthcare system.
Allan: 28:52 Those, those were really cool. Thank you for that. If someone wanted to learn more about you, learn more about the book, Heart Health: a guide to the tests and treatments you really need, where would you like for me to send them?
Dr. Shah: 29:04 So my book is available anywhere books are sold. Amazon.Com, Barnes and Noble, Booka a million, etc. If you want to learn more about heart and all these tests and treatments, want to explore it a little more. Want to know a little bit more about me or want to communicate with me. I have a website called JShahmd.com where I have lot of information about heart conditions, pictures with videos and even if you're being advised for procedure, you're we have videos and written material that is not difficult to understand and so it could be worth looking.
Allan: 29:57 Okay, this is episode 418 so you can go to 40plusfitnesspodcast.com/418 and I'll be sure to have those links there. So Dr. Shaw, thank you so much for being a part of 40+ Fitness.
Dr. Shah: 30:09 Thank you very much for having me. Really appreciate it.
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