 Well, hello everyone. Thank you for joining us again for another episode of Resiliency Radio with Dr. Jill. Today I have special guest Dr. Howard Elkin, who I'll introduce in a moment. We're going to talk about medical advocacy, but we have an integrative cardiologist with us today. So we're going to talk a little bit about heart health as well. Before we begin, let me introduce you, Dr. Elkin. So Dr. Howard Elkin has practiced cardiology in Whittier, California since 1986. He graduated with highest honors in the Medical College of Virginia in 1979, completed his internship in residency in internal medicine at Michael Reece Hospital and Medical Center in Chicago, followed by a fellowship in clinical cardiology at Northwestern University. We share some Chicago roots too. Dr. Elkin moved to Southern California in 1984, where he completed an additional fellowship in invasive cardiology at the Los Angeles Heart Institute. He realized in the early 90s that mainstream cardiology focused on diagnosing and treating patients and patients were not staying healthy long term. In 1984, I'm sorry, 1994, he added a preventative component to his practice with the HeartWise Fitness Institute, combining sound nutrition, exercise, and stress management. His patients are empowered to live happier, healthier, and less stressful lives. Welcome to the show, Dr. Elkin. Thank you. Thank you so much for having me. I'm delighted to be here today. You're welcome, and I'm delighted to talk to you about all things cardiology, about your own journey, about your new book, about everything there. But I always love to start with story, as far as where did you grow up? How did you get interested in medicine? Were there any other doctors in your family? And then how did you get interested in integrated medicine? Yeah, no one's asked me that. That's a great question. Well, I grew up in Richmond, Virginia. And no, I didn't have a medical family. I mean, my father didn't go into grade high school. My mother did. And I'm the one, I'm the second of four children. And I never had a doctor's kit when I was a kid growing up, you know, I didn't have any of that. But I was fascinated in anatomy. I remember that. Remember the world, I don't know if you remember the world book and media, those little cellophane pages? I would like study all the layers, right? You put that in there. You know, so, and then I didn't really know, I was, I really was going, I went to be a writer. And I said, well, maybe you should be a lawyer because that kind of goes hand in hand. But then I think I really didn't like law. So I then became, I got interested again in medicine, but it really wasn't to my senior in high school. Did I decide to really pick that? So in college, I was kind of double major in biology and also in English. So it was good. And so how I got into cardiology, when I started my medical school training, you know, they take you through the various medical, various organisms for the first year, it's normal physiology and anatomy. Second year, it's pathology. And then the third year on is clinical. And when I, when I got to the cardiovascular system, like it just made sense to me, I didn't have to memorize things like an endocrinology and infectious disease. It just made perfect sense. So I was always interested. I didn't make the final position until I was getting close to actually my internship in residency, but I always had a penchant for the heart. Then I came out to California, I was married at the time, had a child and started, I actually was brought out here for a group, a large multi-specialty group in cardiology, but it really wasn't my thing. So after a year, I went back to training in invasive cardiology and then subsequently started around practice in 1986. And here was his young cardiologist. And I was traditionally trained. We did nothing about functional medicine. I don't even think the term was coined then. Right. But by the time, and that was in 86, by the time, then early 90s, I saw the writing on the wall, people were flocking to HMOs. And I saw the same patients come back. You know, they'd had a heart attack, then they'd have a stent, then they'd have another stent. And something's not right about the system because patients aren't really getting better. We're putting a band-aid on and then they come back with the same problem within a few years. And it goes along with cardiac rehab and people that choose exercise programs because 50% of these people are no longer exercising within six months. So there's something about lifestyle that I saw was truly lacking. So I then had advice and I called it the Heart-Wise Fitness Institute back then. And I incorporated a trainer and made a nutritionist and we counseled people. We even had group meetings once a week to kind of base on Dean Ornish's group studies on having cardiac patients talk about issues that they don't normally talk about. So that was exciting. Then I got into longevity side. We're almost finished. And then I took the fellowship and I added basically hormones and longevity medicine in the early 2000s. And that's what I'm at. So I call myself an integrative cardiologist practicing functional medicine. So I use the functional medicine principles that we all use. But most of them are cardiologic standpoint. But you can't spray the gut. I'm really interested in gut because most of the patients that come to see me as a cardiac patient about 60% of them have a gut issue. So that's what I love about functional medicine. You have to be versed in almost all the specialties, at least the internal medicine specialties, because there's an integration that goes on that we just don't see in traditional medicines. Oh, no, there's a heart problem. Oh, no, you got to go to the pulmonologist. It's a lung problem. And I see the spaddling happen all the time. And so this gives me a lot of pleasure to be practicing how I am now. And that's the beauty of being in your own practice. If I was in a large group, I couldn't do this. Yeah, the joy. I see this a lot of time with colleagues who are kind of getting burnt out and frustrated. The joy of why we went into what we're doing is really revived when we do functional and integrative medicine, because we're actually really usually connecting deeply, having these relationships, helping people to heal. And again, there's nothing wrong if you're not, you know, have a heart attack, or you have a car accident, or you have a, in fact, you were in one of the best realms for conventional medicine, because you could intervene and save a person's life, really. But like you said, then when they come back, and they're not doing better after several years, as they fall off the bandwagon, we both realized there was a lot more. So good for you. I love that. So let's start with just, obviously, you're interventional. So you're doing stents and all of that. And again, there's a place for those as lifesaving, but as far as the real life, the life's having band-aid. Yeah, exactly. Exactly. Let's maybe talk just a little bit about, because I feel like, as I'm understanding the heart and the endothelium and all this, there's so much more. And really at the root, it's kind of the endothelium that matters. Do you want to talk a little bit about what you've learned and the kinds of things that we can do to actually heal endothelium and the nitric oxide and those basic tenants versus just put a stent in an emergency? That's such a great question. Thank you for asking. So the endothelium is everything. It's just for your listeners that all your vessels, we have 60,000 miles of blood vessels in our body. Can you imagine that? 60,000 miles. And every one of those vessels is lined with one cell thick called the endothelium. Endo means inside in Greek. One cell thick is very, very important because it, first of all, it can make nitric oxide, which helps these vessels to dilate. And number two, it's semi-permeable. So it disallows things like we don't want like oxidized LDL cholesterol and other harmful substances to enter the endothelium. And that's when inflammation begins. And that's really when you have heart disease. But in traditional cardiology, they don't talk about endothelium, they don't talk about, it's not about prevention. You have high cholesterol, you're going to statin. I mean, I'm simplifying things and generalizing, but that's basically how it is. When someone gets discharged from the hospital with a stent, I can guarantee they're going to be an aspirin, a statin, a beta blocker, plavix or a platelet inhibitor, and usually something, you know, they're on four or five medicines, even if they were on nothing before. So that's just how it's done. So looking at the endothelium, and also I'm very much interested in blood pressure control, because I think it's still the number one risk factor. And what I forgot the number is it keeps on rising. When I wrote my book, it was like 70, 70, I mean, there's like 100,000 people out there more, usually 50% of the population is hypertensive. Why? Yeah. And so I try to look at the preventative side and, you know, weight issues, you know, definitely weight loss. If someone loses 10% of their current rate, they'll drop their blood pressure. Almost, I can guarantee that. But, and, you know, it does get more prominent as we get older. There's a genetic tendency, but that's all about the endothelium. So if you treat the endothelium, you can't treat the endothelium without controlling the blood pressure, because the blood pressure, if it's hypertensive, it'll destroy the endothelium. And there's one test that I do that most people don't know about. It used to be called the pulse test, PULS. And now it's called smart vascular DX. And it's a fascinating test because it's the only test that I know of that actually looks at the health of your endothelium. And so it's a great test. Most doctors don't know about it, but it can actually, you get seven different biomarkers specific for the endothelium. And I tell patients, I'm not, we're not treating your biomarkers. I'm treating your risk. But if you, and you found out when this test, whether you're high, medium or low risk, and it's really helpful because then I can intervene with certain supplements before they have a problem. So it's all about prevention and getting at the beginning of the start. Is this a blood test or an ultrasound or what kind of a test? It's a blood test. It's a simple blood test. They're out of Irvine, California. And again, the name was PULS. But now if you look up smart vascular DX, you can, you know, the website, it's just an unusual test. Most doctors don't do it. I don't think most doctors even know about it. But, you know, I do it. In other words, when I have a patient come into my office, I tell them from the beginning, my plan is to assess your risk, not just treat you with drugs, less assess your risk and let's figure out what you need. So it's custom care. It's customized care. And I think it's the optimal way of doing it. So I will often do certain tests. I won't usually do this as test number one, but I will do things like Cleveland Heart Lab, a Boston Heart Lab, which we can talk more about. And also, oftentimes, a coronary calcium scan. Yeah. So anyway, that's kind of the way. No, I love this because I couldn't agree more and things that maybe let me talk a little bit about some of these labs. Like you said, MPO, TMAO, PLAC, HSC, or if you've many people know about, but some of these, especially that Cleveland and Boston Heart Labs both have a lot of these inflammatory markers. And you don't have to start with all of them and maybe pick a few of your favorites. And let's talk to the person listening about why they might want to ask their doctor for some of these tests. Because it really does give us, like you said, with functional medicine, we're looking at, where is someone on the trajectory of wellness or disease? And are they walking towards a possible stroke or heart attack or incident? And if they are, then you and I can say, hey, you're at risk. And this is what we can do to actually reverse your trajectory. So maybe talk a little bit about some of your favorite inflammatory marker or tests that maybe the patient isn't aware of. Now, Cleveland Heart Lab and Boston Heart Diagnostics are both excellent labs. They're very comprehensive cardiac labs. Cleveland is a little more easily available because it's not was bought out by Quest a few years ago. So you just go to Quest Lab and they can draw your blood and they send it to Cleveland. Boston is a smaller lab and you have to have a phlebotomist and we have very phlebotomists that can do this, that can go to your house and actually draw the blood. But they both are very similar. So number one is the lipids, the cholesterol and your average doctor is still getting cholesterol, triglycerides, HDL, LDL. That's basically it. So with Cleveland, you're not only getting those values, you're getting the size of the particle and the number of particles. So it's probably actually more important. Like, and I want your listeners to know, just remember one thing when it comes to LDL, low-density cholesterol. We think about it as lousy and HDL is healthy, but it's not quite that simple. So low-density or LDL cholesterol can be, it really depends on the particle size. So we want large fluffy particles and that small dense ones because the small dense LDL particles can get easily oxidized and then it can get into the walls of the endothelium, if the endothelium is not healthy, and then you've got the beginning of inflammation. So that information, you get right off the bat with Boston or Cleveland. Then you have the inflammatory markers. And so some of the ones, everyone in my practice gets HSCRP, which is highly sensitive C-reactor protein. A lot of doctors don't even draw that, but you have to know where the patients are. At least, and you can follow it, it's inexpensive to us. You can follow it sequentially. Then I do a couple other inflammatory markers that you can get both with Cleveland and Boston. It's called the LPPLA2. Anyway, that's looking for vascular inflammation. Is there inflammation in the vessel itself? CRP is totally not specific, but very sensitive. LPPLA2 and also myeloperoxidase, those are two markers that you get with these tests and they help determine if you have any systemic inflammation. They also have a test to see whether you have any oxidized LDL. That's the LDL we worry about. It's not LDL. It's not some kind of villain. Because I mean, if we didn't have LDL cholesterol, we wouldn't get to the brain. Not a good part with a bad brain. Yeah, I always say cholesterol is not the bad guy. Cholesterol makes our hormones. It makes up our brain. Cholesterol is the thing we absolutely need. However, if the endothelium lining is sticky, there's inflammation, there's all these other things. Even autoimmune disease, which people don't typically associate with heart disease, then that cholesterol, like you said, the oxidized LDL gets sticky. That's the issue. Not cholesterol itself. Cholesterol itself is neutral, right? Right. But even most cardiologists I do, I don't really get into this, because it does involve education. But like you, the joy I get in practicing medicine is developing relationships with my patients. And it's just very fascinating. So I did leave out one thing. Besides, when you go back to the lipids on these sophisticated labs, you also get what's called LP-little-a. The little-a is in parentheses. And that is a fragment of LDL. And it doesn't bode well for heart disease, because it's very sticky, very inflammatory, can easily get oxidized. Again, start the inflammatory process if it goes into the damaged endothelium. So there's been no treatment thus far for this, which is probably why to talk cardiologists are interested in it. Actually, I've had quite a bit of success using niacin, which is actually vitamin B3. But probably within two years, a biologic will be coming out that will deal with LP-little-a, which is really important, because it's about 27% of the population. It's not small. And with this biologic, we'll be able to decrease LP-little-a by as much as 50% or more in a period of six weeks. Hey, everybody. I just stopped by to let you know that my new book, Unexpected, Finding Resilience through Functional Medicine, Science and Faith, is now available for order wherever you purchase books. In this book, I share my own journey of overcoming life-threatening illness and the tools and tips and tricks and hope and resilience I found along the way. This book includes practical advice for things like cancer and Crohn's disease and other autoimmune conditions, infections like Lyme or Epstein Barr, and mold and biotoxin-related illness. What I really hope is that as you read this book, you find transformational wisdom for health and healing. If you want to get your own copy, stop by readunexpected.com. There, you can also collect your free bonuses. So grab your copy today and begin your own transformational journey through Functional Medicine in Finding Resilience. A period of six weeks. So if that's going to... You find that... I'm just going to ask you about that because I feel clinically the same way. It's hard. I always say this is a little bit more difficult to change. So the nice and potentially, but do you find that's more genetic or is it more lifestyle inflammatory that you see elevated? Opulotoi, it's definitely genetic. Okay. That's what I thought. It is genetic because, and again, you don't know you're having unless you do the test and it's automatic in the Boston and in the Cleveland Heart Lab. And I think it's important to know because patients need to know the risk. And I tell them about it. Even if we can't get it down to optimal levels, I'm going to try to do everything else. It's like the best of all possible worlds, you want to lower everything, but you can unless they respond well to niacin. And I would say over 50, 60 percent of my patients do, but I really know niacin well. So I know how to dose it correctly and how to start people on it. Then we've got the lipids, we've got the inflammatory profile, then we have the metabolic profile, which is really important. So yeah, they do a fasting blood sugar and they do the hemoglobin A1c, which gives you an idea of how well your blood sugar has been controlled in the previous three months. It's a marker on the red blood cell and red blood cells live 90 days. So then it tells you other tests that I really think are important, you're fasting insulin level, which should be, I think less than eight, less than 10. And that's why the thing about being a bodybuilder is that most strength athletes have are very insulin sensitive. So we tend to have really low levels of insulin. So we want to know what that is because, and let me just digress for one second and we also do what's called a C-peptide. So C-peptide tells me how well your pancreas is, how hard your pancreas is working because you could have a normal A1c, an elevated insulin, and an elevated C-peptide. And that's telling me that your body, your pancreas is working really hard to not make you a full-fledged diabetic. But eventually, if the insulin level doesn't come down, your the pancreas will poop out. It just can't keep on producing insulin for years or in years. So I really like, so everybody gets the insulin inflammatory markers and the metabolic markers because really only about 5% of the country's population is metabolically healthy, which is, we were not a healthy country. And I think that worse in COVID. And the other one is genetic markers. And that's what I like. So there's about five that I follow. One is KIF6, which is kind of, I like that because I spent some time in Berkeley Heart Lab with Dr. Soprko several years ago. So KIF6 is associated with premature heart disease or coronary heart disease. NP21 seems to be, they call it the heart attack gene. And it's really common. And about 50% of it have at least one carrier. So it's very, it's very, it's rapid. Then I do the, there's 4Q25, you know, it's on the fourth chromosome. And it, that pretty, that lets you know that you could be predisposed to having developed cardiac atrial fibrillation, which is the most common arrhythmia that we see, especially in people over the age of 70. And then I'm leaving something out. Oh, ApoE. ApoE is really important because ApoE tells me, cardiac-wise, if you, and if it's, if, if it's elevated, if you have one or more marker, one or more of the alleles, then that means you're at risk of coronaries because that means these people tend to absorb more cholesterol from their diet. And it's also associated with Alzheimer's. So it's, and it's, I think it's good to know this because then I talk to people about brain health and what they do to obviate, you know, problems on the line. And I'm in agreement with, with Dr. President and Perlman of that. I, I think we can put a damper on Alzheimer's disease, but it's active process. It's like heart disease. It's not going to stop in its tracks unless we become proactive. So that's what you get from these tests. So you get the lipids, including opioid A, you get inflammatory profile, you get a metabolic profile and you get genetic profile. Amazing. And you've got a nice, you know, potpourri of information that discuss the patients. Yeah. And then you can really look at where is the risk because it died, is it lifestyles, is it genetics, is it the oxidized cholesterol? And like I mentioned before, I always love saying this because we see like Celiac massive increased risk of heart disease. You would never associate those two things, but autoimmunity and inflammation are massive triggers in otherwise healthy women or people that would typically not maybe healthy weight or healthy body mass. That autoimmune component can be a huge trigger. So I love, and you might see that on some of these labs because like MPO or plaque or some of these would show up potentially. Yes. And I have seen it because, and I tell people this inflammation of any cause, it's persistent. It doesn't bode well for aging. So I don't care whether it's heart disease, cancer, autoimmunity or Alzheimer's, all four have inflammation at their base. So that's why in functional medicine, you make a big deal about it. And we try to identify where it's coming from. We try our best. See the difference between like traditional medicine, symptoms, treatment. Yeah. And usually pharmaceutical or procedure. Again, those are appropriate for the right case. There's more. There's so much more. Well, let's shift to men and women. There's a big difference, especially women, after menopause. And do you want to talk just briefly about men and women differences in heart disease, how they present or what you look at with a woman versus? First of all, when you look at symptoms, they can be completely different. And I have my own little dictum in place of that. If it's a woman and it's anything above the belly button, it's hard to prove otherwise. Right. Because you can masquerade as a gallbladder plant. Women can have no chest pain at all. Very common is shortness of breath and also fatigue and dizziness. So they don't usually have that pain that goes on the left arm, blah, blah, blah, crushing. You have to have a really high index suspicion. So presentation is different because the symptoms tend to be different. Even the diagnostic criteria are different. I'm just sorting this out. The last couple of years is that the test that we look for, whether a person's had a myocardial infarction or a heart attack, is the troponin level. Yet the troponin levels are lower in women than in men. Maybe it's higher. I forget which is which. They're different than two genders. And that's really important because before we never, this is kind of a new finding. So now we have to know what is arranged for men and what is arranged for women. And it's, you know, it's pretty well that you'll find out when you do the test. Even when you do the angiograms on these patients, now women tend to have smaller hearts and they tend to have smaller arteries. And so, and you might not see anything major when you do your angiogram on these patients. I mean, you may, but you may not because they also have a higher intensity, what we call microvascular angina, which means the plaque is in the tiny vessels that you can't see on angiogram. Yet it's very common in women. So, and they, you know, it's still totally different. Let's talk about the menopause. But one thing I want to just mention first is that I find this so, so it just, I can't believe it still exists, but about 52% of women in this country still think that their biggest issue is breast cancer or cancer in general. And just to refresh everybody's memory, there's about 250,000 women dying each year of heart disease and 80,000 of breast cancer. Yeah. You know, I mean, I think it's a kind of work that I try to do. It's like women have to know that it's just, it's making women die of heart disease as men. It just happens later in life, about 10 to 15 years later, and that's CO estrogen connection. Yeah, excellent. So great. Thank you for that overview. So I want to go to medical advocacy, but before we do, because that's one of the things you stand for is in your book. But before you do, yeah, yeah, we are both the medical advocates in a good way. Diet. This is a big can of worms and I don't think there's one size fits all, but there's certainly principles. What principles do you find most helpful for your cardiology patients that are trying to improve their health? First of all, I'm not going to say don't eat eggs. That's the last century. I don't make a big deal about cholesterol because cholesterol in your food is not really a quick to cholesterol in your blood. So although, and I really differ with the American Heart Association on this, I mean, I give them credit recorders due. They've been around since 1926, but when it comes to diet and risk factors, they're way behind the disease. So even things like, I basically believe in the Mediterranean diet or variation of, like, I guess you can call me on between Mediterranean and paleo because I try to agree 100%. I just want to say right on with, even with me with cancer inflammation, I find this area is so powerful. Yeah, it really is. And so I don't really, patients are amazed when, why don't you tell me about cholesterol and what I should avoid eating what? I said, I'm going to try to devoid one thing, sugar. Because eating sugar is like pouring gasoline over a fire. And that's what happens in arteries, right? And cancer and autoimmunity and Alzheimer's. There's fire going on. We want to get rid of it. So that's where diet plays a big role. So I'm much into, you know, low starch, low carbs, low starchy carbs, and definitely very low sugar. That should be a treat. So it's Mediterranean, low carbs. Those are my basic principles. Because, and again, if it doesn't grow, if it doesn't grow in the, if it doesn't run in the wild or grow in trees or bushes, it probably has no place on your plate. So I tell people, if it's a box bag or can, forget it. I love that because really it is processed foods that contain more additive, sugar, chemicals, glyphosate, and like you said, sugar inflammation. Before we go into advocacy, I thought one more thing I think is important is hormones. We're both in the realm, we have been at A4M, that's where we met first, and lots of anti-aging principles and hormones. And I do believe, obviously you mentioned this, that the major risk factor for women after menopause is their loss of estrogen. My, I have a listener's probably 50, 80% women and the rest men. But let's talk a little bit about women and hormones. What's your thoughts with heart disease and estrogen replacement? Okay, I'm biased. I admit it because I'm anti-aging. But so I do believe whether you're a man or a female, you look better, feel better, and think more clearly on hormone replacement therapy. Does that mean I encourage every patient? No, it's an individual choice. But with women, it's very important. Women live in the average way, 30 years post-menopause. I mean, they have a nice long lifespan. And so estrogen is very important. First of all, I give hormones, not just for symptoms. I mean, in the old days, you got it for hot flashes and tomnia, night sweats, you know, brain fog. And that's still an indication. I mean, that usually is what a lot of women have as they go through the menopause. I look at the health benefits. Okay, how can it improve the longevity and quality of your life? Heart, no, no, but no doubt about it, because estrogen is very helpful in producing and preserving the endothelium. And you lose that when they go in the menopause. But no more such endothelium starts to have problems. And that's when you start seeing coronary disease. They could have cholesterol elevation their whole life. And I don't care about it until they hit menopause. And if they're not being protected with estrogen. So the estrogen factor is important as far as heart bone health. No question about it. And also brain health. So I'm in accordance with most gynecologists are not functional medicine or really proactive. So I mean, I've had patients come to me because I treat a lot of women with biotechnical hormones being that I'm anti-aging as well as cardiac. And they tell me that they're, they're QA and says, well, you better get on and off as fast as possible, because it's really dangerous. Well, and then they asked me, how long should I be on it? Probably rest of your life. Why would you want to stop? But they're encouraged by their gynecologists to stop it as soon as possible. And, you know, we're still quoting the women's health initiative from 2001, I believe it was. Well, first of all, the average age group, the average age in that group was 71. You know, I'm sorry, 61, which is pretty late in the game. You know, we've not even been looking at premenopausal, premenopausal. We're looking 61. The average age for menopause in this country is about that. So there probably were a lot of patients with heart disease that was undetected. So that was one thing they also used oral estrogen, which we don't recommend, because it goes straight to the liver and you can develop an inflammatory metabolite, which we don't want. We don't want inflammation. And also, come on, they use premarin and premprobe. I know, right? The fake alternative, not natural, not biodegradable. Well, for example, if you look at mares and horses, right, they have 27 different estrogens. Women have three. Yeah. I mean, we're not comparing apples to apples here. They're very good at controlling symptoms, but the long-term side effects. And I do believe the Women's Health Initiative did prove that. There's more heart attacks, more strokes. So all that was true. It's just they didn't give women any alternatives. And this is how I got into it. I swear to God, after the Women's Health Initiative, gynecologists all over this country were like stopping, abruptly stopping hormone. They didn't want to get sued. So all of a sudden, I had teachers and nurses come to me and said, you've got to help us out here because gynecologists in this town know nothing. And I said, okay, I'm up for the challenge. And then we learned. And that's really how I got started because I provided a need that wasn't being handled by the traditional doctors. And I've never had a woman, because I know how to follow hormones, I've never had anyone develop cancer while they were on bio-identical HRT. I'm sure it's happened, but I've never seen one. And I've been doing hormones since 2000, so 23 years. I've said this before, but as a breast cancer survivor, I couldn't agree more with you. 2001, that was the year I got cancer at a very young age. And I am obviously studying this for my own health. And I really, really believe that the benefits far outweigh the risk. Even now, I wouldn't say within the first five years, you need to be a little tiny ways out from cancer to safe. And in that sense, and you obviously, we're not giving medical advice here, you need to talk to your doctor. But if you're getting good information, find a functional, find an integrative trained doctor, because there are ways to test, like you and I am sure test metabolites. So we know where these are. And like you said, the brain, the heart, the bones, there's so many organs that absolutely need. And then the other thing I want to emphasize, you mentioned oral versus transdermal. It's a really big difference in clot risk. The oral metabolites do potentially increase clot risk. So I rarely, if ever use oral estrogens, progesterone is different oral progesterone is safe, biogenical, but transdermal. So creams or patches have a very different risk profile for women for clot or heart attack or stroke. So I love that you said that. It's really individualizing your treatment, you know, because, like I said, I can't, I don't recommend to everyone across the, you know, everybody. Absolutely. It's a discussion to say, because if someone's terrified, I never add to that fear. I get to, I let, I give them the information and then let them choose what they feel best with, because they know their own body is better than me. And they get to choose and I will just support and give them all the information they can do to make the best decision. Sorry. And I'm totally with you. I'm in the same school. Because like when I started in 2000, 2000, before the women's health initiative, so I would like find one sheets on biogenical hormones, which no one even knew about back then. I learned from my 4M. And then I'd give it to the patients. Then when Suzanne Summers came out with her book, The Sexy Years, I said, you know what, just read her book. Because, you know, it's, it's written from a late person standpoint. And that, and that really did help, you know, during the bandwagon, as far as biogenical hormone. So yes, I am pro hormone and the right patient. And I think discussion is really important. And I tell them, I tell them, I want you to think about this, you know, let's meet each other in three or four weeks, you know, do your reading. And women are great about women research things all the time. So I mean, because I have a population of patients that are bright and, you know, and they really concerned about their health, they do the research and they come back and, you know, and we, like I said, I've never had any problems. I'll have to adjust things with men. It's one size fits all but not with women. Women is more complicated, but we were rewarding in the way. So let's shift in our last little bit here to medical advocacy and your book, which is from both sides of the table. And we'll talk about where to get that later. But tell us a little bit about how did you become a medical advocate? What does that mean? And why is it important for our listeners? Well, one of the reasons why I kind of relate to you is because you have your own backstory. And I think when you've had medical, if you're a medical provider like we are, and you go through hell that we went through, it changed you as a person. So it really like the first time I was hospitalized twice. And it's been 19 months. The first time I had a very small heart attack. I mean, I might have no risk factors. I'm not hypertensive. I always worked out. I've never been overweight. I've never smoked. You know, even when I went to Cedars, they said, well, you don't look like the profile, but it doesn't matter because it can happen to anybody. And so I had a stent and then, and then this would have me change the, with the cardiologists who did my procedure, when the discharge me says, well, Dr. Alcott, I don't know what to tell you. I mean, you are so buffed and so forth, you can create your own cardiac rehab program. I said, okay, I can do that. And then he said, but you know what, now this guy was about 20 years younger than me and was about 60 pounds overweight and it wasn't muscle weight. He said, but you know what, everything's going to be great because you have the stent and you're going to do great. And he left and this is when I knew what's going to write a book. I said, okay, he said, I'm good. I'm everything's fine now because I have the stent. First of all, if I, if I'm so healthy, why did this happen to begin with? Number one, number two, what can I do to prevent it from me happening again? And those are the unanswered questions. And then my daughter came up a few minutes later with the writing tab, a dad, it's time to write your book. What happened? So, you know, I did very well at a very small heart attack, but then 19 months later, I ended up in the hospital again, Cedars, Sinai, with an immediate emergency back surgery. I had this condition called spinal stenosis that I knew from 1996. At that time, I was doing triathlon. I wasn't bodybuilder yet, but I knew about it. So I'd have a relapse every, let's say two years or so. But this time, it was so bad, I went through rehab and chiropractic, nothing more. I got worse. I woke up one night and I was, I was reading a book and I'm numb from the knees on down. And I stood up and I just collapsed. I had, I couldn't walk. I crawled until my best friend Barry came to pick me up and bring me to the hospital the next day. And I ended up eating surgery. But here's the thing about it that I'm sure you can relate to is that I just didn't have surgery. I had a botched up surgery. And I have permanent nerve damage as a result of that surgery. And not only was it botched up and I had permanent nerve damage that I'm still dealing with today, 15 years later. But I have, it was incomplete. So he didn't complete the job. So over a period of years, you know, I'm bending over more and more with the waist because stenosis, like flexion, it does not like extension. And it got to be the point in which it was hard to walk mechanically, not because I was short of breath or anything, just mechanically. So I had a second back surgery this past January. But when you have permanent nerve damage, it changes you, especially if you're an athlete, I cannot do anymore. And it's not because of my age. It's because I have limitations. So with those two hospitalizations, it really inspired me to write a book, because I had to become a medical advocate. Because when he said, you're going to be fine because you have a new step. I said, this BS is absurd. And then when I had, here's the other one I want you to hear about is that when I was hospitalized at Cedars for the back surgery within the second day, the discharge planner says, well, doctor, we tried everything we could to get you into rehab, but your insurance was to go to a nursing home. I said, a nursing home? Are you freaking kidding me? I said, and we tried everything we could. So here I am in bed, bedridden, with opiates, in pain, and I spent two hours on the phone with Aetna insurance determined. That's really being your own medical advocate. Because the hospital was not going to go out of their way. And the next day I was, I was wheeled over to the rehab unit. So that's, yeah. And people say, okay, well you're a doctor. Of course you figured it out. It's not true. Not necessarily true at all. In fact, that's why one of the chapters in my book is entitled heroes. Because I interviewed about seven or eight people, both men and women, who had no medical background, yet they became their own medical advocates. It made some important decisions that affected their lives in a positive way. I want people to know you don't have to be a doctor or a nurse. You just have to have the desire to, it's work. And I'm still doing it. I'm still doing it today. So that's how I got into it. And I was inspired to write the book. And although the book starts off with my story, most of the book is really about how you can become a medical advocate. So we talk about nutrition and supplementation and exercise, stress management, and how to not age ungracefully ever after. What a great message. And I could not agree more. I know we have this such in common because the truth is whether it's the insurance denial, which happens as a matter of fact. So I just think of all these, you know, like maybe older people who don't have advocates or anyone can be an advocate, but it's so common for those denials or the standards to be like, oh, you can't do this or you can't do this or you, even for me, I'll look back with my own chemo. I literally requested a completely different drug, a completely different protocol. I did a completely different type of radiation. I basically created my own plan that fit for me. And thank goodness I had doctors that went along with it, but it was completely not the standard. I said, I want to do this and not this. And I want to have my chemo in two days instead of one day. And I want to do this to mitigate side effects. And I'm going to take some antioxidants during chemo, even though it's not recommended. And again, talk to your doctor. I'm not advocating that without your doctor's permission. But I did a lot of things that weren't advocated because I knew that it mattered to my own personal journey in health. And I agree with you. I love empowering patients. And even when you and I sit with them, part of it, whether it's bio-dental hormones or whether it's diet or lifestyle, I give them as much information as I can. And then they still get to make the decision. But I'm there helping them and saying, do you have questions? Is there a way I can help? Because the truth is, we all know our body's best. And even if I believe this supplement or this intervention is going to be best for the patient, if they don't believe it or they're afraid of it, it's not going to do them any good, right? And that's why I related to you so much in your writings and your postings and so forth because you're about patient advocacy. Not many people are. They pontificate about what they know. And I get in some of these arguments, not arguments, but I just against people in social media because it's really not backed by science, some of the things they're saying. And I will interrupt and say, you know what? I understand what you're saying, but your readers need to know this. I mean, if it's really against my grain, I will intervene. But you're absolutely right about it. I did the same. When I had my back surgery on recovering in rehab, I had a friend of mine bring my supplements that they had, Coke U10 and fish oil, vitamin D. And so they make their rounds. The doctors, the interns, the residents, the fellows, and the attendings. They said, what's this? I had everything in a shoebox. I said, well, this is this. And I said, and they looked at me like I was Mars. And I said, do you guys not know about this stuff? Some of the people are like 20 years younger than me. Oh, no, no. All we do here is rehab and pain. Unbelievable. Yeah, exactly. Like you said, the basic, the Coke U10, you can't imagine someone doesn't know the science on Coke U10, but the truth is a lot of doctors still don't. Well, I love the path that you've taken. I love that you've given us some really, really valuable information about the heart, about aging, about biological hormones, and especially about patient advocacy. So obviously, here's your book. Where can people find you, get a copy, both sides of the table? Okay, well, actually, I have two websites. One is HeartWise.com. But if you have my own website for that, it's called, it's a little long name, but it's BeYourOwnMedicalAffecate.com. So although it's my story on both sides of the table, it's really about patient advocacy. So BeYourOwnMedicalAffecate.com. It tells, it's specific about the book. There's a praise page for people that read the book before it's published. And also, it goes straight to my Amazon page, but you can buy it. It's, I think it's like $9.95 for the electronic or? Thank you. Okay. That's all it is, more screen time. So I know. I know. Or the book, I like turning pages. I'm old school. Me too. Me too, as I have the copy there. Again, for your time today, thank you for your information. Thank you for the great work you're doing. If you're listening out there, wherever this podcast is being shown, heard or watched, you'll see the links to the websites that Dr. Elkin mentioned. And thank you again, Elkin, for your work in the world. Joy to be here with you. Thank you. You too.