October 1, 2025 • 29 mins
Dr. Sandeep Rao brings the borderland the latest information in healthcare, medicine and technology. He considers himself a hacker in the positive sense, using his intimate knowledge of the medical system to break down some of the barriers to accessing new medical technologies and information.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Good afternoon. It's another weekend here in the heart of
the dschwall in desert in West Texas. You're listening to
the Medical Hecklers. However, you may be tuned in this
week and I'm your host, doctor Sandy Prout. I'm here
to bring the Borderland the latest information in healthcare, medicine,
and technology on the show.
Speaker 2 (00:21):
I'll consider myself a.
Speaker 1 (00:23):
Hacker, a hack of the politicist, a hacker using my
intimate knowledge of the medical system to break it down
some of the bearish accessing new medical technologies, a current
healthcare information that.
Speaker 3 (00:35):
JUNI here with me, Hey dog, how are you. It's
always good to be here with you.
Speaker 2 (00:40):
Great to have you.
Speaker 1 (00:42):
And I wanted to start this show off talking about
something that I think is actually might be useful information
or applicable to our producer here at Amber. Okay, and
I want to kind of get into the entire area
(01:03):
of heart attacks and what about heart attacks when they
occur in younger women. By a younger women, I mean
anybody under the age of fifty, right, so when we
look at heart attacks, we can kind of stratify it
and say, did it happen to somebody older?
Speaker 2 (01:22):
You know?
Speaker 1 (01:22):
Above fifty or let's say somebody blow fifty. And the
reason why this applicable was because I think some of
the risk factors might be something that you or anybody
under the age of fifty can easily should pay attention
to because it's easily something that can come about. And
(01:45):
what brought this about is there was a particular patient
episode of a patient, a woman, thirty four year old
woman who came into the emergency room. And it wasn't
my patient. I just heard about this because I don't
necessarily deal with heart attacks on the front line. From
the standpoint of I don't treat them. I'm not a cardiologist.
I'm a vascular doc. In the standpoint of I interpret
(02:06):
a lot of the imaging. I see a lot of
these studies that are ordered, but I don't treat them
because I'm not a cardiologist. But I do hear and
I do have my finger on the pulse of a
lot of different types of patients who come in. But
a younger woman thirty four years old, came into the
emergency room with the classic symptoms crushing, chest pain, sweating, nausea.
(02:28):
They did an EKG found sort of the classic symptoms
that you'd see on a woman who has symptoms or
have experiencing a heart attack, who's having what we call
myocardial infarction, which is there's not enough blood flow to
the heart. So there's things on the EKG what we
call st elevation in the on certain leads. There's other
(02:51):
labs they can get things called troponins. These are lab
values that could be a marker for heart attack. This
patient had those going on as well, but she did
not have any of the traditional heart disease risk factors
that you and I JUNI know so well. She did
not have any high risk of having plaque build up
(03:14):
of due to cholesterol. Now what they did is they
went in emergently the cardiology did went and did a
heart catheterization. Now what that means is the same way
I do angiography, meaning I put in ivs in patients'
blood vessels and I typically do that for I do
(03:35):
it anywhere outside the heart. Actually, so cardiologists focus specifically
on the heart. But what they do is they go
through an IV in the using the radio artery that
might go in. Sometimes they might go into the femor artery,
but usually what they do is they go in with
a tiny little wire and a tiny little catheter and
they inject contrasts die, which means that they can now
see how the blood vessels of the heart light up.
(03:59):
They can see if there's a block they can see
if there's decreased blood flow. So what they did is
they found sort of this hazyness with one of the
main blood vessels what we call the lefty entry or
descending that's like the key vessel that sent submits a
lot of you know, blood to the heart, and they
found that there's some hazy narrowing. They are additionally going
(04:21):
and they have access to this. This is also something
that I have access to. It's a way to actually
see how the blood flow is inside the blood vessel.
There's this thing called oct I don't want to get
into this. It's a way to imagine you're flying inside
a blood vessel and you can see all the plaque
build up almost a three hundred and sixty degree in
(04:44):
a three hundred and sixty degree pattern, not just from
a one dimensional So if you look at an X
ray from one dimension, you're kind of seeing blockages. Maybe
you might see what's supposed to look like a pipe,
you might see some irregulary. But now imagine I can
actually travel inside that blood vessel and I can see
you want, the plaque is exactly at let's just say
the twelve o'clock position.
Speaker 2 (05:03):
Like the Magic school Bus.
Speaker 3 (05:05):
Remember that cartoon I do, Yeah, where it shows them
from the inside.
Speaker 2 (05:09):
Exactly like you're flying on the inside.
Speaker 1 (05:11):
So they were able to see that the patient actually
had what's called a dissection. A dissection just means that
there was a tear, a rent in the blood vessel
wall that was causing this heart attack. Okay, so now
this is very important because there's actually a very interesting
study that came out and what that's what raised this issue,
(05:31):
which is that this thing would cause spontaneous cornery ary dissection,
which means spontaneous meaning it just happened out of the
blue cornary artery, meaning these are blood vessels that go
to the heart, and dissection means it dissected it it
was a little tear. This is something scad is the
term that we have. It used to be a very
rare finding at autopsies a while back, but now it
(05:54):
is actually one of the most common causes of heart
attacks of myocardial and fashion m I as we call
it in women under fifty, especially women who are pregnant
or who have recently given birth.
Speaker 3 (06:08):
It what causes that?
Speaker 1 (06:10):
Yeah, I'm going to get into that area because I
think I think it's very applical on something that something
I actually didn't even think about until I started delving
into this a little bit further. Because some of the
things that you might think make you healthier actually predisposes
women to having this type of heart attack. So there's
an interesting study that came out. What they did is
they looked at heart attacks in younger women as opposed
(06:33):
to women over the age of sixty five. And so
what they did is they did over a fifteen year
period of time, they looked at heart attacks and women
and heart attacks and men. Now, when it comes to men,
these men have the classic risk factors JUNI could probably
say what those are as someone who's in the pad space, Yeah, right.
Speaker 3 (06:55):
Plaque, build up, cholesterol, and I mean all sorts of.
Speaker 2 (07:00):
High blood pressure.
Speaker 3 (07:01):
That's right.
Speaker 1 (07:02):
So what's interesting is that what they did is they
found so that's an entireity called a throw trombosis, meaning
there's a blockage in your.
Speaker 2 (07:16):
Heart, in your cornerary.
Speaker 1 (07:18):
Arteries, that's due to some sort of something has been
thrown up into the essentially imagine something gunks up your plumbing. Right,
that's like the classic cause of heart attacks in the
vast majority of patients, Okay, especially men, right exactly, So
in seventy five percent of men, this is the cause.
Now it's only the cause in about fifty percent of women. Okay,
(07:40):
So it's you know, plaque build up, things like that,
which is usually you know, your classic risk factors is
what causes heart attack and the vast majority of patients,
especially in men. But when you start looking at in women,
what is the main cause? Now, plaque build up is
definitely a huge cause, but disproportunately, it's actually this thing
(08:02):
called SCAD, which is dissection. And I want to kind
of get into that, especially after this this little break here,
because it's something that a lot of people feel that
they may not be able to control these risk factors.
And I think that's very important to know because a
lot of us think, you know, eating healthy, being able
(08:23):
to you know, maintain control your blood blood pressure are
going to.
Speaker 2 (08:27):
Be key things to look for.
Speaker 1 (08:29):
But when it comes to younger women, sometimes you might
already be doing these things you might already be exercising.
In fact, you might be over exercising. And that's actually
something that I want to get into because extreme exercise
has been implicated as one of the main causes of dissection.
And I don't want to scare people who do a
lot of exercise. I know Amber you do. You do
(08:51):
a lot of excess. So when this study came out,
when this thing came out, I was actually thinking about you,
and I've kind of wanted to get into this a
little bit.
Speaker 2 (08:57):
So we're going to get into this after this break
a little bit.
Speaker 4 (09:00):
You're listening to the Medical Hackers with doctor Sandeep Row,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four three
seven zero or by emailing Rao at medical hackers dot com.
Speaker 1 (09:27):
Background the Hackers, some doctor Row here having a discussion
about heart attacks, especially when it comes to women under
the age of fifty and so one of the things
I wanted to say, so as you said, spontaneous corner
Lady dissection is a type of heart attack which is
due to a tear in your blood vessel walls, as
(09:49):
opposed to a traditional heart attack that you and I
might think about when we talk about these these sort
of widow maker heart attacks that men classically die of,
where a little plaque has sort of been broken off,
maybe if broke off from somewhere else in your heart,
or maybe a plaque broke off from a little you know,
a little troumbis a little plaque that might have come
(10:10):
from your heart that's kind of you know, breaks off,
and then it tends to clog up the plumbing in
your heart. And that's why it's really important to know
this because this type of other type of heart attack,
which we don't ever think about or very rarely think about,
or something that we've only started thinking about very recently,
tends to affect seemingly healthy women and less there are
(10:32):
men who get affected by this. But it is very
important to know this because once we find that a
woman is suffering from a heart attack, especially due to
this cause, you actually have to treat that heart attack
much differently than another heart attack, which is, you know,
a classic heart attack that we all you know, have
known for long.
Speaker 3 (10:52):
Yes, doctor Rowl, I have a question for you. I
know you have your traditional imaging to detect stuff going
on in our bodies, but what the dissection I know
that polls as challenges for you doctors. What's the best
way to determine that and view that?
Speaker 2 (11:08):
Yeah?
Speaker 1 (11:08):
So the best way is based on what I in
the clinical presentation that had mentioned the docs had initially
done was called Cornery angiography. Right, So that's just a
single two D view, so to speak, of looking at
(11:29):
a blood vessel, of looking at your heart. You're kind
of just looking at it in one plane, maybe a
couple of planes. And what you can do is you
see some narrowing going on in that blood vessel, but
you don't know that could be due to this tear
in the blood vessel lining, or it could be also
due to an underlying plaque. That's the point in which
(11:49):
having this view which I'd mentioned, almost like you're flying
through a blood vessel. And there's a couple of different
tools for that.
Speaker 4 (11:55):
One.
Speaker 1 (11:55):
It's called intravascular ultrasound that I use frequently when I'm
using it in the blood vessels are the lower extremity
or also this thing called optical coherence, the technology OCT
that a lot of cardiologists use. I don't want to
get into the science behind it, but basically you're using
a lot of ultrasound waves. If you're using IVS, it's
(12:17):
a way to really be able to get a three
hundred and sixty degree view of that blood vessel to
where you can actually see maybe it's at the twelve
o'clock position or the three o'clock position, or the six
o'clock position where we're seeing this little tear in the
vessel wall, or is it plaque build up in the
vessel wall?
Speaker 2 (12:37):
And that really.
Speaker 1 (12:37):
Helps guide the treatment, which is what's very important, because
you don't want to treat a woman in her thirties
who's having a heart attack due to a dissection or
a tear in their vessel wall the same way someone
else has plaque that's thrown up and is blocking the
vessel wall. Now, those of your watching who are listening,
(13:00):
actually maybe wondering is what are the risk factors for
having this dissection, having this tear in the vest wall.
So when you look at traditional heart disease risk factors,
high blood pressure, having hyper lipidemia meaning abnormal cholesterol, is
actually a risk factor in both. You know what I'm saying,
You can have the same risk factors and both top
of diseases, although it does tend to be much more
(13:21):
of a risk factor with your traditional heart attacks. Now
when you look at women who've especially who've had this
type of dissection, there's actually three risk factors that you
never think about, because I mean, do you ever think
about migraines as a risk factor, or hormones or pregnancy
or exercise. The reason I'm bringing that up are these
(13:43):
are all significant risk factors for women who have these
types of spontaneous cornary arid dissections. So interesting Steid here
migrain headaches. So they actually found an association with this
spontaneous corninary aoritory dissection, and they found prevalence rates much
high with women who had migraines than the general population.
(14:04):
So what people are suggesting is that, especially with chronic migraines,
you might have an underlying abnormality in your vessel wall
that predisposes you to having a dissection in your heart
but also having a migraine. Now we don't know the
exact mechanism. We just see an association here, but it's
something to think about.
Speaker 3 (14:24):
So, doctor Raol, if you have a young lady that's
having a lot of migraines, and to determine if she
has a dissection, what are those symptoms or what can
lead to that for a doctor.
Speaker 1 (14:36):
Okay, So that's a good question because I don't want
people out there who are listening to me to say, oh,
I have a lot of migraines, Now do I need
to get my heart checked.
Speaker 2 (14:45):
I think it's actually a little bit in reverse.
Speaker 1 (14:47):
Now, if you are a woman out there who is
all of a sudden experiencing chest pain and you are younger,
I don't want and if you also have a history
of migraines, i'd want that to go you know what,
maybe I should get it checked out. I don't want
to say that if you have migraines you should check
out your heart necessarily. But if you do have heart
disease symptoms just because you're young, you're exercising, I don't
(15:08):
want you to dismiss them, especially when you start.
Speaker 2 (15:11):
Having risk factors of migraines.
Speaker 1 (15:12):
So I want migraines to be something that you mentioned
to your doc, because then your doc will go, oh,
you know what, she's having chest pains and she has
history of migraines, this might actually be something that's causing
this this thing to get.
Speaker 2 (15:26):
Worse, and actual migraines, right, not just headaches.
Speaker 1 (15:29):
Exactly, it's migraines, so especially with chronic chest plain exactly.
Along with chest plains, another one is just hormonal influences.
So what they found with the development of these spontaneous
terrors in the arterial walls is that what they found
is that there's no evidence specifically of any specific hormones.
So if you're a woman taking hormone replacement, they aren't
(15:52):
saying that necessarily that's implicated within having terrors in these dissections.
But what they're saying is that there may be some
hormonal influences involved, and that's why we're seeing women at
a much higher rate having spontaneous terrors in the vessel
wall as opposed to men. So if you looked at
a bunch of men who had heart disease, let's just
(16:12):
say we took a bunch of thirty five year old
men and women who'd had heart attacks, women will have
a higher risk of having the dissection. They're saying, could
it be due to hormones?
Speaker 2 (16:23):
Again, we don't know.
Speaker 1 (16:24):
For sure, but that I'm just saying this could potentially
be something that they're investigating now. One thing they have
found is that pregnancy associated tears in the wall is
actually extremely high because what they found is that seventy
percent of these occurred during the first week after having
delivered a child. So if you're a woman who's delivered
a child and you start having these chest paint top
(16:46):
symptoms like the scenario that I mentioned though, young women
who's thirty four year old, women who'd had just delivered
a child, some people might just dismiss that because what's
the odds that someone who's young, thirty four year old
is having chest paint. Maybe just the distress of having
being with a young child that's that's waking up.
Speaker 2 (17:04):
All night, or breastfeeding pains.
Speaker 1 (17:06):
They may exactly that, but I wouldn't be confusing, I
guess exactly. So what they've found is that pregnancy, this
this entity, this spontaneous coronary arready dissection, this terr in
the wall, accounts for almost fifty percent of pregnancy associated
heart attacks. So that's just something that we need to
(17:27):
look out for. And I don't want you to dismiss that. Now,
Another very important one is that what they actually found
is that twenty five percent of people who've had this
spontaneous tear in the vessel wall are actually reporting extreme
exercise at the time of the event or experiencing extreme
(17:51):
emotional stressors. That's not something that nobody ever thinks about
because I think because I work out all the time,
I know amber you you're always training for something.
Speaker 2 (18:00):
Or the other.
Speaker 1 (18:00):
I've literally been diagnosed with an exercise addiction at a
young age. Wow, that can be a good thing if
done in moderation. But it's very important to know that
extreme exercise has actually been something that they've found implicating
women who have these spontaneous terrors in the heart. Now,
I don't want that to dissuade you from doing exercise.
(18:22):
All I want you to think about is, anybody who
does exercise, is that if you started having this type
of chest pain, I don't want you to dismiss it,
because we are seeing this association with younger women who
have done a lot of exercise. So it's just something
to think about. And I'm going to kind of go
into in the next segment, how do we manage these
(18:44):
women who have and not just women, it's also men.
There are men who also have spontaneous dissections, have spontaneous
terrors in the corner arteries. How do we manage that?
And is the management of that different from somebody who
has a traditional heart attack, because it is very different.
And actually so we're gonna take a quick break here
on the Hackers.
Speaker 4 (19:03):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Raw, call nine one five five hundred four to
three seven zero or by emailing Raw at medical hackers
(19:27):
dot com.
Speaker 1 (19:30):
Back into the Hackers, doctor Row here with producer Amber
and Juny, and we're talking about something that's very applicable
to a lot of women, also applicable to you, Amber
as a as a young woman who does exercise who
might experience pain, right Like, I mean, anyone can anyone.
Speaker 2 (19:50):
Can have pain. I mean I'm myself sometimes I have.
Speaker 1 (19:54):
You know, how how do we know that this pain
that's due to over exercise them a muscle versus you know,
just your typical chessman. So this is where it's really
important because the management of this of this problem is
very important because it's very different if I find out
that you have a dissection, a tear in your vessel wall,
(20:14):
it's very different than if you have.
Speaker 2 (20:15):
A plaque build up.
Speaker 1 (20:17):
So you know, when you think about classic, the way
I would treat someone who has an older gentleman or
anybody who has an actual promise a plaque that's developed,
as opposed to somebody who has had a dissection, is
that the number one thing is we don't do what's
called anti coagulation. So antiquagulation just means we thin out blood. Now,
(20:39):
when you have a plaque that's developed inside your blood
vessel walls, we actually want to give you something called antiquagulation.
We want to thin out your blood because we want
to break up the plaque. We don't want to do
that with somebody who's a tear in the vessel wall
because you're actually going to increase the size of that
dissection because think about it, you know what a dice
(21:00):
section is a tear inside the blood vessel wall, and
so what you have is you have bleeding that's going
into the wall. So now that normal wall of your
blood vessels have now become thicker, and by giving something
that's going to promote thinning of the blood, that dissection
could actually get even worse and worse and worse. And
(21:21):
so you don't want people to be bleeding even more.
Speaker 3 (21:24):
So that dissection, doctor Rall, is like a balloon grown
inside your vessel.
Speaker 1 (21:29):
Right exactly, it's growing inside your vessel wall as opposed
to growing. You know, it's it's it's not something that's
on it's not something that's latched onto your wall. It's
imagine if you're inside a room. It's exactly. It's it's
the walls that are getting thicker. It's not that there's
things that have latched onto the wall that you can
(21:50):
just somehow break the stuff that's on the wall. You know,
if you had something that's growing on the blood vessel wall,
you could try to break it up by putting medication
to destroy that and make it more finer.
Speaker 3 (22:04):
Particulates, not less blood go into.
Speaker 1 (22:07):
Earth exactly, But if something is actually bleeding into your
vessel wall, by trying to give that medication, you're actually
going to make that dissection that bleeding even worse. So
that's something very critical because you don't want to treat
all heart attacks the same. That's where the imaging comes
into place. That's where knowing your risk factors, knowing that
a red flag would be if you're a younger woman
(22:28):
who's come in, it could be due to not your
classic heart attack. Now, beta blockers, we've talked about this
on a previous show. Beta blockers are something that we
actually recommend for anybody who has a heart attack. So
if you're coming in with a traditional milcardilin function versus
a dissection, it could be very similar. You know, we
would always prescribe that because it's always good to have
(22:50):
less blood pressure build up within the vessel. So blood
pressure control is going to be very crucial for anybody,
regardless of outcome or regardless of costs. Now, one really
important thing to know when we talk about these dissections
is that actually the in hospital death rate of somebody
who had comes in with a dissection is only about
(23:11):
one to two percent. So it's actually you have pretty
good outcomes. So I don't want to scare everybody out there.
You actually will do better than somebody who's actually thrown
up a plaque into their blood vessel. So if you're
a woman who's listening has developed a dissection, you actually
have good you can actually achieve good functional status going forward.
But one very big concern is recurrence rates. So the
(23:35):
recurrence rate of having another dissection in the future is
about ten to twenty percent in somebody who's had a
dissection who's had to tear in the heart, and the
annual recurrence is about two to three percent. So that's
always something meaning that this is going to be a
lifelong disease process for you. And unfortunately, what's one of
the bigger things that also happens to a lot of
women is there's a lot of trauma, not just the
(23:57):
trauma the initial event, but you can develop a lot
of anxiety because now all of a sudden, you're scared.
And so actually they find a lot of women actually
to develop PTSD anxiety depression from having this dissection because
you thought you were doing the right thing, You thought
you were exercising, you thought you had a child, you
thought you were very healthy, but now all of a sudden,
(24:19):
you don't know what's causing it. The same activities that
you're doing might actually be not helping in any particular way.
So that's something that we always have to do from
a post management standpoint of keeping an eye on these women.
So we always when patients come in, we identify them
having this dissection, we always screen for other abnormalities throughout
(24:43):
their vasculature, throughout their blood system because there's a lot
of women when they have this, they may also have
anisms in the brain, they may have other innism, so
we have to have dues.
Speaker 2 (24:52):
We have to screen them for overall for their.
Speaker 1 (24:54):
Whole body by doing ultrasounds, by doing ct angiograms, because
there's a lot of different vessels that can not just
affect your heart, but it could also affect other parts
of your body. The same mechanism that's causing this issue,
just like I said, migraines, the same path of physiology,
the same thing that might be causing the abnormalities and
(25:15):
the blood vessel wall causing the migraine pain might be
associated with heart disease. Now it's very important and that
thing this might apply to you because you kind of
asked me doing the break about physical activity recommendations, so
I know you do a lot of you know, some
of this is I don't know if it's I don't
know if it's extreme endurance training, but these are things
that have been implicated you know, exercising to exhaustion, ye,
(25:39):
you know, competitive support setting of a lot of what
we call valsolva maneuver, so a valsalva maneuver and if
you've heard familiar with the term, is basically where you
put it bearing down very significantly. So think about squats exactly,
heavy exactly. Think about people who are doing a lot
of dead lists. People are doing a lot of significant
weight movement. You're putting a lot of pressure on your
(26:03):
internal abdominal organs. Now that's actually the same valse album maneuver.
The same thing if you're when you're going to the
to the restroom, you know you're squeezing down your strength.
So people have chronic constipation, that's also something that's going on.
You're causing a lot of internal you know, abdominal pressure
because you're squeezing down on the on.
Speaker 2 (26:21):
Yours like women who have natural childbirth too know they're
squeeze pushes down exactly.
Speaker 1 (26:27):
So that's exactly something that is something that could be predisposing.
So these are all things that you know, so if
you are a woman, and if you have happened to
have a dissection related to and having a myocardial and
function having a heart attack, what most doctors recommend is
try to avoid.
Speaker 2 (26:47):
The extreme sports.
Speaker 1 (26:48):
Now I'm not saying that if you are somebody who's
an extreme athlete, maybe you're participating triathlons, biathlons, you're doing
a lot of running. I don't want you to avoid that.
I don't want you to think that that's something you
have to avoid. But regular, moderate exercise is always encouraged.
But if you're somebody who's developed a heart attack relate
to it, then yes, you might be cautioned to, you know,
(27:13):
scale that back a little bit, even though for the
vast majority of people, I would say exercise is always
a good thing. And honestly, I mean I'm around a
lot of people who do a lot of extreme exercises
to a certain degree, and I don't want people to
think that that's all anytime, you know, a bad thing.
But if you have a heart attack due to the
extreme exercise, you definitely want to look into that. So
(27:34):
I want to kind of go with a couple of
little hacks here that hopefully that might have helped you
out on this show, something I've been wanting to do.
I think the key thing is if you are somebody
who has chest pain after exercise, if you're a younger woman,
you know, look for the classic symptoms. Is it like
a sudden nonset chest pain, is it radiating to your shoulder?
You might want to get an e KG. I'm not
(27:56):
saying that you have to check yourself into the hospital
and get that done immediately, but I think I think
getting an EKG is a certainly something that is a
non invasive test, very easily done, can be done at
your doctor's office, just to see if we see any
of the classic things, if we see st elevations, see
abnormalities in these leads. You can also get a blood
test to proponents. These are all things that I think
you should do before you getting into this mental stress
(28:18):
of am I having something going on? Is this something
that needs to be checked out? So I asked, certainly
something that's worth doing. Unfortunately, our time this Saturday's up.
I hope these healthcare hacks have helped you navigate a
complex medical system.
Speaker 2 (28:32):
If you're interested in more.
Speaker 1 (28:33):
Information on any of the mentioned minimly evasive treatments, You
can always call to get more information at nine to
one five five hundred forty three seventy that's five zero
zero four three seven zero. You can always reach me
about email at raw that's my last name, r Ao
at medicalhackers dot com. If you've been tuned into us
this whole time, bless your heart and your health. I'm
(28:54):
doctor san deep Roo and you've been listening to the
Medical Hackers. The PAD standard of refecibly present to the repasts,
the PA
Good afternoon. It's another weekend here in the heart of
the dschwall in desert in West Texas. You're listening to
the Medical Hecklers. However, you may be tuned in this
week and I'm your host, doctor Sandy Prout. I'm here
to bring the Borderland the latest information in healthcare, medicine,
and technology on the show.
Speaker 2 (00:21):
I'll consider myself a.
Speaker 1 (00:23):
Hacker, a hack of the politicist, a hacker using my
intimate knowledge of the medical system to break it down
some of the bearish accessing new medical technologies, a current
healthcare information that.
Speaker 3 (00:35):
JUNI here with me, Hey dog, how are you. It's
always good to be here with you.
Speaker 2 (00:40):
Great to have you.
Speaker 1 (00:42):
And I wanted to start this show off talking about
something that I think is actually might be useful information
or applicable to our producer here at Amber. Okay, and
I want to kind of get into the entire area
(01:03):
of heart attacks and what about heart attacks when they
occur in younger women. By a younger women, I mean
anybody under the age of fifty, right, so when we
look at heart attacks, we can kind of stratify it
and say, did it happen to somebody older?
Speaker 2 (01:22):
You know?
Speaker 1 (01:22):
Above fifty or let's say somebody blow fifty. And the
reason why this applicable was because I think some of
the risk factors might be something that you or anybody
under the age of fifty can easily should pay attention
to because it's easily something that can come about. And
(01:45):
what brought this about is there was a particular patient
episode of a patient, a woman, thirty four year old
woman who came into the emergency room. And it wasn't
my patient. I just heard about this because I don't
necessarily deal with heart attacks on the front line. From
the standpoint of I don't treat them. I'm not a cardiologist.
I'm a vascular doc. In the standpoint of I interpret
(02:06):
a lot of the imaging. I see a lot of
these studies that are ordered, but I don't treat them
because I'm not a cardiologist. But I do hear and
I do have my finger on the pulse of a
lot of different types of patients who come in. But
a younger woman thirty four years old, came into the
emergency room with the classic symptoms crushing, chest pain, sweating, nausea.
(02:28):
They did an EKG found sort of the classic symptoms
that you'd see on a woman who has symptoms or
have experiencing a heart attack, who's having what we call
myocardial infarction, which is there's not enough blood flow to
the heart. So there's things on the EKG what we
call st elevation in the on certain leads. There's other
(02:51):
labs they can get things called troponins. These are lab
values that could be a marker for heart attack. This
patient had those going on as well, but she did
not have any of the traditional heart disease risk factors
that you and I JUNI know so well. She did
not have any high risk of having plaque build up
(03:14):
of due to cholesterol. Now what they did is they
went in emergently the cardiology did went and did a
heart catheterization. Now what that means is the same way
I do angiography, meaning I put in ivs in patients'
blood vessels and I typically do that for I do
(03:35):
it anywhere outside the heart. Actually, so cardiologists focus specifically
on the heart. But what they do is they go
through an IV in the using the radio artery that
might go in. Sometimes they might go into the femor artery,
but usually what they do is they go in with
a tiny little wire and a tiny little catheter and
they inject contrasts die, which means that they can now
see how the blood vessels of the heart light up.
(03:59):
They can see if there's a block they can see
if there's decreased blood flow. So what they did is
they found sort of this hazyness with one of the
main blood vessels what we call the lefty entry or
descending that's like the key vessel that sent submits a
lot of you know, blood to the heart, and they
found that there's some hazy narrowing. They are additionally going
(04:21):
and they have access to this. This is also something
that I have access to. It's a way to actually
see how the blood flow is inside the blood vessel.
There's this thing called oct I don't want to get
into this. It's a way to imagine you're flying inside
a blood vessel and you can see all the plaque
build up almost a three hundred and sixty degree in
(04:44):
a three hundred and sixty degree pattern, not just from
a one dimensional So if you look at an X
ray from one dimension, you're kind of seeing blockages. Maybe
you might see what's supposed to look like a pipe,
you might see some irregulary. But now imagine I can
actually travel inside that blood vessel and I can see
you want, the plaque is exactly at let's just say
the twelve o'clock position.
Speaker 2 (05:03):
Like the Magic school Bus.
Speaker 3 (05:05):
Remember that cartoon I do, Yeah, where it shows them
from the inside.
Speaker 2 (05:09):
Exactly like you're flying on the inside.
Speaker 1 (05:11):
So they were able to see that the patient actually
had what's called a dissection. A dissection just means that
there was a tear, a rent in the blood vessel
wall that was causing this heart attack. Okay, so now
this is very important because there's actually a very interesting
study that came out and what that's what raised this issue,
(05:31):
which is that this thing would cause spontaneous cornery ary dissection,
which means spontaneous meaning it just happened out of the
blue cornary artery, meaning these are blood vessels that go
to the heart, and dissection means it dissected it it
was a little tear. This is something scad is the
term that we have. It used to be a very
rare finding at autopsies a while back, but now it
(05:54):
is actually one of the most common causes of heart
attacks of myocardial and fashion m I as we call
it in women under fifty, especially women who are pregnant
or who have recently given birth.
Speaker 3 (06:08):
It what causes that?
Speaker 1 (06:10):
Yeah, I'm going to get into that area because I
think I think it's very applical on something that something
I actually didn't even think about until I started delving
into this a little bit further. Because some of the
things that you might think make you healthier actually predisposes
women to having this type of heart attack. So there's
an interesting study that came out. What they did is
they looked at heart attacks in younger women as opposed
(06:33):
to women over the age of sixty five. And so
what they did is they did over a fifteen year
period of time, they looked at heart attacks and women
and heart attacks and men. Now, when it comes to men,
these men have the classic risk factors JUNI could probably
say what those are as someone who's in the pad space, Yeah, right.
Speaker 3 (06:55):
Plaque, build up, cholesterol, and I mean all sorts of.
Speaker 2 (07:00):
High blood pressure.
Speaker 3 (07:01):
That's right.
Speaker 1 (07:02):
So what's interesting is that what they did is they
found so that's an entireity called a throw trombosis, meaning
there's a blockage in your.
Speaker 2 (07:16):
Heart, in your cornerary.
Speaker 1 (07:18):
Arteries, that's due to some sort of something has been
thrown up into the essentially imagine something gunks up your plumbing. Right,
that's like the classic cause of heart attacks in the
vast majority of patients, Okay, especially men, right exactly, So
in seventy five percent of men, this is the cause.
Now it's only the cause in about fifty percent of women. Okay,
(07:40):
So it's you know, plaque build up, things like that,
which is usually you know, your classic risk factors is
what causes heart attack and the vast majority of patients,
especially in men. But when you start looking at in women,
what is the main cause? Now, plaque build up is
definitely a huge cause, but disproportunately, it's actually this thing
(08:02):
called SCAD, which is dissection. And I want to kind
of get into that, especially after this this little break here,
because it's something that a lot of people feel that
they may not be able to control these risk factors.
And I think that's very important to know because a
lot of us think, you know, eating healthy, being able
(08:23):
to you know, maintain control your blood blood pressure are
going to.
Speaker 2 (08:27):
Be key things to look for.
Speaker 1 (08:29):
But when it comes to younger women, sometimes you might
already be doing these things you might already be exercising.
In fact, you might be over exercising. And that's actually
something that I want to get into because extreme exercise
has been implicated as one of the main causes of dissection.
And I don't want to scare people who do a
lot of exercise. I know Amber you do. You do
(08:51):
a lot of excess. So when this study came out,
when this thing came out, I was actually thinking about you,
and I've kind of wanted to get into this a
little bit.
Speaker 2 (08:57):
So we're going to get into this after this break
a little bit.
Speaker 4 (09:00):
You're listening to the Medical Hackers with doctor Sandeep Row,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four three
seven zero or by emailing Rao at medical hackers dot com.
Speaker 1 (09:27):
Background the Hackers, some doctor Row here having a discussion
about heart attacks, especially when it comes to women under
the age of fifty and so one of the things
I wanted to say, so as you said, spontaneous corner
Lady dissection is a type of heart attack which is
due to a tear in your blood vessel walls, as
(09:49):
opposed to a traditional heart attack that you and I
might think about when we talk about these these sort
of widow maker heart attacks that men classically die of,
where a little plaque has sort of been broken off,
maybe if broke off from somewhere else in your heart,
or maybe a plaque broke off from a little you know,
a little troumbis a little plaque that might have come
(10:10):
from your heart that's kind of you know, breaks off,
and then it tends to clog up the plumbing in
your heart. And that's why it's really important to know
this because this type of other type of heart attack,
which we don't ever think about or very rarely think about,
or something that we've only started thinking about very recently,
tends to affect seemingly healthy women and less there are
(10:32):
men who get affected by this. But it is very
important to know this because once we find that a
woman is suffering from a heart attack, especially due to
this cause, you actually have to treat that heart attack
much differently than another heart attack, which is, you know,
a classic heart attack that we all you know, have
known for long.
Speaker 3 (10:52):
Yes, doctor Rowl, I have a question for you. I
know you have your traditional imaging to detect stuff going
on in our bodies, but what the dissection I know
that polls as challenges for you doctors. What's the best
way to determine that and view that?
Speaker 2 (11:08):
Yeah?
Speaker 1 (11:08):
So the best way is based on what I in
the clinical presentation that had mentioned the docs had initially
done was called Cornery angiography. Right, So that's just a
single two D view, so to speak, of looking at
(11:29):
a blood vessel, of looking at your heart. You're kind
of just looking at it in one plane, maybe a
couple of planes. And what you can do is you
see some narrowing going on in that blood vessel, but
you don't know that could be due to this tear
in the blood vessel lining, or it could be also
due to an underlying plaque. That's the point in which
(11:49):
having this view which I'd mentioned, almost like you're flying
through a blood vessel. And there's a couple of different
tools for that.
Speaker 4 (11:55):
One.
Speaker 1 (11:55):
It's called intravascular ultrasound that I use frequently when I'm
using it in the blood vessels are the lower extremity
or also this thing called optical coherence, the technology OCT
that a lot of cardiologists use. I don't want to
get into the science behind it, but basically you're using
a lot of ultrasound waves. If you're using IVS, it's
(12:17):
a way to really be able to get a three
hundred and sixty degree view of that blood vessel to
where you can actually see maybe it's at the twelve
o'clock position or the three o'clock position, or the six
o'clock position where we're seeing this little tear in the
vessel wall, or is it plaque build up in the
vessel wall?
Speaker 2 (12:37):
And that really.
Speaker 1 (12:37):
Helps guide the treatment, which is what's very important, because
you don't want to treat a woman in her thirties
who's having a heart attack due to a dissection or
a tear in their vessel wall the same way someone
else has plaque that's thrown up and is blocking the
vessel wall. Now, those of your watching who are listening,
(13:00):
actually maybe wondering is what are the risk factors for
having this dissection, having this tear in the vest wall.
So when you look at traditional heart disease risk factors,
high blood pressure, having hyper lipidemia meaning abnormal cholesterol, is
actually a risk factor in both. You know what I'm saying,
You can have the same risk factors and both top
of diseases, although it does tend to be much more
(13:21):
of a risk factor with your traditional heart attacks. Now
when you look at women who've especially who've had this
type of dissection, there's actually three risk factors that you
never think about, because I mean, do you ever think
about migraines as a risk factor, or hormones or pregnancy
or exercise. The reason I'm bringing that up are these
(13:43):
are all significant risk factors for women who have these
types of spontaneous cornary arid dissections. So interesting Steid here
migrain headaches. So they actually found an association with this
spontaneous corninary aoritory dissection, and they found prevalence rates much
high with women who had migraines than the general population.
(14:04):
So what people are suggesting is that, especially with chronic migraines,
you might have an underlying abnormality in your vessel wall
that predisposes you to having a dissection in your heart
but also having a migraine. Now we don't know the
exact mechanism. We just see an association here, but it's
something to think about.
Speaker 3 (14:24):
So, doctor Raol, if you have a young lady that's
having a lot of migraines, and to determine if she
has a dissection, what are those symptoms or what can
lead to that for a doctor.
Speaker 1 (14:36):
Okay, So that's a good question because I don't want
people out there who are listening to me to say, oh,
I have a lot of migraines, Now do I need
to get my heart checked.
Speaker 2 (14:45):
I think it's actually a little bit in reverse.
Speaker 1 (14:47):
Now, if you are a woman out there who is
all of a sudden experiencing chest pain and you are younger,
I don't want and if you also have a history
of migraines, i'd want that to go you know what,
maybe I should get it checked out. I don't want
to say that if you have migraines you should check
out your heart necessarily. But if you do have heart
disease symptoms just because you're young, you're exercising, I don't
(15:08):
want you to dismiss them, especially when you start.
Speaker 2 (15:11):
Having risk factors of migraines.
Speaker 1 (15:12):
So I want migraines to be something that you mentioned
to your doc, because then your doc will go, oh,
you know what, she's having chest pains and she has
history of migraines, this might actually be something that's causing
this this thing to get.
Speaker 2 (15:26):
Worse, and actual migraines, right, not just headaches.
Speaker 1 (15:29):
Exactly, it's migraines, so especially with chronic chest plain exactly.
Along with chest plains, another one is just hormonal influences.
So what they found with the development of these spontaneous
terrors in the arterial walls is that what they found
is that there's no evidence specifically of any specific hormones.
So if you're a woman taking hormone replacement, they aren't
(15:52):
saying that necessarily that's implicated within having terrors in these dissections.
But what they're saying is that there may be some
hormonal influences involved, and that's why we're seeing women at
a much higher rate having spontaneous terrors in the vessel
wall as opposed to men. So if you looked at
a bunch of men who had heart disease, let's just
(16:12):
say we took a bunch of thirty five year old
men and women who'd had heart attacks, women will have
a higher risk of having the dissection. They're saying, could
it be due to hormones?
Speaker 2 (16:23):
Again, we don't know.
Speaker 1 (16:24):
For sure, but that I'm just saying this could potentially
be something that they're investigating now. One thing they have
found is that pregnancy associated tears in the wall is
actually extremely high because what they found is that seventy
percent of these occurred during the first week after having
delivered a child. So if you're a woman who's delivered
a child and you start having these chest paint top
(16:46):
symptoms like the scenario that I mentioned though, young women
who's thirty four year old, women who'd had just delivered
a child, some people might just dismiss that because what's
the odds that someone who's young, thirty four year old
is having chest paint. Maybe just the distress of having
being with a young child that's that's waking up.
Speaker 2 (17:04):
All night, or breastfeeding pains.
Speaker 1 (17:06):
They may exactly that, but I wouldn't be confusing, I
guess exactly. So what they've found is that pregnancy, this
this entity, this spontaneous coronary arready dissection, this terr in
the wall, accounts for almost fifty percent of pregnancy associated
heart attacks. So that's just something that we need to
(17:27):
look out for. And I don't want you to dismiss that. Now,
Another very important one is that what they actually found
is that twenty five percent of people who've had this
spontaneous tear in the vessel wall are actually reporting extreme
exercise at the time of the event or experiencing extreme
(17:51):
emotional stressors. That's not something that nobody ever thinks about
because I think because I work out all the time,
I know amber you you're always training for something.
Speaker 2 (18:00):
Or the other.
Speaker 1 (18:00):
I've literally been diagnosed with an exercise addiction at a
young age. Wow, that can be a good thing if
done in moderation. But it's very important to know that
extreme exercise has actually been something that they've found implicating
women who have these spontaneous terrors in the heart. Now,
I don't want that to dissuade you from doing exercise.
(18:22):
All I want you to think about is, anybody who
does exercise, is that if you started having this type
of chest pain, I don't want you to dismiss it,
because we are seeing this association with younger women who
have done a lot of exercise. So it's just something
to think about. And I'm going to kind of go
into in the next segment, how do we manage these
(18:44):
women who have and not just women, it's also men.
There are men who also have spontaneous dissections, have spontaneous
terrors in the corner arteries. How do we manage that?
And is the management of that different from somebody who
has a traditional heart attack, because it is very different.
And actually so we're gonna take a quick break here
on the Hackers.
Speaker 4 (19:03):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Raw, call nine one five five hundred four to
three seven zero or by emailing Raw at medical hackers
(19:27):
dot com.
Speaker 1 (19:30):
Back into the Hackers, doctor Row here with producer Amber
and Juny, and we're talking about something that's very applicable
to a lot of women, also applicable to you, Amber
as a as a young woman who does exercise who
might experience pain, right Like, I mean, anyone can anyone.
Speaker 2 (19:50):
Can have pain. I mean I'm myself sometimes I have.
Speaker 1 (19:54):
You know, how how do we know that this pain
that's due to over exercise them a muscle versus you know,
just your typical chessman. So this is where it's really
important because the management of this of this problem is
very important because it's very different if I find out
that you have a dissection, a tear in your vessel wall,
(20:14):
it's very different than if you have.
Speaker 2 (20:15):
A plaque build up.
Speaker 1 (20:17):
So you know, when you think about classic, the way
I would treat someone who has an older gentleman or
anybody who has an actual promise a plaque that's developed,
as opposed to somebody who has had a dissection, is
that the number one thing is we don't do what's
called anti coagulation. So antiquagulation just means we thin out blood. Now,
(20:39):
when you have a plaque that's developed inside your blood
vessel walls, we actually want to give you something called antiquagulation.
We want to thin out your blood because we want
to break up the plaque. We don't want to do
that with somebody who's a tear in the vessel wall
because you're actually going to increase the size of that
dissection because think about it, you know what a dice
(21:00):
section is a tear inside the blood vessel wall, and
so what you have is you have bleeding that's going
into the wall. So now that normal wall of your
blood vessels have now become thicker, and by giving something
that's going to promote thinning of the blood, that dissection
could actually get even worse and worse and worse. And
(21:21):
so you don't want people to be bleeding even more.
Speaker 3 (21:24):
So that dissection, doctor Rall, is like a balloon grown
inside your vessel.
Speaker 1 (21:29):
Right exactly, it's growing inside your vessel wall as opposed
to growing. You know, it's it's it's not something that's
on it's not something that's latched onto your wall. It's
imagine if you're inside a room. It's exactly. It's it's
the walls that are getting thicker. It's not that there's
things that have latched onto the wall that you can
(21:50):
just somehow break the stuff that's on the wall. You know,
if you had something that's growing on the blood vessel wall,
you could try to break it up by putting medication
to destroy that and make it more finer.
Speaker 3 (22:04):
Particulates, not less blood go into.
Speaker 1 (22:07):
Earth exactly, But if something is actually bleeding into your
vessel wall, by trying to give that medication, you're actually
going to make that dissection that bleeding even worse. So
that's something very critical because you don't want to treat
all heart attacks the same. That's where the imaging comes
into place. That's where knowing your risk factors, knowing that
a red flag would be if you're a younger woman
(22:28):
who's come in, it could be due to not your
classic heart attack. Now, beta blockers, we've talked about this
on a previous show. Beta blockers are something that we
actually recommend for anybody who has a heart attack. So
if you're coming in with a traditional milcardilin function versus
a dissection, it could be very similar. You know, we
would always prescribe that because it's always good to have
(22:50):
less blood pressure build up within the vessel. So blood
pressure control is going to be very crucial for anybody,
regardless of outcome or regardless of costs. Now, one really
important thing to know when we talk about these dissections
is that actually the in hospital death rate of somebody
who had comes in with a dissection is only about
(23:11):
one to two percent. So it's actually you have pretty
good outcomes. So I don't want to scare everybody out there.
You actually will do better than somebody who's actually thrown
up a plaque into their blood vessel. So if you're
a woman who's listening has developed a dissection, you actually
have good you can actually achieve good functional status going forward.
But one very big concern is recurrence rates. So the
(23:35):
recurrence rate of having another dissection in the future is
about ten to twenty percent in somebody who's had a
dissection who's had to tear in the heart, and the
annual recurrence is about two to three percent. So that's
always something meaning that this is going to be a
lifelong disease process for you. And unfortunately, what's one of
the bigger things that also happens to a lot of
women is there's a lot of trauma, not just the
(23:57):
trauma the initial event, but you can develop a lot
of anxiety because now all of a sudden, you're scared.
And so actually they find a lot of women actually
to develop PTSD anxiety depression from having this dissection because
you thought you were doing the right thing, You thought
you were exercising, you thought you had a child, you
thought you were very healthy, but now all of a sudden,
(24:19):
you don't know what's causing it. The same activities that
you're doing might actually be not helping in any particular way.
So that's something that we always have to do from
a post management standpoint of keeping an eye on these women.
So we always when patients come in, we identify them
having this dissection, we always screen for other abnormalities throughout
(24:43):
their vasculature, throughout their blood system because there's a lot
of women when they have this, they may also have
anisms in the brain, they may have other innism, so
we have to have dues.
Speaker 2 (24:52):
We have to screen them for overall for their.
Speaker 1 (24:54):
Whole body by doing ultrasounds, by doing ct angiograms, because
there's a lot of different vessels that can not just
affect your heart, but it could also affect other parts
of your body. The same mechanism that's causing this issue,
just like I said, migraines, the same path of physiology,
the same thing that might be causing the abnormalities and
(25:15):
the blood vessel wall causing the migraine pain might be
associated with heart disease. Now it's very important and that
thing this might apply to you because you kind of
asked me doing the break about physical activity recommendations, so
I know you do a lot of you know, some
of this is I don't know if it's I don't
know if it's extreme endurance training, but these are things
that have been implicated you know, exercising to exhaustion, ye,
(25:39):
you know, competitive support setting of a lot of what
we call valsolva maneuver, so a valsalva maneuver and if
you've heard familiar with the term, is basically where you
put it bearing down very significantly. So think about squats exactly,
heavy exactly. Think about people who are doing a lot
of dead lists. People are doing a lot of significant
weight movement. You're putting a lot of pressure on your
(26:03):
internal abdominal organs. Now that's actually the same valse album maneuver.
The same thing if you're when you're going to the
to the restroom, you know you're squeezing down your strength.
So people have chronic constipation, that's also something that's going on.
You're causing a lot of internal you know, abdominal pressure
because you're squeezing down on the on.
Speaker 2 (26:21):
Yours like women who have natural childbirth too know they're
squeeze pushes down exactly.
Speaker 1 (26:27):
So that's exactly something that is something that could be predisposing.
So these are all things that you know, so if
you are a woman, and if you have happened to
have a dissection related to and having a myocardial and
function having a heart attack, what most doctors recommend is
try to avoid.
Speaker 2 (26:47):
The extreme sports.
Speaker 1 (26:48):
Now I'm not saying that if you are somebody who's
an extreme athlete, maybe you're participating triathlons, biathlons, you're doing
a lot of running. I don't want you to avoid that.
I don't want you to think that that's something you
have to avoid. But regular, moderate exercise is always encouraged.
But if you're somebody who's developed a heart attack relate
to it, then yes, you might be cautioned to, you know,
(27:13):
scale that back a little bit, even though for the
vast majority of people, I would say exercise is always
a good thing. And honestly, I mean I'm around a
lot of people who do a lot of extreme exercises
to a certain degree, and I don't want people to
think that that's all anytime, you know, a bad thing.
But if you have a heart attack due to the
extreme exercise, you definitely want to look into that. So
(27:34):
I want to kind of go with a couple of
little hacks here that hopefully that might have helped you
out on this show, something I've been wanting to do.
I think the key thing is if you are somebody
who has chest pain after exercise, if you're a younger woman,
you know, look for the classic symptoms. Is it like
a sudden nonset chest pain, is it radiating to your shoulder?
You might want to get an e KG. I'm not
(27:56):
saying that you have to check yourself into the hospital
and get that done immediately, but I think I think
getting an EKG is a certainly something that is a
non invasive test, very easily done, can be done at
your doctor's office, just to see if we see any
of the classic things, if we see st elevations, see
abnormalities in these leads. You can also get a blood
test to proponents. These are all things that I think
you should do before you getting into this mental stress
(28:18):
of am I having something going on? Is this something
that needs to be checked out? So I asked, certainly
something that's worth doing. Unfortunately, our time this Saturday's up.
I hope these healthcare hacks have helped you navigate a
complex medical system.
Speaker 2 (28:32):
If you're interested in more.
Speaker 1 (28:33):
Information on any of the mentioned minimly evasive treatments, You
can always call to get more information at nine to
one five five hundred forty three seventy that's five zero
zero four three seven zero. You can always reach me
about email at raw that's my last name, r Ao
at medicalhackers dot com. If you've been tuned into us
this whole time, bless your heart and your health. I'm
(28:54):
doctor san deep Roo and you've been listening to the
Medical Hackers. The PAD standard of refecibly present to the repasts,
the PA
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies!
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy, Jess Hilarious, And Charlamagne Tha God!