Episode 32: A Doctor’s Diagnostics & Research Lead a Myocardial Bridge Patient to “Unroofed” Progress.

SPEAKER_00 0:00

Having this done has allowed me to return to an aspect which I haven't had for a long time and just to be physically active.

SPEAKER_02 0:09

It's the most rewarding thing. That's why we do this. You know, the other hat that I wear is I put stents in people. And people often mistakenly assume that if you put a stent in somebody's blockage, that those are the most appreciative patients. But I will tell you hands down, when you give somebody a diagnosis after 10 years of suffering, it's it's really it's heartwarming to me because I obviously put a lot of effort into doing this testing and to expanding access to it. But David, people like you are the reason that we we do this. I'm lucky you do it.

SPEAKER_01 1:14

We'll talk with healthcare professionals, those in related fields that support our condition, and others just like us with stories of their myocardial bridge experiences. 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. This episode is our first ever where we've had the opportunity to have both doctor and patient present, and is also unique in that our doctor today is heading up a research project that's going to give us a perspective on many heart conditions, myocardial bridges included, that cause ischemia with no apparent coronary obstructions. We'll get into that more in the episode. Our doctor is Dr. Samit Shaw. He earned both his PhD and his MD at University of Illinois, did his residency at Yale New Haven Hospital in New Haven, Connecticut, and is currently assistant professor of cardiology at Yale School of Medicine. He has held various administrative positions and has received multiple honors and recognition, including the 30 in their 30s award from the Society for Cardiovascular Angiography and Intervention. He is also responsible for the Discover Inoka clinical trial currently underway and continuing through 2029. And for this, we are all going to be grateful. He's authored and co-authored numerous peer-reviewed articles and presentations, and is an expert guest for USA Today as well as several local broadcast stations. Our patient, David Treder, is a retired Connecticut state trooper where he had the privilege of working with a canine partner, a very special patrol dog who was cross-trained in search and rescue and human remains detection. David is an active 60-year-old married father of two adult boys. He was born and raised on the shoreline in southeastern Connecticut, where he still resides with his wife and German shepherd, Clover. He's physically active and certainly not one to be indoors. We appreciate your service, David. Now let's get this conversation rolling. Gentlemen, Dr. Shaw, David, welcome to Imperfect Heart.

SPEAKER_02 3:32

Jeff, thanks so much for having us today.

SPEAKER_01 3:34

Dr. Shaw, I'd like to start with you. You've pioneered a research program called Discover INOCA. And first, for the benefit of those who don't know what ENOCA is, would you walk us through that and tell us what the research is, what you're hoping to provide at the outcome?

SPEAKER_02 3:50

ENOCA is ischemia and non-obstructive coronary arteries. So it's a funny term. It's not one that many of us are used to hearing, but it's become increasingly used in medical literature. And now patients are starting to grasp this term as well. Enoka encompasses things like coronary microvascular dysfunction or microvascular disease, which has historically received the most attention. And then other disorders like myocardial bridging and coronary vasospasm that we know can cause symptoms in patients are also under the umbrella of enoka. When patients have chest pain or shortness of breath or symptoms that we think are indicative of heart disease, most people's minds automatically jump to plaque or cholesterol blockages in the blood vessels. But anybody who practices clinically can tell you that at least 50%, or not, if not more, patients will have ENOCA. They'll have the same symptoms, but they won't have plaque in their blood vessels. And so what we've designed at Yale is a research program that focuses on ENOCA and investigating these other disorders.

SPEAKER_01 4:51

Did David actually come to you through that program? Is that how you had him as a patient?

SPEAKER_02 4:57

David can tell us if it's true or not. I don't think so. I think he came to us through a clinical referral, which is really how we mostly focus.

SPEAKER_01 5:04

And David, before we go there, is Yale the only institution involved in this program?

SPEAKER_02 5:10

No. So we have a clinical program first. And I tell all of our patients who participate in research with us that our first goal is clinical care. And so we aim to make patients feel better and to live longer. From our clinical programs, we've developed a number of research programs, and they've been funded by a number of entities. Locally, we follow all of all of the patients who we do testing on because it's in the patient's best interest that we keep track of what's going on with them. And then from that local program that we have at Yale, we launched a research study called Discover ENOCA. Discover ENOCA is the first multi-center study in the United States to do formal physiologic testing in people with ENOCA. So we take patients who are referred to the CATH lab for a cardiac cathodization for clinical reasons. So a cardiologist who's caring for the patient says you have symptoms and I think you need a cardiac cathodization. And then every patient who gets enrolled in the study will get the same battery of testing. So we do a coronary angiogram to look at the blood vessels with contrast dye, and that's the standard procedure that almost anybody in the United States gets. But then up front, the participating centers will all do acetylcholine testing for vasospasm, wire-based testing for microvascular disease and for myocardial bridges, and then intravascular ultrasound or optical coherence tomography to further assess the blood vessels as well. So this allows us to formally diagnose microvascular disease, vasospasm, myocardial bridges, both on the angiogram and by intravascular imaging, which has never been done before, where we actually look both with an ultrasound at the inside on every patient, and then other disorders that are often overlooked. And so the centers that are participating right now, there's eight of them that are active, and we have a few more coming on. So Stanford University, and that's Jennifer Tremel, and then Christ Hospital, Tim Henry, NYU, Nat Smilowitz, Columbia University, Magar Pasad, New York Presbyterian, Brooklyn Methodist is Yuhei Kobayashi, Northeast Georgia Part Institute is Habib Samadi and Glenn Henry. And then Michael Savage at Thomas Jefferson. And so we'll have a few more sites added to that soon. But so far we've enrolled over 150 patients, and we're aiming to enroll 500 patients across the country.

SPEAKER_01 7:20

That's fantastic. And just to think that there could be a standardized protocol for this testing that is a gold standard, that if you use it, the likelihood is a better outcome, is something we so desperately need because so many people are functioning in the dark. And it's it's frustrating because we can even see that through the conversations we have with the program with patients and doctors who are going in and performing the surgery, sometimes successfully, sometimes not, without any provocative testing. Which is a it's frustrating and it's it's a disappointment. And while we're excited to know that doctors are accepting of the condition and they're actually working to relieve it, it's unfortunate to go that far, have the surgery, and then find out you missed something or didn't do it properly.

SPEAKER_02 8:04

Jeff, I I fully agree. And we so wholeheartedly share that that we share the entire protocol for Discover and Oka open access. And so that's published in the Journal of the Society for Angiography and Interventions, J Sky. But the entire study protocol is there. So if somebody at a center that's not participating in the study wants to do the same testing, it's easy. It's there step by step. Somebody can pick it up and do all the same testing that we're doing in the study.

SPEAKER_01 8:29

And while we're talking about it, you have a uh expectation for 500 in the program, 150 there. How does somebody apply or get involved in the program?

SPEAKER_02 8:38

The upfront way to get into the study is that it has to be a clinical indication. So we're not taking healthy volunteers or we're not taking people who want to donate to science, but patients who are symptomatic. And I, David, I can't even remember if you're an enrolled subject and discover an OCA. But basically, patients as they get referred in will be screened and then approached about participation in the study.

SPEAKER_01 8:59

And then if they want to get access to the application process, where do they go?

SPEAKER_02 9:03

They can reach out to me, they can contact me directly, and then we can route them either to the nearest center or answer any questions that they have.

SPEAKER_01 9:09

Okay, and we will have that application process or your information in the show notes for the episode. And just for the benefit of those who are listening, do you want to give me that address that you'd like them to go to, Dr. Shaw?

SPEAKER_02 9:20

You can use my Yale website address, Jeff, and I'll share that with you. Or actually, I think we have discover at Oka.org, which will link you to it as well.

SPEAKER_01 9:27

Excellent. Thank you. All right, so David, I'm gonna come back to you. Would you give us a brief recap? What led you to the realization you had a significant issue?

SPEAKER_00 9:36

Well, I guess the realization was the ambulance ride to the hospital. You know, I I was having multiple arrhythmias prior to going to the hospital. You know, I I ended up going to a couple walk-in clinics, and they were telling me that my heart was bouncing all over the place from too slow to too fast. And so I saw my cardiologist who put a halter monitor on me. And I had an episode where I kind of just keeled over and collapsed in a field I was working in. And with the halter monitor on it, I got a call from a doctor who said my heart rate was over 250 and that I needed to be in hospital. So that that that was the I think the final straw for me that I knew something significant was going on.

SPEAKER_01 10:22

I would say at a 250 beats per minute, that's something significant.

SPEAKER_00 10:26

Yeah. Yeah, it was it was interesting.

SPEAKER_01 10:29

So what was it that led you to the identification of the fact that you have or had a myocardial bridge?

SPEAKER_00 10:36

Well, for from from that episode, I went to the local hospital where they did some testing and they did a catheterization to me, and they were having problems finding a root cause, so they sent me to Yale where they did some more studies and they were gonna do a an ablation to me. And while I was waiting for the ablation, they asked me to do another stress test. So I lasted about three or four minutes doing uh a walking treadmill stress test, and I guess I failed that where they thought I had a significant blockage, but Ina had just been catheterized. It wasn't adding up, so I guess my electrophysiologist, Dr. Blitzer, said, you know, we need to go somewhere else, another direction, and he brought me to Dr. Shaw.

SPEAKER_01 11:25

Well, that was a good thing. That was fortuitous.

SPEAKER_00 11:28

Very fortuitous, yeah.

SPEAKER_01 11:30

So, Dr. Shaw, when David shows up, how did he present? What were you what were you seeing? What were you looking at? What were you thinking?

SPEAKER_02 11:37

So I remember this that we did a telehealth visit, and I I always ask patients the same question, which is how can I help? And I looked at David, and he's a very physically well-appearing person. He's a state trooper by trade and has been active his whole life. He told me that he likes to go fishing, but he can't even walk down the dock without getting chest pain or shortness of breath. And he had had a bunch of tests done already. I think when we we met, we recounted that he had already had a catheterization about 10 years before that. He'd had another stress test as part of a physical. And then, like he said recently, just before we had met, he'd had another catheterization on kind of an urgent basis. And I had reviewed all of that, and I I never liked to guess. And so I try not to say, okay, this is what I think it is, because I've learned after doing this a few hundred times that we're always wrong. And so what I told David is that we should thoroughly investigate what's going on. So I noticed that he had a myocardial bridge on his prior angiogram. It wasn't reported that way, but when you look at the images, you can see a segment that had a bridge. And so we brought him to the cat lab and we did our full diagnostic workup. So we did an angiogram. Again, he had a bridge that didn't look incredibly significant just on the on the surface. We tested him for vasospasm, which he didn't have, and then we tested him for microbascular disease, which he also didn't have. But then when we tested the bridge with doutamine, he progressively dropped the amount of blood flow getting to his heart. We reproduced the chest pain that he was having when he came in, and then his EKG looked like he was having a heart attack. David, do you remember being on the table and having that procedure? Absolutely. Yes. Did it feel like what you who had had been experiencing before we met?

SPEAKER_00 13:20

Yes. I remember you asking me questions through different phases of the test. And I recall explicitly there were times when it mirrored exactly what I was feeling at different times of this ordeal.

SPEAKER_02 13:38

When things are static, you you know, if you break your arm, it's broken no matter how you look at it. So you do an x-ray and and you don't really have to bend it a certain way to show it. With something like a myocardial bridge, like David has, it's only under certain circumstances. So he's out in a field, he's working, and he gets his heart rate 250 because he has an arrhythmia. That's a secondary problem with this. That's when it manifests itself. And so everything else that we're doing is artificial. We're trying to reproduce the circumstances that that David experiences these symptoms under. And so in the catheterization laboratory, we were able to actually put that together, reproduce what brought him in, and now we're able to tell a story of why he feels the way that he does and come up with a treatment plan to make him feel better.

SPEAKER_01 14:20

Is it possible that the AFib was a cause of the myocardial bridge?

SPEAKER_02 14:26

So we went back and forth with this a lot and in in a very collaborative way. I worked with his electrophysiologist, his general cardiologist, and then a cardiac surgeon who did the unroofing. And so it wasn't totally clear what was the chicken and what was the egg. So, for example, if we blunted his heart rate down to 70 beats per minute and he never went to 250 again, is the bridge a significant problem? We weren't sure. And so what we did is a course of anti-arrhythmic drug therapy to completely take out the arrhythmias. So he had had an ablation and then he was on now amioderone to prevent him from going back into AFib. David, how did you feel when we were doing all the medication changes?

SPEAKER_00 15:03

I know I struggled on the medications. You know, I I think it did control somewhat. It depended on what I was doing, what time it was. I mean, it didn't get rid of the chest pain completely. I don't think it totally got rid of the arrhythmias. That would be a question for Dr. Blitzer. I did I did have the permanently installed heart monitor, which I think was beneficial because I I think it allowed guys to see just what was going on on the medication. But no, I I still at times really struggled, and and I not only with the symptoms from this, but I think with the symptoms or side effects from the medication.

SPEAKER_02 15:41

You know, when we met, I had told you that our goal was to get you feeling at least 80% better than where you were before we met. And at that point, it had been a few months. We met in August of 2023, and I think by December we realized that we we basically had hit a wall. And so we didn't want to leave you there, and so that's when we put our huts together. And so your options were either another ablation for an arrhythmia or a referral for cardiac surgery, and then they could invade, you know, surgically do an ablation at the same time that they did an unroofing. And so I referred you to my friend and colleague, Dr. Roland Assey, who's a cardiac surgeon at Yale. David, what what did you think when you did your consultation with him?

SPEAKER_00 16:18

For me, it was I was pretty sure it was a direction I had to go. I mean, he was pretty straightforward that it may not answer all my problems or it may not fix, you know, he he was straightforward about that. He couldn't make me any promises that it was gonna fix me. I felt pretty certain he was the guy who wanted to do the procedure. I didn't question that. So there there was, even after that initial consultation, there was some doubt, but I I was pretty sure that that I needed to go that direction.

SPEAKER_02 16:49

Yeah, I agree. So when we were putting all this together and I was we had referred you to Roland, I looked at your CAT scan that you'd had for as part of your arrhythmia workup, and it shows this really deep myocardial bridge. It's over a centimeter deep. And I think it's hard to imagine that your heart could have functioned normally, especially with the symptoms that you were having without having that surgery done. And so we never want to send somebody for open heart surgery, but I think it it was a path forward for you that seemed medically appropriate and reasonable.

SPEAKER_01 17:20

Dr. Shaw, did David go through the current protocol to identify the depth and the length and the condition of the bridge?

SPEAKER_02 17:28

So David went through the routine clinical care that we provide, and then everything that goes into the our study is taken from there. It's a registry. So basically the data that we provide gets put into the study, but we didn't do anything special or different because he was put into a study. We just want to make sure that every patient gets a thorough workup and gets an answer. So that's why this is the what I call the Yale coronary physiology protocol is that this is what we do in the CAF lab for somebody like David who has unanswered chest pain. But then he's followed in the study because we want to know what happens to him in the lung.

SPEAKER_01 18:01

Sure. And David, when did you have your surgery?

SPEAKER_00 18:04

End of January of 23. 24.

SPEAKER_01 18:08

I think it was just just five months ago, right?

SPEAKER_00 18:10

Sorry, right, 24, 24, January 22nd of 24.

SPEAKER_01 18:14

There we go. My wife's birthday. I'll remember your surgical date. So we're about six and a half months out and six months out. How are you feeling?

SPEAKER_00 18:23

I can't describe it. Amazing. Amazing. I'm able to physically work out to a high level again, which I had not been able to do without really struggling. I mean, it's like someone opened up a drain plug after you know the the surgical issues went away, you know, the the chest pain and and the cramps I was having and the muscle spasms in my chest. I just recently finished up my cardiac rehab, which was phenomenal. I kind of was apprehensive at first before I did it, but haven't done it. It was reassuring the the people at Lawrence Memorial in that were phenomenal. And know that I wasn't having any issues was reassuring. And so I've continued to work out since being done. And you know, just go outside and and and work my dog or or run around with the dog and you know, get in the garden and do things that I was really struggling to do. Walk up and down my driveway and get the paper. I I stopped in three or four times. All that is gone. It's it's amazing. Forever in in debt to these guys for what they did.

SPEAKER_01 19:35

Post surgery, immediately post-surgery, did you notice something different? Were you able to identify that whatever those symptoms you were incurring prior seemed to have changed or dissipated? I and I'm talking, you know, in those first few days, maybe that first week, as you're starting to realize something's different.

SPEAKER_00 19:56

I know in the hospital I was they had me on an external pacemaker, you know, so uh it was hard to say initially right off the bat, and especially in ICU, but when I got home, I felt different. And I I guess I couldn't put my finger on it and say it was my heart, but that that has steadily increased. Just a feeling of well-being. I I feel so I feel so much better. It's so no, I when I came out of the surgery I had a hard time in ICU. I I would say no, I didn't feel any different then, but shortly thereafter, yes.

SPEAKER_01 20:32

And Dr. Shaw, knowing the significance of his bridge, any observations that you had post-surgery once he was unroofed?

SPEAKER_02 20:42

I'm so glad that he did cardiac rehab because people are apprehensive about what I call taking it for a test drive if they're doing it on their own. And so cardiac rehab is a great way for people to do it in a structured and monitored setting. And people don't really understand how good they're going to feel until they do that. And I think three months later, David can attest to the fact that having somebody push him on a regimented basis helped him really increase what he was able to do.

SPEAKER_01 21:07

Dr. Shaw, in terms of bridges themselves, there's a lot of conversation today about multiple bridges. Most of us are aware in our coronary LID, left anterior descending, that's that's the primary feeder. But there could be other roofed arteries in the heart that could be causing some semblance of ischemia. What's your position on diagnosing those properly and then treating them?

SPEAKER_02 21:34

Yeah, so part of this is normal anatomy. So for example, the proximal circumflex coronary artery is almost always covered by some muscle. And that's a normal part of biology. Whether it's causing symptoms or not, I think is where we need to make sure that if a patient comes to us that we do a thorough uh investigation. So somebody like David, who had persistent symptoms for 10 years, there were 10 years of opportunities there to figure out what was going on. So at some point we didn't have the technology. And you can say that because the tools didn't exist, we couldn't give him the right diagnosis. But at some point over those last 10 years, the technology did exist. And so at that point, it's an awareness problem. So either the bridges that he had or the bridge that he had wasn't recognized, or the people who were taking care of him, despite doing their best, it just wasn't on their radar. Even if you look at his catheterization report from last year, he had a catheterization in, I believe it was August before, right before we met. No obstructive plaque. There was no comment of a bridge, but it was clearly there. So there may be bridges in other blood vessels, but it's not clear if they're being, you know, if they're causing a problem. And that's why we have to use all the tools that we have to test them and to make sure that they're not causing a patient's problems. The other technology that we have, and and David benefited from this, is CAT scans. And so coronary CT angiograms, or in David's case, a CT angiogram of the chest, can show these really clearly in every blood vessel. And the benefit of a CAT scan instead of a catheterization is that it looks at the entire heart. So you can identify problems with any blood vessel. And so for David, what we did is we looked at, he had had a number of catheterizations. We did our physiology testing, and then we looked at his CAT scan, and we were able to put all of that information together to help him get the treatment that he needed. And so as a field, we need to move towards his cardiologist to make sure that every patient gets a really comprehensive workup. Because the majority of time when patients come back and say, I still have symptoms, it's not because they like our attention. We shouldn't be so vain to say people are coming because they want to see their cardiologist. You know, 90% of the patients that we see are coming because they have clear cardiac disease that just hasn't been diagnosed.

SPEAKER_01 23:39

The CT scan has has really become the non-invasive gold standard to identify bridging. And we still have a lot of cardiologists, surgeons out there that are apprehensive to accept the fact that these can cause symptoms, that that bridges do create symptoms in patients. What would you say to those that are still on the fence going, well, it's a bridge, it's benign, don't worry about it, it's something else, we'll try to find it.

SPEAKER_02 24:09

Prove it. I love it. Yeah. So for David, what we did is you could have said that. You could have said it's as arrhythmia as it's anything else. But what we did is we set out to prove it. We systematically tested for everything else. And then we tested the bridge and we bumped his heart rate up as high as we could get it. At some point he went into an SVT, which we had to break with IV adenosine. And we really wanted to replicate what he does at home to see if we can get the same symptoms. And that's what we were able to do, which helped us give him a diagnosis.

SPEAKER_01 24:36

Which just gets us back to that full provocative test to be 100% certain there is your proof.

SPEAKER_02 24:42

Right.

SPEAKER_01 24:43

David, when you were in in your cardiac rehab, and I know many patients don't go through the rehab, but it certainly is the ultimate confidence builder because you've got all this protection around you, as Dr. Shaw mentioned, you're now testing the performance of the heart with some s sense of security because you've got medical care around you in the event something should happen. When you first started, how did it feel? What were you thinking?

SPEAKER_00 25:09

I was apprehensive, you know. I mean, I felt good. I mean, like enough time had passed. It was you know two and a half months or so before I started after my procedure. So uh physically I was feeling ready to to try something. I was apprehensive at first, but once I got into it, uh I mean they started out pretty light, pretty slow. But w once, you know, af after the initial first two weeks or so and feeling pretty good, I I was able to start pushing myself on a daily basis, slowly ramping it up. I think I went from being apprehensive to really happy.

SPEAKER_01 25:45

And I know in the introduction we mentioned that you were a state trooper, canine division. You have a wonderful black shepherd at home called Clover. Did Clover notice anything different in David when he was coming around?

SPEAKER_00 26:00

I I think she she ignored me because she was hanging out with my wife for so long. But for me, she's therapy. And I give her credit because she kept me moving all the time, even when I didn't want to move. So now I'm able, you know, to get up in the morning at six o'clock and go out and throw the ball and do some rudimentary training with her and let her run around. And it was hard to do that before. And and I think she kind of accepted that and took what she got from me. But yeah, it, you know, just in a nutshell, I just it's just having this done has allowed me to return to an aspect which I haven't had for a long time, and just to be physically active. And yeah, it's it's hard to describe.

SPEAKER_01 26:50

And Dr. Shaw, I see you smiling there, but it's probably not common you have a patient on the line with a third party to actually hear their expression of appreciation and recovery that is just so significant from all of us after we've had the surgery. Is there anything else you'd like to add at this point?

SPEAKER_02 27:10

I just want to comment on that quickly and say that it's the most rewarding thing. That's why we do this. You know, the other hat that I wear is I put stents in people. And people, you know, often mistakenly assume that if you put a stent in somebody's blockage, that those are the most appreciative patients. But I will tell you, hands down, when you give somebody a diagnosis after 10 years of suffering, it's it's really it's heartwarming to me because I obviously put a lot of effort into doing this testing and to expanding access to it. But David, people like you are the reason that we we do this. I'm lucky you do it. So I just wanted to ask, what did people in your life think for the last 10 years? So you you tell somebody at home, I've I've been having this chest pain or shortness of breath, and then the cardiologist says, well, your catheterization was normal or your stress test was normal. What was that experience like?

SPEAKER_00 27:57

I think it gets frustrating, you know, and it because uh through my job, I was uh I exposed to Lyme disease and other aspects, and I knew I didn't feel right. And it just was a lot of questions, a lot of frustration. I know one of my primary care docs, he he went above and beyond trying to figure it out. And this is specifically after ten years ago when I had a negative stress test and immediately had a catheterization, and I said, Ah, it must have been a a mistake because your heart looks great. But yet I still went on to feeling short of breath was my biggest complaint. I mean, I would have bouts of chest pain, but I mean, even being sedentary, just going to bed, I would be struggling. And it got old. It was discouraging.

SPEAKER_02 28:46

That's a long time to go with that kind of defeat and to to feel that way. It's I think we've all kind of experienced things like this, whether it's your own body, you know, a family member, even taking your car to a shop or something like that, when you know that there's a problem and somebody keeps telling you, you know, everything's fine or we can't figure out what's going on. It's in addition to the symptoms and and the suffering, that's its own form of suffering when you really you know that there's a problem, but you can't find the answer.

SPEAKER_01 29:12

And so often, so unfortunately, that happens to many, many patients with myocardial bridges because everything looks fine. Everything appears fine until you get into deeper testing to really identify it. And I can't applaud you enough, Dr. Shaw, for the research that you're doing, because this is what will drive more cardiologists and a lot more surgeons to understand, oh, we just need to do this test because we can't seem to find what this patient's problem is. And I think in many cases, that may reveal a bridge. Hopefully it will, because then they've got at least a proper diagnosis and a place to go as opposed to the uncertainty, the unknown. And in many cases, just the fear of what's going to happen. If it's your heart, you you hurt and you know something's not right, and certainly you imagine the worst. What you're doing is just just incredible. David, I I thank you for your service as a as a state trooper, but more importantly, for the courage to come on and tell the story. You actually reached out and said, I'd I'd like to talk to you to share, because you were hearing stories from others on the podcast. And I know public speaking is not your favorite thing to do. So I I really, really appreciate the fact that you did that. So thank you so much for doing that. And and Dr. Shaw, the research that you're doing is so, so necessary, and it's going to prove so helpful. And I'm so excited that you've got other hospitals inclusive. And Dr. Tremel did my provocative testing. So I'm thrilled to see that she's involved with the research that you're doing in Discover Inoka. And I am really anxious to see this over the course of I I think you said it's a five-year program.

SPEAKER_02 30:50

Every patient, yeah, will be followed for five years. So we're going, we're continuing to enroll. So the patients that we enroll now will obviously be followed longer than the patients who, you know, who were in at the beginning. And so we'll go until at least 2029.

SPEAKER_01 31:03

Wonderful. I I cannot wait to see the the outcome of the procedures and the research and the transitions in lives that you're making for the people that are being treated. From the bottom of my imperfect heart, gentlemen, thank you so much for the opportunity to speak with you today. I I certainly appreciate it more than you know. And it is the first time we've had a doctor-patient conversation. And it's going to benefit so many people to hear the way that dialogue went because not everybody has a dialogue with their doctor like you two just demonstrated it should be. So thank you.

SPEAKER_02 31:39

Jeff, thanks so much for the opportunity. It's been an honor to be with you today.

SPEAKER_00 31:43

Yeah, thank you. Thank you. You know, the the podcast when I first found it, after Dr. Shaw gave me my initial diagnosis, answered some questions for me, and gave me a direction to look into other things, you know. But I I appreciate your service on what you're doing.

SPEAKER_02 31:59

David also used it to educate me. He actually shared it with me when he found it.

SPEAKER_00 32:02

He had sent me an email.

SPEAKER_01 32:04

I love it, David. The patient educating the doctor. That's that's not the normal way.

SPEAKER_00 32:09

I don't know if you could do it with many doctors, but Dr. Shaw seemed like he would be open to it.

SPEAKER_01 32:14

Gentlemen, thank you so much.

SPEAKER_00 32:16

All right, sir. Thank you.

SPEAKER_02 32:18

Thanks, Jeff. Thanks, David.

SPEAKER_01 32:20

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 My ImperfectHeart.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.