46. Lessons Learned: Colin Zhu, Peter Valenzuela & Louisa Nicola

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Alright, back for another lesson learned. My man, Dr. Shansha. What's up, man? What's up? How are you, buddy? I'm doing well, man. I can't complain. I'm in clinic this month of Pimentar Clinic, so it's been nice, man. I mean, kind of putting everything together, you know what I mean? Like you see everything inpatient, but then you don't really understand the rehab side of things, your PGOI two years, so I don't understand that rehab side of things and connecting the dots. So it's been good. How about you? Right. It's really, I'm good, I'm good. No, but to your point, it's really about discharging, I'm seeing that really the deficits of functional, you know, deficits that they are appreciating in the context of their life and then how you can help navigate that for sure. Yeah. That's good. Good. A couple months left before big boy, big boy life, you know, so it's wild over that. It's been flying by. It's been a long road, a very, very long road, you know, and people don't appreciate that, but the training and learning doesn't stop though, right? Every single day. That's for sure. Sure, man. Yeah, it definitely will not. Real quick. I wanted to talk to you about athletic greens and element, man, because I actually, I just started element like last week and, you know, obviously these would be awesome sponsors for us, but we do really enjoy taking these. But what have you noticed with element at least is what I'm interested in, because we haven't talked about that. Yeah, so I, I'm still kind of, they've been very generous into letting us try the different types and stuff. And so I'm still just playing with the flavors and stuff like that. To be honest with you, I, oh man, this was hard, right? This is where my analytical type of personality wants objective measures, so I can really quantify, right, like the difference that you feel. But what I'll say is as simple as wanting to drink 16 ounces of water first thing in the morning. Yeah. Is that just that simple, you know, looking forward to it because the raspberry flavor is incredible and I'm just like, yeah, I'm going to have this, right? And it tastes good. I mean, you can definitely taste the salt a little bit. I mean, and so if you're not into that, like my, my better half, then you got to cut it a little bit, but just getting more hydration and I think that's awesome. What about you, man? Yeah, man. So I use it today. I'm fast and doing a 24 hour right now. Usually I'll get more like foggy in the head. And I realized, hey, it's probably because I mean Peter Tia talks about this, not we don't, we don't really account for how much salt and water we actually need when we fast. So I worked out today as well, and I think I've really honestly felt a difference just drinking it. I drink it again two days ago at the element packet and actually more sustained energy like throughout the afternoon drinking it. But again, we'll see. I mean, we got the fiesta pack and now I'm thinking about using it in some of my alcoholic beverages because it tastes so good. No, it's real quick to your point about food and the content of water within food. So important. This is one of the reasons why people say, oh, don't eat too close to bed, right? Because it'll make you, you know, it'll disrupt your sleep quality and it'll make you know, I don't know about the fat part of it. But one of the things is because if you're eating too close to bed because of the water content, you will often wake up in the night to go to the bathroom. If you go to the bathroom a bunch of times in the middle of the night, that's going to disrupt your sleep quality. And there's a decent correlation between poor sleep quality and excess calories. That's been documented. So it's an indirect way and people don't take that nuance approach. They just say, don't eat after a certain amount of time because you'll get fat because of a lot. The insulin piece of it probably isn't as well defined as this simple explanation, I think. Yeah. But that's a different discussion for a different different day for today, though, my friend. Sure. Dr. Collins, right, Peter Valenzuela and Lisa Nicole, all amazing guests, exciting, talked about some different topics, but of course, it all comes back to, you know, health approach of health rather than sick here. You flew solo with Dr. Collins, and how was that experience? It was cool. Yeah, it was really cool, right? Because him and my program director went to the same med school and so they know each other pretty well. And she was like, oh, you have to get this guy on your podcast, and I was like, you know what's funny? I've heard about this guy because he was actually on Heather Hammer sets podcast, and so that's how I kind of heard about him. But he does really interesting stuff, right? I mean, double board certified, right? So family medicine, lifestyle medicine, he's a diplomat for lifestyle medicine. So heavily involved in that. And he also does culinary medicine, right? I mean, this guy cooks and he is a legitimate chef that went to the Natural Gourmet Institute. So how he incorporates those things, I just find it to be pretty fascinating, right? And I think the biggest, you know, the best word I could describe Dr. Zoo is just unique. He's just a unique individual with his life experiences. And I think what's fascinating is that he's not afraid to showcase that, right? I think as positions, we tend to think in more so in a tribalism way almost, right? Like part of the herd. We don't really know how to set ourselves away from the pack, have our own individual identity. But he's really mastered that. And I think it's one of his biggest strengths and a reason why he's doing really well. Yeah, I think to his point about being unique, you know, what's interesting about him is I got the sense he has a very malleable, adaptable approach, right? It's very much like a good coach should have in, I think, both of our experience. You know, we keep coming back to this concept of when we're doing individual coaching, when we're trying to provide the best care for the patient in front of you. He talked about, again, meeting the person where they're at, right? And we've said that several times, right, on this show before. But like, what does that really mean, right? And he was extremely eloquent in the way that he answered your question. But I think to kind of dissect a little bit further for those, you know, it's really about evaluating what the person's background knowledge is, right? What their world view is, I think it's to paraphrase what he talked about. Really, what their perception around food is, what their perception around health is, you know, is the person really, really analytical, right? Maybe if there are, maybe calorie tracking is a viable approach for that person. If the person is extremely prone to anxiety and food, then they have this interesting relationship with food, you know, positive or negative, then maybe calorie tracking and that kind of stuff and that hyper-awareness of food isn't the best approach. Then maybe you just simply use the three words that he talked about, eat more plants, right? I really, really loved this nuance answer that he gave you. And I think that that's so important for our clinician friends to understand or really any healthcare practitioner who's working with people in the front lines and helping coach them. So many times we get burdened with the minutia and the details, which are important. I don't want to dismiss them, right? I mean, those are sexy, those are fun. We, you and I love focusing on that too, but I think when you take a step and you look at the bigger picture, you really got to be able to go whichever way. And it's really ultimately about helping the client and getting that person to, from point A to point B, not the way that you think is best, but that might work best for that person. Yeah, absolutely, right? I mean, I'm reading Changemaker right now, Dr. John Barardi, 10, 10, 10, 10 book, dude, thank you. Thank you so much for sending that over. I mean, it's fascinating. I think everyone should read it, even if you're not going into health and fitness, I think, you know, the principles in that book are fantastic, but he even talks about it, right? In the sense that you can have all the knowledge of the world, all the degrees, and you can talk scientific, you know, up the wazoo, but the person across the table from you probably doesn't, like, doesn't care how much you know, right? What they care about is, can you help me get to my goal and my emotions and my sentiment? And can you actually truly understand who I am as a person, right? And I think the opposite also, you know, as coaches, we have to understand that sometimes we need to keep it simplistic, right? So currently texting one of my kind of students, I guess, friends through Instagram, he's asking me about losing weight and all these things. And so often I notice him getting way too nuanced. Oh, I need a fast, but I also need to work out how long should I work out for? What should I exactly do? And I'm like, listen, man, like your biggest goal is keep it simple. Like you just need to lose weight. You don't need to get hyper optimized right now, right? And I think sometimes as coaches, we have to be aware of the patient's needs and exactly what fits the bill for them, even if they don't recognize what it is, you know? Yeah. And I think that one of the, you know, one of the things that the way he does that, right? So really about education. And I mean, that's part of the purpose of this, right? And when we asked him, or I wasn't there, you asked what his approach was with patients, you know, despite having, you know, drive, I think he has a book, he's got a podcast. And it's based around the foundations of the decision because that's his passion. That's he's got a pedigree with his family that comes from that. He answered this question that it's really about education, right? And how do you want to deliver it? Again, coming back to the concept of coaching, you know, what's the best way that it's going to work for that person at that time, right? Given those circumstances, the same person on a different day with a different phase of life could be completely different approach, but at that time, and it's really, and I love that. I mean, you talk about this all the time, you know, the word doctor literally means to educate, right? Or maybe don't teach him not really sure exactly how to do it, but we get the sense. The other thing, I think his worth noting is, you know, he mentioned that the bridge right between acquiring knowledge and instilling it into practice is often the healthcare practitioner, right? I mean, he mentioned that, you know, we're blessed to have people like him who kind of paved the pathway and it's easily accessible, right? ACLM, all these other practices that make it easier to have these conversations, to have this platform, whereas he didn't have that, right? It's a steeper hill to climb up, but it also reinforces the importance of leading it by example, something that, again, you're exceptional at on social media, right? You recently had an awesome post about accountability, right? Home of yourself accountable, holding other people accountable, and to do that publicly in front of patients to, you know, I mean, that says a lot, right about his approach. So that was awesome. Yeah, I mean, I love his wisdom and mindset, right? Even to the point where as coaches, it can get very frustrating when you don't see results, right? And oftentimes you can either blame your client or patient, or you can blame yourself. And, you know, he has this mindset of saying, listen, I'm here to guide you. I'm not going to force you to do anything, but in the end, this is your body, right? So it almost gives you that a little bit of space just to realize like, hey, in the end, just realize who the two people are, right? You can't intertwine both those, both your ideas, both your habits, whatever. It's two separate people, and you're there just to guide that person across from you. Yeah, I think ultimately, we're kind of talking about the same thing in terms of coaching, and I think that's what we're both most impressed by. And I think it resonated with me the most, as we've talked about both online and offline, that, you know, it's important to focus on the details of the mechanistic explanations and the science behind all these cool things of what supplement as ideal, what approach is the best, just kind of the anecdote you've just shared right now. But to me, the most potent way to become a changemaker, if you will, you know, it's about you know, being more effective rather than focusing on what the most efficient approach is from an efficient standpoint. And so, yeah, I mean, I think that's all I'll say about that one. Awesome. Cool. All right, then let's move on to the next episode. So this was with Dr. Peter Valenzuela, and essentially everything that was wrong with the healthcare system. So super relatable to a bunch of us, but then again, offer some solutions as well. But this was an awesome episode, man. I think this one actually went a little viral because of I put a post up on Instagram that reached a lot of people. And so I think a lot of people resonated with this. I think so. I think for the healthcare practitioner, they're really appreciated us lifting the curtain a little bit more. And I think we just scratched the surface to be completely honest with you. I think if you really want to dive a little bit deeper, cannot recommend his book enough. I finally started it. And it's pretty awesome. You've read it. You've talked about it. You know, I think that again, for those just giving light to the issues that we face, right, early manager retirement, there's a reason for that. The golden age of medicine from 40 years ago doesn't exist today. Here are a lot of reasons why. And, you know, and I think for those not on this side of the curtain, right, on backstage, they got to see what it's like. And they're like, oh crap, maybe it's not, it's all peaches, roaches, don't get me wrong. I mean, there are a lot of great things about it, right? But they're not so great things about it. And so hopefully people got a sense of appreciation of the struggles. And maybe next time, if you're a patient, you are, when you go and you see some of these things, you'll have insight, or why is my physician behaving this way? I think more often than not, doctors don't want to do some of the things. And it goes back to this concept I heard is unfortunately too many times the business of medicine drives a practice of medicine. And I really wish it wasn't that case, but it is, unfortunately. Yeah, even today, you know, I was sitting by the computer with a patient, my attendings in the room, and she's like, hey, just put an order in for like outpatient physical therapy with blah, blah, blah, blah. And I'm like, all right, I can do this first step. How do I do step two, three, four? And then she has like walk over to the computer, explain it to me, then it has to turn to the patient and say, you know what, I'm sorry, but like, this is the reality of medicine right now. I wish it wasn't like on computers and having to teach, you know, residents this. But you know, kind of kind of made fun of the process and said, you know, any day of the week, I would rather be writing all of this down and at least facing the patient. So yeah, it kind of goes to show, you know, how things have changed over the years. And for the worse, for the better, right, I think with EMR, it's a little more organized. You can actually read handwriting. But you know, I think scribing is one of those solutions at least when it comes to EMRs, right? And I'm a big proponent of having scribes for for hospital systems. I was a scribe in, you know, chop ED doing PZD. And it's a learning opportunity for somebody who's trying to go, you know, to medical school. But then it also just saves so much more time and efficiency for the provider that you're working with. So I really wish I had a scribe. Yeah, absolutely. I mean, and we definitely mentioned some things that are being done, have been done and potentially could be done, right, to augment the efficiency of care. And again, it all always starts about openly discussing issues. So speaking of calling out biases and things from before, I do want to call out that Darshan's audio sucks right now. And we do apologize for that. It does. But you know, hopefully, hopefully you guys are getting what you think is valuable from this. I shared a story on that. I want to give you an update. I shared a story about my struggle with insurance companies, right, where a preventive visit was built incorrectly, just because the coding was flipped, right? So an update on that. I actually, after we had that conversation, I was like, you know, let me just check in on this, you know, because I'm sure that I, it's, they tell me it's addressed, but let me just check in six months later. I called and I checked in and I tell them about, hey, XY and Z happened and they're catching up because I'm no longer with that insurance company at that employer and that kind of stuff. And the person that I talked to on the other side, he's like, oh, well, we have no records of any of this. Mind you, again, this was a nine month battle, right, a war, not even a battle. My gosh. And they're like, we have no records of this situation. No. And I was like, this is preposterous. And so of course, you escalate up the chain. You always escalate up the chain. That's an important activity, but I want to give people because sometimes the first person that you see, they are, I don't want to say incapable, but maybe they're not the best train or well equipped to be able to dig deeper into some of these things. And so you escalate up the situation when you have a struggle like this. But the most important thing that I want to tell people is when they have a struggle like this, a tactic is to keep diligent notes like a running word doc. So what I had done throughout the time is I had a word doc spoke to this person. I had by date and bullet point spoke to this person from this place, right? This is what we talked about this blah, blah, blah, blah, blah, blah. And so literally I told the person, I was like, no, no, no, this did happen. On this date, I spoke to this person, this happened this day. I gave her 18 dates and she was like, oh my god, I got to look into this. And she escalated up and then it was like, oh, you're right. I'm sorry. It was actually here and all the notes are right there. So at any time you have a conversation, I should say 99% of time with these types of insurance companies, they had their own internal notes. And you should take your own internal notes too. That would be my recommendation. Yeah. Because often people will, they'll offer, hey, would you like a reference number or a case number? Always take that down to. But remember that a reference number is not for the entire case. It's usually for that phone call only. So every phone call might have a different reference number. Yeah. So that was an important thing that people can be equipped with the tactic that hopefully will make their life a little bit easier to fight this struggle. You know who else gave that tip? Man, I forgot the guy's name, but he was on all the hacks podcast talking about insurance companies. I don't know if you're in that episode. Yeah. He was talking about that and this struggle and writing down every single thing. Yeah. Yeah. It's super important. I mean, look, nobody's going to be a better advocate for you than yourself, right? And so again, going back to the insurance company is incentivized to pay as little as possible and take as much premium as possible. Unfortunately, maybe I'll get some flag for this, but that's just the reality of the situation. And so you got to fight for it. Yeah, absolutely. So okay, we touched on EMRs during the episode we touched on the complexity of insurance. One of the crazy things that I did not realize until I read his book was, you know, the whole patient satisfaction versus patient experience, but then patient's leaving reviews. And you as a doctor and being able to do anything about that because it's a violation of HIPAA, which is absolutely mind-boggling. It's just crazy. Yeah. Yeah. I mean, it wasn't as surprising to me. Again, going back to it wouldn't be the writing to do anyway, but it is unfair, right? To say the least. I know some people will be like, oh, boo-hoo, like you and a doctor, you can't. But I think in today's day and age where everything's dictated by reviews, right? Amazon, even healthcare, like I'm kind of in the market looking for a physician. I mean, we always are. And you all with the first thing you do is you Google that person and you see, you know, I think it's just something that's been instilled within our brains at this point that reviews dictate the quality of care. And it's always interesting because I actually had a conversation with a patient about this today that I told them I was like, you also have to keep in mind with the reviews that, you know, people who complain are more likely to be vocal about it, right? It's just the concept of squeaky-wheel-guess agrees. Yeah. Rather than people who are satisfied or content with the care are less incentivized to go leave a survey or review or detailed review, right? You want to voice your complaint. So that's something to keep in mind, too. But yeah, I don't really have a solution for that one. I'm not really sure how we overcome that one. Yeah. I don't know. Hi, guys. Yeah. It's it's frustrating, I guess. But the last point I wanted to touch on here was at least the great resignation, right? Is what was what we're calling this time period due to COVID when you were seeing all these industries with workers fleeing from them, healthcare being one of the biggest, right? We've seen a 20% reduction of the healthcare workforce now. Obviously, some of that's due to COVID mandates, but majority of it I'd like to say is due to honest, just burnout and people being frustrated with how healthcare, hospitals, clinics, the whole administration has just been run, right? And this is where the part of the podcast we start talking about solutions and resolutions and what we can do. And I think one of the most important things that Peter talks about and especially what he's been through is getting education on this, right? He went out to get an MBA, go to business school so that he could be part of the change, right? And I think physician, it's very tough, right? I mean, I think residency, there's no time to really learn this stuff, attending life, you're getting used to a whole other system, there's no time to learn it, medical school, no one's teaching this stuff, right? So we really have to do our part really here just to find the little list of times where we can go out and make a difference to learn this stuff first, right? In order to make a difference. And that's to get into leadership positions. I know here at Penn State, they're teaching more healthcare systems. So I was trying to be a part of that. I couldn't this year because again, time and missions on Fridays, but maybe in the future, you know, I mean, this is something that I'm passionate about a little bit too, especially with executive coaching and stuff. So the biggest thing I can say to people listening is go out and try to get educate as much as possible on these topics. Yeah. And dude, when you get there, I'm going to request that you start making some policy changes that these discussions should be had an early undergrad courses and maybe even high school because if we think about when people decide that they want to become a doctor, it's really that time, right? High school, college and that kind of stuff. And we take a lot of these stupid chemistry courses that that you really don't use in clinical life. Maybe I don't want to upset any any of my researches here. I know you like chemistry. I apologize. I do not. But you know, they're clinically not applicable, but this this conversation, this business of medicine is much more relevant. I think clinically day to day practice in today's medicine. Maybe 40 years ago, not so much. So I think that, you know, in order to really know, hey, quote unquote, what are you getting into? I don't think you'll ever truly know. That's why shadowing is so important. But also some of the discussions because I think when students are shadowing, it's rare that attendings are having these discussions. My experience, when attendings are having these discussions, it's really attending complaining about it myself included. So I think that a better way to communicate that to young minds and hey, listen, you want to get into medicine, this is kind of what it's about. This is a big piece of it, right? It's not just I'm going to save somebody's life by putting a stent in and get a standing ovation. That might happen, but this is probably more like it happened. Exactly. I actually even tell my premedicine students, whenever you're shadowing, don't go in with the objective of trying to learn medicine. I mean, that's what medical school and residency sport go in with the objective to see what is the attending doing? How much time are they spending with a patient versus versus behind the computer and talk to them about what they wish was different? Would they do medicine again? If they did, what did what did they wish they knew earlier? And then I also tell them this to write down on a piece of paper what they ideally see themselves doing as a doctor, who they want to see, how they want to practice, not necessarily what, right? But just the idea and take that paper and go to the attending and say, hey, this is what I'm trying to do. Do you think this is possible? Because we have this very idealistic vision, right? When we're 18, 19 in terms of the medicine, we're going to practice. And I guarantee you 99% of that time, that attending would probably look at that paper laugh and be like, there's no way, right? But at least it gives you some perspective and a realistic sense of what to expect as a pre-med so that you know, hey, maybe I don't go down this route. Maybe I do PA for the possibility. Maybe I do NP because I want as much schooling, right? So I think understanding that is necessary as a pre-med. Absolutely. Or you just change your expectations, but like looking, it's not so, so when you get, I mean, because I think that if you come in with different expectations, the concept of burnout is less likely to exist, right? It's still going to happen, probably. But I think that's a big driver, right? Expectations are completely off, and it doesn't match reality. Absolutely. Yeah. All right, buddy. Last but not least, certainly, Dexter Lewis and Nicola, right? Coming down from the down under, we're talking about sleep, talking about neuroathletics, talking about the brain, you know, awesome, awesome background, awesome journey with her own personal struggles, right? The adversity she faced, her passion, very cool. A lot of different things we kind of well all over the place, but yeah, biggest takeaway for you. Yeah, I mean, Lewis is like the girl wonder, right? I mean, she does so much, and it was crazy. Connected with her on clubhouse, we never realized that she was a triathlete, you know, in the making. And I mean, not in the making, she was, but a future like Olympic probably medalist, you know, in the making. But obviously, had that car accident things, what she was running. And, but that led her down the road of neuroscience, right? Through Coach Glenn Mills, which he's referenced it again, changemaker. So it's just, yeah, everything comes back to changemaker. But yeah, big, biggest takeaway, I mean, the majority of what we spent on was sleep, right? And again, this is going to be a common theme throughout medicine redefined is sleep and why it's so important. And we always mention, you know, we've, we've always known why it's kind of important or it's something that we do, but now we're truly understanding the why and the physiology behind a lot of this. But I find it so fascinating that she's taking neuroscience and putting it together with athletics and not just athletes, but also high performance coaches, portfolio managers, health tech companies. So I just think this is something booming. And I think she's she's in the perfect niche to kind of make a difference. Yeah, I think, you know, again, with future guests coming up, we're going to spend more time discussing sleep and the different aspects of it. I think I don't think one or two or three, even four episodes is enough to discuss this ridiculously complex topic, something that every single person shares like everything else that we talk about, not every single person takes the same medication, not every single person exercises, not every single person needs the same diet. But almost every human, I always leave the room for almost because there's somebody out there. But basically, we share that and you can't go for a prolonged period of time with a significant detriment to your health, either in the acute phase or in the chronic phase with the lack of sleep. So that's something she's passionate about, right? She calls it the most potent performance enhancing drug, right? Legal. That's the best part about it, right? I mean, no concerns and a sub certified, all kinds of certified. So I love that. You know, and some of the things we talked about, right, is that hey, sleep deprivation and injury risk, right? And so there was actually an interesting paper I was reading in current sports medicine reports. I think it was in 2021, maybe 2020 published, just kind of a review article. I'll find it and we can link it for folks. You know, documenting the increased risk of injury, you know, the literature supports is almost a two-fold injury risk. Now, you know, Luisa kind of focused on two ways, right? The physical, the curtailing of deep sleep, right? And maybe the growth moment that's one, actually, physically, like the tissue quality maybe isn't as good, right? But there's also a cognitive component. I think I would probably argue that latter is maybe more directly related. I don't think that we have true causal evidence to support this. But I do think that the correlation is strong enough that we should be paying attention to it, right? And I think that in the professional sports, the discussion of this has really ramped up for the better. And so I thought that was really awesome to get a first-hand view of how she deals with the high-level professional to work around these barriers that they face. Yeah, and those things that she's doing, right? Going into actual hotel rooms, figuring out the mattress situation, figuring out if there's a tub, right? Because she knows if you can get heat, magnesium bath or something, they're going to sleep better. Even the cold bath, maybe, for recovery. She's a huge advocate for that. And then also, just I think the way tech is going, right? She uses eight sleep with a lot of her athletes. And I was looking into eight sleep wild, you know, how much it can do. And I think Matthew Walker touches on this a little bit in a recent episode with Kevin Rose about the future of sleep tech and where it's going. And how mattress days will soon be able to kind of just monitor your heart rate, your temperature, all these things, transition throughout the night without you even knowing so that you're just physiologically in the best prime state to be able to maintain your sleep. Yeah, that would be pretty awesome. I will say that we're probably a little bit away from that. But who knows, man, the rate of the advancements in technology over the last two decades, it's been exponential, right? And so I don't, I mean, it's possible that it'll happen in our lifetime. It kind of is, right? I mean, that's the eight sleep technology. I'm not too familiar with it just because I looked at the price tag and I said, no, not right now, maybe in the future. But, you know, the emphasis on temperature, I think that is critical. I do think there's something we said about that. Again, in a future episode, we have a guest talking about, you know, one of the, there are many reasons for quote unquote pathological sleep. But if you don't have some of these other comorbid conditions that are contributing to pathological sleep, you know, really addressing temperature might be low hanging fruit, something worth looking at. It's always safe to work with a qualified professional, such as Luisa, your clinician or somebody who who's well versed with this stuff. But there is something we said about it. And she talked about the different types of temperature, right? You have ambient temperature. And I don't forget the term for the other one is, but something something worth investing. Yeah, that was pretty cool. The other point, you know, taken away from her was how much she uses HRV, right? Heart rate variability with her athletes. And using that as a marker to tinker with the day to day, right? So, for the guests, if you have a high HRV, that's something you want. That means you have a better balance between your parasympathetics and your sympathetic system and the heart, right? So, that lovedub between the beads has pretty much more compliance and more flexibility in terms of getting the output that you want. A low heart rate variability is the opposite. You don't have that great balance between parasympathetic and sympathetic. And you're probably more in that overdrive state of the sympathetic nervous system. So, you're more stressed, anxiety driving kind of system. She would probably laugh at me right now, because today my recovery was at 93%. And my HRV was at 41. If Luisa had a 41 on her aura ring, she'd probably be like negative 30, like HRV was not a thing. But yeah, that's right. I'm really am curious if the metrics and the reported, it's if the technology is different. It just doesn't, I don't know. I haven't looked into it. I know, I mean, I have to ticker at a word because I think she does this much more than I do. It just seems a little odd to me, you know? So my brother is in the same area. Again, so this is also interesting. But is he, but he's using a whoop though. Yeah, he's using a whoop. And my best friends also use a whoop. And he's the same thing. So I'm like, hey, is this just a brown thing? Like your brown male, your HRV? Like, but then you said you're in the well, yeah, I mean, I average in, you know, anywhere from like, so I think an average would be 150 for me. And I think you and I are both equally brown. So I don't really know if that's what I'm saying. That's a limiting thing. But I'm curious though. Yeah. So, yeah, I mean, that that is, that is certainly interesting. I mean, this HRV concept is very, very interesting, actually. So she talked about the validity of the order ring specifically, right? The one that she likes, the one that I like that I've talked about just because it's tickiness and feasibility to actually, you know, day to day or night to night, I should say. And there's actually a decent amount of literature. If you go to PubMed and actually look at our ring and the validity and then not only are they looking at the sleep metrics when they're comparing it, had to head against PSG, had to head against medically grade, uh, activity, which is like a wristwatch, right? Not whoop, but other actually medically approved. They're also looking at HRV markers. I think there was a study published. I mean, we're recording this in towards the end of January, beginning of January or mid-January. They were still looking at the different parameters and checked EKG marking or recordings and head to head comparisons that way. So I think that, you know, it's not robust data. And again, it's mostly in healthy patients. That's important to note as well. But I think it tracks pretty well when it comes to sleep. So I don't know, to be fair, I haven't looked at some of the other ones. I haven't looked at whoop. I don't know if whoop has a lot of data. I'm sure somebody can, if they're curious. Does, does aura have a red light, you know, um, what do you call the sensor or whatever's using the penetrate the skin or the green? Um, I think it's green. I don't really know what the different colors mean. So red penetrates farther, right? So medical grade is like always red. So if you look at like a pulse ox, pulse ox, it'll be red penetrates farther into the skin. So whoop, their newest 4.0 has four red sensors and a green as well. So it's supposed to be more accurate now that, you know, that's like the way that they're trying to, trying to move forward with. Interesting. Yeah. Um, the aura, the aura new version, to be fair, I have the version two. There is a version three. And I wonder if that has a bit more. So, um, that's interesting. Yeah, it makes sense. But, um, yeah, interesting. Huh. Cool. Anything else, um, from this episode, I mean, we talked about the culture of sport. I found it really cool that she's like met Roger Gidele and told him to, uh, told us, told it to his face that like, hey, this is a death wish if you're playing football. Yeah. Uh, it's a bit harsh. Uh, I do love me some football. Um, but, you know, she, she makes a valid point, right? We spend a lot of attention given to CTE concussions, a lot of that kind of stuff and just mild dramatic brain injury. I mean, you and I have seen the dysfunction it can really cause in lives and not just for the individual, but also the families and loved ones. Um, so the good news is the game is constantly being refined to be better. Some people will say it's been taken too far. Um, but I don't know. Uh, I think that's probably beyond the scope of this discussion, at least for today. Yeah. No, absolutely. I mean, this weekend playoff, have you seen, would you watch any of the playoff games this weekend? No, but I saw some highlights and it seemed insane. Probably going off a tangent, but yeah, probably, you know, arguably the best football ever played on, on playoff weekend. Um, but that's a, that's a whole other story as well. Um, so bring it back on topic. Yeah, I think, you know, I'm seeing a lot of commercials with the NFL saying that they're using more data, right? Like IBM Watson, all this stuff to see concussions, the data, the impact. How do we build safer pads, safer helmets? Um, so, I mean, I don't know. Hopefully this is not just on the surface, kind of advertising and marketing and they're actually making a difference behind the scenes, because like you said, we, we have seen what brain injury looks like. Um, and we've seen not how it only ruins, um, the patient, but also the, the circumstance of the family, you know, just the trickle effect goes, goes, it doubles down further. So, um, yeah, I just think the culture of sport needs to be changed a little bit. Hopefully it's getting there. Um, and Luis is on the forefront of that, which is super cool to see. Awesome. All right, guys, thank you so much for listening. Um, of course, as always, you know, we appreciate your support. Definitely recommend going back and checking out the full episodes for all these, um, awesome guests that we've had. I think you're, you're going to find a valuable and much more in depth than some of these topics that we were touched on. As always, feedback is king. We love it. Uh, you can email us at med redefined at gmail.com. We'd love to hear it. Oh, we read it. Uh, we will probably respond back if you say nasty things. Maybe we won't, but, you know, whatever. Um, and, uh, you know, if you find this valuable, uh, share it, share it, spread the love. Um, that's what it's all about. Absolutely. All right, all. Thanks so much for tuning into this episode. If you could rate and review this podcast, episode on whatever platform you're using, it wouldn't mean the world to us. 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