World Class Prevention Experience Part 4: CIMT

World Class Prevention Experience Part 4: CIMT

August 14, 2019 8 By Bertrand Dibbert


So this is part 4 in the series on
world-class preventive personal prevention experience. Now, here’s the
first problem. People pay between 1500 up to 15,000 for
a typical Bale/Doneen type of prevention experience. My goal was to
make it far more affordable. So one of the things I did, when I started this
channel and we’re going deeply into this with this series, was I said, look I’m
gonna make a lot of this basic prevention information. It’s, you know,
prevention is something I’ve been doing over 30 years and again, it’s bailed on
AIDS, a great approach to cardiovascular prevention. I want to make this for free.
At least the information free on YouTube. And in this series we’re actually using
the, the deck that we used to use with patients that paid routinely $5000
for our version of that type of prevention experience. So we got
a lot of good reviews. Actually, this is a review from Steve Hubbard. Just a couple
of days ago, “Dr. Brewer, great goal and we really appreciate the videos. Would you
please consider an entry level consultation for something like $90
which would be online only and might include recommendation and
review of planned tests, then a basic one-time email review of the results.”
Well, it’s a great idea Steve and it brings up a couple of other issues as we
go down this path. The first is a legal issue. There has to be something called,
legally something called a patient-doctor relationship. Now, you may
remember I used to run the medical staff for MD live, the number two telemedicine
company in the world. I still do some work with them. All the states and the
states are responsible for these laws. All the states are responsible for
developing a law and saying, how the doctor and patient can interact
and when you can write scripts, when you can give the patient advice, there has to
be a personal description from the patient of what’s going on. Now,
originally that all used to be face to face. Telemedicine broke a lot of old
ideas and thoughts and then it became available to do that remotely. As you may
know, I’ve done a couple of videos on this. I’m still working now with a couple
of other telemedicine companies. One of them is K-health which is doing a
great job. It’s sort of like the deep-blue of urgent care.
Helping the doc diagnose using computer, deep computer logic. I’m
also working with Advil and a company that is doing something very similar but
in a medicare advantage space. The reason I bring that up is now in – in most
states of the union, you can develop a doctor-patient relationship using email
or even text. It’s going on. There are companies that have been doing that for
over a year now. So there’s a lot of opportunity. Meanwhile I’ll continue to
work with these two companies to meld the prevention experience into that type –
of that type of experience. Before we go into the video though just one other
thing I want to tell you about in terms of solutions in this area, have you seen
the cardiovascular inflammation course? It started off as sort of a an informal,
all-I-could-do kind of you know just a few videos on the basics. Caim Hermoso, our
media manager, has come in and provided captions and just today I saw the first
draft on the entire text for the inflammation course. That should be ready
in about a week and guess what, and the price is, it’s not 1,500, it’s not 15,000,
it’s 30 bucks. That’s the cardiovascular inflammation
course. So we’re making a lot of progress in getting something that’s available
for masses. We’re already about 2/3 of the way
through a course now on insulin resistance, prediabetes, metabolic
syndrome, so there’s a lot of work going in this area and thank you so much for
your responsive – response to it and your interest. Now, let’s get back to the
video. This one’s going to be specifically what – what the patient would
hear in a – an interaction and deck regarding the CI-MT. I start off with
some introduction that’s actually for you – video, YouTube video viewers. You know
we’ve got multiple videos out there that talk about CI-MT. This is more about that
personal experience. Now, speaking of other videos, if you have
other questions about CI-MT, I’ve got cash, what about a half dozen, maybe more
videos going into the details of CI-MT. Todd Eldredge, pardon the – the bad visuals
here. I’m plagued with those on a routine basis, but Todd Eldredge is a PhD
epidemiologist. He’s focused on quality and interrater reliability. Basically,
the bottom line is, he’s one of the best qualified in the world for making sure
that you get an excellent CI-MT, first time, second time, every time you do it.
Todd is one of my major suppliers for this activity.
Now we – to go a little bit further into the – I mentioned cafes cave study a few
minutes ago and I mentioned there were a lot of people that we thought did not
have risk until we looked and found that they do have plaque. So here’s what
happens. If you go to those other 299 carotid ultrasound areas and get a
carotid ultrasound, it’s going to tell you it’s negative. Unless there’s so much
plaque that it actually obstructs the flow. However, the literature is – the
science is totally clear. If you have any plaque whether it obstructs the flow or
not, you have major risk as in 40% risk for heart attack over the next 10 years.
Now what the standard, nonpreventive folks, and standard prevention folks use
for assessing risk is things like the Framingham studies, again other studies
and try to apply those to you based on your risk factors. The reason I mentioned
that is, according to those just a Framingham risk factor, the – the agreement
is, the standard is, if you have a 10% probability of heart attack or stroke
over the next 10 years and some people say 20%, then you have high risk. When you
have class 3 CI-MT which you won’t get from a carotid ultrasound. In other words,
if you have any plaque, your probability is 40%. That gets a little complicated.
Let’s go look at this image and that’ll help us understand. These are people that
have no plaque. People that have plaque but it’s less than one millimeter, in other
words we would call that no plaque as well. These are people on the fourth
column here that have plaque so much that it’s obstructing the artery flow.
Now, routine Framingham history risk factors would, will differentiate usually
this group from this group; but here’s what it’ll also do. It’ll usually – it will
not differentiate this group at all. Some of them at random will go into – into no
risk. Others at random will go into high risk. So here’s the thing. We’ve got a
test and that’s why CI-MT is so important if you’re actually looking for
your heart attack and stroke risk. If you have plaque over 1
millimeter thick, your probability is at least 40% of having a heart
attack or stroke over the next 10 years. So again, if you – if you patiently waited
for me to get through that, I really appreciate it it’s an important point
and it helps us understand why. Even though it’s hard to find the CI-MT in
this – in most cities, it’s important. Brad and Amy loved to talk about the cat in
the gutter. They’re talking about a hot plaque in – in the artery wall and here
they’re showing inflammation. If you’ve got inflammation that cats more likely
to jump out and get that bird. Now where did this, where did this cat in the
gutter thing come from with – with Brad Bail and Amy Doneen? They were in Italy
White’s I think presenting some – some of their science; and as you know in Italy
there are plazas and they were sitting having a having coffee or tea at a plaza
and they noticed these – these pigeons, these birds hanging around the plaza.
They also noticed a cat who was hanging, lurking around in the drainage air
gutters, and that cat would jump out get a snack on the – one of the pigeons.
So Brad’s point was, you know what, that’s just like a hot plaque in our arterial
wall. It’s just sitting there waiting and it’s going to get another pigeon if it
jumps out of that artery wall and into the artery. Now, a couple of comments
about inflammation and the history of inflammation and then we’ll wrap up this
this video in the series. If you’ve ever seen the movie, or the series Charity or
Charite’, Charite’ was a hospital built or it still is as a hospital built just
north of Berlin. It was built by Kaiser Wilhelm. I think
back in the days around the Black Death. It was built north of the city. The
reason for it was again, they didn’t want to be carrying bodies of people that had
died to the Black Death through the city itself. That’s how far we’re talking about. I mean, Middle Ages, Dark Ages kind of time
period, 150 well what Middle Ages, 157 years ago. Actually at this point, closer
to 160 years ago. Virchow was a – Dr. Virchow was they – was the chief of staff
of the medical staff there and that’s medical staff by the way. Still going
strong and has won more Nobel prizes than any individual hospital medical
staff in the world. Dr. Virchow said, you know what I think
atherosclerosis is not so much just laying down plaque and fat, I think it’s
inflammation and there’s the citation, if you want to look it up, 160
years later we’re finally beginning to realize he was right.
Virchow was right. The plaque is caused from inflammation We’ll go back into more
details on this in the next video in the series. If you’ve made it this far, thank
you very much for your interest! Thanks and if you hit that subscribe or a like
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