Episode 31: What to Say to Your Primary Care Physician When You’re Experiencing Chest Pain.

SPEAKER_01 0:00

I think that's the thing about the knowledge and education, about knowing a myocardial bridge, that it doesn't commonly is not the person that you would suspect of having a cardiac condition that can be deadly. But you also have to reflect on the fact that it's congenital, meaning they've had this for a long time. Myocardial bridge is you've had that for a long time, now is just manifesting itself in a cardiac symptom that could be deadly.

SPEAKER_00 1:20

It's my intention for this content to inform, educate, entertain, and even motivate or inspire you in your personal journey on dealing with a myocardial bridge. Most importantly is to have you leave each episode with hope, knowing you're not alone and that what you're experiencing is real. All too often, we don't know where to go, where to start, or what to ask when we experience chest pain and know it's not the usual ache or something we've had before. We're likely scared. And in many cases, we may not even want to know. This episode is for those who've been experiencing chest pain, angina, shortness of breath, and radiating pain in the back, jaw, or arms. Or for somebody you may know who's got these symptoms but just doesn't want to go to the doctor. If you knew what to ask, how to speak with your doctor, how to be certain he or she knew what it was you were concerned about, it would be that much easier and more comfortable to start the dialogue. This episode, we're going to hear from Dr. Thomas Hopkins, known to his patients as Dr. Tom. He's a board-certified internal medicine physician at Hopkins MD in Roseville, California. He's been serving the medical needs of Californians since 1995, starting at a large multi-specialty practice before opening his current private practice. Patients often recognize him as the chief medical correspondent from the local Sacramento NBC affiliate TV station. Dr. Tom began his education in 1981 at the University of Denver in Colorado, graduated, and went on to attend the University of Colorado School of Medicine, where he earned his Doctor of Medicine degree in 1992. After graduating with honors, he stayed there for his residency in internal medicine. Dr. Tom is an active member of Sutter Independent Physicians, Hill Physicians, the American Medical Association, and the American Society of Bariatric Physicians. He offers aesthetic and obesity management services as well as primary care physician services and values the importance of looking and feeling one's best when it comes to wellness, focusing on future health and longevity and holistic well-being. I'll add that he's my primary care physician as well. You're going to learn a lot in this session, whether you're on the patient side or if you're a medical professional. Dr. Thomas Hopkins, welcome to Imperfect Heart.

SPEAKER_01 3:50

It's great to be here.

SPEAKER_00 3:52

So, Dr. Tom, and Dr. Tom OK as opposed to Dr. Hopkins?

SPEAKER_01 3:57

That's fine with me.

SPEAKER_00 3:58

Okay, great. You actually were studying to become a heart surgeon at one point before you became a primary care physician. Is that right?

SPEAKER_01 4:06

Yeah, that's correct. I mean, that's that long journey of going in medical school and being five years old and always knew that I was wanted to be a cardiac surgeon, and then things change along the way. And so I do internal medicine, but I still have a keen interest in the heart.

SPEAKER_00 4:21

Which I really appreciate because we're going to be talking about that today. And here we are, whatever number of years later that is, and in our prior conversation, our pre-interview conversation, you really weren't even aware of what a myocardial bridge was.

SPEAKER_01 4:36

That's correct. And you know, when you we had this conversation, when you mentioned that to me, I thought, oh gosh, I've heard of most everything, but this was something I wasn't familiar with. And of course, having my interest in cardiac and heart health. Um, it just so happened today. I was asking one of my newer colleagues who is just out of residency program, internal medicine, dealt with a lot of complicated cases of heart disease and whatnot. And I said, Hey, have you ever heard of a myocardial bridge? And he says, Nope, what is it? So again, there's a lot to be done about educating not only the patients, but also professionals about uh this condition.

SPEAKER_00 5:09

And and that really is the whole purpose of the podcast. And the reason I'm speaking with you today, full disclosure, you are my primary care physician, but you had a protocol in place, even though you didn't know in the specificity of what was my condition, you had a protocol for people who present with chest pain and maybe what we might call heart attack-like symptoms. And it's implemented in the practice. So without that, I don't know that we would have gotten to where we got to as quickly as we did. Would you walk us through what happens when somebody comes in and presents that way and says, I got this really strange pain. It's I think it feels like it's my heart. I'm not quite sure what it is. Walk us through for the benefit of not only the people who are just starting this journey with their PCPs or general practitioners, but for those who maybe have started but haven't gotten in the sequence of proper diagnosis.

SPEAKER_01 6:06

Thank you. That's a great point. I think that's a big thing about when we're talking about the significance of myocardial bridge and the education of the public and also the professionals that are dealing with this. So, you know, I think that what I like to tell my patients, and I as I tell even some of my colleagues, the younger people that come to the office about that I train, is when you think about chest pain in itself, I want them to envision every person that comes in, think about, let's just say if you look at this as a pen, and you took that pen or a needle and it pierced through the chest wall and came out the back of the chest wall. So the pen is through and through, like as if someone were a pen cushion. Chest pain can involve every place that the pen pierced, every layer of tissue. So when you look at chest pain, you don't think that just it's a heart pain. You don't think it just it's something else specifically, you know, it could be the GI tract, but you really think about all of those things. So encompassing the skin that it touches on the outside, the tissue that it goes through there, the lungs, the heart, the esophagus, the ribs, going all the way to the back, right? The aorta. There's so there's a lot of things that touch in that realm. So chest pain is a broad subject, it's a broad symptom. So the way to kind of look at you have to have a systematic kind of approach to figure out what's going on in the patient. And as I tell patients and I tell clinicians, young clinicians, the goal of that evaluation is to make sure you don't miss anything that is deadly. And even when you look at myocardial bridge, you're looking at a condition that can be deadly. So you add that to the list of the reason why you kind of want to get it right and have a system. It's the same thing with any kind of checklist of things that are crucial for airlines and all types of safety, it's just you want to have a chest checklist so you can try to pick it up because you know that these things do exist. So when I first I would say number one is you listen to the patient, hear their story to see if that helps you with where the pain is coming from. And I tell you, remember, you're talking about from skin to skin and everything in between and listen to what they say. Number one. Number two, you're looking at for that patient who's telling the story, you want to assess what are their risk factors for having whatever can for chest pain. And of course, any of those factors that are related to everywhere the pen touches, right? Do they have a rash that's causing this? Do they have a history, a family history of having heart disease or lung disease or malignancy? All those things are very important. So it's part of the listening and then knowing what are the risk factors they do, what are the behaviors they have, right? Are they a smoker? Are they sedentary? Do they have obesity? Do they use drugs or any type of drugs they shouldn't be using that could be causing that, right? Then you also have to understand about what are the mental aspects of it. And as you probably know, that when we sometimes go down a pathway, we don't know what's going on, we just say, oh, well, it could be stress and anxiety, but you really want to rule out all these other things. So that's two. Second is the risk factors. The third is really going to be in the terms of I think the risk factors, and it could be genetics involved with that. But third is in involves like behaviors. What are the people actually doing in their life that could be provocative, provoke a situation of chest pain? And then if you look at those things, keeping it very so the genetics and the behaviors are also those factors there, you're just trying to find out who's in front of you and what's the nature of the symptom that they're having. Remember, chest pain is a symptom, it's not a diagnosis. So it's just because it's chest pain, people will think, well, clinicians and patients narrow in that it's God, we're looking, it's for the heart. And you, in doing so, sometimes you can miss the other things, but in doing so, you can really kind of miss still things that are happening with the heart because you're just trying to rule out the other the main thing. Oh, is it a heart attack? And what does that mean? So thinking about that, I think for a clinician, it's listening, it's making sure, looking at the patient as an individual, what are their risk factors, you know, think about what are their behaviors and think about really what are the genetics that are involved for them. And I do that to that system. And then to try to find out, okay, once you do that, what are the next steps? Okay. So, Jeff, that's that's really where I would start from there.

SPEAKER_00 10:50

Well, and I really appreciate the fact that you're listening to the patient because so many of the people on the program and so many of the people on our Facebook page complain that nobody's listening to them. They're just shoving them into a space. And the the key one that you said is the stress and anxiety one, especially if it's a woman. You know, you're just stressed, you got the kids, you got everything else, your husband, the money, all that stuff. And and so often that's the worst situation because that becomes a diagnosis, and then it gets treated as if that's the case. And the next thing you know, they're taking all sorts of either pain relievers and muscle relaxants and antidepression medication, which is the furthest thing from what they need at this point. In terms of that process, let's it would be really hard given the amount of time that we've got to address all the nuances, you know, from obesity to diabetes to family history, et cetera. Let's just say you take an average person, somebody who's in reasonably good health, you know, middle age, let's say they're 45, 50 years old, and they come in and they present like this. Now you've assessed that they seem to be in pretty good shape. What would be the next steps that you would recommend to further appropriately diagnose if you start to even get the inkling of we want to rule out the heart? Because if it's the heart, we have a real issue.

SPEAKER_01 12:14

Right. So I would start with that. It's listening and all the other things I would say. Then I said, okay, what do you do next? If you kind of say, all right, I'm going to narrow in and focus on the heart and looking at that. Well, with a listing, you want to look at those things, those characteristics of what chest pain typically cardiac chest pain, the pattern of cardiac chest pain, to see if it's the chest pain is usually due to ischemia. That's why we have it. The the complainant chest or the medical term for chest pain that's related to heart is angina, or people say angina. So you're looking at that. If you feel that it could be cardiac and you want to kind of narrow that down further, there are some diagnostic things that you do. Now, one, everyone wants an EKG. I look at an EKG is a snapshot in time. If you're not having any chest pain at that moment, and you do that snapshot with an EKG, likelihood that you see anything abnormal for in terms of the etiology of chest pain is pretty small. Now, if that chest pain, you're not having it, but you have your heart, any rhythmia, the heartbeat is irregular, then that EKG may indicate something that is helpful in that moment, right? So that's the snapshot in time. So that doesn't mean that the condition is not present because the EKG is normal. In a lot of pain syndromes of chest pain, that EKG is going to be normal. So that's the snapshot study. If you look at the next step and say, okay, I think this paid this person in front of me has a cardiac etiology. I'm not sure, but I'm concerned to rule it out. Then you put them on a treadmill, a stress exercise stress test. That's more like the movie of the heart looking at it. So it's a dynamic test as opposed to a static test, like the porter Polaroid that you do with the EKG. So putting someone on a treadmill, having a run to see if anything triggers evidence of ischemia. And sometimes that may not indicate that anything is going up wrong. So you then would move to, say, let's do a much more dynamic type study where it is an echo, a stress echo. You give the put them on a treadmill, or you give them medication to stimulate the heart. So you're also doing two things. You're actually really looking at an EKG that continues to run, and you're looking at pictures to see what's going on with the echo and ultrasound to see if there's anything that's abnormal in the way the heart is moving that would indicate an ideology for chest pain. So those three things would be done. Now, the key thing is I'm a primary care physician, right? I don't have those things that are just right down the hall. So generally, the pathway, if you think that there's a suspicion of heart condition, is the referral to a cardiologist. And some of those things then you send to the cardiologist and hope that they're the ones who are going to be able to diagnose a cardiac etiology for chest pain. So that's the basic kind of pathway. Now, primary care physician like myself can order all of those tests that I mentioned before, or do an EKG in the office. I can order the stress test, the exercise stress test for like a stress echo. Those things can be done and have the patient come back. But of course, as a lot of folks have done, if you're doing that, there is a more likely a time delay. But it depends on how soon you can get them to a cardiologist, would probably be the ideal thing to do if you think that condition exists. But the most critical thing, if you think it's the heart and you're listening to the patient and you think it's critical, especially if they're having something acutely right now, you've got to get them to the ER. So that's kind of a basic pathway that way.

SPEAKER_00 16:14

And I appreciate that. That's so helpful because what happens is many times the patient gets in and they start down the wrong path because somebody's not listening appropriately, and they do everything. They're testing everything as opposed to the significance of what that condition is. And I think just now with the understanding that you've got, as a result of me, and I'm sure other patients that you're now going to recognize have maybe a myocardial bridge, that you might look a little bit differently. And I say that to the benefit of all the physicians that listen to the program, to just look through a different set of eyes than you've always looked at it, as opposed to this is the way we've always done it. Now we need to look at this a little bit differently. This thing is starting to present in a lot more cases. It's becoming more prevalent and more and more people are accepting it. But I also really appreciate the quick reference to a cardiologist, because so many times, again, every part of the upper chest is getting diagnosed when in fact time is of the essence. And you just don't know when something more significant could happen beyond the chest pain. And even in my case, because I presented healthy, it couldn't be the heart. I mean, I would be the first one to tell you it couldn't be the heart. You know, and I would have I was saying that it's it can't be my heart. Let's look at this. And if maybe it's gas, maybe it's esophageal, and so many things that we tried first until the last resort was well, get to a cardiologist. And you know, ironically, in my case, cardiologist appointment was on Friday and Thursday at in the morning, I had a heart attack. So and we couldn't have done it any faster. That was started on Monday, and it was just Friday of that week. So I went through your protocol and I understand it, and we were so close. Almost made it. But I had progressed so quickly, nobody would have expected that. So for the for the benefit of those people listening to this particular situation, that's a process in the doctor's office. Let's flip it the other way around. What's important for you to hear from the patient? So I'm the patient that's coming in, something's wrong. And I I know you people don't want to talk to you. They don't want to tell you something's wrong because they don't want to admit something's wrong. But it gets to that point where they have to say something because now it's becoming even debilitating. So they're gonna they're gonna fess up and they're gonna come in. What are the key questions that the patient should ask of the doctor, the key things that they should share that you need to hear to properly move them in the right direction?

SPEAKER_01 18:54

Well, I think it goes back to the list I mentioned before. It's gotta be a shared process, right? I'm listening for these things, the very same things that I'm listening for. I think the patient provides that information. So they really have to be forthcoming about, you know, just there's there's nothing to hide, right? They should just be able to put it on the table. What is the impact that this condition, these symptoms, this chest pain, is having on their quality of life. So they have to communicate, you know, their risk factors, their genetics, their behaviors, all of those things that I'm listening for, those are things I think they should provide for the physician. Because if the if they're not providing the right information, even when the doctor's listening, it could go down a pathway that will miss a critical diagnosis. So it's really about sharing and being comfortable sharing. And you know, even even to in the asking of the question, right off the bat, if you're concerned that it's your heart, because that's the concern of mine, it's always concern of the physician to say, what is that thing that could be deadly that they have, right? So it's also important for the patient to say, hey, could this be my heart? Or communicate, I am worried that this is my heart. It's okay to say that, and people should be comfortable with that. Now, if you as you educate yourself about certain conditions, even let's just say myocardial bridge, right? I think that's the value. Not only primary care physicians, but even some even specialists have in the past, they may have there may be specialists currently that have not heard about a myocardial bridge, cardiologists, or they haven't heard about it, or they think it's really less benign, it's congenital, it's so rare, therefore, I don't go looking for it, right? So it's like the analogy in in medical school, we would say if you hear hoof beats outside your door, you you think it's going to be more commonly, it's horses, because it's probably not a zebra, but depending upon where you're living, it could be a zebra, and you don't want to miss the zebra. So whether myocardial bridge is that zebra, you still have to open your eyes, open the window, and see what's out there, because then you want to be able to have that drive you to what you're going to do or what you need to do. But I think for a patient, it's really being, as there's listening, telling your story and then asking the question of the things that are most worrisome and bothersome to you. So is this my heart? Could this be my heart? Asking, Doc, well, what are the next steps that I need to take for this? Asking what could be done, even if it's something significant. Asking, asking the question, not so much telling, but asking the question, Doc, do you think I can get in to see a cardiologist? Right? Especially when you, you know, understanding that you're seeing your primary care physician, if they don't have an interest, they don't have a knowledge about this, then asking. So it's okay for a patient to say, hey, look, I want a referral to cardiologist, or ask, get just asking, and you think it's necessary to do additional testing. And it's not, it's not unreasonable that if this and you're telling the story, if this chest pain is interfering with your quality of life, that's urgent, that you can ask the question about being referred to a cardiologist and having a sense of projecting that this is urgent to you, so that you can at least let the doc know that it's something that worries you, that you want to be taken seriously, want to be heard, so that you can get that referral in the quickest fashion that you can. Like you said about the symptoms. We always symptoms end up helping us drive early detection or diagnosis, right? So without symptoms, we we in any disease state, without symptomatology, and that symptoms are lab evidence, you know, that that's the difference between earlier or early detection and and you know bad outcomes.

unknown 23:26

Right.

SPEAKER_01 23:26

Earlier is everything is early detection is the the key. You know, that's the you know, the prevention is you know, more than that, try to cure, try to fix something. Because if it's later in the game, or you never get a chance to fix it. So I was really intrigued about the autopsy studies, and autopsies are done that are people who die of what appearance is a sudden cardiac death, right? You say the person died to study cardiac death. And I have a friend who's a pathologist, uh forensic pathologist, if you will. But you know, looking at autopsy, like if someone dies of a heart attack, when they look at that autopsy, they go through and they can say, Yeah, hello, and they can die stick down. They say, Okay, that was caught at you know, there was occlusion of a major vessel, that's what caused it. But really, I'm looking at those autopsy studies to say when someone's looking again, it takes again with all these, it takes somebody looking to find it. Yeah, so if you're a pathologist, you're looking at the heart, you're looking around, and you're looking what they what they do, their thing, looking for where the areas of ischemia and everything. But if you and and they're very detailed to say, oh gosh, this is interesting. This is a bridge, it drops down there. This person has it. So I think that the part of the when you're looking at the research of that question about you know, not everybody has symptoms for a condition that can be deadly, you may only have one symptom, yeah, it's death.

SPEAKER_00 24:47

It's death. Oh, thank you. You're the first person that said that without me prompting it. That's that's what I'm trying to scream to say. Yeah, if you go to the cardiologist, you present something that looks odd and they can't figure it out, like, oh, you have a bridge. Okay, now go down that path, don't dismiss it, or vice versa. The cardiologist wants to do everything but the bridge, start with CT, which is the most identifiable, get the bridge out of the way and then go down the path of because you might see it right there and go, There's your problem.

SPEAKER_01 25:20

But yeah, sometimes people, and I think probably traditionally what I was reading about, people might see that. They saw that and said, Well, that doesn't seem like it would be a problem. Yep. But if you understand you did dig, you dug, man.

SPEAKER_00 25:32

That's good.

SPEAKER_01 25:33

And even as you understand the pathophysiology of what that means and the impact, it's it's very basic in a sense, it really is. But the most of the time, the heart is perfused during the relaxation phase, diastole, right? Of the heart. And that's where the heart gets all this nourishment. And when it doesn't get its nourishment, it acts out and has a pain syndrome, right? So when you have a bridge, you know, there's an impact of what it does there. It's not getting, you're not getting that feeling. The bridge is dysfunctional during the most pivotal part of the contraction in the heart. And that's then when it's relaxed. And so when you're not getting, and then when it squeezes, you're not getting perfusion through that that bridge because it's clamped down, it's squeezed like a hose. And then when it goes through, when it relaxes, it's not really relaxed, it doesn't relax just like that. It just takes some time, and then the next phase comes on, and and essentially you're having a non-functional artery that is at risk for causing arrhythmia or occlusion, both of which can cause a sudden cardiac death. But it's interesting if you don't really look at it and think about the pathophysiology, you can kind of miss and say, well, maybe that's not it, and you go look for something, you're looking for something else, even though you kind of identify the bridge. I think probably with this education, you're doing everything like that. And even for cardiologists, you know, in their journals to educate their specialists to go looking for it and say that this the good thing about this is fixable. It's treatable.

unknown 27:07

Yep.

SPEAKER_01 27:08

You know, not with meds, it's treatable but actually going in there and modifying and removing that, taking that bridge and you know, adjusting it, removing, removing the defect.

SPEAKER_00 27:17

Yep. Yep. Man, I I you did. You I'm I'm I'm thrilled at how deep you you went. And as people start to search, once you have that pain, that that something's wrong, most of us know it's serious. The majority, and that's why we don't want to talk to you. We don't want to find out and confirm that what we think is reality. So it's difficult. It really is hard. And I I appreciate that back and forth here because it's incumbent on the patient. If they want to change whatever is happening, this course of deterioration, they've got to be honest and they've got to be able to face the situation with the doctor regardless of what it is. Yes, maybe you're overweight and you haven't been taking care of yourself. It doesn't matter. That's you still have to address it and to push for that next referral to the cardiologist. And again, the conversation here, just opening this conversation to primary care physicians and general practitioners to say, just be aware of this condition. It presents like a heart attack, but it's very difficult to diagnose. So that patient keeps coming back, get them to a cardiologist. What happens once they've gone to the cardiologist then? How do you stay involved, or is it then just a handoff to the cardiologist for the patient's care to continue down the process of diagnosis?

SPEAKER_01 28:44

Great question. I think that's the most important thing. You know, for as a primary care physician, even though I have an interest in heartache health and heart health, like a lot of physicians probably do, and internal medicine, which I specialize in, it's I think the most critical thing is feedback. Letting the patient, inviting the patient to then give provide feedback of what went on with the visit. One, of course, I like to so I set a follow-up appointment. That is in a timely fashion. If I think something's really serious, and the heart all chest pain in itself is serious until proven that it's you know non-life threatening and it's non-cardiac or whichever. But I really want to arrange for follow-up, timely follow-up. So again, I like to give a game plan of I'm gonna refer the person to a cardiologist. I want to trade, if it's urgent, I want to get that person in to see the cardiologist as quickly as I possibly can. And then I want to provide a timeline of when I would like them to have follow-up. And that follow-up is going to be so I'll know what is going on in that event or interval. Keep in mind, you can always use the notes, referral notes, and things that you get back. But if unless you're on a common medical, electronic medical record, you may not get a phone call back to saying, here's what we're doing, here's the process. It is often that the patient tells you or calls you and gives you an update of what actually happened. So follow-up is very, very key in this process. It's important for to close that loop for the doctor and the patient to really figure out, make sure that there's a game plan. And it's also part of education. If you just merely send a patient off as a spec to a specialist for them to manage, for them to diagnose, if you don't have the follow-through, you miss on a great opportunity of educating yourself about what is going on. So I think a follow-up is very, very critical.

SPEAKER_00 30:49

And I'm smiling because I recall ours, you saw it on some common records because of the system. And you you reached out and called me and say, You said, what the hell is going on with you? Which we wouldn't have known had I not been in the care of the cardiologist, which you referred me to. As you think of this episode and this discussion to your peers, I think you've done a really good job of making it clear this cardiac condition could be fatal. And we are now getting more and more of the doctors saying directly that a myocardial bridge could cause sudden cardiac arrest. Some might obfuscate it a bit and say, well, it's not the bridge that causes it, it's the symptoms of the bridge that cause it, because it has some narrowing of an artery or it causes a blood flow loss to the heart. But ultimately the end result is the same. It could be catastrophic. As you think of the other peers that you've got out there, if you could say something to them in terms of a better way to address it. I think the zebra analogy was great, but maybe even more in a medical term to a doctor who's listening. What would you say about this myocardial bridge condition?

SPEAKER_01 32:03

Well, first of all, I think it's the education, letting it be aware that this is one, it, you know, having a myocardial bridge can be associated with, you know, fatal MIs, sudden cardiac deaths. Really, those are through causing an arrhythmia that can be fatal, knowing that it does exist, that it is not a benign condition, even though it's congenital and not common and considered rare, that now that we've identified that it does exist, and to being aware of it. So I think that that's the key thing. Education is the key thing. What doctors don't know, they don't know. So I would say that if I had to say when you look at the traditional things that my peers would think about chest pain, you know, a clogged artery, you know, poor health, poor diet, all of the traditional cardiac risk factors, I would say that consider the myocardial bridge that happens can happen in the person. Otherwise, you would not suspect a cardiac etiology, right? And that's the issue. People that are most commonly overlooked and could be overlooked, even like yourself, are the person who you are not suspecting that this is the case. The woman who, for example, how we kind of don't identify high-risk patients because we think, okay, it's a female, she's busy, she's got a lot of kids, she's running around busy. We think, ah, that's not the person who's gonna have a heart attack. Well, I think that's the thing about the knowledge and education, about knowing a myocardial bridge, that it doesn't commonly is not the person that you would suspect of having a cardiac condition that can be deadly. They're too healthy to have it. But you also have to reflect on the fact that it's congenital, meaning they've had this for a long time. Most of the other cardiac ideologies that cause sudden death are a result of something that has happened to build up, you know, and build up over time that may be habits related and associated with other conditions. Myocardial bridge is you've had that for a long time, now is just manifesting itself in a cardiac symptom that could be deadly. So I think it really just says, hey, even for cardiologists, I think probably every primary care physician, my peers in my condition, my position, had a patient who has a heart condition after they listened, after they've decided what to do, they made that referral. That's why I think that feedback loop is there. Because you still want to make sure that the person who you are referring to understands the clinical significance of having a myocardial bridge. It may be that's where the doc needs to get involved and say, hey, you know, hey, have you heard of a myocardial bridge? Ask me the question, could this be a myocardial bridge? Because if that's the case, and I know that you would ask this question, and you probably have had some many experts way above my pay grade know and about this condition, you know, through and through, is that ask if that's the possibility, making sure that the patient is getting the studies that are more likely to indicate this. Because some of the traditional things that I've talked about, they could be normal, but yet not indicate the myocardial bridge condition.

SPEAKER_00 35:28

I don't think you could have worded that any better. And and that's exactly what we're hoping to see come across. You know, as long as I've known you, you've been a staunch supporter of patient wellness. You represent some some great products, you have moved more and more, as patients have asked, into a holistic health situation where it's not just about meds. I mean, you you've walked the talk in in everything health-oriented. You've done radio shows, and and you are actually a host of a podcast now for the Hills Physicians Group for physicians. So you you you get the value of getting important messaging out. You know, I I know it's not a general consumption program, but what you're doing there is also so, so helpful because it educates docs. And I am sure that at some point in time you can get across a cardiologist, they'll come on the show and you can even touch a little bit on this particular condition. But you are absolutely considered a leader in the field, and you know what you're saying here is really going to get shared. I know from a variety of different perspectives, from the people who are listening who are going to say to their PCP, hey, here's a guy. This guy is a PCP, he's like you. I need to go down this path. Can you help me? It will ease their angst of getting in. So, you know, from that perspective, I really want to thank you for your time and you know your confidence and acknowledgement to say, hey, I don't know about these things either. Because we hold our doctors in such high esteem, we have to recognize that sometimes we need to be more communicative to them so they understand what it is you know we're experiencing. So as my primary care physician, I'm I'm blessed to have you and and your expertise and your team. I just I I really appreciate you. And so from the bottom of my imperfect heart, Dr. Tom, thank you.

SPEAKER_01 37:24

Thank you. I just think this is such great value. I mean, talk about something to be able to present this, share this with the public, share it with professionals to increase the awareness, the knowledge, the education about this condition and its impact on people's lives. I think it's valuable, valuable work that you're doing. And I appreciate that.

SPEAKER_00 37:46

Well, thank you again. Thank you for listening to Imperfect Heart. It's my hope that this information helped in some way to improve your situation or will help you better understand this condition. More importantly, that it gives you hope through stories that there is help and you most certainly are not alone. If you've been diagnosed with a myocardial bridge, please be sure to join the private Facebook group, Myocardial Bridge Support Group. For more information about our program or to reach me directly, visit the website myimperfectheart.com. If you like what you heard today, please give a positive review, thumbs up, high five, whatever your app likes. And be sure to share with everyone important to you so they understand what it is you're dealing with. Please subscribe as well. Welcome each day with gratitude and positivity. The views and opinions expressed in this program are solely those of the host and the guest and are not intended to provide, nor are they a suitable substitute for professional care by a doctor, therapist, mental health professional, or other qualified medical professional. Imperfect Heart is a production of Hear Me Now Studio.