Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Heart Health and Resilience: A Journey with Dr. Jonas Cooper from Pacemakers to Positive Mindsets
Join us for a fascinating journey with Dr. Jonas Cooper, St. Luke's acclaimed cardiologist and electrophysiologist who shares his life story from Toronto to St. Louis, and his work as an "electrician" for the heart. Together, we navigate everything from high-volume pacemaker implantation to the imperative of cardiovascular exercise, and even uncover Dr. Cooper’s literary muse, Malcolm Gladwell's "Outliers." He reflects on how his father's legacy as a thoracic surgeon shaped his path and offers practical, heart-healthy tips grounded in years of expertise. Dr. Cooper's insights are not just about the technicalities of cardiology but about embracing heart health as an integral part of life.
We also explore the intriguing intersection of technology and health, with the Apple Vision Pro’s potential impact and the Apple Watch's role in detecting atrial fibrillation, transforming unknown heart risks into actionable insights. Delving into mindset’s power, we discuss how positive attitudes can transform health recovery and sports performance, revealing mental resilience's true strength. Dr. Cooper’s passion for maintaining a hopeful outlook is contagious, inspiring listeners to embrace a proactive approach to heart health and life’s challenges. This conversation is a powerful reminder of the interconnectedness of mind, body, and the technology that bridges the two.
Hello, this is Jason Edwards and I'm here with Dr Jonas Cooper, a cardiologist and electrophysiologist. Jonas, how are you doing today?
Speaker 2:I'm well. Thanks for having me. How are you?
Speaker 1:I'm doing very well, Thank you. Now you're not only a cardiologist, but you're kind of a specialist cardiologist in that you're an electrophysiologist. Yes, that's correct. And what is that? What do you do?
Speaker 2:So there's a little division of labor in cardiology. I usually call the plumbers the people who are dealing with blockages, blood pressure, cholesterol valve functions. There's the surgeons, who of course do what they do in terms of opening chests if fixes are needed that way. The electricians or electrophysiologists deal with heart rhythms, so fast beats and slow beats, and pacemakers and defibrillators, that sort of aspect of cardiology.
Speaker 1:And so if somebody has an abnormal rhythm, they come see you and you either give them medication or do you implant the pacemaker, or does the surgeon do that.
Speaker 2:No, I do actually put in the pacemakers.
Speaker 1:Yeah, I think we've actually shared a patient where I was radiating one side and you had to move the pacemaker from one side to the other.
Speaker 2:We did. You did a wonderful job with them.
Speaker 1:Yeah, you as well. Yeah, and the patient's doing well. Now are you from here in St.
Speaker 2:Louis originally. I saw you did most of your training at Washington University. Yes, if you look far enough back, toronto, canada, but I've lived most of my life in St Louis.
Speaker 1:The TO huh, so you're Canadian.
Speaker 2:Yeah, those Canadians, they walk amongst us yeah.
Speaker 1:Okay, now I detect the accent to some degree. That's an incredible city, very multicultural, of course, and so where is your family from originally? Are they originally from Canada?
Speaker 2:No, it depends, I suppose, how far back you look, but my dad is a physician. He's a thoracic surgeon and was there doing lung surgery work.
Speaker 1:At the University of Toronto. At the University of Toronto he was involved in inventing. That's an amazing tale. Yeah, the reason I ask is how far back is because I know a lot of people that they're. They're not too many generations back, you know, from their move to Canada, but of course you could have some, some people who have a longer run there.
Speaker 2:Um, yeah, so my dad's dad's dad, I guess. So my great grandfather? Um, I did not get to know Dad, so my great-grandfather, whom I did not get to know, lived there and had moved over from Eastern Europe around 1900, 1904, something like that. Somewhere we have the paperwork where they went in through I believe it was through Halifax, Okay, but yes, approximately then Coopers came over to North America and it's never been the same since.
Speaker 1:Yeah, actually, my folks used to have a place in PEI, prince Edward Island, which is close to Halifax.
Speaker 2:Absolutely. I think you have to go through Halifax to get there.
Speaker 1:Yeah, and of Green Gables, of course, yes. And so how many pacemakers would you say you do in a year? Pacemaker implantations, you would perform in a year, sure.
Speaker 2:I mean probably devices. I want to say a couple hundred a year plus minus, and that's some combination of new devices, putting in and revising devices, in that they are battery powered and when the battery goes low, unfortunately we don't have a rechargeable version where we can lay you on a mat of sorts and charge it back up, so there's a surgery to replace the unit there as well.
Speaker 2:That sounds like high volume. It certainly seems that way. I usually tell my patients I'd rather you not need me, Not that what I do is that crazy, but I'd rather you be healthy than need me. But if you do, thankfully we have fixes for this.
Speaker 1:Certainly, and so are there any things that you do in your own life, any positive habits, health-wise, that you feel like have been beneficial, whether it's exercise or yeah, it's usually telling other people or my kids what they should be doing for good for themselves.
Speaker 2:But you're right, it's good to follow our own advice.
Speaker 2:So yes cardiovascular exercise is the right thing to do. Yeah, and what we mean by that is often not so explained. Yeah, and what we mean by that is often not so explained. So typically we mean by that 20 30 minutes most days of the week, and doesn't have to be something that is so intensive that you can't breathe during the activity. So if you are exercising to the point of, oh my god, this is a great workout ever, uh, that's that's more intense than you need, something that makes you a little out of breath. 20 30 minutes most days of the week is really the heart healthy aspect of things is that what's considered zone two, um or?
Speaker 1:I've heard that. I don't know if that's right.
Speaker 2:They do go by these zones or heart rate goals, although I often tell my patients not to use them, because most of our patients are on medicines that adjust their heart rate, so the scales are based on patients who are not on heart medicine. So instead we use breathing, because it's every bit the same amount of benefit from the exercise. It actually isn't the heart rate, but the heart rate as a surrogate for intensity of exercise, and you can use breathing as a surrogate.
Speaker 1:Yeah, so like running or walking at a talking pace, that's much more practical too.
Speaker 2:Exactly yes, yeah, very good.
Speaker 1:And then you know, I like to know a little bit about the guest. Do you read at all, or do you have a favorite book or any recent books that you've read that you found interesting?
Speaker 2:A few. Actually, Probably my favorite recent book is a book called Outliers by Malcolm Gladwell, and it goes into what does expertise mean and where does it come from? And I've believed in this for a long time that it is not so much innate, as in born in you and not achievable by someone else, but rather it is so much to deal with opportunity and work. And he makes a very compelling case for that by looking at Steve Jobs and a number of really sort of famous success stories about how they just had great opportunity and worked hard.
Speaker 1:Yeah, this is the 10,000 hours thing right To be an expert. You need to put in at least 10,000 hours and certain things are going to come to certain people easier based off their kind of makeup, but in general you have to get your reps in. We had the Super Bowl this week. You have to run the play a lot of times to have it perfect.
Speaker 2:Yes, there's a Tom Brady series called the man in the Arena that I think is on Netflix. Not to advertise anyone, okay, and he goes over what it took to make Tom Brady Tom Brady. And when he was drafted he was sixth round. Yeah, and he will admit this. I wasn't that physically able, but what I was able to bring to the table was the repetition and doing it over and over and over again to make up for any physical deficiency, and I love that story. It's the hard work and achievable outcomes.
Speaker 1:So yeah, and that was the man in the arena, of course, making a play on Teddy Roosevelt's speech, which was a great one, and then the. You know that has a corollary with medicine too the more you do something, the better you are, and which is it's why it's good to be a busy, whatever you do physician. You know whatever it may be, and so, and you know, I think a lot of the doctors here that we interview are busy doctors, and that's a really positive thing. You figure out what to do, what not to do. You see nuanced situations more often that maybe people don't see very often.
Speaker 2:I think that's right. That's part of why we have a specialty. And when patients ask, well, do I have three different kinds of cardiologists? Unfortunately the answer is often yes, because there's so much to know about each it's really impossible to be the master of all, and so you can do a lot of repetitions when it's a more narrow field, like just hard electrical versus a little hard electrical, a little plumbing, etc. And for the training path to do this career depends on exactly when you want to start the clock. But if you start the clock at let's call it grade one, your first year of education, it's about 27 or 28 years of school. Until you're officially doing this job not as a trainee, but I typically will tell people it takes another five years or so before you actually finally kind of hit your strides. 32 years and you too could be a hard electrician.
Speaker 1:Yeah, uh, you graduate from medical school, which is four years, then you do three years of internal medicine residency, right, and then if you're a high achiever in internal medicine, then you become a cardiology resident. And then I mean, many high achievers don't become cardiology residents, but it's fortunately. But but all cardiology residents are high achievers, and so you do three years of cardiology. Residents are high achievers, and so you do three years of cardiology and then two more years of electrophysiology.
Speaker 2:So normally it is two more years. For 28 years I did my electrophysiology training at Washington university, down the street, and I did my cardiology there as well, and so my third year of general cardiology, which is normally more dedicated towards research. I actually did a year of electrophysiology that year, so I got away in four years.
Speaker 1:Was it a combined program? It was yeah. Yeah, that's nice. Yeah, cut a little bit of time off training. Yeah, the? There's a you know one of the things. I'll kind of come back to Valentine's day a little bit. You know, for a long time a lot of philosophers would talk about the heart as being like this emotional thing, even as late as Arthur Schopenhauer had a quote. He said he viewed the world as fundamentally driven by a blind, irrational will, which he considered the essence of the heart. And there are many more philosophers who use heart as emotion. And a lot of people know this now that emotions don't emanate from the heart but they emanate from the limbic system of the brain. But there is a corollary. I'm aware of a phenomenon called Sakotsubo. Are you familiar with this? Yes, yeah, I'm putting you on the spot, but could you explain that roughly for me?
Speaker 2:Yeah.
Speaker 2:So the term Sakotsubo as I understand it is a Japanese term for I want to say, octopus, pot or jar, how they catch them. Apparently, they put these jars in and the octopus just goes in there to just sort of hang out like a birdhouse, I suppose, is to a bird, and they pull them up and it comes from sort of the shape that the heart starts to take when it's not quite squeezing right from this condition, this condition they call it sometimes broken heart syndrome and it is a funny condition that happens in response usually to just a large sudden surge of adrenaline or emotional response, and it can be God forbid the death of a loved one or something particularly stressful or straining. And for some reason some hearts will get weaker in this very unique pattern and it will look to the world like a heart attack. But it isn't quite that. Thankfully, with time and meds it usually gets better and actually goes away.
Speaker 1:Okay.
Speaker 2:So typically gets back to normal.
Speaker 1:Okay, and so kind of a relationship between emotion and the heart. Absolutely, is that a type of cardiomegaly where the heart is enlarging because the injection fraction has decreased?
Speaker 2:It certainly does. Thankfully it typically does actually reverse remodel or it would get better when it's done. I can remember when this was all starting to become popular. One older gentleman I saw when I was at Barnes as a fellow who the only stressor we could find was being outside and shoveling snow in the very bitter cold and ice. And he was a gentleman in his later 80s and that was all that they could attribute to what emotional or physical stress caused his takotsubo attribute to what emotional or physical stress caused his takotsubo.
Speaker 1:So do they think it's a um, like a one-time event, or like a prolonged stress, like over a period of like months, or like maybe just like one individual event?
Speaker 2:um, as I understand, it is typically one particularly uh, sentinel event that that really suddenly triggers this cascade, uh, and causes the weakening of the heart in a funny pattern where the sort of the tip of it or the bottom part of it gets weaker, but the upper part doesn't. So the upper part is sort of squeezing, but the bottom part is not.
Speaker 1:And that's what makes the box shape. Yes, okay, yeah, fascinating, fascinating, okay. Now I like to talk about current events a little bit, and so I'm going to give you three choices here to discuss which way you want to go here. We've had the Super Bowl recently. We've had, we could talk about Valentine's Day or the Apple Vision Pro. Do you have any interest in any of those three topics?
Speaker 2:I mean. I mean some interest in all of them, not a ton of familiarity with the Apple Vision Pro, other than what my kids tell me and the ads that I've seen as they tried and sell me on that they need one.
Speaker 1:Yeah, so it's. It's a mixed reality headset. I think they purposefully did not use the term virtual reality, and have you seen the videos of it?
Speaker 2:I have yes.
Speaker 1:It's expensive. It's like $3,500 and the insurance plan is like $500. So four grand is not cheap. So they will have a limited market. I think so. But everything they do seems to be fairly successful. You know, the Apple Watch didn't seem like it took off and then everybody's got, or a lot of people have them. You know the iPad kind of the same thing. Do you think it has wheels? Do you think it's going to work?
Speaker 2:I mean, I suppose you don't bet against technology. It's hard to imagine exactly how that's going to help your day-to-day life, but maybe you never know. It's sort of, if you build it, they will come perhaps.
Speaker 1:Yeah, yeah, probably a little bit of that. And so you know, talking about one of the Apple products, we have the Apple Watch now and it can detect arrhythmias, something like atrial fibrillation. How often, or what's the frequency in the general population of atrial fibrillation in general? And then, how good is the watch at actually picking up on that?
Speaker 2:Sure. So the numbers are somewhere in the three to five million Americans at the moment have a diagnosis of atrial fibrillation and there probably is a decent amount of atrial fibrillation that is out there that is otherwise unknown, in the sense that about half of people can feel their AFib in the sense of palpitation of their chest. About half of people can't, and they may not know that it's there. The Apple Watch rhythm identification is actually pretty good, and so we are finding more and more AFib that we never would have known about had these tools not been in existence. Almost not a week goes by before some patient is seeing me for the first time with a diagnosis that actually was arrived at by nontraditional means, like an Apple Watch.
Speaker 2:Or there's another product called CardiaMobile, which is a little piece of metal that you can do a home EKG on. A little piece of metal that you can do a home EKG on. I recall a study that was done with incredibly large number of patients that they gave them all Apple watches and the rates of finding arrhythmias in people that previously did not have a diagnosis was somewhere in the 0.5%. But still, if that's, one in 200 people has some rhythm trouble that has not been known, that's a very large number of people.
Speaker 1:And so if you catch the arrhythmia before it becomes symptomatic, the value of that is that you prevent like a clot forming and spreading and causing a stroke. Is that right?
Speaker 2:Yes, the biggest problem of atrial fibrillation is that blood isn't quite flowing as smoothly as it's supposed to and therefore there's a little bit not a lot, but not zero of clot development risk. And if that clot that develops in the heart exits to the head, that's a stroke. So knowing about it early helps you be on some version of treatment. Sometimes it's blood thinner, Sometimes it's a device to wall off where the clots can form to help prevent stroke risk. Even if you don't feel your AFib, the stroke risk is there.
Speaker 1:Yeah, that's incredible. Yeah, the one thing I worry about with it from a health standpoint is I don't know, it feels like that. You know, mental health is kind of becoming a bigger issue. Whether we're detecting it more or it's getting worse is maybe not crystal clear, but I do feel like the technology or maybe working from home or some of these things I don't know how helpful that is for individuals and their mental health. I don't know how helpful that is for individuals and their mental health and some of this technology. I feel like it kind of enables us to sit on the couch longer and kind of become less inactive or less active.
Speaker 2:I agree. I worry about that. What are the long-term effects? Because the truth is they're not known, because these haven't existed for 40 years and so it's hard to imagine that it'll be good for health. To reverse the question Doesn't mean it is bad for health, but a little worried.
Speaker 1:Yeah, I mean we're obviously speculating. Nobody knows, but it's okay to speculate and kind of think into the future. Yeah, I agree, I think kind of the base in my mind to live a healthy life, it's kind of the basics it's like have good human interaction. You know you need some personal touch with other people. You know whether it's a pat on the back from your friend or whatever it may be good, good food. You know a positive environment if you can have it.
Speaker 2:Yeah, absolutely. I mean, I love reading about history in the sense that, although circumstances change, human beings have been fairly the same types of behaviors for a really long time, and I think our ancestors had a number of things right about what is really important and what is a life well lived a life well lived.
Speaker 1:I agree completely. There's a book called the Almanac of Naval Ravikant. You may have seen it on Amazon or Reddit even, but he says if you want the solution to old problems, look in old places. And it kind of jives with what you're saying here. Love that quote. Yeah, because evolution does not happen very quickly, you know, over the course of like thousands of years. But civilization has dramatically changed in the last thousand years and really in the last 200 years, and our body, we're not that much different, you know, than we were, you know, 10,000 years ago, as far as our brains and our bodies Is. That.
Speaker 2:Yeah.
Speaker 1:I agree.
Speaker 2:Looking at various different ancient texts and realizing that humans have been struggling with the same things for a really long time, and so try and gain from wisdom and apply to new circumstances.
Speaker 1:Yeah, and so I've read a little bit of a book called the Tao Te Ching by Lao Tzu. But when you say ancient texts, are there any texts that you lean on or found?
Speaker 2:useful. I'm blanking on the name of it it was an ancient flood story actually.
Speaker 1:Not the story of Gilgamesh, epic of Gilgamesh, sorry, yes.
Speaker 2:Which is really a fascinating story of it's sort of it's got the hero's quest in it, which I think in some level it's sort of it's got the hero's quest in it, which I think in some level we all sort of feel where things start well in life a lot of the times and you have the useful innocence and then the struggles of the realities of life happen and you have to go out and sort of prove yourself and figure out how to behave in this world that is not perfect and is not roses and sunshine, and then try and come to some not necessarily heroes returns to be dramatic about it, but figure out what is your happy place, where is your achievement of peace and success in life? Yeah, and how to keep your heart happy.
Speaker 1:Yeah, yeah, yeah. In the process, keep your heart and mind happy, for sure. I think that's the oldest story, the Epic of Gilgamesh. Did you ever read Hero of a Thousand Faces by Joseph Campbell?
Speaker 2:No, but I have read. Joseph Campbell is phenomenal, yeah yeah, familiar with it.
Speaker 1:Yeah, yeah, for sure. Like that's the story of life Things are going well, and then all this every Disney movie you've ever seen things are going well and then Simba's father dies and you are contending with this unexpected obstacle. And you have to contend with it and it's painful and it causes you to reflect and through that reflection you learn and grow and become a better person, and the cycle continues and continues, and continues.
Speaker 2:Yeah, I remember as a kid with the Star Wars series not to date myself, but with Empire Strikes Back I was like how did they write a story where bad things are happening to the good people? I didn't understand it as a kid. And then you get a very different perspective when you grow up. But it's the same cycle that we all really do go through and hopefully grow by and not become shrinking violets too, though I understand that reaction.
Speaker 1:Yeah, yeah, for sure. You know I always tell our cancer patients like you can look at yourself as a delicate orchid or a bull, and I would prefer you look at yourself as a bull, because life's tough and you got to get tough to contend with it and um and so, and that that means you know it from a health standpoint. I believe that your, your blood flow is really your health. You know, from a health standpoint, I believe that your blood flow is really your health. You know, for the most part, you know most dementia is vascular dementia and in my mind and I'm, you know, I'm not a cardiologist but in my mind, if you have plaque in the arteries of your heart, I would assume that you have plaque in the arteries of your brain and your kidneys don't work as well and so if you can get that blood flow right and have good cardiovascular health, there's a high probability that you will have good overall health.
Speaker 2:Yeah, I agree. Yeah, keeping your heart and your blood vessels healthy is certainly a great way to try and improve your health, the quality of your health, not just the quantity but also the quality of your health long term. So yeah, blood vessels are very important. We like to think so, especially as cardiologists, and say well, without the heart we can't supply the rest of the organs with blood, so doesn't that make us most important? But I know it's not really a competition that way.
Speaker 2:However, to your point about the positive outlook, I've found that to be incredibly true in life. I recall back in the day where I could do more physical activity in Taekwondo, when you were breaking boards. If you thought you might break the board, it would never break. If you knew you were going to break the board, then somehow that psychologically changes how you behave. And I was telling Mike to tie in the Super Bowl is. Somehow that psychologically changes how you behave and I was telling Mike to tie in the Super Bowl.
Speaker 2:I find it fascinating that you can have a certain group of people for the first half of the game and then they go into the locker room and something happens, and then the second half of the game they play differently. They're the same people, the same talent. They didn't just suddenly work out muscles and gain any particular skill, but the idea of finding the right words and the right motivation to get our behaviors to where they can be and the positive outlook there is incredibly important. It can completely turn around a football game, a health outcome, how you do after a heart attack. If you are going to sort of roll over, then you're right. You won't have as good an outcome. If you are. Take the life by the horns. You have better outcomes and it's like if you build it, they will come. If you believe it will happen, that's really the main first step to make it happen.
Speaker 1:Yeah, yeah, I totally agree. Great words, dr Cooper. I thank you so much for joining us here. It was an honor and a pleasure to talk to you, and I'd like to have you back sometime. I think it'd be great. I'd love to Thank you. This was a lot of fun, thank you.