1 00:00:00,320 --> 00:00:03,919 Speaker 1: The content of this podcast is provided for general informational 2 00:00:03,960 --> 00:00:07,000 purposes only and is not intended as nor should it 3 00:00:07,040 --> 00:00:21,719 be considered a substitute for professional medical advice. Hello, this 4 00:00:21,800 --> 00:00:24,480 is Karen Nickel, family nurse practitioner, and you are listening 5 00:00:24,480 --> 00:00:27,280 to Itchy and Bitchy, a podcast that provides answers to 6 00:00:27,320 --> 00:00:32,439 your many unanswered health questions. I have some very exciting 7 00:00:32,520 --> 00:00:37,679 news to share with my wonderful listeners. For almost nine years, 8 00:00:37,920 --> 00:00:40,880 I have been the host of Itchy and Bitchy formally 9 00:00:40,960 --> 00:00:45,479 named Sweaty and pist. It is time for the podcast 10 00:00:45,560 --> 00:00:49,079 to grow and evolve with new hosts and a slightly 11 00:00:49,119 --> 00:00:52,880 different format. Growth and change is a good thing. People. 12 00:00:53,759 --> 00:00:57,679 My dear friends, Stephen Miller and Keith Millica will be 13 00:00:57,759 --> 00:01:01,840 the future hosts of Itchy and Bitchy. As hosts, they 14 00:01:01,920 --> 00:01:05,560 will have a comprehensive approach to wellness with a focus 15 00:01:05,599 --> 00:01:11,000 on connecting human health, animal health, and environmental health. To 16 00:01:11,079 --> 00:01:14,920 provide a transition period for you, for me, and for 17 00:01:15,000 --> 00:01:18,920 Stephen and Keith. We have a series of four episodes planned. 18 00:01:19,560 --> 00:01:23,640 I will introduce Stephen Miller, a fellow nurse practitioner, in 19 00:01:23,719 --> 00:01:27,519 the first of four episodes. In the next episode, I 20 00:01:27,519 --> 00:01:31,760 will introduce you to Keith Nilika, a veterinarian. The third 21 00:01:31,840 --> 00:01:35,200 episode will include all three of us as I interview 22 00:01:35,280 --> 00:01:38,599 both Stephen and Keith. All three of us will also 23 00:01:38,799 --> 00:01:41,560 be in the fourth episode, but this time the tables 24 00:01:41,599 --> 00:01:45,599 will be turned and Keith and Stephen will be interviewing me. 25 00:01:46,640 --> 00:01:49,840 I'm confident you will enjoy and learn from all that 26 00:01:49,879 --> 00:01:53,599 they have to share. Stephen Miller is an acute care 27 00:01:53,680 --> 00:01:58,120 nurse practitioner known for his expertise in diagnosing and treating 28 00:01:58,159 --> 00:02:03,519 cardiovascular disease. He is highly respected for his patient centered approach, 29 00:02:04,000 --> 00:02:09,120 consistently ensuring that each individual remains at the heart no 30 00:02:09,240 --> 00:02:14,039 pun intended of their care. Committed to excellence. Stephen earned 31 00:02:14,080 --> 00:02:19,280 his Doctor of Nursing Practice from Vanderbilt University, further strengthening 32 00:02:19,319 --> 00:02:25,439 his clinical knowledge and leadership in advanced nursing practice. Most importantly, 33 00:02:25,520 --> 00:02:28,639 from my point of view, anyway, we have been friends 34 00:02:28,680 --> 00:02:34,960 from about twenty five years. Welcome Stephen, High Care. Stephen 35 00:02:35,000 --> 00:02:38,439 and I are going to chat about something called Takatsubo 36 00:02:38,560 --> 00:02:42,879 cardiomyopathy because I suspect that many of you have not 37 00:02:43,080 --> 00:02:47,159 heard about this heart problem. So Stephen, let's first to 38 00:02:47,240 --> 00:02:49,680 find cardiomyopathy. Let's start there. 39 00:02:50,080 --> 00:02:55,919 Speaker 2: Yeah, so, cardiomyopathy is anything that decreases the function of 40 00:02:56,000 --> 00:02:59,479 mild cardial tissue and can lead to weakening of the 41 00:02:59,520 --> 00:03:05,199 lift and or later more severely congestive heart failure types 42 00:03:05,240 --> 00:03:05,759 of symptoms. 43 00:03:05,960 --> 00:03:10,639 Speaker 1: Yeah, not good. So what about Takatsubo cardiomopy? What makes 44 00:03:10,680 --> 00:03:12,319 that different? What is it? Yeah? 45 00:03:12,319 --> 00:03:16,919 Speaker 2: So, Tukatsubo is an interesting syndrome. It is otherwise also 46 00:03:17,039 --> 00:03:22,120 known as broken heart syndrome. It is this temporary condition 47 00:03:22,840 --> 00:03:27,439 that is triggered by intense emotional or physical stress. It 48 00:03:28,039 --> 00:03:32,960 mimics something that we call acute coronary syndrome, which can 49 00:03:33,039 --> 00:03:37,560 come with obstructive coronary artery disease. However, the difference for 50 00:03:37,639 --> 00:03:42,240 Tucketsubo is that there is no obstructive coronary artery disease 51 00:03:42,319 --> 00:03:46,080 or blockage in the arteries as the cause for this 52 00:03:46,159 --> 00:03:47,240 particular event. 53 00:03:47,560 --> 00:03:51,479 Speaker 1: It's so interesting. So what are the likely symptoms of 54 00:03:52,280 --> 00:03:53,840 this problem? 55 00:03:53,919 --> 00:04:02,319 Speaker 2: Most women will experience an intense emotional or intense psychological 56 00:04:02,400 --> 00:04:04,599 stressor that triggers the events and. 57 00:04:04,520 --> 00:04:07,680 Speaker 1: It presents a lot of women have those, by the way. 58 00:04:07,560 --> 00:04:13,240 Speaker 2: Yes they too, and they present with what would be 59 00:04:13,319 --> 00:04:17,399 like a typical heart attack, so coming in with chest 60 00:04:17,519 --> 00:04:21,279 pain or unusual shortness of breath. Of course, you always 61 00:04:21,279 --> 00:04:24,079 have to remember in women's symptoms are also atypical, so 62 00:04:24,120 --> 00:04:27,279 a lot of those symptoms can present as jaw pain 63 00:04:27,399 --> 00:04:32,319 or back pain. So some atypical and typical symptoms generally 64 00:04:32,639 --> 00:04:35,759 examples of triggers for women for these events would be 65 00:04:35,879 --> 00:04:39,279 some intense event like the death of a family member 66 00:04:39,399 --> 00:04:45,519 or loved one, and acute illness, a surgery, stroke, and 67 00:04:45,639 --> 00:04:48,759 sometimes other severe psychological stressors. 68 00:04:48,800 --> 00:04:52,399 Speaker 1: So, yeah, I had a patient with Takatsubo and she 69 00:04:52,519 --> 00:04:57,079 was in a very difficult relationship. She was really struggling 70 00:04:57,120 --> 00:05:01,519 on how to make this relationship work, and the stress 71 00:05:01,600 --> 00:05:06,360 was so immense that she ended up with Tukatsubo cardiom 72 00:05:06,360 --> 00:05:07,800 my alpathy. Yeah. 73 00:05:08,160 --> 00:05:10,639 Speaker 2: Yeah, I've seen a number of cases over the twenty 74 00:05:10,680 --> 00:05:15,519 six years of practice in cardiology, and all with different 75 00:05:15,639 --> 00:05:22,240 presentation situations. I have one patient who experienced her husband 76 00:05:22,839 --> 00:05:27,560 injured himself and she had an episode right there in 77 00:05:27,639 --> 00:05:33,040 her yard during his event, And so you know, it 78 00:05:33,079 --> 00:05:36,040 can be. It's real, and the symptoms are real, and 79 00:05:36,160 --> 00:05:40,480 the and oregon effects of it are very real. It's interesting. 80 00:05:40,600 --> 00:05:46,759 Has a funny little name. Tucketsubo is something that is 81 00:05:46,920 --> 00:05:50,120 named after the octopus strap. 82 00:05:50,600 --> 00:05:53,519 Speaker 1: So something that catches octopus. 83 00:05:53,800 --> 00:05:59,720 Speaker 2: Yes, that's right. So when we look at echo cardiograms 84 00:05:59,720 --> 00:06:04,160 and herzations for women who have tacosuba or men more 85 00:06:04,240 --> 00:06:08,399 rarely men, you see this classic sort of ballooning of 86 00:06:08,439 --> 00:06:11,480 the apex or bottom part of the heart, and so 87 00:06:11,560 --> 00:06:13,680 you get this sort of narrow neck at the top 88 00:06:13,759 --> 00:06:17,480 and ballooning of the ventricle. And that's where it essentially 89 00:06:17,480 --> 00:06:19,560 gets its name from it and it's very typical and 90 00:06:20,759 --> 00:06:24,480 very classic presentation. And once you see it on echo 91 00:06:24,639 --> 00:06:26,920 or cardiac cathization, you know exactly what. 92 00:06:27,040 --> 00:06:30,879 Speaker 1: It's pretty clear on that imaging that that's what's going on. Yeah, 93 00:06:31,000 --> 00:06:34,560 oh good. Are there certain people who tend to get 94 00:06:34,560 --> 00:06:38,120 this or have greater risk of developing takatsubo. Yeah. 95 00:06:38,319 --> 00:06:41,120 Speaker 2: Ninety percent of the cases are women or female people, 96 00:06:41,800 --> 00:06:46,279 particularly among postmenopausal women, as there is a strong trigger 97 00:06:46,319 --> 00:06:50,639 from the hormonal shift that happens at menopause and declines 98 00:06:50,639 --> 00:06:53,920 in estrogen levels around the age of fifty five, risk 99 00:06:54,000 --> 00:06:56,759 goes up. And honestly, the majority of the cases that 100 00:06:56,839 --> 00:06:58,839 I've seen over the years have been women in that 101 00:06:58,920 --> 00:07:03,000 age group. There are also other sort of pre existing 102 00:07:03,120 --> 00:07:07,439 conditions that can set someone up for having tucketsubas, so 103 00:07:07,519 --> 00:07:13,480 like neurologic conditions, stroke, epilepsy, and then of course anxiety 104 00:07:13,519 --> 00:07:17,399 and depression, and who doesn't have anxiety and depression, so 105 00:07:18,240 --> 00:07:19,000 lots of people. 106 00:07:19,360 --> 00:07:23,920 Speaker 1: It's really quite incredible and interesting that we now know 107 00:07:24,120 --> 00:07:28,160 that estrogen is so heart protective and the lack of 108 00:07:28,279 --> 00:07:32,879 estrogen is part of the reason women experience this way, 109 00:07:32,879 --> 00:07:34,160 way way more than men. 110 00:07:34,639 --> 00:07:38,639 Speaker 2: Sure, and when you take that into account for the 111 00:07:38,680 --> 00:07:42,959 fact that during these events you get this intense surge 112 00:07:43,560 --> 00:07:47,360 of fight or flight response, and so all of that 113 00:07:47,480 --> 00:07:50,959 ramps up and causes this intense vase of constriction in 114 00:07:51,000 --> 00:07:54,519 the coronary arteries and subsequent lack of blood supply to 115 00:07:54,560 --> 00:07:58,480 the malcardium or heart muscle. So catecholamines are not our 116 00:07:58,519 --> 00:07:59,720 friend in this situation. 117 00:08:00,720 --> 00:08:04,560 Speaker 1: Gotcha, We're going to take a quick break, and after 118 00:08:04,600 --> 00:08:08,319 this break we will talk about who is the likeliest 119 00:08:08,399 --> 00:08:12,480 person to come up with the Takatsubo cardiomyopathy. We'll be 120 00:08:12,639 --> 00:08:29,959 right back. Welcome back. So you mentioned a couple of 121 00:08:30,040 --> 00:08:34,000 other things that put people at risk, but are there 122 00:08:34,039 --> 00:08:36,840 other events that could trigger takatsubo. 123 00:08:37,720 --> 00:08:41,919 Speaker 2: Oh yeah, yeah, so you look at sometimes surgical events, 124 00:08:41,960 --> 00:08:47,039 people can have intense catecholamine released during surgery. Of course, 125 00:08:47,120 --> 00:08:51,039 the death of a loved one, relationship breakups, which large 126 00:08:51,080 --> 00:08:54,240 percentage of people go through divorce in the middle age 127 00:08:54,279 --> 00:08:57,360 of a life. I've seen a number of cases in 128 00:08:57,480 --> 00:09:02,639 our office of people who had were having intense arguments 129 00:09:02,679 --> 00:09:05,639 with a loved one, a husband, or a family member. 130 00:09:06,200 --> 00:09:10,279 And then of course intense fear can set off these 131 00:09:10,320 --> 00:09:15,320 events of this surge of ctcola means or ctcolam mediated 132 00:09:15,480 --> 00:09:17,080 events that people get. 133 00:09:17,360 --> 00:09:20,600 Speaker 1: So so like if you were hiking and a bear 134 00:09:20,679 --> 00:09:23,440 started running down the trail right at you and you 135 00:09:23,559 --> 00:09:24,759 manage to survive. 136 00:09:24,399 --> 00:09:25,360 Speaker 2: It the bear. 137 00:09:25,559 --> 00:09:28,919 Speaker 1: Yeah, yeah, if you survive the bear, the fear from 138 00:09:28,960 --> 00:09:31,399 that experience could trigger this. Yeah. 139 00:09:31,519 --> 00:09:34,679 Speaker 2: Or if your husband were a bear, well, if. 140 00:09:34,639 --> 00:09:38,519 Speaker 1: You're marrying a bear, that's a little weird, but hey, 141 00:09:39,120 --> 00:09:43,000 but hey, to each his out. It happens. So you 142 00:09:43,120 --> 00:09:48,879 mentioned the echo cardiogram or angiogram that there's clear physical 143 00:09:48,919 --> 00:09:52,960 findings to help confirm your suspicion of takatsuba. Are there 144 00:09:52,960 --> 00:09:55,000 any blood tests that you do for that? 145 00:09:55,519 --> 00:09:58,600 Speaker 2: Yeah, So when someone presents. Say, for example, they come 146 00:09:58,600 --> 00:10:02,120 in the emergency room and they have the presentation of 147 00:10:02,879 --> 00:10:06,600 angina a Q cornary syndrome type of thing. We run 148 00:10:06,639 --> 00:10:10,240 an EKG. So a basic EKG can show some ST 149 00:10:10,399 --> 00:10:15,360 segment elevation or depression depending on where they are. Additionally, 150 00:10:15,679 --> 00:10:20,279 you would get now high sensitivity traponents or troponin levels, 151 00:10:20,279 --> 00:10:25,399 which often are elevated and not always peaked like they 152 00:10:25,480 --> 00:10:29,320 might be with an acute occlusion of an artery, because 153 00:10:29,360 --> 00:10:33,919 you have to remember this a transient occlusion. Back to 154 00:10:34,000 --> 00:10:38,759 EKG again, we see ST segment elevation, ST segment depression, 155 00:10:38,759 --> 00:10:42,919 T wave inversion, and even QT prolongation. So all of that, 156 00:10:43,159 --> 00:10:46,440 putting that in English, just EKG changes that might show. 157 00:10:46,320 --> 00:10:48,360 Speaker 1: Up that are typical for this problem. 158 00:10:48,440 --> 00:10:52,919 Speaker 2: Pretty typical. Yeah, And then once level of suspicion is 159 00:10:53,039 --> 00:10:58,639 high and screening testing is indicative, then you would move 160 00:10:58,679 --> 00:11:03,720 on to something like a heart catherization and or echo cardiogram. Generally, 161 00:11:04,120 --> 00:11:07,879 in this situation we would end up doing both. The 162 00:11:08,360 --> 00:11:14,000 cardiac catheterization is particularly helpful because it helps us to 163 00:11:14,080 --> 00:11:17,360 diagnose coronary disease or flow limiting. 164 00:11:17,559 --> 00:11:19,960 Speaker 1: Rolling out that part that's right. 165 00:11:20,080 --> 00:11:24,120 Speaker 2: Ideally and in Takatsubo, you would not see necessarily flow 166 00:11:24,200 --> 00:11:27,480 limiting coronary disease. And then we also do what it's 167 00:11:27,480 --> 00:11:31,360 called l V or left ventricula gram shoot die into 168 00:11:31,399 --> 00:11:33,919 the left centrical and that's where we would see that 169 00:11:34,039 --> 00:11:37,399 ballooning of the apex of the left fentricle. 170 00:11:37,679 --> 00:11:44,960 Speaker 1: Interesting, So, say someone gets diagnosed with Takatsubo cardiomyopathy, is 171 00:11:45,000 --> 00:11:48,279 there hope, what is the treatment for the condition. 172 00:11:48,759 --> 00:11:51,240 Speaker 2: When the blood flow to the heart is temporarily blocked 173 00:11:51,240 --> 00:11:53,960 and a patient has an event and then you see 174 00:11:53,960 --> 00:11:57,759 some weakening of the left fentricle and you don't see 175 00:11:58,360 --> 00:12:01,759 any flow limiting disease and you've determined it's a takatsubo. 176 00:12:02,200 --> 00:12:06,919 The prognosis is really quite excellent because with medical therapy 177 00:12:07,960 --> 00:12:12,879 then you can see significant improvements. So prognosis is excellent. 178 00:12:13,279 --> 00:12:17,600 Outcomes bad outcomes are pretty rare. It's about a mortality 179 00:12:17,679 --> 00:12:20,120 rate of about one percent to three point two percent, 180 00:12:20,559 --> 00:12:24,159 and that includes you know, things like life they're threatening, 181 00:12:24,159 --> 00:12:27,600 a arrhythmias and that kind of thing. 182 00:12:27,559 --> 00:12:29,519 Speaker 1: And that might happen because the heart's baggy. 183 00:12:30,080 --> 00:12:34,200 Speaker 2: It's it's boggy, and it's not pumping efficient right right, 184 00:12:34,200 --> 00:12:39,679 and so when we help people through the acute phase 185 00:12:39,679 --> 00:12:42,799 of takasuba with medications, and we give medicines to help 186 00:12:42,840 --> 00:12:46,200 decrease the work of the left ventricle and medications that 187 00:12:46,360 --> 00:12:50,639 help improve ventricular remodeling, then we start to see the 188 00:12:50,759 --> 00:12:52,639 heart go back to its normal shape. 189 00:12:52,679 --> 00:12:55,720 Speaker 1: And so what kind of medications are those? What typically 190 00:12:55,919 --> 00:12:56,799 would you start? 191 00:12:57,080 --> 00:13:02,120 Speaker 2: So it's interesting there are treatments considered to be supportive 192 00:13:02,600 --> 00:13:05,600 because certainly in this situation you would not do any 193 00:13:05,679 --> 00:13:07,799 kind of intervention. You wouldn't need to do intervention as 194 00:13:07,840 --> 00:13:11,879 far as stints or angioplasti or anything like that. But 195 00:13:13,279 --> 00:13:18,720 treatment is tailored to what we call hemodynamic phenotype or 196 00:13:18,799 --> 00:13:23,720 an English basically the person's hemodynamic presentation and what their 197 00:13:23,759 --> 00:13:26,799 body can tolerate. As far as adding on GDMT or 198 00:13:26,879 --> 00:13:32,159 guideline or directed therapy, there are no guidelines currently because 199 00:13:32,159 --> 00:13:36,840 there aren't any randomized controlled trials looking at standards of 200 00:13:36,919 --> 00:13:37,879 care for these patients. 201 00:13:38,200 --> 00:13:39,799 Speaker 1: Maybe because it's mostly women. 202 00:13:40,840 --> 00:13:42,480 Speaker 2: You know, one can only. 203 00:13:42,799 --> 00:13:46,799 Speaker 1: But listen my listeners hear me say this all the time. Now, Yeah, 204 00:13:46,799 --> 00:13:51,080 that didn't get studied because it's a women problem. 205 00:13:52,039 --> 00:13:55,639 Speaker 2: So yes, the truth of what you're saying is that 206 00:13:55,840 --> 00:14:02,720 historically when women are under represented in population studies, and 207 00:14:02,799 --> 00:14:07,000 so the data historically has been skewed to the male population. 208 00:14:07,480 --> 00:14:08,919 And that's very accurate. 209 00:14:09,480 --> 00:14:13,720 Speaker 1: But you would use medications you would use often in 210 00:14:13,799 --> 00:14:18,720 heart failure of other causes, so that like beta blockers and. 211 00:14:18,840 --> 00:14:22,360 Speaker 2: Yeah yeah, so things like data blockers like matopra law 212 00:14:22,559 --> 00:14:25,000 in which we would use in acute cornery center ace 213 00:14:25,039 --> 00:14:31,600 inhibitors ARBs. Those things are helpful. Definitely some type of 214 00:14:31,879 --> 00:14:37,159 aspirin and or plavix because clearly if that person had 215 00:14:37,200 --> 00:14:40,960 a tendency toward having a Takatsubo event, you would want 216 00:14:41,000 --> 00:14:45,120 to make sure they're protected moving forward. They don't need 217 00:14:45,200 --> 00:14:50,919 another insult. The interesting thing about that is that reoccurrence 218 00:14:51,000 --> 00:14:53,320 rates are actually pretty low, but they do happen. They're 219 00:14:53,320 --> 00:14:55,080 about one point five percent. 220 00:14:55,360 --> 00:14:59,200 Speaker 1: Yeah, so if somebody has this, they can feel it's 221 00:14:59,279 --> 00:15:02,159 terrible that it, but they can feel pretty good about 222 00:15:02,320 --> 00:15:07,600 regaining heart function, yes to normalish levels to normal. Yeah. 223 00:15:07,919 --> 00:15:11,200 Speaker 2: Yeah, So we repeat an echo cardiogram when they come back, 224 00:15:11,360 --> 00:15:15,120 and as a general rule, their ejection fractions improve and 225 00:15:15,200 --> 00:15:20,840 mil cardial function returns to normal. So and that usually 226 00:15:20,960 --> 00:15:23,559 happens somewhere between three to six weeks. 227 00:15:23,799 --> 00:15:27,679 Speaker 1: Oh, okay, the ejection fraction tells us how well the 228 00:15:27,960 --> 00:15:31,360 left ventricle, the bottom left chamber is squeezing. Yeah, so 229 00:15:31,399 --> 00:15:35,840 we're looking to see if they've regained the function that 230 00:15:36,120 --> 00:15:38,320 we want to see in that left. 231 00:15:38,320 --> 00:15:42,240 Speaker 2: Bottom Nay, yeah, that's absolutely correct. So the ejection fraction 232 00:15:42,360 --> 00:15:44,519 is the percent of blood pump from the left ventricle 233 00:15:44,559 --> 00:15:49,159 with each contraction, and it's normally somewhere between fifty to 234 00:15:49,200 --> 00:15:52,679 seventy percent, somewhere in that range. A lot of these 235 00:15:52,720 --> 00:15:56,279 people will see their ejection fractions during their event decline 236 00:15:56,360 --> 00:16:02,279 into the thirties twenties, but then with proper medication, then 237 00:16:02,320 --> 00:16:05,840 you can see those that ventricular recovery occur. 238 00:16:06,440 --> 00:16:11,639 Speaker 1: So it's hopeful for the people who experiences that they'll 239 00:16:11,799 --> 00:16:15,480 recover function pretty quickly and the chances of it happening 240 00:16:15,480 --> 00:16:21,559 again are pretty slim. Do you, ever, as a cardiology practitioner, 241 00:16:22,000 --> 00:16:26,159 do you send them for cognitive behavioral therapy or anything 242 00:16:26,200 --> 00:16:30,320 that would help avoid another event if an emotional stressor 243 00:16:30,440 --> 00:16:34,320 especially was one of the triggers for the event. 244 00:16:34,879 --> 00:16:40,120 Speaker 2: Yes, So a lot of people who have intense emotional 245 00:16:40,159 --> 00:16:47,360 reaction around events in life benefit may benefit from certain 246 00:16:47,879 --> 00:16:53,919 medications for their anxiety or you know, if they're bipolar 247 00:16:54,159 --> 00:16:59,679 or whatever underlying psychiatric issue is going on, and so 248 00:16:59,799 --> 00:17:02,919 it's a very good idea to get these people connected. 249 00:17:03,159 --> 00:17:07,920 I've actually historically given a couple of the patients treated 250 00:17:07,960 --> 00:17:13,200 them with SSRIs and there is a slim amount of 251 00:17:13,240 --> 00:17:19,599 evidence there serotonin reuptake inhibitors. So yes, behavior those. 252 00:17:19,480 --> 00:17:24,920 Speaker 1: Are things like prozac, pax paxel lexapro. Yeah, just for 253 00:17:24,960 --> 00:17:26,200 our listeners, Yeah. 254 00:17:25,880 --> 00:17:30,759 Speaker 2: That's right, and so yes, a good referral to mental 255 00:17:30,799 --> 00:17:35,640 health specialty is vital. Cardiac rehab is another really vital 256 00:17:35,720 --> 00:17:39,480 part of recovery. A lot of people when they have 257 00:17:39,640 --> 00:17:45,160 this event, feel utterly exhausted. So the heart deconditions really 258 00:17:45,319 --> 00:17:49,559 rapidly when you have an event, and people will notice 259 00:17:50,000 --> 00:17:54,119 unusual fatigue for weeks after, shortness of breath for weeks after, 260 00:17:54,880 --> 00:17:58,000 while the ventricle is recovering and their bodies are having 261 00:17:58,079 --> 00:18:01,759 get readjusted because they're now new medications on board with 262 00:18:01,759 --> 00:18:04,039 all kinds of side effects that they have to deal with. 263 00:18:04,480 --> 00:18:09,240 But certainly cardiac rehab is highly recommended for these folks. 264 00:18:09,400 --> 00:18:12,599 Speaker 1: Yeah, that's great. I just think this is a really 265 00:18:12,720 --> 00:18:16,519 interesting subject and one that I don't think gets talked 266 00:18:16,519 --> 00:18:19,880 about a lot, and so I appreciate you filling in 267 00:18:20,119 --> 00:18:23,400 all that information that most of us don't know. I 268 00:18:23,480 --> 00:18:27,000 really appreciate that. Is there anything you would like to 269 00:18:27,000 --> 00:18:29,880 share about who you are or what you hope to 270 00:18:29,920 --> 00:18:32,559 bring to the listening audience as a future host? 271 00:18:33,119 --> 00:18:37,160 Speaker 2: Yeah, I think this will be super fun and exciting. 272 00:18:37,400 --> 00:18:42,839 I'm definitely after twenty six years of practice, I've got 273 00:18:43,359 --> 00:18:47,519 lots of experience with all manner of people and on 274 00:18:47,599 --> 00:18:55,160 multiple levels. And I think the ability to bring that 275 00:18:55,640 --> 00:19:03,039 rich history of practice into conversation with people and present 276 00:19:03,440 --> 00:19:06,799 data in an appropriate way, that's another thing through my 277 00:19:07,240 --> 00:19:11,440 especially through my doctorate work. So we have studied that 278 00:19:11,599 --> 00:19:14,559 and God spent a lot of money and degrees learning 279 00:19:14,559 --> 00:19:17,400 how to gather up that data and present it in 280 00:19:17,400 --> 00:19:19,640 a way that people can understand. And so I think 281 00:19:19,680 --> 00:19:22,359 the ability to do that should be able to we 282 00:19:22,400 --> 00:19:24,599 should be able to enhance people well. 283 00:19:24,640 --> 00:19:28,000 Speaker 1: I think the listeners over the last almost nine years, 284 00:19:28,279 --> 00:19:32,160 I do talk about studies in most of my episodes. 285 00:19:32,200 --> 00:19:36,160 I don't go into pee values and all that, but 286 00:19:36,240 --> 00:19:39,720 I think it's helpful for people to know what's being studied, 287 00:19:39,759 --> 00:19:42,920 what the results were, you know, how many people were 288 00:19:42,920 --> 00:19:44,440 in the study, right, that kind. 289 00:19:44,319 --> 00:19:47,599 Speaker 2: Of thing, helping people tease through that's really important. 290 00:19:47,640 --> 00:19:48,559 Speaker 1: Yeah, I think so too. 291 00:19:48,759 --> 00:19:53,680 Speaker 2: And historically, you know, with women, the population of women 292 00:19:53,880 --> 00:20:00,200 in studies within medicine have been underrepresented, and so maybe 293 00:20:01,000 --> 00:20:05,319 we have missed the mark on finding pathways for women 294 00:20:05,359 --> 00:20:05,960 in healthcare. 295 00:20:06,079 --> 00:20:08,480 Speaker 1: Yeah. I mean the fact that ninety percent of the 296 00:20:08,519 --> 00:20:12,519 patients who experiences are women and we don't have information 297 00:20:12,680 --> 00:20:15,599 really on the best way to treat that and we're 298 00:20:15,640 --> 00:20:18,039 in twenty twenty six is sort of incredible. 299 00:20:18,119 --> 00:20:19,000 Speaker 2: There are no guidelines. 300 00:20:19,039 --> 00:20:23,400 Speaker 1: Yeah, yeah, that's yeah. Well, I won't go on my tirade. 301 00:20:24,079 --> 00:20:28,359 I promise all my listeners are going, oh, thank god. Well, 302 00:20:28,400 --> 00:20:31,039 I'm so glad you're here. I'm so glad Keith is 303 00:20:31,240 --> 00:20:34,480 going to be here with us. And I also want 304 00:20:34,519 --> 00:20:37,960 to point out that you're a musician and Keith is 305 00:20:38,000 --> 00:20:43,079 an artist, and so they you know, have similar experiences 306 00:20:43,079 --> 00:20:45,880 that I have as a musician. So they bring that 307 00:20:46,039 --> 00:20:48,799 to the table as well, which I think is a 308 00:20:48,839 --> 00:20:50,920 really good fit for this podcast. 309 00:20:51,319 --> 00:20:56,160 Speaker 2: Sometimes it takes an artistic mind to take something so 310 00:20:56,480 --> 00:21:00,000 technical and look at different ways of getting across to peace, 311 00:21:00,519 --> 00:21:05,960 and certainly music being so scientific, but yet so creative 312 00:21:06,039 --> 00:21:08,799 and colorful, and it taps into our right brain, and 313 00:21:08,839 --> 00:21:12,160 so it allows us the ability to extend beyond the 314 00:21:12,240 --> 00:21:15,039 sort of robotic care that I think people really just 315 00:21:15,119 --> 00:21:15,559 don't want. 316 00:21:15,960 --> 00:21:18,599 Speaker 1: We love our right brain, Yes, it love it. 317 00:21:19,240 --> 00:21:22,240 Speaker 2: I am working to preserve mine every day. I know 318 00:21:22,400 --> 00:21:25,440 it's important and a lessons saying all of that. 319 00:21:26,119 --> 00:21:31,359 Speaker 1: See, it's so good, Keith painting, painting, My gosh, it's 320 00:21:31,359 --> 00:21:35,039 so important. Right brain is so good, it is. Well, 321 00:21:35,079 --> 00:21:38,559 thank you so very much, Stephen. I'm excited that you're 322 00:21:38,599 --> 00:21:42,839 coming on board, and I appreciate your time and knowledge 323 00:21:43,039 --> 00:21:44,079 about Takatsubo. 324 00:21:44,440 --> 00:21:47,119 Speaker 2: Well, thank you, Karen. We love you very much and 325 00:21:47,960 --> 00:21:53,240 consider you family and we're so excited to do these 326 00:21:53,319 --> 00:21:56,000 next few episodes with you, and it'll be fun and 327 00:21:56,160 --> 00:22:00,359 continue to honor your work through this podcast to your listeners. 328 00:22:00,440 --> 00:22:04,319 I think that's a brain child of yours and we're 329 00:22:04,359 --> 00:22:06,160 just thrilled to be able to carry it forward. 330 00:22:06,359 --> 00:22:10,880 Speaker 1: I appreciate that very very much. I appreciate that well, 331 00:22:10,920 --> 00:22:14,160 MANI thanks to all of you out there for listening, 332 00:22:14,440 --> 00:22:17,720 and wherever you listen to this podcast, please leave a 333 00:22:17,759 --> 00:22:21,599 review and rate the podcast. Your reviews and ratings really 334 00:22:21,759 --> 00:22:25,200 do matter. Also, make sure you follow the show so 335 00:22:25,240 --> 00:22:30,000 that it will be automatically downloaded. That absolutely matters. I 336 00:22:30,079 --> 00:22:33,000 encourage you to visit our Facebook page imb Podcast, where 337 00:22:33,000 --> 00:22:34,880 you can give us a like or leave comments or 338 00:22:34,960 --> 00:22:39,119 questions for me. Our website is itchymbitchi dot com, where 339 00:22:39,119 --> 00:22:42,039 there are blogs with some of our subjects available for 340 00:22:42,160 --> 00:22:45,319 you to read. Thank you to Forrest winsl my son, 341 00:22:45,480 --> 00:22:47,680 our producer and composer of our theme music and the 342 00:22:47,720 --> 00:22:50,440 person who does all the behind the scenes work to 343 00:22:50,519 --> 00:22:54,200 make this podcast possible. Thank you so much, Forrest. And 344 00:22:54,319 --> 00:22:58,359 Forrest continues to thrive at Peabody Music Conservatory and is 345 00:22:58,440 --> 00:23:01,799 finishing up his final semester the Master's program, and he 346 00:23:01,920 --> 00:23:05,319 has informed us that he has been admitted to the 347 00:23:05,359 --> 00:23:09,640 Peabody Doctoral Program to receive a Doctor of Musical Arts 348 00:23:09,680 --> 00:23:12,960 in Composition. His dad and I are so so very 349 00:23:13,000 --> 00:23:17,000 happy for him. It's fun to see his immense musical 350 00:23:17,079 --> 00:23:20,759 talents recognized. If you want to listen to what he's creating, 351 00:23:20,839 --> 00:23:26,599 you can go to his website Forrestwinsle dot com. Remember 352 00:23:27,079 --> 00:23:37,319 that your health is in your hands.