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Ever Onward Podcast
The Ever Onward Podcast is your go-to business podcast, offering engaging discussions and diverse guests covering everything from business strategies to community issues. Join us at the executive table as we bring together industry leaders, experts, and visionaries for insightful conversations that go beyond the boardroom. Whether you're an entrepreneur or simply curious about business, our podcast provides a well-rounded experience, exploring a variety of topics that shape the business landscape and impact communities. Brought to you by Ahlquist.
Ever Onward Podcast
Preventing Heart Disease Before It Starts with Dr. Danny Noonan | Ever Onward - Ep. 129
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Heart disease remains the leading cause of death in America, yet much of it is preventable.
In this episode of Ever Onward, Tommy Ahlquist sits down with Dr. Danny Noonan, cardiologist, electrophysiologist, and co-founder of High Desert Heart & Vascular, for an eye-opening conversation about the future of medicine, cardiovascular health, and what patients should be doing long before symptoms appear.
Dr. Noonan shares his journey from launching an independent cardiology practice to helping patients take a more proactive approach to their health. Together, Tommy and Danny discuss the importance of patient-centered care, the growing role of AI in healthcare, advanced screening tools like calcium scoring and CT angiograms, and why exercise may be the most powerful medicine available.
They also dive into nutrition, VO2 max, longevity, prevention strategies, healthcare costs, and the simple habits that can dramatically improve quality of life and long-term health.
Whether you’re focused on optimizing your health, preventing disease, or simply understanding the rapidly changing world of medicine, this episode is packed with practical insights and actionable takeaways.
Learn more about High Desert Heart & Vascular at highdesertheart.com.
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Meet Dr. Danny Noonan
Today on the Ever Onward Podcast, we have a great guest. We're going to stick in a medically related topic. This guy is probably as smart as any guy we've ever had on, Dr. Danny Noonan, MD F H R S F A C C. Danny is a brilliant, brilliant physician. He's a cardiologist here in town. He's the president and co-founder of High Desert Heart and Vascular. Danny is an unbelievable guy. He started into medicine at a very early age in high school. He volunteered at hospitals. He eventually became a nurse's aide and a cardiac cath attendant. He then attended the University of Missouri, Columbia, where he received his doctorate degree, and then the University of Minnesota, Minneapolis for his residency program in cardiology. He had another program where he became an electrophysiologist in cardiology with a fellowship at the University of Utah. Dr. Noonan focuses on cardiac electrophysiology, sports and exercise cardiology. He's originally from St. Louis, Missouri. He's a die-hard St. Louis Cardinals fan, which may be the only real negative about this guy because as a Dodger fan, we uh we don't see eye to eye there. Uh 12 years ago, he came to the Treasure Valley and he has been doing amazing things here since. And again, he is the founder of High Desert Heart and Vascular, an amazing cardiology uh clinic here in the Treasure Valley, and we're going to talk about the latest and greatest with Danny Noonan. For those of you that are listening to our podcast, uh please give us a like, share, um, or give us a review. We really appreciate you listening. And um today we have Dr. Danny Noonan. Dr. Noonan. Dr. Offquest. This is gonna be awesome. I'm so excited to catch up with you. Likewise, my friend. Um, I've already done your bio. I've already told everyone how cool you are. I was just asking how the new practice is. Uh it is awesome. Um, it's awesome. You know, I I I haven't been there yet. Yeah. I'm gonna come, especially after today's podcast. But but um high desert heart and vascular.
Building A Patient-First Cardiology Practice
Um, you get some great partners. A lot of a lot of old school guys that I know from the old back in the day, right? Talk about your different cardiologists, you have. You know, we uh uh so we have great partners. It's um we have four guys that left St. Luke's. Um, you know, some of them were there when you were there. That's what I'm saying. They're old guys. Yeah, it's uh Costello, right? Yeah, and and Hinchman, uh Moses. Yeah. So we have all the stuff, all the electrophysiology, interventional cardiology, general cardiology, sports cardiology, um, and tons of experience. I mean, Dave has been there 22 years, he was at St. Luke's, uh, been Fred 15. I remember when Dave got there. Oh my gosh. That's how old I am, but great, great guys. And and you know, uh medicine's still medicine, right? You still need someone that's got great bedside manner, takes good care of you, and and I love who you've got because they're those they're those guys first. Yeah, they're super smart guys after, but for anyone listening that needs cardiologists, these guys are like legacy kind of good good humans that take good care of people. I used to judge, I used to judge people though. I judge people harsh. People will call me all the time, like, do you know Dr. So and so? Yeah, and I always say, Hey, let me preface this with one thing. Yeah I judge every doctor by what they treat patients like when I wake them up in the middle of the night, because I did night shifts for 10 years. Yeah. And I said, So if they're really nice guys, great bedside men are in the day, they're not my that I wouldn't know if they're jerks at night. You're gonna know. And Hinchman, Costello, those guys were always the best of the best. I don't I don't know Moses. Uh he so he does like I do pacemakers and um uh just super nice guy, also been here 15 years. And uh, you know, it's amazing. The um we started looking at the data for this. Uh because, you know, as you know, take doing a business, oh yeah, especially something as complicated as medicine. How is it that doctors jump off and do the most complicated business you can possibly do up front? Yeah. Um, and you know, I there's I I'm I'm being a little facetious, but but it's a challenging business. But what I found out, and you know this already, is it it the the strength to step away is the hardest thing to do. Yeah. And when you just have good people that want to take care of people, they enjoy what they do, it's this level of caring goes up another level that you didn't think existed, and not that you cared less before. That's not it. It's just it's different when it's yours.
What Professional Care Really Means
I didn't daddy, I didn't know where we'd go here today, but let's start talking. Like I I I'm an old guy, right? So I trained trained, I trained in the 90s, yeah. Uh, you know, medical school, early 90s, uh, emergency medicine, St. Luke's guy for a long, long time. And um, you know what's really funny? I'll I don't I didn't like we I go into these completely unscripted. Hey, but there was a cardiologist that um I met with this week. I've he's 84 years old, his name's J.W. Smith. He's still in town, has a nice ranch over has a nice ranch. So let me let me tell you J.W. Smith's story. So when I first got here, again, I did night shifts for 10 years. Um he was Catherine Albertson was still alive. Get out of here. Yeah. And for whatever reason, I had the great pleasure of being her doctor in the ER multiple times because she'd come in at n at night, and she was just uh I I would describe her, I tell her grandson Joe Scott. Yeah, she she like glowed. She was like the this this wonderful, kind, wonderful human being, like one of the nicest, nice people I've ever come in. You can you can feel that. Oh, you can feel it. You see them, and you're like, oh, there's something special about you. Yeah. But JW Smith was her was her cardiologist. And I would freaking call him. So he would come, she would come in, and as soon as I knew she was there, I'd call him. He would be there within 10 or 15 minutes to see her and took care of her. What's cool about that story is that was J.W. Smith, Dr. Smith taking care of Catherine Alberts and like VIP of the VIP of the VIP. Yeah. If I called her, called him about Mrs. Jones at two in the morning, same treatment. Man, same come in, yeah. Kind, wonderful, amazing, and and he was their doctor. Now what happened with medicine is you had you had it go from I'm your doctor, I'm gonna take care of you just because of lots of things, but but now you had hospitalists and you had just in change and it things change, right? I mean, I'm I'm the old Grant Trino, get off my lawn guy, but but it but it changes. Right. But man, it's different now. It is it's different now. And I don't know, Obamacare, all the layers of stuff that went in between, regulation and stuff, and then you got big and you got bigger, and you got you know, value-based care was the next big promise it's gonna change. And I think we're going to a place where like great doctors are like, hey, I'm gonna get back to where I'm closer to the patient, where I'm it's it's me and the patient. I I think things are swinging back the other way, don't you think? I I 100% agree with you, and you can feel it, it's palpable. It's this um pendulum. You've seen it, we've all seen it. It swings back and forth. And you know, um at the end of the day, people are gonna do what they're incentivized to do. Yeah. Um, and that's gonna take different forms over whatever 10 years or 12 years, and so it'll make these sort of swings. But I couldn't agree more in that I think medicine has been so commoditized, and this um medical economic space that we're in is so challenging that I think people are coming back down to that very simple thing. I'm overstating the obvious, but just that conversation of talking to someone, looking them in the eyes, caring that they're a person in front of you, not a one or a zero on a spreadsheet. And if you would have told me that three years ago, I'd have been like, uh, maybe, uh maybe. Um, but but I would have been way off. Uh people care more about that. They want the personalization of medicine. They want to know that you care about them, not just what some guideline says. Uh and you can see it. Oh, you feel it. I mean, you feel it. Um just to your story. You know, when you just treat someone as if they're in your family and they're just asking you a medical question, uh the receptiveness is, as you know, um it's palpable. Yeah. I this is gonna sound corny, but in the ER, you can get jaded, and I watched a lot of my partners get jaded. In fact, in fact, when I first came out as a young guy, because I really think I went into medicine for the right reasons. I really did. I mean, I I I I mean, I you may say, well, whatever, you went in, but I was intellectually stimulated. I thought that's gonna be fun. I was motivated by the only doctor I knew growing up, which was Dr. Knowles on the corner. I thought that that guy gets to take care of people for a living, right? So I went into it that way, and I re I remember uh early on, uh I had a mentor, Sam Kime was his guy's name. Okay, and um I was seeing patients on in my residency and he was our residency director, and I was cranking them through and being efficient. And he sits me down and he says, he says, Um, do you know what it means to be a pro? And I said, What do you mean? He's like, No, if you're like a pro athlete, yeah, he's like, Do you know what that means? I said, Yeah, he said, if you were a professional jazz musician, what would you know what that would mean? And I said, Yeah, I think I know what that means. He's like, What does it mean to be a professional health care provider? And he said, I don't want you to answer me tonight. I want you to think about over the next few months, and I want you to come back and kind of tell me what that means to you. Yeah. And what it meant, I'll cut the story short, was Did you come up with the answer quick? I came up with what I thought the answer was, and it wasn't what he thought the answer was. Yeah, that's because here's what he taught me. He's like, he's like, you will meet people way smarter than you. Yeah. You'll meet people that are encyclopedic when it comes to differential diagnosis and medicine and science and all that. He said, I'm gonna challenge you that what it means to be a pro in medicine is to be a healer and someone that can sit down and listen to somebody connect with them and heal their ills. Yeah. And he said, as an ER doctor, that may be, they're not there for what's on the chief complaint. And he said, I'm gonna challenge you to become a pro. And I it it left an indelible image on my mind of, and so I had to ask myself as I got out, like, Am I being a pro? Yeah, and so for me, that was always sitting on a sitting on a stool, looking them in the eye, and saying, How can I help you tonight? And if I started there and listened, it put me in the right frame of mind versus where you can get, which is pretty jaded, that this isn't someone's loved one, this isn't someone's child or someone's mother or someone's brother or whatever. And sometimes it who knew what the what the answer to that was gonna be. But but I think that left medicine. I I I I've had some horrible, and it hasn't been in this state, so I don't mind saying this, but my mom has been in the hospital a bunch the last few years, my in-laws have been in the hospital a bunch a bunch. And I'm telling you what, Danny, it ain't it's not good. It's depersonalized, isn't it? It's not good. Yeah. Um they would not have passed the Sam Kyme muster. Yeah. If he sat them down and said, Are you being a pro? Yeah, uh, it would they wouldn't even be anywhere on the chart because it's not about the patient right now. It's about something else. I don't know what it is, but it's not about the patient. Yeah, and you know, it's um uh I couldn't agree more with you. Um I think you're spot on. And it it makes me think um that look, that's what people want. Why are we not why are we not doing that? It's the simplest thing you can possibly do is shut your mouth and listen. Even if you faked it. Even if you faked it. Out of a 20-minute visit, whatever you get allocated to you, even if you freaking faked it for the first five minutes, you would be better off. It's true. We we can't shut our mouths for like eight seconds is the average time a doctor like starts saying words before the patient, you know, uh uh is done. Eight seconds. Can you believe it? I mean, of course we believe that. Um but it is it does, it is changing. And um uh, you know, I think it takes it back to this AI
AI And The Return To Basics
thing, you know. We'll um uh we'll talk about that, I'm sure, a whole bunch. But uh uh, you know, it does so much for us, it is changing so many aspects of our world. But boy, I'll tell you, those things that aren't gonna need it, those skills are gonna be more important than ever. They're gonna be more important than ever. That's how I I've had a lot of people ask me, what do you think? And I'm and I'm I'm like, hey, listen, I think it's gonna make us tremendously more productive. I think that's gonna allow things to happen that will blow our minds from a productivity advancement, but but the human skills will become more important than ever, and the people that figure that out will succeed, and the people that don't won't. I mean, that's basically it, right? That's exactly right. I mean, we said it earlier, change is tough. Change is great when it's not you. If you're changing, that's fine, but um but that's that's the thing. Complacency is a first step towards failure, and if we're not gonna move and adapt with this, and I think the benefit is we're not we're just going back. We're going back to basic. We're going back to listening to that. I love that. Um, yeah. Hey, um, so your start of the new practice, and it's been awesome. It's I I mean, like again, I have heard absolute rave reviews from everyone that's been there. Thanks, Tommy. I appreciate that. I send that's where I send people, and it's been great. But um, what have been your surprises or challenges? What have been the what have been the good, the bad, and the ugly? Uh lots of all of those things uh as as you know. Um boy, it is uh I could wax philosophic on that for a long time. Um but I like to start with the the positives. The positives are look, hey, we have cardiovascular disease as the number one killer on the planet. 80% of it is preventable. Can you believe it? 80% of it preventable. I I'm not gonna interrupt you as much as you can. No, no, you're listening I this is where I want to go today because I think even in my I mean, I'm a physician and I have horrible heart disease. Horrible high blood pressure, coronary disease, stant in my LAD, open heart surgery. Right, I got it all. But I will tell you in the last two years, I have learned more about myself than ever before. Tell me. Well, I want to know. I just think like so. I've been to I've got a cardiologist that I've see, and um, until I started going to Dr. Lyall, yeah, so Eric Lyall, and I'm gonna give him a giant plug down here. Yeah, hey Eric, I know. Eric's so I go to him, he's a longevity doctor, right? And so you it's kind of a concierge medicine deal, and I go walking into him and I'm like, hey, here's where I'm at. Yep. Dude, he has figured out some stuff on me that nobody else has, but I'm pissed. I believe it. I'm pissed. I believe it. So I'm like, why didn't anybody else do the Boston Hard stuff? Why didn't they why didn't they go get this blood test that tells me how I produce cholesterol? Why didn't they check my Apo E risk on the back end of how I'm consuming or what how I'm creating stuff? Yep. So that that's a hard stop right there. Why not? You should be pissed. Um uh you
Heart Disease Prevention And Calcium Scans
should be pissed. And in fact, and I'll I'll double it up. Yeah, there's um I saw a guy yesterday, a very famous guy here in the state, you know him, um, who ended up getting a calcium score. Um and and for those listening, a calcium score is is a very inexpensive way to just test for old healed coronary disease. So you can see how much plaque is there. I do want to, we're gonna get a little technical, but for all I we do have a lot of people or business people listening. I want you to leave this podcast going somewhere, probably your shop. It's the number one killer. It's the it's it if you look at what kills people under 70, this is it. This is it. And there and most of this is preventable, most of it's diagnosable, and I think it it it should be it should be uh something that is is decreasing in our lives and at least manageable. You can at least know what you have, know how to manage it, and live long and prosper, right? And that is not the version we're in medicine right now. If you're in a traditional primary care doctor role, you are missing the boat. 100%. Okay. Couldn't agree with that. So we're gonna talk about we're gonna talk about some genetic stuff. We'll I'm sure we'll get into it, but let's start. Calcium, calcium scoring is a big deal, and I don't even know how many people out there have been scored. Uh not many. Yeah. So so this guy, and I'll just because it it it sets the stage for exactly what we're talking about, um he gets a calcium score and it's off the charts. 2,000. I mean, and so these scores are anything over double digits is is a big score. Um 2,000. And so he said the same thing. He's like pissed. I have had the top of the line physicians for my entire life. And I can assure you he has. You name the institution, he's bit there. How is it that he goes until he's 65 years old in great shape? I mean, you know, muscular, good looking, thin, doesn't do all the bad things. He just very healthy. Um he's like, how do I go and see all these people for 30 years? And no one catches this uh for 150 bucks. 150. It's insane. It's insane. So we're missing it. We are missing the boat. And why is that? You know, you know, you can stay these ages off top of your head. We know to go screen for colon cancer. In fact, before here, I just went and took my wife for her colonoscopy this morning. Which, by the way, is a zillion times more invasive with potential complications than anything else. Right? I mean 100% right. And they do, oh boy, they do a lot of those a day. Uh, about 60 a day. Um so you notice screen for colon cancer, breast cancer. You know, you talk to any person, they'll tell you what month is breast cancer month, prostate cancer. Hell, you go to the dentist twice a year and look for cavities. Yeah. Why are we not looking for the thing that is preventable that kills everybody? Yeah. I mean, step back for a second and just like just the very simple. This is simple. But how are we doing that? It's it's it's mind-blowing. Um, so calcium score. Um, very simple. It looks at old healed coronary disease, so it gets your foot in the door. It can miss a lot, right? It can miss blood flow, ischemia, infarcts, but it gives you a good idea if there is coronary disease. But um, we've all been working on coronary disease, so we're zero years old, right? So we're gonna have some. Um but what can you do about that? All the same things we've been saying forever. Just have a good diet, nutrition, make sure you're exercising, make sure you're getting good sleep, not too stressed, have a good social network, be outside, and you can actually reverse coronary disease. Yeah, reverse it. Um but that's not the message. The message is you come in when you get really sick, we're gonna take you to cath lab or we're gonna treat your AFib or whatever it is. But it's like treating lung cancer when you're coughing out blood for two weeks. I'm really interested in getting into the specific So I'm gonna give you my a little bit of my history, and then at the end of this, I'm gonna ask you what I
Lipids Genetics And Getting Personal
should be doing. But um, so uh family history, a lot of it. Yeah. ER, slept poorly, stress, never smoked, um, but started having really bad searing nipple pain for like a year. Yeah, and ultimately it became so exertional that I went and got calf, had a 95% LAD, got stented. They couldn't find my right coronary artery because I had a malorig of my right coronary, went down to my best friend who did my open heart surgery, redid my coronaries. Yeah, and then I had a heart attack the next year, uh, probably COVID vaccine related, probably is why that came out. I think it was COVID vaccine related, which is crazy. Yeah. So um, anyway, uh I'm I'm I'm on Rapatha because I didn't tolerate a statin. Um, and uh almost convinced by one of my primary doctors that that uh oh cholesterol is not that bad, which which is a little crazy to me with my history. Um, but and and and they the recommendation was actually back off the repatha, don't do it, don't do it twice a month, right? So you're this is this is crazy. So then I'm going along, I got high blood pressure, I'm trying to figure life out, you know, and I'm doing this. I go see Lyall, yeah, Dr. Eric Lyall. Yeah, and the first time he's like, What the hell are you doing? Right. Like, have you not have you not dug into this? And I'm like, Well, I've been doing all this stuff anyway. He does all the he does all the stuff on me, and he's like, No, take the Rapath as dose. And it turned out, so they can test how you produce cholesterol and how you produce plaque. Yeah, and that's the right drug for me. Yeah. And then on the back end, I do have some diet questions. Yeah, yeah. There's a lot of information out there about fat and food and meat and how much you can and can't have. And it's no, we've they've overdone this for years. It's not bad or it's not good. But I just got some testing back from him last week. Yeah, awesome. And I think he's telling me you need you need to go leaner on the meat. You need to go, you need to go less, less saturated fat. Tell me what your take on is on that.
Simple Nutrition Rules That Work
Yeah, you know, it's um it's a it's a funny story with fat. Yeah. Um, uh, we could get real deep and ugly into that if you want, talking about when the food pyramid came out and um and how that science was completely flawed. Yeah, but here's the reality. I think data for nutrition is very challenging. Uh there are so many biases, there are so many factors of control that we have to take it with a grain of salt. And I think we all forget that. Um we have to keep it simple. So keeping it simple, I have three rules. Okay. Number one, eat less food. Number two, eat real food. So, you know, real food, not all this process. And number three, mostly plants. Okay. And I think if you keep it that simple, you are gonna make progress. Directionally, you are correct. I love that. Right? Less food, whole foods, mostly plants. Okay. And people can remember this. And so I think if you start there, what I have found is that if you are concentrating on protein amounts, I'm not gonna get on the protein bag. I mean, we can talk about that too, spend hours and hours, but just for simplification, if you focus on protein, the carbs take care of themselves, the fats take care of themselves. Generally And the reason for that is the number that you probably recommend. It's like someone for me, like I should probably get 160, 170 grams a day. If I'm doing that, I'm gonna be satiated, I'm gonna eat less. If I'm doing good, clean protein, and I'm adding some other whole foods during the day. I'm gonna probably be full and be done for the day. You're gonna be full because you're also drinking water, you're drinking 15 grams of fiber with your protein shake. Um and you're right. And so the number you're talking about is at least 1.6 grams per kilo of protein per day. Yeah, that's a lot of protein. Uh we are all probably underprotenated, uh, but ideally up to 2.2, and that sounds like a lot. I mean, this is you know, for a guy like me, I'm almost 200 pounds. You know, that's 180 grams per I found without doing like I I try every day to do a I do a shake that's got it's got um a couple of scoops of really, really great protein in it, and then I put put that PB fit, the organic stuff in there. Not Andy Scoggin might be listening, just you know, he owns that company he owns that company. Yeah. Andy, there's a shout-out for PB Fit, but it's organic, PB fit goes in there. And if I do that, I get like 65 grams of protein in one shake, and I try to do that at work. And if I do that, then I have a chance of getting it. But if I if I miss that, I'm not even sniffing, I'm not even close. Yep, yep, that's exactly right. Um, but and so I think that just gives us uh more information for just focus on the protein. Yeah, just just do that, make it easy, because then we can talk all day about saturated or unsaturated fat if you want. Because you're down to you're down to something that's yeah, I love that. I love this advice. Yeah, it's great. Um and I think we just take it with a grain of salt. Yeah. Um don't make it more complicated than it is. I think we I think we all want to sort of not find uh a cheater way or an easy way, but cut corners if possible. And the reality is just just keep it simple. We love it, just keep it simple, you know. Okay, I'm gonna go to the next
VO2 Max And Training For Longevity
couple of questions. So um exercise clearly. Oh, yeah. And one of the things that happened to me is I so I'm I'm in my late 50s, I've had heart stuff. So I was in the mindset of, hey, I'm gonna walk my dogs every day. I'm not gonna get hurt. I'm just gonna I'm gonna cruise on into my old age. Yep. I do my VO2 Max with with Lyol. It's one of the greatest stories ever. Because I've been I've been really good for like a year and a half. I've lost some weight. I've been doing, I've been doing my walking every day with my dogs. I'm thinking, I got this thing. Yeah. So I get on, I get on the VO2 Max thing, and I think I kill it, Daddy. I'm like, yes, I can't wait. So I go sit down with him and he's he hands me the thing, and it's it's it's it goes, it's red, yellow, green, and then I'm my score's on it, and I'm off the bottom of the red. And I still, because he handed it to me and he was talking about something else. I'm like, well, this is this isn't age adjusted, right? As soon as the age adjusted, I'm gonna be fine. I'm like, hey, Eric, is this age to adjust? He's like, Oh yeah. Oh boy. So what he's got me doing now, I didn't realize that I might get hit on this. Like, I've got to be doing more. So I've started running good um a mile, not nothing horrible, but I've been running a mile at a pretty good clip on the treadmill, and I've been jump roping. Yeah, and his point is you've got to have some of this high-intensity stuff for short bursts, or talk about this for heart health. Um yeah, great question. Um, I love talking about this. Um, so I've been the consultant for the Boise State Athletic Department for a while, uh, almost 10 years, and so I see all their athletes. And so um, this is really important to me because if there's a take home, take it home. This is it. Exercise is the greatest pill if we could put in a pill. There is nothing that would heal our ills more than exercise. Um, so with that, exercise is uh things to know about VO2. So VO2 is most highly correlated with longevity, far and away. We probably have over a million patients of data saying that there is no ceiling. If you get your VO2, as long as it keeps going, your longevity will keep going. We haven't reached the max, and that is replicated in study after study, robustly positive. Um, what is that? That's the ability for your body to exchange oxygen. Where does this happen? How do you get that energy? This happens in the muscles, right? And so it's very important to have increased musculature as we age, right? And this is goes back to that protein conversation. But when you have muscles like that, you are going to be stronger. It will make your bones stronger. But talking about the seventh decade of life, that's kind of when heart disease doesn't go down, but as a cause of death, it goes down. Some cancers go down, Alzheimer's goes up, falls go up. And so as you are stronger, you are avoiding these things that increase your mortality: falling, hip fractures, getting pneumonia, and getting all these things. So muscle, very important. So we know that. Number two, the VO2 max, tremendously important. How do you raise it? It's not the easiest thing in the world, uh, but it can be done. And so I tell my folks look, you should probably be exercising aerobically six days a week. Um, probably 30 minutes a day. Four of those days should be zone two rides. So zone two is it right at your aerobic threshold. So the sort of big dumb way to do that is 180 minus your age. So I'm let's call me 50. Um, so 180 minus 50 is 130. So I can get on a bike, keep the my heart rate 130 for 30 minutes. So I can talk, I can breathe. But you know what? I will another plug. It's pretty inexpensive to get these heart rate monitors. Yeah. You know, on Amazon. I've I got went through a couple brands, but early on, and then once you learn what your zones are, then you can kind of leave them off because you know. But I think for people listening that haven't ever had to do that, it's kind of nice to have, hey, here's where I'm at, and I'm kind of learning how my body reacts. But yeah, but it but it's helpful, right, to know kind of where your heart rate is. That's a great point. Um and I'll use that to also say, look, you know, I wear these things all the time. I have whoops and Apple watches and all these things. Um don't I don't want people to perseverate on it because people get too focused on the watch and the data rather than the thing. Remember, the main thing is to keep the main thing, the main thing. Yeah. And you were exercising, so let's focus on exercise, not the number. But we think about you know, four days of zone two and two days of HIT training. And this is where you were going. So hit we talk about is that high intensity intervals. The best studied one is actually nor uh Norwegian intervals or Nordic intervals. Four by four things. Yeah, and they're they're tough. Um, and so sort of an example routine, you can just do this on a bike is uh 15 seconds of bust and hump. You just all out. Uh I'm sorry, 30 seconds, and then 15 seconds of rest. And you do that 13 times. And then you do that three times. So it takes about 40 minutes uh and you're cooking, you know you were working out, and it will change your VO2 for sure. Um, there will be a direct correlation to your longevity for sure. I love it. Well, I I can't wait. Um he he wanted me to wait like six months before I redid it. Yeah, yeah. So I've got like two more months to go, but I'm so I'm four months into doing this new thing in the morning. But now I'm like, the first few times I was jump open, I'm like, I'm gonna freaking die. Dude, I bet. And now I'm doing it and I'm doing my thing, and so I can't wait to get on and see if I'm at least I want to at least be in the red zone. Oh, you will the red zone. You will. It's good. I can't wait. Okay, that'll be the follow-up show in six months.
Sauna And Cold Plunge Reality Check
Sauna. Sauna, um love it. Great, do it. Um at the end of the day, again, most of the data comes out of Finland. There's a couple of labs that it comes out of. The data is good for um relaxation, uh focus, um, recovery. Um, but it is out of one lab. So the bigger I think another question is does this cause any harm? No, it doesn't cause any harm, and and the signal is that it certainly improves your performance. Um and so so much so that I'm doing it every day. Um, you know, I'll have a routine where I get on the bike, I'm in the sauna for 30 minutes, and I'm in a cold plunge or a hot tub. Um I I'm about I'm about 14 months into sauna and cold plunge. Yeah, I don't like I I'm doing so much stuff that I don't know what's working and what's not, but I'm like I'm just keep doing everything. I'm feeling so good about it. But I I think it's great. And I think for a lot, I'm sleeping better than I ever have, right? Like ever have. Um, so I think it's all good. That is good. I want to shift, I knew this would go by fast. I want to shift into some questions here.
CT Angiograms And Predicting Heart Attacks
Yeah. So there's some advanced procedures that you guys are doing with AI clarity tests. I don't I don't this is new to me because the question for me is with no symptoms, should I get a baseline or not? Yeah. Uh this is one of my favorite things to talk about. Let's do it. Let's do it. Um, so um so we're in an age now where we're looking at disease. We're not guessing, right? So as we were growing up thinking about this, we basically were guessing. We were like, look, okay, here's coronary disease. We're gonna take a bunch of trial trials that are only 10-year data, and we're gonna apply that to someone's entire life. So this is a 30, 50, 60-year disease, and we're treating it like it's a 10-year disease, which goes back to our very first statement why we are doing so badly. Um, why would we do that? I I don't I just don't understand why we so now we don't have to guess. Now we can look. So now we can just get a CAT scan. It takes one heartbeat, it takes a couple of minutes to get this scanned, and we can look at the entire uh pathophysiology of your coronary arteries. We can tell you how much calcium is there. That's amazing. Soft plaque, hard plaque, and in fact, and this isn't even uh it will be public here any day now, uh, and we just got this published in the journal of the American College of Cardiology this week. Um, we can now see uh perivascular inflammation. So we can look at the fat attenuation index and tell you that as that goes up, there's more inflammatory activity, which means a heart attack is imminent. And and you've seen this too, right? Like you go see these guys that have 90% lesions or whatever, and you know, they don't have a heart attack. Or you see the 40% lesions that do have heart attack, and in fact, those are the ones that have heart attacks more. We can predict it now. Wow. So to your question, what are we doing with AI? We're predicting heart attacks, and we're telling you exactly what you have. So it's no longer this 10-year-old. So the test is a CT angiogram, C T angiogram. Little bit of dye, right? So they're able to visualize those, those, those arteries, but the technology is what's caught up because in the old days this just wasn't even a thing, and now you're able to get a snapshot, run that through these tools, and really get predictive. Really get predictive. Is it good for so if someone like me is it good to track, like, like get a baseline of where you're at just to know? It is. Um there will be people um that we could sit and have a whole bunch of discussion on on this. I will say, for me personally, uh, I am on the side of let's prevent this. Why even get to the spot where you have disease? There is a disconnect between how these things can get done. So if you are a person of means and you can get it and you don't have symptoms, by all means. Yeah, I think it's a great idea. Some people don't want to know, some people just don't want to know, and um, okay, that's fine. Uh but yeah, I I absolutely encourage it. Um it's preventable. It's preventable. Yeah, and I guess the so the counter argument is, well, what would you be doing differently? And the answer might be nothing, but the answer might be I might monitor it more often. Like, like, like so, even if I stay on this routine I've been on for 14 months, and I get five years out, I might say, Hey, I am I am I, you know, is there any I don't know. I just times are changing. The technology is gonna keep getting better and better and better, right? Oh, for sure. There's probably a day with medication and treatment and early intervention that this just doesn't kill as many people. Yes. And that would be in our lifetime. Yeah. I think we're gonna see that. In fact, this is our community. Why don't we just do that? We are in the most isolated community of people of 250,000 in the United States of America. There's not another city here closer than Salt Lake. So we're very isolated. What does that mean we can do? Why don't we scan some people? Why why haven't this is I know this is philosophical and whatever, but when the cost of treating this stuff is exponentially more than preventing it, why why aren't people paying for this? Why isn't it not great question?
Why Healthcare Costs Keep Rising
Great, great question. Um and and and I know that's I know you know the answer to this, so we'll just say it for the benefit of people out there, but um well, they're on cycles, right? I mean, uh who gets the control of this? The CEO of the insurance company, the CEO of the uh health system, and a politician. And they're all short timers. I mean, they don't um they don't have to make those decisions. Uh they're not going to. If you amortize that out over years and years and years, you know, they're gonna look better to the people that they are held accountable to by keeping their margins up for the next couple of years. It's not about tomorrow, right? It's not. Uh, and that's the attitude we have. Um well, that's the attitude some people have. Doctors don't seem to have that as much. Yeah. Um, well, and I and it's probably why we're always so slow to adapt, because of well, I I don't know. I I didn't want to get too negative today on healthcare, but I I I heard the the lie for 20 years of just wait till value-based care is here, value-based this. We're gonna bring let us control everything, because once we do, we're gonna bring the cost down on all things. And you know how many times that's happened, Professor? Um, let's just do a history lesson here. All the MAs in the history of healthcare in the United States, of every single one of them, they all promise we are gonna, yep, we are gonna have supply chain power, we're gonna have purchasing power, we're gonna lower the cost. Yeah, I'll give the audience members a guess. How many times has that happened in the history of the United States? That's a bit fat zero. Um, and check me on this. Someone AI it and look, but it has never happened. Yeah. It's not gonna happen. It's not gonna happen. I heard a I I heard a I listened to a lot of podcasts, and I heard a podcast that when I I ran to listen to it because it was a it was a health insurance um executive. Yeah. And I actually knew the guy, and I thought, well, I can't wait to hear what they're saying about the current state of affairs. And there's this point in the podcast where he gets asked, what's the future? Yeah, what's the future of healthcare? I'm like, okay, here we go. And it was, well, you know, concierge medicines making like, and when you have someone from an industry saying that, I'm like, what the hell? That's mind-blowing. That's my blowing. At least they're admitting it. I mean uh this is interesting. Okay. So these insurance companies, a sneaky little trick. Again, you you know this. But you think about traditional insurance. You go out, you buy your insurance, your health insurance, it's a nice packaged product, you get it from your employer or whomever. And then there's also this self-funded pathway, right? Yeah. Guess who controls both pathways? Yeah. It's the same people. It's the same TPAs. I mean, you can look at the same people who run Cig. Cigna runs 87% of the TPAs in the United States of America. 87% of the TV. The third-party administrators for um uh insurance companies. Yeah. So you had T TPAs you'll hear, and PBMs, pharmacy benefit managers. Didn't exist before Obamacare. Obamacare came out and all this bureaucracy comes in, and then they convinced people that hey, let us control this because we're going to be able to control it better and bring down costs. Yeah. Never happened. No, uh to the tune of $81 billion. Um I mean, so if you if we think about um, you know, what these guys are doing just simply with things like 340B, if we really got talked on 340B, uh, we might need some Zofran because we could get pretty nauseated. So I didn't know what 340B was until I opened a pharmacy. I I I was the original owner of Portico Pharmacy. Oh uh we owned it for like three and a half years. I think I know who you sold it to. Lost a lot. Well, I I sold it to Charles. He I hired him and then we sold yeah, he's a great guy. But the point is, I thought, oh, hey, this is gonna be great, or by the hospital. And then I wait a minute, you can buy drugs at a fraction of the cost, and you can sell it at an outpatient pharmacy to people that aren't even your patients. Because why? Because they road at an Obamacare. I mean, it's the craziest like people like it is the some of the some of the legislation surrounding health care is the craziest thing you've ever seen. And now that everything's failing, it's the fact that the government needs to give more money because it's it's this you know, costs are so high. And I'm like, at what point does the American public not say, wait a minute, you're the ones that have been telling us all along you got this under control and you're gonna figure it out? And we keep dumping tens of I mean we I don't know what percentage of our GDP goes into it now, but it's it's insane. I'll tell you exactly 18 percent. Which is larger than the entire GDP of Germany, which is the third largest GDP on the planet. Yeah. Our healthcare spend is larger than the GDP of the third largest country on the planet. In fact, AFib is uh almost 1% of the GDP. One disease. Cardiology spend is three percent of the GDP, one organ. Uh and so you okay, okay, well let's put some numbers to it. Let's just figure let's just take 340B in and of itself. So for those aren't familiar, uh 340B is a program where um hospitals can purchase medications for critical access hospitals in order to provide care for rural areas. And they can basically do it at cost or or extremely discounted. But what these systems have done is if they have a critical access hospital anywhere in their system, they buy all these drugs and then they upcharge them to you, listener. They that's your chemotherapy, that's your rheumatoid arthritis. And the dirty little trick about this is they can absolutely do that. And they are catching all that margin, all that profit as a nonprofit. And the 340B that's right here in Meridian, outpatient pharmacy is not rural, not rural, not rural. So this is 81 billion dollars that the so okay, it's too expensive. Well, how about that 81 billion dollars? There that you're just charging uh patients, you're charging your patients, you're upcharging your patients. And then we wonder why costs are so high. Like it's just maddening. They s they're doing it. So this is it's working exactly how they set it up, right? I mean uh but because we can look at, you know, let's look at independence, let's look at an independent, let's look at an physician-owned hospital. So speaking of Obamacare, you can take any physician-owned hospital in the entire country and it its margins, its profit is quite quite good versus most hospitals, about 40% of the hospitals in America are operating uh in uh in the negative side. Yeah, 40% versus physician-owned hospitals where generally they can deliver care much less expensive, generally by half. Yeah um, but you can't do that. Why? Because that was out outlawed in Obama change. Do you remember? I will never forget. I had a really good friend that owned a surgery center. Yeah. When they that dirty trick of if you had a hospital ID number that you could assign to your billing, yeah, the second you had it, you could bill, like it was the same fee schedule, time seven. Yep. And I remember when he sold them and he called me, he's like, This is the craziest thing ever. I'm like, what? He's like, they bought me out for a number that I could never say no to. I get to work here on Monday, it goes from being independently physician-owned to hospital-owned. They're paying me way more than I made before, and they're all making seven times as much. And I remember thinking, are you kidding? Like, who, who, who behind the curtain? The Wizard of Oz behind the curtain's got to be saying, just because you can, you shouldn't, because this is gonna bankrupt the country and screw our patients. Thank you. You're right. And it doesn't no one ever said anything. No, I mean they're trying now. I mean, they're talking about site neutrality. Um and so, you know, site neutrality is uh lose that spread. So you currently, if you do an echocardiogram at a cardiology office off the hospital campus, they can charge you as if you were doing it in the hospital. And I'm just here to tell you that's about 10 or 15 times the echo. So normal echo is like 300 bucks, they'll charge you $3,000. Yeah, it's it's insane. And and pick pick the procedure. Pick a pick pick pick what it is. If it's hospital affiliated, you are getting charged. It's not what it costs. In fact, uh another rabbit hole. But if you ever a few years ago when we bought Salt Store, we tried our hardest to develop an app with some really smart guys that just gave a transparency tool to patients. And we had really smart guys that were out of medicine and they're like, we're gonna figure this out, we're gonna figure out how to pull this, and we're gonna we're gonna have you say, I need an echo, and I live in Meridian, Idaho, and it's gonna pull up what the cost of that echo is everywhere and what you're gonna get charged. I said, You won't give you won't be able to get it. They said, pull out, pull crap, we're figured out. Yeah, they gave up. Gave up. I that's unbelievable. They're like, there's so many, there's so many, uh they don't want you to know. And every time legislation comes out for transparency, it's got all these other veils of secrecy behind it, it never happens. There it's black boxed to some degree, these contracts like um I correct me if I'm wrong, but sometimes judges actually can't even unseal the contractual terms. And I'm no rocket surgeon, but let's just step back and say, is that really the way that should be working? I don't know. I'm not so sure. This went by way too
Where To Go Next And Goodbye
fast. Can you come back? Yeah, let's do that. We have so much more to talk about. I don't even think we got like item two. I don't even know. But the bottom line is for anyone listening, if you haven't if you haven't been somewhere modern, kind of the next version of medicine, let's prevent this stuff. High Desert Cardiology. There's the website, it's highdesertheart.com. Yep. These guys are all fantastic. There they are. I appreciate that. Hey look, it means a lot. Old Hinchman's got some gray hair now. I mean I I told him to hide mine. It's Costello doesn't look much older, but Hingman. David looks a lot older. You tell him that he's aged a little bit. I'm definitely gonna tell him, though his VO2 max might be the best for all of us. Uh he's a great guy. He's a great guy. He's a great guy. Hey Danny, thank you so much. This was awesome. I really appreciate it. Likewise, thanks. Thanks, everybody.