December 18, 2024 • 24 mins
Join us for a fascinating journey with Dr. Jonas Cooper, St. Luke's acclaimed cardiologist and electrophysiologist who shares his life story from Toronto to St. Louis, and his work as an "electrician" for the heart. Together, we navigate everything from high-volume pacemaker implantation to the imperative of cardiovascular exercise, and even uncover Dr. Cooper’s literary muse, Malcolm Gladwell's "Outliers." He reflects on how his father's legacy as a thoracic surgeon shaped his path and offers practical, heart-healthy tips grounded in years of expertise. Dr. Cooper's insights are not just about the technicalities of cardiology but about embracing heart health as an integral part of life.
We also explore the intriguing intersection of technology and health, with the Apple Vision Pro’s potential impact and the Apple Watch's role in detecting atrial fibrillation, transforming unknown heart risks into actionable insights. Delving into mindset’s power, we discuss how positive attitudes can transform health recovery and sports performance, revealing mental resilience's true strength. Dr. Cooper’s passion for maintaining a hopeful outlook is contagious, inspiring listeners to embrace a proactive approach to heart health and life’s challenges. This conversation is a powerful reminder of the interconnectedness of mind, body, and the technology that bridges the two.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Hello, this is Jason Edwards and I'm here with Dr
Jonas Cooper, a cardiologist andelectrophysiologist.
Jonas, how are you doing today?
Speaker 2 (00:10):
I'm well.
Thanks for having me.
How are you?
Speaker 1 (00:11):
I'm doing very well, Thank you.
Now you're not only acardiologist, but you're kind of
a specialist cardiologist inthat you're an
electrophysiologist.
Yes, that's correct.
And what is that?
What do you do?
Speaker 2 (00:26):
So there's a little division of labor in cardiology.
I usually call the plumbers thepeople who are dealing with
blockages, blood pressure,cholesterol valve functions.
There's the surgeons, who ofcourse do what they do in terms
of opening chests if fixes areneeded that way.
The electricians orelectrophysiologists deal with
heart rhythms, so fast beats andslow beats, and pacemakers and
defibrillators, that sort ofaspect of cardiology.
Speaker 1 (00:49):
And so if somebody has an abnormal rhythm, they
come see you and you either givethem medication or do you
implant the pacemaker, or doesthe surgeon do that.
Speaker 2 (00:59):
No, I do actually put in the pacemakers.
Speaker 1 (01:01):
Yeah, I think we've actually shared a patient where
I was radiating one side and youhad to move the pacemaker from
one side to the other.
Speaker 2 (01:07):
We did.
You did a wonderful job withthem.
Speaker 1 (01:09):
Yeah, you as well.
Yeah, and the patient's doingwell.
Now are you from here in St.
Speaker 2 (01:17):
Louis originally.
I saw you did most of yourtraining at Washington
University.
Yes, if you look far enoughback, toronto, canada, but I've
lived most of my life in StLouis.
Speaker 1 (01:21):
The TO huh, so you're Canadian.
Speaker 2 (01:23):
Yeah, those Canadians , they walk amongst us yeah.
Speaker 1 (01:26):
Okay, now I detect the accent to some degree.
That's an incredible city, verymulticultural, of course, and
so where is your family fromoriginally?
Are they originally from Canada?
Speaker 2 (01:41):
No, it depends, I suppose, how far back you look,
but my dad is a physician.
He's a thoracic surgeon and wasthere doing lung surgery work.
Speaker 1 (01:52):
At the University of Toronto.
At the University of Toronto hewas involved in inventing.
That's an amazing tale.
Yeah, the reason I ask is howfar back is because I know a lot
of people that they're.
They're not too manygenerations back, you know, from
their move to Canada, but ofcourse you could have some, some
(02:13):
people who have a longer runthere.
Speaker 2 (02:15):
Um, yeah, so my dad's dad's dad, I guess.
So my great grandfather?
Um, I did not get to know Dad,so my great-grandfather, whom I
did not get to know, lived thereand had moved over from Eastern
Europe around 1900, 1904,something like that.
Somewhere we have the paperworkwhere they went in through I
believe it was through Halifax,Okay, but yes, approximately
(02:41):
then Coopers came over to NorthAmerica and it's never been the
same since.
Speaker 1 (02:43):
Yeah, actually, my folks used to have a place in
PEI, prince Edward Island, whichis close to Halifax.
Speaker 2 (02:47):
Absolutely.
I think you have to go throughHalifax to get there.
Speaker 1 (02:49):
Yeah, and of Green Gables, of course, yes.
And so how many pacemakerswould you say you do in a year?
Pacemaker implantations, youwould perform in a year, sure.
Speaker 2 (03:01):
I mean probably devices.
I want to say a couple hundreda year plus minus, and that's
some combination of new devices,putting in and revising devices
, in that they are batterypowered and when the battery
goes low, unfortunately we don'thave a rechargeable version
where we can lay you on a mat ofsorts and charge it back up, so
(03:22):
there's a surgery to replacethe unit there as well.
That sounds like high volume.
It certainly seems that way.
I usually tell my patients I'drather you not need me, Not that
what I do is that crazy, butI'd rather you be healthy than
need me.
But if you do, thankfully wehave fixes for this.
Speaker 1 (03:38):
Certainly, and so are there any things that you do in
your own life, any positivehabits, health-wise, that you
feel like have been beneficial,whether it's exercise or yeah,
it's usually telling otherpeople or my kids what they
should be doing for good forthemselves.
Speaker 2 (03:54):
But you're right, it's good to follow our own
advice.
So yes cardiovascular exerciseis the right thing to do.
Yeah, and what we mean by thatis often not so explained.
Yeah, and what we mean by thatis often not so explained.
So typically we mean by that 2030 minutes most days of the
week, and doesn't have to besomething that is so intensive
that you can't breathe duringthe activity.
So if you are exercising to thepoint of, oh my god, this is a
(04:17):
great workout ever, uh, that'sthat's more intense than you
need, something that makes you alittle out of breath.
20 30 minutes most days of theweek is really the heart healthy
aspect of things is that what'sconsidered zone two, um or?
Speaker 1 (04:28):
I've heard that.
I don't know if that's right.
Speaker 2 (04:29):
They do go by these zones or heart rate goals,
although I often tell mypatients not to use them,
because most of our patients areon medicines that adjust their
heart rate, so the scales arebased on patients who are not on
heart medicine.
So instead we use breathing,because it's every bit the same
amount of benefit from theexercise.
(04:49):
It actually isn't the heartrate, but the heart rate as a
surrogate for intensity ofexercise, and you can use
breathing as a surrogate.
Speaker 1 (04:55):
Yeah, so like running or walking at a talking pace,
that's much more practical too.
Speaker 2 (05:00):
Exactly yes, yeah, very good.
Speaker 1 (05:03):
And then you know, I like to know a little bit about
the guest.
Do you read at all, or do youhave a favorite book or any
recent books that you've readthat you found interesting?
Speaker 2 (05:15):
A few.
Actually, Probably my favoriterecent book is a book called
Outliers by Malcolm Gladwell,and it goes into what does
expertise mean and where does itcome from?
And I've believed in this for along time that it is not so
much innate, as in born in youand not achievable by someone
(05:36):
else, but rather it is so muchto deal with opportunity and
work.
And he makes a very compellingcase for that by looking at
Steve Jobs and a number ofreally sort of famous success
stories about how they just hadgreat opportunity and worked
hard.
Speaker 1 (05:55):
Yeah, this is the 10,000 hours thing right To be
an expert.
You need to put in at least10,000 hours and certain things
are going to come to certainpeople easier based off their
kind of makeup, but in generalyou have to get your reps in.
We had the Super Bowl this week.
You have to run the play a lotof times to have it perfect.
Speaker 2 (06:16):
Yes, there's a Tom Brady series called the man in
the Arena that I think is onNetflix.
Not to advertise anyone, okay,and he goes over what it took to
make Tom Brady Tom Brady.
And when he was drafted he wassixth round.
Yeah, and he will admit this.
I wasn't that physically able,but what I was able to bring to
(06:37):
the table was the repetition anddoing it over and over and over
again to make up for anyphysical deficiency, and I love
that story.
It's the hard work andachievable outcomes.
Speaker 1 (06:49):
So yeah, and that was the man in the arena, of course
, making a play on TeddyRoosevelt's speech, which was a
great one, and then the.
You know that has a corollarywith medicine too the more you
do something, the better you are, and which is it's why it's
good to be a busy, whatever youdo physician.
(07:10):
You know whatever it may be,and so, and you know, I think a
lot of the doctors here that weinterview are busy doctors, and
that's a really positive thing.
You figure out what to do, whatnot to do.
You see nuanced situations moreoften that maybe people don't
see very often.
Speaker 2 (07:28):
I think that's right.
That's part of why we have aspecialty.
And when patients ask, well, doI have three different kinds of
cardiologists?
Unfortunately the answer isoften yes, because there's so
much to know about each it'sreally impossible to be the
master of all, and so you can doa lot of repetitions when it's
a more narrow field, like justhard electrical versus a little
(07:49):
hard electrical, a littleplumbing, etc.
And for the training path to dothis career depends on exactly
when you want to start the clock.
But if you start the clock atlet's call it grade one, your
first year of education, it'sabout 27 or 28 years of school.
Until you're officially doingthis job not as a trainee, but I
(08:10):
typically will tell people ittakes another five years or so
before you actually finally kindof hit your strides.
32 years and you too could be ahard electrician.
Speaker 1 (08:20):
Yeah, uh, you graduate from medical school,
which is four years, then you dothree years of internal
medicine residency, right, andthen if you're a high achiever
in internal medicine, then youbecome a cardiology resident.
And then I mean, many highachievers don't become
cardiology residents, but it'sfortunately.
But but all cardiologyresidents are high achievers,
and so you do three years ofcardiology.
Residents are high achievers,and so you do three years of
cardiology and then two moreyears of electrophysiology.
Speaker 2 (08:40):
So normally it is two more years.
For 28 years I did myelectrophysiology training at
Washington university, down thestreet, and I did my cardiology
there as well, and so my thirdyear of general cardiology,
which is normally more dedicatedtowards research.
I actually did a year ofelectrophysiology that year, so
I got away in four years.
Speaker 1 (09:01):
Was it a combined program?
It was yeah.
Yeah, that's nice.
Yeah, cut a little bit of timeoff training.
Yeah, the?
There's a you know one of thethings.
I'll kind of come back toValentine's day a little bit.
You know, for a long time a lotof philosophers would talk
about the heart as being likethis emotional thing, even as
(09:24):
late as Arthur Schopenhauer hada quote.
He said he viewed the world asfundamentally driven by a blind,
irrational will, which heconsidered the essence of the
heart.
And there are many morephilosophers who use heart as
emotion.
And a lot of people know thisnow that emotions don't emanate
from the heart but they emanatefrom the limbic system of the
(09:45):
brain.
But there is a corollary.
I'm aware of a phenomenoncalled Sakotsubo.
Are you familiar with this?
Yes, yeah, I'm putting you onthe spot, but could you explain
that roughly for me?
Speaker 2 (09:58):
Yeah.
So the term Sakotsubo as Iunderstand it is a Japanese term
for I want to say, octopus, potor jar, how they catch them.
Apparently, they put these jarsin and the octopus just goes in
there to just sort of hang outlike a birdhouse, I suppose, is
to a bird, and they pull them upand it comes from sort of the
shape that the heart starts totake when it's not quite
(10:21):
squeezing right from thiscondition, this condition they
call it sometimes broken heartsyndrome and it is a funny
condition that happens inresponse usually to just a large
sudden surge of adrenaline oremotional response, and it can
be God forbid the death of aloved one or something
(10:41):
particularly stressful orstraining.
And for some reason some heartswill get weaker in this very
unique pattern and it will lookto the world like a heart attack
.
But it isn't quite that.
Thankfully, with time and medsit usually gets better and
actually goes away.
Speaker 1 (10:57):
Okay.
Speaker 2 (10:57):
So typically gets back to normal.
Speaker 1 (10:59):
Okay, and so kind of a relationship between emotion
and the heart.
Absolutely, is that a type ofcardiomegaly where the heart is
enlarging because the injectionfraction has decreased?
Speaker 2 (11:12):
It certainly does.
Thankfully it typically doesactually reverse remodel or it
would get better when it's done.
I can remember when this wasall starting to become popular.
One older gentleman I saw whenI was at Barnes as a fellow who
the only stressor we could findwas being outside and shoveling
snow in the very bitter cold andice.
And he was a gentleman in hislater 80s and that was all that
(11:34):
they could attribute to whatemotional or physical stress
caused his takotsubo attributeto what emotional or physical
stress caused his takotsubo.
Speaker 1 (11:42):
So do they think it's a um, like a one-time event, or
like a prolonged stress, likeover a period of like months, or
like maybe just like oneindividual event?
Speaker 2 (11:49):
um, as I understand, it is typically one particularly
uh, sentinel event that thatreally suddenly triggers this
cascade, uh, and causes theweakening of the heart in a
funny pattern where the sort ofthe tip of it or the bottom part
of it gets weaker, but theupper part doesn't.
So the upper part is sort ofsqueezing, but the bottom part
(12:09):
is not.
Speaker 1 (12:10):
And that's what makes the box shape.
Yes, okay, yeah, fascinating,fascinating, okay.
Now I like to talk aboutcurrent events a little bit, and
so I'm going to give you threechoices here to discuss which
way you want to go here.
We've had the Super Bowlrecently.
We've had, we could talk aboutValentine's Day or the Apple
(12:31):
Vision Pro.
Do you have any interest in anyof those three topics?
Speaker 2 (12:35):
I mean.
I mean some interest in all ofthem, not a ton of familiarity
with the Apple Vision Pro, otherthan what my kids tell me and
the ads that I've seen as theytried and sell me on that they
need one.
Speaker 1 (12:46):
Yeah, so it's.
It's a mixed reality headset.
I think they purposefully didnot use the term virtual reality
, and have you seen the videosof it?
Speaker 2 (12:56):
I have yes.
Speaker 1 (12:57):
It's expensive.
It's like $3,500 and theinsurance plan is like $500.
So four grand is not cheap.
So they will have a limitedmarket.
I think so.
But everything they do seems tobe fairly successful.
You know, the Apple Watchdidn't seem like it took off and
then everybody's got, or a lotof people have them.
You know the iPad kind of thesame thing.
(13:18):
Do you think it has wheels?
Do you think it's going to work?
Speaker 2 (13:22):
I mean, I suppose you don't bet against technology.
It's hard to imagine exactlyhow that's going to help your
day-to-day life, but maybe younever know.
It's sort of, if you build it,they will come perhaps.
Speaker 1 (13:35):
Yeah, yeah, probably a little bit of that.
And so you know, talking aboutone of the Apple products, we
have the Apple Watch now and itcan detect arrhythmias,
something like atrialfibrillation.
How often, or what's thefrequency in the general
population of atrialfibrillation in general?
And then, how good is the watchat actually picking up on that?
Speaker 2 (13:56):
Sure.
So the numbers are somewhere inthe three to five million
Americans at the moment have adiagnosis of atrial fibrillation
and there probably is a decentamount of atrial fibrillation
that is out there that isotherwise unknown, in the sense
that about half of people canfeel their AFib in the sense of
palpitation of their chest.
(14:16):
About half of people can't, andthey may not know that it's
there.
The Apple Watch rhythmidentification is actually
pretty good, and so we arefinding more and more AFib that
we never would have known abouthad these tools not been in
existence.
Almost not a week goes bybefore some patient is seeing me
(14:37):
for the first time with adiagnosis that actually was
arrived at by nontraditionalmeans, like an Apple Watch.
Or there's another productcalled CardiaMobile, which is a
little piece of metal that youcan do a home EKG on.
A little piece of metal thatyou can do a home EKG on.
I recall a study that was donewith incredibly large number of
(14:58):
patients that they gave them allApple watches and the rates of
finding arrhythmias in peoplethat previously did not have a
diagnosis was somewhere in the0.5%.
But still, if that's, one in200 people has some rhythm
trouble that has not been known,that's a very large number of
people.
Speaker 1 (15:14):
And so if you catch the arrhythmia before it becomes
symptomatic, the value of thatis that you prevent like a clot
forming and spreading andcausing a stroke.
Is that right?
Speaker 2 (15:25):
Yes, the biggest problem of atrial fibrillation
is that blood isn't quiteflowing as smoothly as it's
supposed to and thereforethere's a little bit not a lot,
but not zero of clot developmentrisk.
And if that clot that developsin the heart exits to the head,
that's a stroke.
So knowing about it early helpsyou be on some version of
(15:48):
treatment.
Sometimes it's blood thinner,Sometimes it's a device to wall
off where the clots can form tohelp prevent stroke risk.
Even if you don't feel yourAFib, the stroke risk is there.
Speaker 1 (15:58):
Yeah, that's incredible.
Yeah, the one thing I worryabout with it from a health
standpoint is I don't know, itfeels like that.
You know, mental health is kindof becoming a bigger issue.
Whether we're detecting it moreor it's getting worse is maybe
(16:19):
not crystal clear, but I do feellike the technology or maybe
working from home or some ofthese things I don't know how
helpful that is for individualsand their mental health.
I don't know how helpful thatis for individuals and their
mental health and some of thistechnology.
I feel like it kind of enablesus to sit on the couch longer
and kind of become less inactiveor less active.
Speaker 2 (16:41):
I agree.
I worry about that.
What are the long-term effects?
Because the truth is they'renot known, because these haven't
existed for 40 years and soit's hard to imagine that it'll
be good for health.
To reverse the question Doesn'tmean it is bad for health, but
a little worried.
Speaker 1 (16:59):
Yeah, I mean we're obviously speculating.
Nobody knows, but it's okay tospeculate and kind of think into
the future.
Yeah, I agree, I think kind ofthe base in my mind to live a
healthy life, it's kind of thebasics it's like have good human
interaction.
You know you need some personaltouch with other people.
You know whether it's a pat onthe back from your friend or
(17:20):
whatever it may be good, goodfood.
You know a positive environmentif you can have it.
Speaker 2 (17:27):
Yeah, absolutely.
I mean, I love reading abouthistory in the sense that,
although circumstances change,human beings have been fairly
the same types of behaviors fora really long time, and I think
our ancestors had a number ofthings right about what is
really important and what is alife well lived a life well
(17:49):
lived.
Speaker 1 (17:50):
I agree completely.
There's a book called theAlmanac of Naval Ravikant.
You may have seen it on Amazonor Reddit even, but he says if
you want the solution to oldproblems, look in old places.
And it kind of jives with whatyou're saying here.
Love that quote.
Yeah, because evolution doesnot happen very quickly, you
(18:13):
know, over the course of likethousands of years.
But civilization hasdramatically changed in the last
thousand years and really inthe last 200 years, and our body
, we're not that much different,you know, than we were, you
know, 10,000 years ago, as faras our brains and our bodies Is.
That.
Speaker 2 (18:31):
Yeah.
Speaker 1 (18:32):
I agree.
Speaker 2 (18:33):
Looking at various different ancient texts and
realizing that humans have beenstruggling with the same things
for a really long time, and sotry and gain from wisdom and
apply to new circumstances.
Speaker 1 (18:45):
Yeah, and so I've read a little bit of a book
called the Tao Te Ching by LaoTzu.
But when you say ancient texts,are there any texts that you
lean on or found?
Speaker 2 (18:54):
useful.
I'm blanking on the name of itit was an ancient flood story
actually.
Speaker 1 (19:02):
Not the story of Gilgamesh, epic of Gilgamesh,
sorry, yes.
Speaker 2 (19:05):
Which is really a fascinating story of it's sort
of it's got the hero's quest init, which I think in some level
it's sort of it's got the hero'squest in it, which I think in
some level we all sort of feelwhere things start well in life
a lot of the times and you havethe useful innocence and then
the struggles of the realitiesof life happen and you have to
go out and sort of proveyourself and figure out how to
(19:27):
behave in this world that is notperfect and is not roses and
sunshine, and then try and cometo some not necessarily heroes
returns to be dramatic about it,but figure out what is your
happy place, where is yourachievement of peace and success
in life?
Yeah, and how to keep yourheart happy.
Speaker 1 (19:47):
Yeah, yeah, yeah.
In the process, keep your heartand mind happy, for sure.
I think that's the oldest story, the Epic of Gilgamesh.
Did you ever read Hero of aThousand Faces by Joseph
Campbell?
Speaker 2 (19:57):
No, but I have read.
Joseph Campbell is phenomenal,yeah yeah, familiar with it.
Speaker 1 (20:02):
Yeah, yeah, for sure.
Like that's the story of lifeThings are going well, and then
all this every Disney movieyou've ever seen things are
going well and then Simba'sfather dies and you are
contending with this unexpectedobstacle.
And you have to contend with itand it's painful and it causes
you to reflect and through thatreflection you learn and grow
and become a better person, andthe cycle continues and
(20:25):
continues, and continues.
Speaker 2 (20:27):
Yeah, I remember as a kid with the Star Wars series
not to date myself, but withEmpire Strikes Back I was like
how did they write a story wherebad things are happening to the
good people?
I didn't understand it as a kid.
And then you get a verydifferent perspective when you
grow up.
But it's the same cycle that weall really do go through and
hopefully grow by and not becomeshrinking violets too, though I
(20:51):
understand that reaction.
Speaker 1 (20:53):
Yeah, yeah, for sure.
You know I always tell ourcancer patients like you can
look at yourself as a delicateorchid or a bull, and I would
prefer you look at yourself as abull, because life's tough and
you got to get tough to contendwith it and um and so, and that
that means you know it from ahealth standpoint.
I believe that your, your bloodflow is really your health.
You know, from a healthstandpoint, I believe that your
blood flow is really your health.
(21:14):
You know, for the most part,you know most dementia is
vascular dementia and in my mindand I'm, you know, I'm not a
cardiologist but in my mind, ifyou have plaque in the arteries
of your heart, I would assumethat you have plaque in the
arteries of your brain and yourkidneys don't work as well and
so if you can get that bloodflow right and have good
(21:35):
cardiovascular health, there's ahigh probability that you will
have good overall health.
Speaker 2 (21:39):
Yeah, I agree.
Yeah, keeping your heart andyour blood vessels healthy is
certainly a great way to try andimprove your health, the
quality of your health, not justthe quantity but also the
quality of your health long term.
So yeah, blood vessels are veryimportant.
We like to think so, especiallyas cardiologists, and say well,
without the heart we can'tsupply the rest of the organs
(22:01):
with blood, so doesn't that makeus most important?
But I know it's not really acompetition that way.
However, to your point about thepositive outlook, I've found
that to be incredibly true inlife.
I recall back in the day whereI could do more physical
activity in Taekwondo, when youwere breaking boards.
(22:22):
If you thought you might breakthe board, it would never break.
If you knew you were going tobreak the board, then somehow
that psychologically changes howyou behave.
And I was telling Mike to tiein the Super Bowl is.
Somehow that psychologicallychanges how you behave and I was
telling Mike to tie in theSuper Bowl.
I find it fascinating that youcan have a certain group of
people for the first half of thegame and then they go into the
(22:43):
locker room and somethinghappens, and then the second
half of the game they playdifferently.
They're the same people, thesame talent.
They didn't just suddenly workout muscles and gain any
particular skill, but the ideaof finding the right words and
the right motivation to get ourbehaviors to where they can be
(23:05):
and the positive outlook thereis incredibly important.
It can completely turn around afootball game, a health outcome
, how you do after a heartattack.
If you are going to sort ofroll over, then you're right.
You won't have as good anoutcome.
If you are.
Take the life by the horns.
You have better outcomes andit's like if you build it, they
(23:28):
will come.
If you believe it will happen,that's really the main first
step to make it happen.
Speaker 1 (23:34):
Yeah, yeah, I totally agree.
Great words, dr Cooper.
I thank you so much for joiningus here.
It was an honor and a pleasureto talk to you, and I'd like to
have you back sometime.
I think it'd be great.
I'd love to Thank you.
This was a lot of fun, thankyou.
Hello, this is Jason Edwards and I'm here with Dr
Jonas Cooper, a cardiologist andelectrophysiologist.
Jonas, how are you doing today?
Speaker 2 (00:10):
I'm well.
Thanks for having me.
How are you?
Speaker 1 (00:11):
I'm doing very well, Thank you.
Now you're not only acardiologist, but you're kind of
a specialist cardiologist inthat you're an
electrophysiologist.
Yes, that's correct.
And what is that?
What do you do?
Speaker 2 (00:26):
So there's a little division of labor in cardiology.
I usually call the plumbers thepeople who are dealing with
blockages, blood pressure,cholesterol valve functions.
There's the surgeons, who ofcourse do what they do in terms
of opening chests if fixes areneeded that way.
The electricians orelectrophysiologists deal with
heart rhythms, so fast beats andslow beats, and pacemakers and
defibrillators, that sort ofaspect of cardiology.
Speaker 1 (00:49):
And so if somebody has an abnormal rhythm, they
come see you and you either givethem medication or do you
implant the pacemaker, or doesthe surgeon do that.
Speaker 2 (00:59):
No, I do actually put in the pacemakers.
Speaker 1 (01:01):
Yeah, I think we've actually shared a patient where
I was radiating one side and youhad to move the pacemaker from
one side to the other.
Speaker 2 (01:07):
We did.
You did a wonderful job withthem.
Speaker 1 (01:09):
Yeah, you as well.
Yeah, and the patient's doingwell.
Now are you from here in St.
Speaker 2 (01:17):
Louis originally.
I saw you did most of yourtraining at Washington
University.
Yes, if you look far enoughback, toronto, canada, but I've
lived most of my life in StLouis.
Speaker 1 (01:21):
The TO huh, so you're Canadian.
Speaker 2 (01:23):
Yeah, those Canadians , they walk amongst us yeah.
Speaker 1 (01:26):
Okay, now I detect the accent to some degree.
That's an incredible city, verymulticultural, of course, and
so where is your family fromoriginally?
Are they originally from Canada?
Speaker 2 (01:41):
No, it depends, I suppose, how far back you look,
but my dad is a physician.
He's a thoracic surgeon and wasthere doing lung surgery work.
Speaker 1 (01:52):
At the University of Toronto.
At the University of Toronto hewas involved in inventing.
That's an amazing tale.
Yeah, the reason I ask is howfar back is because I know a lot
of people that they're.
They're not too manygenerations back, you know, from
their move to Canada, but ofcourse you could have some, some
(02:13):
people who have a longer runthere.
Speaker 2 (02:15):
Um, yeah, so my dad's dad's dad, I guess.
So my great grandfather?
Um, I did not get to know Dad,so my great-grandfather, whom I
did not get to know, lived thereand had moved over from Eastern
Europe around 1900, 1904,something like that.
Somewhere we have the paperworkwhere they went in through I
believe it was through Halifax,Okay, but yes, approximately
(02:41):
then Coopers came over to NorthAmerica and it's never been the
same since.
Speaker 1 (02:43):
Yeah, actually, my folks used to have a place in
PEI, prince Edward Island, whichis close to Halifax.
Speaker 2 (02:47):
Absolutely.
I think you have to go throughHalifax to get there.
Speaker 1 (02:49):
Yeah, and of Green Gables, of course, yes.
And so how many pacemakerswould you say you do in a year?
Pacemaker implantations, youwould perform in a year, sure.
Speaker 2 (03:01):
I mean probably devices.
I want to say a couple hundreda year plus minus, and that's
some combination of new devices,putting in and revising devices
, in that they are batterypowered and when the battery
goes low, unfortunately we don'thave a rechargeable version
where we can lay you on a mat ofsorts and charge it back up, so
(03:22):
there's a surgery to replacethe unit there as well.
That sounds like high volume.
It certainly seems that way.
I usually tell my patients I'drather you not need me, Not that
what I do is that crazy, butI'd rather you be healthy than
need me.
But if you do, thankfully wehave fixes for this.
Speaker 1 (03:38):
Certainly, and so are there any things that you do in
your own life, any positivehabits, health-wise, that you
feel like have been beneficial,whether it's exercise or yeah,
it's usually telling otherpeople or my kids what they
should be doing for good forthemselves.
Speaker 2 (03:54):
But you're right, it's good to follow our own
advice.
So yes cardiovascular exerciseis the right thing to do.
Yeah, and what we mean by thatis often not so explained.
Yeah, and what we mean by thatis often not so explained.
So typically we mean by that 2030 minutes most days of the
week, and doesn't have to besomething that is so intensive
that you can't breathe duringthe activity.
So if you are exercising to thepoint of, oh my god, this is a
(04:17):
great workout ever, uh, that'sthat's more intense than you
need, something that makes you alittle out of breath.
20 30 minutes most days of theweek is really the heart healthy
aspect of things is that what'sconsidered zone two, um or?
Speaker 1 (04:28):
I've heard that.
I don't know if that's right.
Speaker 2 (04:29):
They do go by these zones or heart rate goals,
although I often tell mypatients not to use them,
because most of our patients areon medicines that adjust their
heart rate, so the scales arebased on patients who are not on
heart medicine.
So instead we use breathing,because it's every bit the same
amount of benefit from theexercise.
(04:49):
It actually isn't the heartrate, but the heart rate as a
surrogate for intensity ofexercise, and you can use
breathing as a surrogate.
Speaker 1 (04:55):
Yeah, so like running or walking at a talking pace,
that's much more practical too.
Speaker 2 (05:00):
Exactly yes, yeah, very good.
Speaker 1 (05:03):
And then you know, I like to know a little bit about
the guest.
Do you read at all, or do youhave a favorite book or any
recent books that you've readthat you found interesting?
Speaker 2 (05:15):
A few.
Actually, Probably my favoriterecent book is a book called
Outliers by Malcolm Gladwell,and it goes into what does
expertise mean and where does itcome from?
And I've believed in this for along time that it is not so
much innate, as in born in youand not achievable by someone
(05:36):
else, but rather it is so muchto deal with opportunity and
work.
And he makes a very compellingcase for that by looking at
Steve Jobs and a number ofreally sort of famous success
stories about how they just hadgreat opportunity and worked
hard.
Speaker 1 (05:55):
Yeah, this is the 10,000 hours thing right To be
an expert.
You need to put in at least10,000 hours and certain things
are going to come to certainpeople easier based off their
kind of makeup, but in generalyou have to get your reps in.
We had the Super Bowl this week.
You have to run the play a lotof times to have it perfect.
Speaker 2 (06:16):
Yes, there's a Tom Brady series called the man in
the Arena that I think is onNetflix.
Not to advertise anyone, okay,and he goes over what it took to
make Tom Brady Tom Brady.
And when he was drafted he wassixth round.
Yeah, and he will admit this.
I wasn't that physically able,but what I was able to bring to
(06:37):
the table was the repetition anddoing it over and over and over
again to make up for anyphysical deficiency, and I love
that story.
It's the hard work andachievable outcomes.
Speaker 1 (06:49):
So yeah, and that was the man in the arena, of course
, making a play on TeddyRoosevelt's speech, which was a
great one, and then the.
You know that has a corollarywith medicine too the more you
do something, the better you are, and which is it's why it's
good to be a busy, whatever youdo physician.
(07:10):
You know whatever it may be,and so, and you know, I think a
lot of the doctors here that weinterview are busy doctors, and
that's a really positive thing.
You figure out what to do, whatnot to do.
You see nuanced situations moreoften that maybe people don't
see very often.
Speaker 2 (07:28):
I think that's right.
That's part of why we have aspecialty.
And when patients ask, well, doI have three different kinds of
cardiologists?
Unfortunately the answer isoften yes, because there's so
much to know about each it'sreally impossible to be the
master of all, and so you can doa lot of repetitions when it's
a more narrow field, like justhard electrical versus a little
(07:49):
hard electrical, a littleplumbing, etc.
And for the training path to dothis career depends on exactly
when you want to start the clock.
But if you start the clock atlet's call it grade one, your
first year of education, it'sabout 27 or 28 years of school.
Until you're officially doingthis job not as a trainee, but I
(08:10):
typically will tell people ittakes another five years or so
before you actually finally kindof hit your strides.
32 years and you too could be ahard electrician.
Speaker 1 (08:20):
Yeah, uh, you graduate from medical school,
which is four years, then you dothree years of internal
medicine residency, right, andthen if you're a high achiever
in internal medicine, then youbecome a cardiology resident.
And then I mean, many highachievers don't become
cardiology residents, but it'sfortunately.
But but all cardiologyresidents are high achievers,
and so you do three years ofcardiology.
Residents are high achievers,and so you do three years of
cardiology and then two moreyears of electrophysiology.
Speaker 2 (08:40):
So normally it is two more years.
For 28 years I did myelectrophysiology training at
Washington university, down thestreet, and I did my cardiology
there as well, and so my thirdyear of general cardiology,
which is normally more dedicatedtowards research.
I actually did a year ofelectrophysiology that year, so
I got away in four years.
Speaker 1 (09:01):
Was it a combined program?
It was yeah.
Yeah, that's nice.
Yeah, cut a little bit of timeoff training.
Yeah, the?
There's a you know one of thethings.
I'll kind of come back toValentine's day a little bit.
You know, for a long time a lotof philosophers would talk
about the heart as being likethis emotional thing, even as
(09:24):
late as Arthur Schopenhauer hada quote.
He said he viewed the world asfundamentally driven by a blind,
irrational will, which heconsidered the essence of the
heart.
And there are many morephilosophers who use heart as
emotion.
And a lot of people know thisnow that emotions don't emanate
from the heart but they emanatefrom the limbic system of the
(09:45):
brain.
But there is a corollary.
I'm aware of a phenomenoncalled Sakotsubo.
Are you familiar with this?
Yes, yeah, I'm putting you onthe spot, but could you explain
that roughly for me?
Speaker 2 (09:58):
Yeah.
So the term Sakotsubo as Iunderstand it is a Japanese term
for I want to say, octopus, potor jar, how they catch them.
Apparently, they put these jarsin and the octopus just goes in
there to just sort of hang outlike a birdhouse, I suppose, is
to a bird, and they pull them upand it comes from sort of the
shape that the heart starts totake when it's not quite
(10:21):
squeezing right from thiscondition, this condition they
call it sometimes broken heartsyndrome and it is a funny
condition that happens inresponse usually to just a large
sudden surge of adrenaline oremotional response, and it can
be God forbid the death of aloved one or something
(10:41):
particularly stressful orstraining.
And for some reason some heartswill get weaker in this very
unique pattern and it will lookto the world like a heart attack
.
But it isn't quite that.
Thankfully, with time and medsit usually gets better and
actually goes away.
Speaker 1 (10:57):
Okay.
Speaker 2 (10:57):
So typically gets back to normal.
Speaker 1 (10:59):
Okay, and so kind of a relationship between emotion
and the heart.
Absolutely, is that a type ofcardiomegaly where the heart is
enlarging because the injectionfraction has decreased?
Speaker 2 (11:12):
It certainly does.
Thankfully it typically doesactually reverse remodel or it
would get better when it's done.
I can remember when this wasall starting to become popular.
One older gentleman I saw whenI was at Barnes as a fellow who
the only stressor we could findwas being outside and shoveling
snow in the very bitter cold andice.
And he was a gentleman in hislater 80s and that was all that
(11:34):
they could attribute to whatemotional or physical stress
caused his takotsubo attributeto what emotional or physical
stress caused his takotsubo.
Speaker 1 (11:42):
So do they think it's a um, like a one-time event, or
like a prolonged stress, likeover a period of like months, or
like maybe just like oneindividual event?
Speaker 2 (11:49):
um, as I understand, it is typically one particularly
uh, sentinel event that thatreally suddenly triggers this
cascade, uh, and causes theweakening of the heart in a
funny pattern where the sort ofthe tip of it or the bottom part
of it gets weaker, but theupper part doesn't.
So the upper part is sort ofsqueezing, but the bottom part
(12:09):
is not.
Speaker 1 (12:10):
And that's what makes the box shape.
Yes, okay, yeah, fascinating,fascinating, okay.
Now I like to talk aboutcurrent events a little bit, and
so I'm going to give you threechoices here to discuss which
way you want to go here.
We've had the Super Bowlrecently.
We've had, we could talk aboutValentine's Day or the Apple
(12:31):
Vision Pro.
Do you have any interest in anyof those three topics?
Speaker 2 (12:35):
I mean.
I mean some interest in all ofthem, not a ton of familiarity
with the Apple Vision Pro, otherthan what my kids tell me and
the ads that I've seen as theytried and sell me on that they
need one.
Speaker 1 (12:46):
Yeah, so it's.
It's a mixed reality headset.
I think they purposefully didnot use the term virtual reality
, and have you seen the videosof it?
Speaker 2 (12:56):
I have yes.
Speaker 1 (12:57):
It's expensive.
It's like $3,500 and theinsurance plan is like $500.
So four grand is not cheap.
So they will have a limitedmarket.
I think so.
But everything they do seems tobe fairly successful.
You know, the Apple Watchdidn't seem like it took off and
then everybody's got, or a lotof people have them.
You know the iPad kind of thesame thing.
(13:18):
Do you think it has wheels?
Do you think it's going to work?
Speaker 2 (13:22):
I mean, I suppose you don't bet against technology.
It's hard to imagine exactlyhow that's going to help your
day-to-day life, but maybe younever know.
It's sort of, if you build it,they will come perhaps.
Speaker 1 (13:35):
Yeah, yeah, probably a little bit of that.
And so you know, talking aboutone of the Apple products, we
have the Apple Watch now and itcan detect arrhythmias,
something like atrialfibrillation.
How often, or what's thefrequency in the general
population of atrialfibrillation in general?
And then, how good is the watchat actually picking up on that?
Speaker 2 (13:56):
Sure.
So the numbers are somewhere inthe three to five million
Americans at the moment have adiagnosis of atrial fibrillation
and there probably is a decentamount of atrial fibrillation
that is out there that isotherwise unknown, in the sense
that about half of people canfeel their AFib in the sense of
palpitation of their chest.
(14:16):
About half of people can't, andthey may not know that it's
there.
The Apple Watch rhythmidentification is actually
pretty good, and so we arefinding more and more AFib that
we never would have known abouthad these tools not been in
existence.
Almost not a week goes bybefore some patient is seeing me
(14:37):
for the first time with adiagnosis that actually was
arrived at by nontraditionalmeans, like an Apple Watch.
Or there's another productcalled CardiaMobile, which is a
little piece of metal that youcan do a home EKG on.
A little piece of metal thatyou can do a home EKG on.
I recall a study that was donewith incredibly large number of
(14:58):
patients that they gave them allApple watches and the rates of
finding arrhythmias in peoplethat previously did not have a
diagnosis was somewhere in the0.5%.
But still, if that's, one in200 people has some rhythm
trouble that has not been known,that's a very large number of
people.
Speaker 1 (15:14):
And so if you catch the arrhythmia before it becomes
symptomatic, the value of thatis that you prevent like a clot
forming and spreading andcausing a stroke.
Is that right?
Speaker 2 (15:25):
Yes, the biggest problem of atrial fibrillation
is that blood isn't quiteflowing as smoothly as it's
supposed to and thereforethere's a little bit not a lot,
but not zero of clot developmentrisk.
And if that clot that developsin the heart exits to the head,
that's a stroke.
So knowing about it early helpsyou be on some version of
(15:48):
treatment.
Sometimes it's blood thinner,Sometimes it's a device to wall
off where the clots can form tohelp prevent stroke risk.
Even if you don't feel yourAFib, the stroke risk is there.
Speaker 1 (15:58):
Yeah, that's incredible.
Yeah, the one thing I worryabout with it from a health
standpoint is I don't know, itfeels like that.
You know, mental health is kindof becoming a bigger issue.
Whether we're detecting it moreor it's getting worse is maybe
(16:19):
not crystal clear, but I do feellike the technology or maybe
working from home or some ofthese things I don't know how
helpful that is for individualsand their mental health.
I don't know how helpful thatis for individuals and their
mental health and some of thistechnology.
I feel like it kind of enablesus to sit on the couch longer
and kind of become less inactiveor less active.
Speaker 2 (16:41):
I agree.
I worry about that.
What are the long-term effects?
Because the truth is they'renot known, because these haven't
existed for 40 years and soit's hard to imagine that it'll
be good for health.
To reverse the question Doesn'tmean it is bad for health, but
a little worried.
Speaker 1 (16:59):
Yeah, I mean we're obviously speculating.
Nobody knows, but it's okay tospeculate and kind of think into
the future.
Yeah, I agree, I think kind ofthe base in my mind to live a
healthy life, it's kind of thebasics it's like have good human
interaction.
You know you need some personaltouch with other people.
You know whether it's a pat onthe back from your friend or
(17:20):
whatever it may be good, goodfood.
You know a positive environmentif you can have it.
Speaker 2 (17:27):
Yeah, absolutely.
I mean, I love reading abouthistory in the sense that,
although circumstances change,human beings have been fairly
the same types of behaviors fora really long time, and I think
our ancestors had a number ofthings right about what is
really important and what is alife well lived a life well
(17:49):
lived.
Speaker 1 (17:50):
I agree completely.
There's a book called theAlmanac of Naval Ravikant.
You may have seen it on Amazonor Reddit even, but he says if
you want the solution to oldproblems, look in old places.
And it kind of jives with whatyou're saying here.
Love that quote.
Yeah, because evolution doesnot happen very quickly, you
(18:13):
know, over the course of likethousands of years.
But civilization hasdramatically changed in the last
thousand years and really inthe last 200 years, and our body
, we're not that much different,you know, than we were, you
know, 10,000 years ago, as faras our brains and our bodies Is.
That.
Speaker 2 (18:31):
Yeah.
Speaker 1 (18:32):
I agree.
Speaker 2 (18:33):
Looking at various different ancient texts and
realizing that humans have beenstruggling with the same things
for a really long time, and sotry and gain from wisdom and
apply to new circumstances.
Speaker 1 (18:45):
Yeah, and so I've read a little bit of a book
called the Tao Te Ching by LaoTzu.
But when you say ancient texts,are there any texts that you
lean on or found?
Speaker 2 (18:54):
useful.
I'm blanking on the name of itit was an ancient flood story
actually.
Speaker 1 (19:02):
Not the story of Gilgamesh, epic of Gilgamesh,
sorry, yes.
Speaker 2 (19:05):
Which is really a fascinating story of it's sort
of it's got the hero's quest init, which I think in some level
it's sort of it's got the hero'squest in it, which I think in
some level we all sort of feelwhere things start well in life
a lot of the times and you havethe useful innocence and then
the struggles of the realitiesof life happen and you have to
go out and sort of proveyourself and figure out how to
(19:27):
behave in this world that is notperfect and is not roses and
sunshine, and then try and cometo some not necessarily heroes
returns to be dramatic about it,but figure out what is your
happy place, where is yourachievement of peace and success
in life?
Yeah, and how to keep yourheart happy.
Speaker 1 (19:47):
Yeah, yeah, yeah.
In the process, keep your heartand mind happy, for sure.
I think that's the oldest story, the Epic of Gilgamesh.
Did you ever read Hero of aThousand Faces by Joseph
Campbell?
Speaker 2 (19:57):
No, but I have read.
Joseph Campbell is phenomenal,yeah yeah, familiar with it.
Speaker 1 (20:02):
Yeah, yeah, for sure.
Like that's the story of lifeThings are going well, and then
all this every Disney movieyou've ever seen things are
going well and then Simba'sfather dies and you are
contending with this unexpectedobstacle.
And you have to contend with itand it's painful and it causes
you to reflect and through thatreflection you learn and grow
and become a better person, andthe cycle continues and
(20:25):
continues, and continues.
Speaker 2 (20:27):
Yeah, I remember as a kid with the Star Wars series
not to date myself, but withEmpire Strikes Back I was like
how did they write a story wherebad things are happening to the
good people?
I didn't understand it as a kid.
And then you get a verydifferent perspective when you
grow up.
But it's the same cycle that weall really do go through and
hopefully grow by and not becomeshrinking violets too, though I
(20:51):
understand that reaction.
Speaker 1 (20:53):
Yeah, yeah, for sure.
You know I always tell ourcancer patients like you can
look at yourself as a delicateorchid or a bull, and I would
prefer you look at yourself as abull, because life's tough and
you got to get tough to contendwith it and um and so, and that
that means you know it from ahealth standpoint.
I believe that your, your bloodflow is really your health.
You know, from a healthstandpoint, I believe that your
blood flow is really your health.
(21:14):
You know, for the most part,you know most dementia is
vascular dementia and in my mindand I'm, you know, I'm not a
cardiologist but in my mind, ifyou have plaque in the arteries
of your heart, I would assumethat you have plaque in the
arteries of your brain and yourkidneys don't work as well and
so if you can get that bloodflow right and have good
(21:35):
cardiovascular health, there's ahigh probability that you will
have good overall health.
Speaker 2 (21:39):
Yeah, I agree.
Yeah, keeping your heart andyour blood vessels healthy is
certainly a great way to try andimprove your health, the
quality of your health, not justthe quantity but also the
quality of your health long term.
So yeah, blood vessels are veryimportant.
We like to think so, especiallyas cardiologists, and say well,
without the heart we can'tsupply the rest of the organs
(22:01):
with blood, so doesn't that makeus most important?
But I know it's not really acompetition that way.
However, to your point about thepositive outlook, I've found
that to be incredibly true inlife.
I recall back in the day whereI could do more physical
activity in Taekwondo, when youwere breaking boards.
(22:22):
If you thought you might breakthe board, it would never break.
If you knew you were going tobreak the board, then somehow
that psychologically changes howyou behave.
And I was telling Mike to tiein the Super Bowl is.
Somehow that psychologicallychanges how you behave and I was
telling Mike to tie in theSuper Bowl.
I find it fascinating that youcan have a certain group of
people for the first half of thegame and then they go into the
(22:43):
locker room and somethinghappens, and then the second
half of the game they playdifferently.
They're the same people, thesame talent.
They didn't just suddenly workout muscles and gain any
particular skill, but the ideaof finding the right words and
the right motivation to get ourbehaviors to where they can be
(23:05):
and the positive outlook thereis incredibly important.
It can completely turn around afootball game, a health outcome
, how you do after a heartattack.
If you are going to sort ofroll over, then you're right.
You won't have as good anoutcome.
If you are.
Take the life by the horns.
You have better outcomes andit's like if you build it, they
(23:28):
will come.
If you believe it will happen,that's really the main first
step to make it happen.
Speaker 1 (23:34):
Yeah, yeah, I totally agree.
Great words, dr Cooper.
I thank you so much for joiningus here.
It was an honor and a pleasureto talk to you, and I'd like to
have you back sometime.
I think it'd be great.
I'd love to Thank you.
This was a lot of fun, thankyou.
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