One Life, Two Hearts: Surviving Cancer, Loss and Heart Failure

Dr. Dawn Mussallem1:13

I grew up in Columbus, Ohio. A little small city outside of Columbus called Johnstown, Ohio. I was about 45 minutes outside of Columbus. Went to a Catholic school in Columbus, Ohio, and then went on to go to Ohio State University for college.

Dr. Dawn Mussallem1:27

Yeah, I did.

Dr. Dawn Mussallem1:30

I was a competitive gymnast.

Dr. Dawn Mussallem1:37

Let's do a handstand contest.

Dr. Dawn Mussallem1:42

I love it. And I love to run. From a very young age, I remember because John was a country city, country town I should say. And so I remember, you know, gosh, I was literally in the sixth or seventh grade and every weekend I would go for these long runs. Now I look back and, you know, one would say, was that even safe to be in these back country? But I would go for hours. I just get lost in the, you know, in the streets of the cornfields.

It was just such amazing peaceful time. So from an early age, I was really focused on my health and wellness. I mean, I'm saying way back to from like the time I was four. I was just really fascinated

With people that were elderly, hundred years old, and who were still vital. Yeah.

And so, I just thought, "Oh my gosh, I want to be like them." And I think I need to take good care of myself. Kind of unusual for a young kid to be this way, but I set out to be really healthy at a young age.

Dr. Dawn Mussallem2:46

That's great parenting. It starts young. You know, in the longevity industry that I'm now in, everyone, you know, at 50, 60, they're asking these questions,

But wow, we have a lot of room to make up when there's been insult from the time they were kids. And, you know, we're kind of this generation of the fast food, the TV dinner. And so, this is a huge shout out to parents. You and Shelby have done such an beautiful job with your family, but to have those family meals and to encourage the kids to eat healthy and to retrain that palette so it can actually taste the natural food, not these artificial flavors. So that's so cute about your son.

Dr. Dawn Mussallem4:04

You know, this is an important message, Joe. It doesn't have to be perfect.

And you know, we know what foods are healthy

And we know what foods are unhealthy. I think getting rid of some of those fake foods. And the thing is is the majority of Americans are not getting enough vegetables and fruits.

Dr. Dawn Mussallem4:18

And this is the most simple message. If you can just really work with the kids and with us as adults at getting enough vegetable and fruit to start with and getting enough fiber, that is a really important starting point. F. You know, we can talk about protein too, but if we look at these age clocks and longevity, you know, everyone's looking for this magic bullet to increase health span or lifespan or given more years.

If we look at something called the grim age, and that's basically what's going to predict our mortality.

There's one thing that is shown to increase that life expectancy to dial it up and it's vegetable and fruit consumption.

Dr. Dawn Mussallem4:56

It's so easy. And there's been really nice studies that have actually confirmed that, you know, that it reduces the risk of cancer, reduces the risk of heart disease, it reduces the risk of dying from any cause just by getting simply five servings of vegetables and fruits a day. But the majority of Americans aren't doing it. I did a study at Mayo Clinic and my patient population there where there was no food insecurity. Everyone could actually for the most part minus just a few people afford their food.

This was over 800 individuals and 95% were not getting enough vegetables and fruits

Really. And that that is online with what we know of the American population which marches out to about 90% of Americans aren't getting enough vegetable and fruit.

Dr. Dawn Mussallem5:35

I know. So just if anyone takes a take home, what I tell people is every single time you eat, just look at what you're eating and ask yourself, is half of what I'm eating coming from a vegetable or fruit? And it can be frozen. It doesn't have to be fresh. I mean, just make it convenient.

Dr. Dawn Mussallem5:48

So that's a that's a important place for people to start with and including kids getting used to vegetables and fruit.

Dr. Dawn Mussallem6:13

I did. I did track. So, you know, the gymnastic season went through the fall and winter and then track was always in the spring. So, track.

It worked out perfect. So, I did both. and the track made you so fit for the gymnastic season moving forward. So, it was it was a nice combination and it was kind of funny because I always loved lifting weights.

You know, this is the same thing with the nutrition. This starts young,

But I remember heading to the weight room in high school and I would lift with the football players. I thought it was so cool. So, I was really always

Dr. Dawn Mussallem6:41

Actually, they did. They thought it was really neat that I would, you know, try to do the pull-ups with them and I would try to do, you know, bench press. Now, I think it's a lot more accepted for women to be in the in the weight room, but I was definitely the only woman that would girl, I should say, that would visit the weight room young at age. And that muscle memory has served me so well as a middle-aged woman now, where there's a lot of fitness experts talking about how women need to pay attention to lifting weights.

And I have a lot of women ask me, well, how do you maintain muscle? I I attribute a lot of that to the fact that I lifted really heavy as a young girl. So, again, huge shout out to parents. Get your kids active. have them exercise, introduce them to safe forms, biomechanically aligned strength training. It's so important. And instead, kids are on their phone so

Dr. Dawn Mussallem7:39

Yeah.

Dr. Dawn Mussallem7:52

You know, it's so interesting. So, I was a cheerleader, so I basically transitioned all of that over to cheerleading, and I did competitive cheerleading towards the end of my high school years and into college with the competitive cheer, but it got so hard. You know, I knew I wanted to be a physician. I had to focus on my studies. So, as I entered into my freshman year of college, even though I was intended to do the competition cheer, I phased that part out of what I was doing as well.

But I love the cheerleading back then. It was very different than now. It was really an expression truly of joy and connection with people and you be a good cheerleader.

I love that energy and plus I could tumble and I was always petite so you know I was easy to to do the stunts and stuff. So, so I aunt really had such a beautiful childhood and so many of my childhood memories were always centered around athletics and you know my daughter was also into competitive gymnastics and so much of the time when she grew up was also with that. You probably noticed that with your kids these organized family events that are kind of structured around our child's activities and that's how it was when I grew up and I thought it was really great.

Some of my favorite memories, I think, you know, sitting in the backseat of a car on the way home from gymnastics. You know, my parents would kind of critique me and you kind of like grind your teeth sort of a thing. But man, that's what life is about. Like that's what our career paths are about, you know, always trying to perfect yourself and be better to show up and and to serve this this greater good, this greater mission. So, a lot of life lessons from sports.

Dr. Dawn Mussallem9:20

I did. I was kind of geeky, but I still worked out all the time. Yeah. Um, you know, I would wake up very early. I would wake up at 5 Well, I I've always woke up at 4:00. So, I'd wake up at 4:00. I'd study a little bit. I'd get to the gym at 5:30 a.m. It was the World Gym that was downtown Columbus, Ohio. So, I'd go workout, lift my weights early, get my run in, and then head to class. Never missed a workout. Um, and in college, I worked, you know, a few jobs and my job was I taught aerobics.

So, I would also usually teach an aerobic class in the morning. I teach one at lunch. I got all this all this fitness in and

I was still so focused on the resistance training, the weight training and I was really fascinated with fitness competitions. That's when the miss fitness and stuff were really popular. So I did that for for a period of time also and had a lot of fun with it.

Dr. Dawn Mussallem10:10

They do. And in fact, I think it was my last year of college that I had the honor of actually being with Arnold and handing out awards because I was so involved in that whole fitness arena. And then it was my last year of college after I graduated. I was actually Miss Fitness Texas.

Dr. Dawn Mussallem10:26

I know. It's really a kind of a cute story, but I love that discipline. But again, it was so focused on eating healthy, not the absence of food, but but really paying attention to how healthy you eat in this just really dedicated exercise regime that I thought was great.

Dr. Dawn Mussallem12:47

Yeah.

Dr. Dawn Mussallem13:14

It really is and you know I don't know that it's the healthiest diet either how some folks do it because they get so restrictive and they're not thinking about eating the healthy food. They're sometimes just doing the very um you know low calorie food that's not giving them all the nutrients that they need and they're in such a calorie deficit towards the end. Anything extreme isn't necessarily healthy. But this is an equal encouraging message I would have to people doing endurance sports is a lot of times when they're doing the endurance sports, they're just burning so many calories that they are like, "Oh, I can have that cookie or I can have this."

I I mean, you know, when you're putting forward that amount of aerobic exertion and oxidative stress on the body, your body really needs to have proper nutrition. It is critical.

Dr. Dawn Mussallem15:14

I love it. You're you're exactly right. This message is so important and it's hard on social media because you may have your favorite influencer that isn't doing the exercise output that that Ken Ride Out is doing or any athlete, but our body depends on carbohydrate metabolism. So, you need carbohydrates.

Dr. Dawn Mussallem15:30

And unfortunately, the majority of Americans are fiber deficient. Fiber is a carbohydrate. So, when people cut out their carbohydrates, they're also cutting out fiber. And fiber is really the magic bullet for the gut microbiome, which is really what's governing so many of the body's responses. Everything from the gut brain, you know, optimization to our immune system, etc., when it comes to that gut microbiome. So, I guess to break it down, when we think about carbs, you want complex carbs. So, you want those whole grains that have the presence of an intact fiber.

So, think brown rice instead of white rice. Think whole grain bread instead of white bread. One of the easiest messages I would share with my patients is look at the label. And we should always look at the label and the ingredients. But if it's a whole grain, it's going to just have the grain on the ingredient list, right? But I always would have my patients look at the grams of fiber. And if it would have three to five grams of fiber per serving, that is like great.

That's really good if you can find a whole grain that has that amount of fiber. And so that's what I would usually encourage my patients to do. Wild rice is great. Quinoa is great. Oats are great, you know. So en enjoy that. One of my favorite types of bread is the sprouted bread. We were talking about this earlier, the Ezekiel bread. I love the sprouted bread because it's actually complete protein and there's a little bit of legumes or beans actually part of that sprouted bread. So it's giving you that protein component.

So that's pretty cool if you can get a carbohydrate that's also giving you the presence of a complete protein.

Dr. Dawn Mussallem17:01

Well, the research is is like it's incredibly powerful. So if if you were to say Don what is the most important thing someone should get in their diet I would say without pause fiber you know and I always share with people when you hear someone sharing a study you always want to pause and say first of all is that study done in humans

How many people were in the study and what are they comparing it to so there was a study published over the last two years that had 17 million people as part of the study it was called an umbrella review

Dr. Dawn Mussallem17:31

I mean that's that's a massive study And what this study showed is that those individuals that consumed more fiber had a 24% reduced risk of dying from heart disease. So fiber is so important from cholesterol management, from hormone management, as well as even kicking out toxins, even things like microplastics. People don't think about this, but fiber was huge in the study. Cardiovascular disease is the number one reason men and women die. And so,

Man, that's an ugly message. I don't ever like to use that mortality thing, but you know, the truth is is something as simple as fiber needs to be acknowledged and it's something that you get to add. We're not taking away from anything. I'm saying, "Hey, I want you to add it." So, I think that's awesome message.

Dr. Dawn Mussallem18:16

So, it's certainly not going to hurt you, but I always step back and say, why if you can get it from food?

So, I really just want people to get it from food. And if someone wants to add that extra, that's a great benefit.

You know, we know that that fiber, that same study with that 17 million person review, it also showed a reduced risk of pancreatic cancer.

Dr. Dawn Mussallem18:34

A reduced risk of diverticular disease. We see in studies, study after study after study, a reduced risk of both cancer incidents as well as dying from cancer. And we also know that fiber is great when it comes to metabolic optimization and weight loss. So, it's like my goodness, like checks every single box. Yeah.

And then we we know that fiber and resistant starch is so good for that gut microbiome and it releases something uh called these short- chain fatty acids that can really ignite that metabolic response which is which is really really important. So when it comes to fiber unfortunately 90 to 95% of Americans are deficient.

Dr. Dawn Mussallem19:31

So I went to medical school. So it was interesting. So after my undergraduate training, I went and did research at the Cooper Institute.

Dr. Dawn Mussallem19:39

Exercise physiology and nutrition?

Oh wow. And so then my research was studying centinarians who were still running as well as elite runners and studying their gate, their running their running, you know, optimization, what that looked like, as well as studying muscle development in an anti-gravitational environment. So I worked with Tom Pervvis and and we were the ones that

Dr. Dawn Mussallem20:01

Exactly.

Dr. Dawn Mussallem20:05

They do. And it's how do you how do you load it? Because if you have weights, the weights float. you can't. So, you know, we worked on really loading it with different bands and different different forms of resistance. So, that was very exciting research that took me to medical school. I actually went to naturopathic school before traditional medical school. I was interesting.

I was so disenchanted even back in the 1990s with what I was seeing medicine do. Nowadays, we hear medicine is so reactive. Well,

I mean, I'm here to say in longevity it's also reactive because the majority of Americans have chronic disease. So, we're having to fix up,

You know, all of of the brokenness that we have in the body because people just haven't taken good care of themselves for so long.

Um, so we're we're kind of in this reactive phase of trying to to to

Reverse chronic disease, if you may. It's exciting to be at that that position of prevention, but in naturopathic school, I learned so much about the body's innate capacity to want to heal if you give it everything it needs. eating healthy, moving the body, getting a proper sleep, and most importantly, just loving kind connections. It's actually so easy. It doesn't even cost money to do any of those things, you know.

So, naturopathic school and then I realized in naturopathic school that, you know, that was going to really limit me potentially. So, I went to traditional medical school in Arizona. And this is actually when I also became, you know, part of doing my clinicals at Mayo Clinic. So, in the year 2000 is when I started that relationship with Mayo Clinic.

And what school did you go to in Arizona? I went to Midwestern University with my clinicals. So, it was very exciting. I've always loved studying. I, you know, I'm like I feel like I'm a lifelong learner. I think, you know, ev anyone considering going into medicine or those of us in medicine, you should never lose that desire for lifelong learning and curiosity. You should always be curious and you should always be trying to problem solve something. Um, because there's so much mystery uh within the body that I think we're really starting to unlock.

And you know, Peter Diamandis, I have this gift of working with him at this time. And I love what he says where if you can stay alive for the next 10 to 15 years, we will pretty much be able to reverse everything at that point. It is unbelievable at the speed in how rapid we are with discovery in innovation because of AI.

Dr. Dawn Mussallem22:18

It's so cool. I I almost at times find it hard to sleep because it's like, whoa, I want to read this paper. I want to read that paper. So, you know, it's a really fun time to be in medicine and we wouldn't be able to be making these advancements without AI tech, you know, AI advancements.

Dr. Dawn Mussallem23:33

So this is what was so interesting. So in medical school, it was a few months into medical school that I was diagnosed with cancer.

Dr. Dawn Mussallem23:44

Well, I had met my husband before I went to traditional medical school, right around that period of time. And it was about three months into medical school. I wasn't feeling well and I would I saw the first doctor and you know it was so interesting because I was again like you I would run Camelback Mountain was in Arizona so I did twice a day up down up down you know we would like pride ourselves doing on the hottest day like kind of this like insane stuff but again it was like just this level of discipline and you would like just these challenges.

All of a sudden I couldn't do the mountain and then I'm like oh my gosh I can't even do the steps to get to the mountain. So I saw a doctor. He didn't listen to my lungs. He's like, "It's asthma. Use this inhaler." I was like, "Okay." Yeah. I didn't think twice of it. Use the Didn't get better. Saw a second doctor. He said, "Use the inhaler more." Still didn't listen to my lungs. And at this point, now I can't even walk like 10 feet.

So, I see a third doctor and that third doctor said, "It's in my head. It's psychossematic. It's what happens to every medical student." And, you know, I would say one of the things that, you know, we all have our own little weaknesses is maybe one of my weaknesses is I don't always speak up. like I'm kind of the nice the nice person in the room and and I also believe in honoring a physician like trusting a physician where I knew the kind of physician I was going to be one day and so I just kind of trusted that everyone was that sort of physician but unfortunately this doctor didn't pay attention and didn't listen to me either.

So fast forward, you know, coming home from medical school, I collapsed. I was taken to the emergency room. I had a 15 centimeter mass wrapped around my heart in the great vessels that was compressing it. So the blood wasn't getting to the brain the way it needed to. They took me to urgent surgery. And the next morning, that is when they found out that I had a stage 4 cancer. It was a diffused large B cell lymphoma. This was in the year 2000. And you know, back then young people just didn't really get cancer.

Cancer wasn't common like

Dr. Dawn Mussallem25:36

Yeah. And if you got it, you were going to die. I mean, just no one survived cancer back then. And the chemo is just so different than it is nowadays. And thank goodness we learned from the year 2000 to today how to treat this cancer better. All cancer is better, how to reduce the toxicities, and how to individualize treatment strategies. But, you know, I had met my my daughter's dad, my husband prior to all this and he stood by my side during this time. Of course, I didn't like invest into a a serious relationship during my cancer treatment because I just didn't want to be like this burden, you know.

I remember actually I had a lot of delightful men in my life during my cancer treatment. I dated a lot. I don't know. I guess that people felt sorry for me, but I would my chemo nurses would always joke. They're like, "You always have a different man with you. Why is this?" They were just friends, you know? So, We had a lot of fun. Every chemo I would do and I had many months of chemotherapy and it was

Dr. Dawn Mussallem26:32

It was a diffused large bell lymphoma. So it was a cancer of the immune system.

Dr. Dawn Mussallem26:37

And the doctors actually said you have three months to live without treatment, 20 months to live with treatment. Right? I mean, and so this is, you know, my husband, he he wasn't my husband at the time, but he was next to me. And I remember him saying, "How how long does she have?" And I remember saying, "Don't Why would you ask that question? I it doesn't even matter how long they're going to project I have because I'm not just

A number and they're not God. How can they predict how much time I actually have?

And I wasn't fearful. It's kind of interesting and I never battled it.

Dr. Dawn Mussallem27:11

I don't know, Ken. It's so interesting. You wouldn't be if you had total control over it. The thing that would terrify me is if a family member of mine had it.

Dr. Dawn Mussallem27:26

Ken, you're And I remember when you and I had this conversation when Shelby was diagnosed. It's so much harder to be the loved one because you're just standing in this place of total vulnerability with no ability to control it. Y

Where she had all the answers, just this innate wisdom of knowing what to do and how to power through.

Yeah.

But I never fought it. I never battled it. There is something that is so important when you're given a diagnosis and it is the art of acceptance and I would say with the multiple adversities I've had in my life I have become very masterful at looking for lessons like there was a lesson here and I also was given this you know benefit of being a medical student and having this curiosity my whole life of being healthy and my thought was how can I overcome this like I'm going to figure out a way I I have been given this ability to have knowledge and a lot of connections in the industry So, I'm going to figure it out.

I was very playful during all my chemos. We would have fun. I would always, you know, schedule something really fun after my day of chemo. I never felt sick during chemo ever. My existence actually was super elevated.

I was so wildly alive during my chemotherapy. Like, music was a more harmonious sound. If I heard a bird, it was just this like beautiful symphony. The grass was greener. The mountains were more vast. I mean it gives me chills to like revisit it. It was just this glorious powerful life. If I was to die at any point in that journey, it would have been okay.

Dr. Dawn Mussallem28:56

Was very religious. I was raised Roman Catholic. I had deep belief in God. I wouldn't say that I was like a consistent church go and I didn't like promote like, oh, you should practice your faith, but it was something very private and personal to me. Um, and I would just always like silently pray and the the gift of understanding the importance of gratitude. I would just be so thankful like gosh, I'm so thankful that I have these beautiful friends next to me during chemo and that I am like feeling fine during this chemo versus these other people that are just clearly very sick.

And so I

Dr. Dawn Mussallem29:31

Yeah, I stayed in medical school. The doctor said I needed to drop out, but man, when you're given that level of adversity, you need to remain as authentic and true to yourself as you possibly can. And what else was I going to do? Man, it kept me busy. It gave me something not to worry about the cancer. I had to worry about the next test that I had.

Dr. Dawn Mussallem29:53

Oh, yeah. That's the hardest part.

Dr. Dawn Mussallem30:00

Yes. the worst here. I was a fitness competitor. I got so fat because you not really but kind of I could show we could share a picture.

That was the hard part because your I was on tons of steroids.

Dr. Dawn Mussallem30:15

Tons. I mean, my face is so round and I mean I guess people didn't but I remember my clothes would get more more tight. I remember what there it was coming Valentine's Day after you know the chemo was going around and one of my dear friends, Michael Fitzpatrick, we're still dear friends. He he wanted to take me to Valentine's Day. I had a bone marrow transplant. So, it was a few weeks before my bone marrow transplant. You know, he thought, well, if this girl dies, I want her to have her nice like a nice nice nice Valentine's Day.

So, took me this lovely uh dinner. I remember was at the Four Seasons in Arizona. And I remember putting on my pants. I was like, they were gold silk pants with like this little jacket. It's kind of a cute outfit, but I remember I was like, "Oo, these are kind of tight. I want the eyes." And I was like, "How disgusting." But I always wore a wig. My wig looked just like this. I had them made, you know, like clip it back. And so yeah, but I I remember looking in the mirror feeling pretty good.

Like I I felt when I look back I'm like yeah, you were pretty sick.

Dr. Dawn Mussallem31:08

Yeah, they were so supportive. They were just amazing. My professors were amazing during this time and I you know I studied really hard. Uh I ended up graduating first in my class actually medical school. Yeah, it was like really cool. I was like really challenged that I had a uh my my medical school years actually got delayed by a year because of ongoing health situations. I had to kind of slow down in my training. But it was really incredible. Did my chemo. Did a bone marrow transplant.

Dr. Dawn Mussallem31:39

It was really interesting Ken. So you have to check into the hospital and you're going to be in the hospital for many weeks, months in some situations

Dr. Dawn Mussallem31:47

Mhm. So they give you high doses of chemo. So okay, you know, I had regular like outpatient chemo for

For I guess six to nine months. And then in in March after my diagnosis, I was admitted to um Good Samaritan Hospital, which was City of Hope, that's who did my bone marrow transplant. My medical oncologist, Dr. Jeffrey Scriber, amazing healer, amazing doctor. He knew I loved exercise. So he had a bicycle in my hospital room and he also had a bicycle at the nurses station. And I wake up at 4:00 a.m. every morning. have since I was a kid. So he said, "I know you're going to wake up early, do your studies." He's like, "So you have the bike in your room, but if you want to kind of sneak out, you can go ride the bike at the nurses station." And that's when I had this like aha moment.

I remember like I I I remember so much of this so so vividly stepping out of the hospital room 4 a.m. to go ride the bike. And I remember looking out and it was almost like what we see in an ICU, a critical care unit was all glass doors. You kind of peek in the rooms. And everyone was dying in an effort to stay alive. And I remember just like floating through the halls like I just attained this vitality without pause. You know how powerful is that?

And I was getting these high doses of chemo. My immune system is essentially zero. And most people are very very sick. This is the testament to meaning, purpose, keeping your schedule, you know, one that you align with. You know, if I was tired, sure, I would would take a nap during the day, but I always felt best waking up at 4 in the morning. So that's what I did in the hospital.

You know, I would ride that bike. We now know that exercise, you know, with some cancers that marches right along the same benefit as chemotherapy.

Doesn't mean you shouldn't do chemotherapy. It just means in combination you get this really powerful outcome. And one would wonder, is this why I'm alive today? Because back then, people with my kind of cancer just didn't survive. And so I was really like an end of one situation.

Dr. Dawn Mussallem34:24

Yeah, beautiful question. So, they give you this highdose chemo over about a week period of time and or radiation in combination with that.

Dr. Dawn Mussallem34:36

Day after day after day of highdose chemo with all different times. So you'll get that like a lifetime dose one day, day two, day three, day four, day five, and they drop your immune system to zero cuz they're killing all the immune cells in your body. Okay?

So they drop your immune cells to zero and then when that time comes then they give you back cells. Then you have to wait for those new stem cells

Basically. You think of like nowadays we're doing some stem cell therapies. You get these new stem cells that are then going to implant into your bone marrow to create your new immune system.

Yep. So you're giving back a new healthy immune system that won't have cancer.

So you have to wait for days for those new or weeks for the new immune system to start to kick in. And so that's what that's all about. And during this window of time, they're watching for severe infections because

Dr. Dawn Mussallem35:29

So this is a positive pressure floor. They don't allow many people to come in because the the basically the the pressure of this of this unit doesn't allow for the air is constantly pushing out. Yeah. So, so air can't come in. It's very sophisticated of filtration through the vents and everything in the rooms. I obviously

Dr. Dawn Mussallem35:51

Clean gown, mask. This is back in the 2000s. So, all sorts of precautions. They were very you were very limited to just your first you know your immediate family that could come and visit you. So you're exactly right. And of course when I would come out to the nurses station everyone else was in their rooms. I would have to wear a mask when I came out. Um but for the most part you just stay in your room during that period of time. You make it feel like home and it was you know you just accept again.

It was just like this is what it's going to be like for the next month and then I have the rest of my life to embark upon you know the remarkable journey that I have. Um and then I was cured of the cancer ultimately. I I had to do several months of radiation therapy after that. Um

Dr. Dawn Mussallem36:33

So radiation therapy is just it for me it was basically angled right towards the heart section nowadays in terms of radiation therapy. There's a lot of different modalities and ways of doing radiation. Even very targeted radiations that basically tone or hone right into that exact tumor. Back when I had had radiation, it was more just kind of non-specific. My

Dr. Dawn Mussallem37:02

Exactly. Where the tumor once was. So, they just want to make sure that there's no hospitalitable territory that that tumor can grow back again.

Dr. Dawn Mussallem37:12

You know, they couldn't remove the tumor because of how it was placed

And they were able to pull pieces of the tumor off during that original surgery so that the vessel would be able to have blood flow. They sampled it. They debulked it some uh but ultimately they were not able to remove my sort of cancer. That's not a kind of cancer that they can typically remove.

Dr. Dawn Mussallem37:30

So with the radiation though, you know what happened after my cancer journey is I ultimately developed heart failure. And

Dr. Dawn Mussallem37:39

It was about 2 years after.

Dr. Dawn Mussallem37:46

Oh yeah.

Dr. Dawn Mussallem37:47

my heart." Well, it was really fascinating because, you know, I finished my cancer treatment in 2001 and I was cured in that summer of 2001 and then my husband and I found out the gift of growing our family in 2002. This had never happened before.

So, this was a year after about a year and a half after my chemo that I I wasn't having menstrual cycles and I wasn't feeling good. And in fact, they had thought that my cancer was coming back. I was losing weight. I was nauseated.

Dr. Dawn Mussallem38:24

Yes. This was my husband. So this was this was in 2000. This was in my last year of medical school.

Dr. Dawn Mussallem38:34

Yes.

Dr. Dawn Mussallem38:39

No. This is a different kind. So I just, you know, when you go through that high of dose of chemo, one thing the doctors told me when they first diagnosed me was you're never going to be able to have kids. You don't have time for ovary preservation. Typically, when you are a young woman given that load of chemo, what they want to do is they want to try to preserve some eggs from the ovary. But that takes time. And they had to start chemo right after.

Dr. Dawn Mussallem39:02

They do egg retrieval.

Dr. Dawn Mussallem39:06

That is so difficult.

Dr. Dawn Mussallem39:14

I am so sorry. It's And you're right. Hey, I mean, I remember watching women with breast cancer be diagnosed and we would do that egg retrieval and we should we should always try to do it, but it's just so hard on women's bodies.

Dr. Dawn Mussallem39:55

Oh, God bless her.

Dr. Dawn Mussallem39:57

You have beautiful babies now because of it though.

Dr. Dawn Mussallem40:16

Oh my goodness.

Dr. Dawn Mussallem40:19

We see this happen. You know, it's it's so interesting. We just wonder if you know, you have that adopted child, you kind of like relax and the nervous system just settles in and then boom, the the body works how it's intended to work. It's just

Dr. Dawn Mussallem40:47

I just the the stress around wanting to be pregnant.

Dr. Dawn Mussallem41:07

I get pregnant. You know, I remember doing PET scans, MRIs. They're doing all these scans because they think that the cancer's back. And I go to see my gyn. This is where, you know, like as a doctor, just listen to the patient. And I said, "Can I do a pregnancy test?" And they're like, "No, there's no way you're pregnant. It's not possible. You're not even having periods." I said, "I know, but they've checked everything else and can we just check it?" And he's like, "No." And so the nurse comes in.

I'm like, "Can I please just check?" "Sure, go ahead." And so they both come in after like blue, like you're pregnant. And they called my doctor, my oncologist like, "There's no way this is a viable pregnancy. It's probably something called a molar pregnancy, meaning like an artificial pregnancy, you know, and so sure enough, they do an ultrasound. I'm four months pregnant. I'm not just like a little pregnant." I'm like,

Dr. Dawn Mussallem41:56

Exact. Well, exact. I was actually losing weight because I was I was having nausea and I just wasn't feeling good. And I'm like, "Oh." So, I'm like very pregnant. So, I remember I called my husband because I was still in Arizona. He had a business both in Florida and Arizona. So he is in Florida. I'm like, honey, I'm pregnant. He goes, what do you mean? I was like, I know. You know, he was older than me. He was 20 years older than me and he had had kids from a previous marriage.

And so it was kind of like, oh, we weren't expecting this, right? You know, and and he's just wonderful. He he he was a he's a wonderful man. And so, yes. So, in 2003, May delivered this beautiful, perfect, healthy baby. And I remember during the delivery of Sophia, it was so hard. I remember thinking, whoa, like no one talked about this being this hard. This is

Dr. Dawn Mussallem42:45

Natural delivery, but I was like, this every woman deserves a cape.

Dr. Dawn Mussallem43:19

Were they big babies?

Dr. Dawn Mussallem43:35

Well, you're right. I think every woman deserves a K. They're all super women. But what I later learned is, you know, it was a few weeks after Sophia was born that I started getting progressive shortness of breath. It wasn't just during the child birth. And so I had had heart failure during the child birth. That's why it was so hard. But we didn't

During the child birth.

Dr. Dawn Mussallem43:53

No, but it the heart failure had probably been there for some time. It probably happened shortly after my chemo, but I was so fit. I had such a massive cardiovascular reserve that it was unrecognized. It was unwitnessed. So, a few weeks after my daughter was born, and this is a huge shout out I want people to understand. Never compare your journey to mine or to anyone else's. Our our journeys are so unique to ours.

When I had cancer, I didn't have to worry about anyone. I just had to worry about me. Yeah. You know, I didn't have kids. I wasn't married. Big deal. I was going to be okay. man, if I if I did die, that was meant for me. But now the whole narrative was different. Now I have a a husband to worry about. I have a beautiful baby. I can't even hold her. I'm so weak. And so I don't want to tell anyone, you know? I'm just like keeping it to myself and keeping to myself and keeping to myself.

And I'm thinking, "Oh my god, is the cancer back? What's going on?" At

Dr. Dawn Mussallem44:44

I was finishing up my last year of medical school at this point.

And so

Dr. Dawn Mussallem45:03

I didn't know he went through that. I didn't know he struggled with that.

Dr. Dawn Mussallem45:09

I love Jeremy. Yeah,

Dr. Dawn Mussallem45:10

Oh, both him and his wife are just such special people. They remind me actually of you and Shelby.

Dr. Dawn Mussallem45:15

So Oh, I'm so sorry to hear that.

Dr. Dawn Mussallem45:21

I didn't realize that.

Dr. Dawn Mussallem45:53

Oh, wow.

Dr. Dawn Mussallem45:55

Well, he's extremely inspirational without me even knowing that. So, I just really think he has such powerful message as well.

Dr. Dawn Mussallem46:01

Thank you for sharing that.

Dr. Dawn Mussallem46:25

Great question. So basically finally went to the ER, right? Same symptoms I had when I basically presented the ER with cancer. So I thought for sure that's what they're going to tell me.

They did an ultrasound of the heart. My heart was only beating at 8%.

Oh my god. Heart failure for me, I didn't have anything wrong with the blood vessels in my heart, but the muscle had gotten extremely weakened from scar tissue from the radiation

As well as from the chemotherapy. So, it was both things. And

Dr. Dawn Mussallem46:56

Not good. It was a dilated cardiammyopathy with this restrictive element. So, it had like both things wrong with it. It was dilated, but it was stiff. So, it was just really kind of locked in. So, that hospital had said, you know, you're going to need an urgent heart transplant. This was in 2003. And this is when I actually first became a patient at Mayo Clinic. And I remember going to Mayo Clinic and seeing the medical team there. And they just filled my heart and my family.

It was so much hope saying, "Hey, we're going to put you on medicines that are going to help to remodel and and heal the heart." And there may be a point when those don't work. And so I have to do some procedures, some different devices. And you may get to a point that you need a heart transplant, but let's not worry about that right now. Let's just start with the basics and let's get you exercising again. I was like, "Yes, I can do that." So cardiac rehab, medications, heart got stronger.

I was able to go back to medical school. So this is what happened. I had to take some time off from medical school because of the heart failure. I couldn't even move like I couldn't walk from here.

That is a hard diagnosis. You know, it's funny, Ken, when I was diagnosed with cancer and these doctors are like, "You have asthma. You have asthma. You have asthma." This is to validate anyone with a chronic condition. I was like, "Wow, this is so hard with asthma." When I got cancer, I'm like, "Thank God I don't have asthma. you're going to cure this cancer and I'm going to get my life back. And that's what I did. But now Harford, I'm like, "Oh no."

And I remember describing my life though outward like no one would ever have known this, but it was kind of like my life was shackled. You know, I was young. I was 29 years old. I was a baby with a heart failure of ejection fraction of 8%. This is generally a disease of of elderly. Whether you're old or young, this is not an easy diagnosis because your heart just isn't getting the blood to where it needs to go. So I would have word finding difficulties. I would have shortness of breath.

I didn't have the swelling in my legs like most people would have, but I would hold a lot of water in my liver, so my my belly would hurt me a lot. Um, but you know, the medicines helped me eventually and I got stronger, went back to residency, got really strong and actually was able to to do really well in residency. I thought, gosh, I think I'm going to eventually want to go into hospital medicine, but I overdid it. I had to take some time out in 2007, and it was it was then when they did my first device.

It was called a bentricular pacer to help my heart beat in a little more optimal sequence and they also put a defibrillator in. So in the event that I would have a fatal arrhythmia that defibrillator would come to the rescue to save my life.

Dr. Dawn Mussallem49:19

No.

Dr. Dawn Mussallem49:27

Well, that's interesting, you know, and it's it's everyone should look at their heart rate variability, their personal trends. Yes. But I do love heart rate variability because it is a good indicator of stress, you know, and how we're managing our stress. We all have stress, right? But how do we respond to it? How do we manage it? So, we can talk about that like how you can help. What do you mind if I ask what your heart rate variability is?

Dr. Dawn Mussallem49:50

Oh, that is that is good.

Dr. Dawn Mussallem49:58

Yeah.

But then I've also had readings that are like 17. that would be lower. So, if you're at 35, you would just want to stay in that trend. If you're going from 35 and dipping to, you know, less than 20, well, you're not where your baseline should be. But 35, you know, it could always be a little bit better, but I thought you were going to say it was in the single digits.

Dr. Dawn Mussallem50:15

Yeah. So, that's that's not bad. I can't measure heart rate variability now in myself. We can get to that why I can't, but it's kind of interesting why I can't measure it anymore. Um, so in so in 2007, I take this time off. I have this procedure. I don't get better initially, but in 2008 is when the most the hardest part of my entire journey happened and my husband actually died a sudden cardiac death. Oh my god. So this this message about what what Dr. London went through with his heart attack with you having the elevated lipoprotein little A and the APOB you know now I am chief medical officer at Fountain Life where we do multimodal diagnostic testing.

It is, you know, basically the fountain life platform is one for, you know, optimization of health span and longevity. But the truth is pretty much everyone coming in the door has chronic disease. So the first thing we have to do is detect. Let's find it early. Let's find the individual strategies for you that can help you to reverse this disease. And the reason I bring this up is would you believe out of the clearly scans we do or the the quantitative coronary angographies we do with AI overlay 88% of people coming through and these are people that are very proactive with their health.

So I want to say that this is for the most part like looking at their lifestyles these are healthy people.

Dr. Dawn Mussallem51:32

Well guess what percentage of people have heart disease?

Dr. Dawn Mussallem51:36

88%.

Dr. Dawn Mussallem51:38

I mean it makes me it gives me chills. So, it's even crazier. I mean, I never would have picked this. So, when I started at Fountain Life and I I looked at these numbers, you know, the reason I joined Fountain Life was because I was like, gosh, this is my opportunity to democratize well. And I like what what does keep people well and it's impossible to do this kind of research in the academic setting because it would cost so much to do these studies. So here we have this major IRB and institutional review board where we're collecting all this data and making sense of the data like when someone has this heart disease that we find what does it take to reverse it when someone has this heart disease what biioarkers are most consistent with improvement with regression of that plaque so it's it's been really a gift to be a part of this but what's more interesting is with this quantitative CT angography or

In your case you were talking about that clearly skin you're going to go get is that 22% % of the individuals had soft plaque with no calcium. So, this would have otherwise been missed on a traditional calcium score. So, this scares me because when people come in and they're like, "Oh, my calcium score is zero." And they go about their their kind of haphazard lifestyle. They're eating junk food, not exercising, not sleeping, because they're like, "I don't need to worry about my calcium score zero." Well, you don't know that.

We we need to know what the soft plaque is. And just because a calcium score is zero today doesn't mean in one year, two year, three years, 5 years, 10 years. if you keep those patterns of just destructive living going on, it's going to catch up with you, you know. So, this is a huge shout out that we have to show up for ourel. We have to live healthy. Um, so it's been really really rewarding to be in this space and we see that, you know, 26% of our members halt or reverse that progression.

Now, I'm on this path to making that number much bigger. I've only been at Fountain since February um of this year. So, you know, just just just now getting close to that that five month mark. But I I want to see that we can have really respectful numbers of reversing that coronary plaque.

Dr. Dawn Mussallem53:44

So number one is lifestyle. You know nutrition is is key. So nutrition we have a nutritionist work with every patient where I'm at. This is so special. you know, coming from Mayo Clinic where I thank Mayo Clinic for the years of of exquisite education they gave me and the opportunity to work with some of the world's most amazing patients, but in the conventional medical model, there are not enough nutritionists.

And it's just because the majority of insurance coverage won't pay for it. And it was just such a shame, especially in cancer, that these people dealing with this major disease that we know cancer is so driven by lifestyle in and of itself. When it comes to heart disease, lifestyle, nutrition matters. So, every one of our patients works with a nutritionist. Um, so it starts with nutrition. You know, getting rid of the saturated fat is critical. You know, whether that's red meat, whether that's highfat dairy, those things are really important.

Getting rid of the ultrarocessed food for sure. Leaning into more fiber. This is so important. And trying to get more plant protein.

Dr. Dawn Mussallem54:42

So, that's very, very important. Um, the next is exercise. You know, you've got to move your body. the importance of V2 testing. If someone to say, Don, what is the most important biioarker you have for your members coming in outside of love connection relationships because that is the most important. What I would say is V2 know your numbers, but the V2 max, how good your heart and lungs at cardiorespiratory fitness is, is the predictor of your mortality. When I was on that heart, you know, with my heart failure, that is the one thing that they would check twice a year, sometimes more, was my V2.

Dr. Dawn Mussallem55:20

I love doing it because it's it was the most

Objective marker for when I was going to tilt to need the heart transplant.

Dr. Dawn Mussallem55:33

Cuz you're so competitive.

Dr. Dawn Mussallem55:53

Yeah.

Dr. Dawn Mussallem56:14

That is a that is a massive that is a very impressive V2 by the way. So really yeah. How old are you?

Dr. Dawn Mussallem56:20

That is an incredible V2. You're at the top percentage for your age. Yes.

Dr. Dawn Mussallem56:27

Well I mean I think you're up there. So that's excellent. And some of it is a little bit genetically aligned as well. You can train it. Um you know so I think V2 is a lot of fun. And you know there's a lot

Dr. Dawn Mussallem56:38

Well,

Dr. Dawn Mussallem56:40

It is. This is

Dr. Dawn Mussallem56:46

It's right. This is my

Dr. Dawn Mussallem56:48

like a nut so hard and you're sucking that machine. You're sucking that air

Dr. Dawn Mussallem57:01

Well, it's pretty cool now. So there's, you know, scientists that are doing some research to say, okay, when our V2 is this number, what what certain labs and what genetic patterns and so, you know, maybe eventually we'll have a a biioarker that'll be able to predict what your V2 is. We can just check your blood and be like, here's where your V2 is. We're not there yet, but I love V2. So this is a shout out for people to, you know, talk with your doctor, get a V2 test.

Um, I think that's that's really an exciting test. So nutrition, exercise, so important when it comes to optimization for heart health. Obviously, sleep in relationships, but now when it comes to medication management, statins, they get a bad w, but we know that statins are still very, very good medications when it comes to optimizing cholesterol. There's something called pharmaccogenomics, meaning your genetics and what medicines you will most favorably respond to. So, some people are just more inclined not to be uh as tolerant to statins as other people.

And so being able to have that precision medicine guidance with our genome is really cool.

Dr. Dawn Mussallem58:02

That would be a pharmaccogenomics test. So that's something that we also do at Fountain Life. It's also something that we were looking at at Mayo Clinic early on with different companies um some time ago. So it is a big part of not just being able to do more precision care with medicines like statins. This is a big issue when it comes to psychiatric medications as well. how people can properly respond to the proper medication. But this is an area of medicine that's evolving because why should we look at just big numbers and just guess for guess for dawn.

We should be able to say these are the medicines that your genome predict are best for you to respond to and get rid of this guessing game. So we're there. It's just currently those tests cost a lot of money but they're getting less expensive.

Dr. Dawn Mussallem58:44

It depends. I mean the one panel that we do at this time it does the whole genome sequence. It does the pharmaccogenomics and it also does something called a polygenic risk score. This polygenic risk score is integrated with lifestyle. This is the coolest test. It's one of the tests that I love the most because what I find is that we have to find reasons to inspire people to show up for themselves.

Yeah.

Many people, you know, we were talking about this earlier where it's kind of like we're very pleasure- seeeking, right? You know, meaning and purpose are important. And if you can align the reason you're showing up for yourself as something that's meaningful to you, it's purposeful to you, so you can be the healthiest version of yourself for the rest of your life and feel good as you age, so you're there for your family, you're there for your grandkids. If we can align more that udemonic philosophy, it's very helpful.

So what I find is this polygenic risk score can tell Ken exactly what your risk of heart disease is paired with your genetics as well as your lifestyle.

So how much does the test cost? So, this particular panel is about $800, you know.

Dr. Dawn Mussallem59:51

But, you know what's funny is I guarantee if someone was just to piece out this other part, just the the genome as well as the pharmacomics, it's probably less expensive. It's just I I went after this advanced panel because I wanted this

Polygenic risk score because it's not just heart disease, it's also for different cancers. And I find that that's really nice for that conversation of precision saying that Ken's risk of of heart disease, his risk of cancer, his risk of these various things, and we can drill down and then continue to follow that.

Dr. Dawn Mussallem1:00:25

It's fascinating. Well, listen, in at Fountain Life, the test that I think is the coolest is our whole genome sequence. And Dr. Tom Kalis is our our geneticist. He's just truly brilliant. I'm just so gifted to be surrounded by these brilliant people. And basically he has created this precision genomic report. It's so cool. And so I can go in and you know find out everything about you. Like you would be best to do your important work in the morning or you would be best to do your important work in the evening or you actually do not process your alpha lenolytic acid very favorably.

So you really do need to be mindful of getting more sources of DHA in your diet. and these really cool like fine-tuned little ways of drilling down and knowing exactly how Ken should live. So, it's a lot of fun. You know, you don't unpack this in one visit with a patient. It takes a full year and then some to kind of unpack these different tools and methods of optimization, but this is just a really hopeful message to let people know that these tests are on the horizon and our mission is really to democratize this so we can kind of piece out what really matters most for disease prevention.

So, you know, we were talking about the statins to re reduce or improve that apo. There's also the PCSK9 inhibitors like these medications I find very very favorable for that plaque regression. And there's so many new novel therapeutics that are coming to market as well. You know, everything that may be splicing out lipoprotein little a genetically and and such. I don't know. That seems pretty definitive. I'm very conservative doctor. I like to see treatments taken all the way through phase one, two, three trials, large studies with people to show that there's not risk with the medication that there is this proper upside.

Um, so I am very slow to go with novel therapeutics and I like to be very mindful. The other medication that's really exciting for heart health are these GLPS. So, you know, metabolically when it comes to heart optimization, you want to know what the inflammation is. You want to know what the metabolic optimization is. 88 to 93% of Americans, depending on what studies you look at, are not metabolically healthy, you know, so beyond just the cholesterol optimization, including triglycerides, thinking of waist circumference, how much fat does someone have, as well as how are you responding to your glucose, you know, the hemoglobin A1C, man, when that starts to go up, we're kind of like way too late.

You want to look more at the fasting insulin. So, it's just so fun for me as a physician after all these years to be able to really be on this path of exploration to figure out what tests matter the most. And when it comes to inflammatory markers, you know, again, A1C, fasting insulin for the glucose control, but inflammatory markers, you know, the high sensitivity CRP, I really like homoyine levels for my patients, you know, as well as sometimes I check something called an interlucan 6. So, this is a lot for listeners to hear.

I think the take-home message here is we are still figuring out what tests matter the most. Every day I have hours of meetings with our scientific team going through the patterns that we're seeing to figure out which tests matter most for people. But we know what lifestyle matters. We know what medications can help. And unfortunately, when people have this lipoprotein little a elevation, you know what that tells me? That does tell me that even despite a perfect lifestyle, the genetics that you were given and that's really that that representation of what lipoprotein little A is, is it may just be too hard for those people to do it all on their own.

Dr. Dawn Mussallem1:04:02

That that apoprotein B when that apoprotein B is high, that is the aoggenic portion of the plaque, the stuff that's going to or the aogenic portion of the of the cholesterol that's going to cause a problem in in your arteries. So that's when I do think that the medications um whether it's the statin, the PCSK9 inhibitors paired with the GLP make a whole lot of sense in these.

Dr. Dawn Mussallem1:04:35

Yep.

Dr. Dawn Mussallem1:04:38

Heart's failing. and my husband passes away of the sudden cardiac death and then it's just like wow this is

Dr. Dawn Mussallem1:04:47

He he had a heart attack and he had a strong family history you know 54

But you never think it's going to happen to you you know we never

Dr. Dawn Mussallem1:04:55

He was he had lifted weights a lot but he had started to gain weight you know it's just like one of these things and you know I knew better as a white but you kind of you don't like try to control other people you know and it's just you hope that they that they realize the importance of this and It worried me, but I never we never we thought I was going to be the one to die, not him. And it's the hardest thing when a loved one when a loved one has an illness or of course loss.

And loss is really the persistence of love. I came to this realization that why is this so hard? Of course, it's hard. But it was just that I had such beautiful love and I learned to kind of pivot it to where I was so grateful that I had the presence of that love in my life and that he gave me this beautiful daughter that is just a spitten image of him by the way. Like a total spitten image of him. Um this is when I became very strong in my faith because I had to understand the reasons why this was happening to me.

You know, I had to go back to work. Not that I I mean I wanted to go back to work, but I wasn't really ready to go back to work, but I had to go back to work for benefits and to to afford like being a single mom. I mean, it was just not easy. People I don't really know that side of what happened. I had to find a home and I had to get a car. Like it was just like whoa. Like I was really dependent on my husband.

Like really, really dependent. And life all of a sudden had this total change. And God bless my daughter because here she is used to this life and then things really had this huge shift. So, you know, it's so interesting. I think a lot of people have heard my story and they think that I'm like that I'm really strong and resilient, blah blah blah. And I I think I've been given a lot of gifts that I am strong and I've been given this gift of knowing how to bounce back.

But like the real strong person here has been my daughter. Like I just look at her in just such awe. I could like it's so emotional because she has witnessed so much in her life and it's so hard. And this is also a shout out for for for moms and dads not taking care of yourself. You know, I watched what my what my daughter went through when her daughter went through when her dad died. dad died. And I think if he would have And I think if he would have known that, known that, he probably would have tried he probably would have tried a little a little harder, maybe went to the harder, maybe went to the doctor a doctor a little more, maybe done these little more, maybe done these things.

Things. You don't think about it when You don't think about it when you're you're young. I we think we're young. I we think we're invincible. We invincible. We don't think it's ever don't think it's ever going to happen to going to happen to us. But on the other us. But on the other side, side,

Dr. Dawn Mussallem1:07:10

Yeah. Well, we're going to take care. We're going to we're going to optimize We're going to we're going to optimize you. We'll come back. We'll be like, you. We'll come back. We'll be like, "What do we do? We're going to we're "What do we do? We're going to we're going to get that. You know, I watched going to get that. You're going to get your Clearly and we're going to find out what it shows and then we're going to get all your I'm gonna help you.

Dr. Dawn Mussallem1:07:21

Yeah. I'm going to have you stop. You're going to stop that red meat.

I'm going to turn you into a vegan. No, I'm not here to promote veganism.

Dr. Dawn Mussallem1:07:36

Exactly. Well, we know we got to get rid of the the saturated fats, right? And so there is way too much data with red meat and heart disease. You know, it doesn't mean that you can never have it again. It just means that we shouldn't have it every single day. And we we really in people at high risk, we really need to dial it all the way back, optimize the numbers, see things regress, we can add like back little pieces is what I would say. But a low-fat diet really matters.

And particularly that saturated fat

And there's so much delicious food out there. And it does matter like the joy of food, you know, in the perception of it. And you have that strong mindset that everything will be great. Yeah.

You know, I've been given the gift of working with Dr. Caldwell Esleston as well as Dean Ornish and they both have strong data showing cardiac disease reversal with a whole food plant-based diet. The question is is I don't feel like again I said early on that it needs to be compared to what? And I do feel if someone does a healthy Mediterranean diet that's whole food, lowsaturated fat, leaning in on healthy forms of fish, especially fish that you know maybe there's some control over the microplastics and in the um and the heavy metals potentially can be a very healthy diet.

Um low-fat dairy. There was a really cool study. The dietary patterns on healthy aging showed that with a healthy diet, it can contribute to healthy aging by 86%.

Dr. Dawn Mussallem1:08:49

Everyone's looking for these magic bullets and spending this outrageous money and some are just eating junk. I recently was with someone and they're like on this this path and spending all this outrageous money on these like heroic interventions. They were eating this huge cookie. I'm like, "Wait a minute. This isn't line. It's okay. You can have a cookie. It's not going to hurt you." But this person has like a lot of those little snacky foods and like your nutrition matters so much. You cannot

Outrun a a junky diet. It's what fuels your body. You can't run. I love nutrition. I mean it's just it is like what ignites our like our vital force, you know. So I think food is medicine. Food is love. It should never be restricted. Um you know we need to change that mindset. If you feel it's restricted, we need to step back and ask why and how we can recreate foods that you enjoy and just retrain that pallet. Because I think if people are are consuming the diet in a place of restriction, we're failing them.

Yeah.

And I get super excited about food. And it's so funny, David, my fiance, he's like, "Yeah, she can really eat. I can eat a ton of food and I'm I'm pretty petite,

But it's all healthy food and I don't gain weight." It's because it's healthy food.

Dr. Dawn Mussallem1:09:59

So my husband passed away. I was given this miraculous gift of of somehow getting stronger. So eventually that bentricular pacer started working

And I got so strong that I was able to go back to work. I even did a hospital fellowship. I became a very successful hospital physician at Mayo with this like wild schedule.

And then eventually I was asked at Mayo Clinic to start the integrated breast oncology program. So I founded that program at Mayo Clinic. And then in 2016, the success of the program, I was able to present to hospital leaders that I wanted to roll this program out to the entire organization so people with heart disease can have this or diabetes, whatever, kidney failure, because it was such a remarkable program for women with breast cancer. As I'm giving this presentation to in the boardroom to all these hospital leaders, I remember, have you ever like used a mouse and you're like, why won't the mouse control the cursor?

And I remember just looking and I'm feeling like I'm getting disoriented as I'm trying to control it and things the cursor on this far screen as I see all these colleagues and hospital administrators around me gets more pale and more pale and that was my last conscious memory.

I had a 4-minute near-death experience.

Dr. Dawn Mussallem1:11:28

It's so well

Dr. Dawn Mussallem1:11:32

I don't know what happened um I don't actually think I collapsed I think what happened is I had just lost consciousness and slumped over and then they took me to the ground because when I came back to consciousness I was lay on the ground that defibrillator recorded my electrical conduction system and I was in a total flatline for 4 minutes.

Dr. Dawn Mussallem1:11:50

And my defibrillator was shocking me the whole time.

Dr. Dawn Mussallem1:11:56

You're the only person that's ever asked that. So my colleagues, no one knew I had a health problem. I mean, no one would have known. I I never let people really know it except for my doctors and that's kept pretty private, you know. So they thought I was having a seizure.

Oh, cuz the thing is shocking you having a seizure. So, no one did CPR. Like, they just thought she's having a seizure. And you know, when this happens to your colleague, you don't think clear. Like, you don't think in the boardroom someone's going to have a cardiac arrest, but here I'm having a cardiac arrest, total asisle, flatline. There's nothing different they would have done anyways, you know.

Dr. Dawn Mussallem1:12:27

Well, the defibrillator was doing that basically, you know. So, I was getting shocks. It probably would have been nice if I was getting some chest compressions along the way, but

Dr. Dawn Mussallem1:12:37

You know, we don't think that that's as necessary as we once did. Um they've set since like restructured all the the code pathways in Mayo Clinic because this happened. They're like what do we do like she's having a code not in the hospital but we're in a border you know all these things you know everything's going to happen to a friend. So from that point forward is when they knew that my heart was never going to be be able to sustain life and so I was listed for heart transplant in 2019.

I waited you know 12 whole months without one single call and I was in the outpatient setting. This is during COVID. So, I didn't want to go in the hospital because once I went in the hospital, I wasn't really able to have visitors, you know, once one or two family members, but they weren't excited about my daughter coming to visit me because she's in high school.

Dr. Dawn Mussallem1:13:20

Oh, I'm sick. Like, I'm like near losing consciousness all the time if I talk too much. Word finding difficult bed.

No, I would never let myself do that. I knew how to control myself. Like, I knew like I would live like this. like I'd grab on when I remember that feeling of like when I would feel like I was going to lose consciousness. It just happened so often that I just wouldn't get enough profusion to my brain.

Um and I just didn't overdo it. I took it easy. You know, I worked from home at that point. I was just doing video visits with patients. I love doing that because it just kept me busy and the only thing I really could do was that I was not exercising, wasn't walking. I just the it was hard for me to talk. It was hard for me to think. Um, so in 2021 in January, that was the point when my labs were just no longer safe to be at home.

They admitted me to the hospital for supportive therapies that would actually help my heart pump. And then

Dr. Dawn Mussallem1:14:10

She was in high school. So, she would come and visit me after school.

Dr. Dawn Mussallem1:14:15

My mom.

Dr. Dawn Mussallem1:14:16

My mom. You know, my mom is such an angel. I was so It was so beautiful because my mom helped me raise my daughter. You know, I couldn't lift her. I couldn't bathe her. I had such severe heart failure when she was born. And I really in raising my mom, in raising my daughter, I had my mom really central to to helping me with that because if I did die, I I wanted my daughter to have that really close relationship with my mom and they do.

Um because of that,

Dr. Dawn Mussallem1:14:42

And it kept my mom so young.

Dr. Dawn Mussallem1:14:44

And so so sharp. And I mean, it was really it was such a blessing. you know, multigenerational living is a is a real link to longevity because it she had to remain so young and vital. And so now she she she has her own life that she's able to reclaim with my dad. And it's kind of nice to see the two of them living their own life for the first time cuz here as a mom, she was tied up with me as a sick patient with cancer.

And then oh my gosh, now I have a I have heart failure and she has to help me raise my daughter essentially. So

It was I I have a beautiful family, very blessed, but um yes. So they they find a matching heart in the hospital. I

Dr. Dawn Mussallem1:15:23

It was pretty quick. I was very high status for a heart waiting. So they knew once I was in the hospital, I should get a call pretty quickly, but still no matches and my numbers were getting worse and worse. They there was no additional therapies they could offer me. I was not a candidate for a balloon pump. I wasn't a candidate for a a heart pump like a VAD. It's called ELVAD. So the next thing they were going to do is put me on ECMO, which is full life support.

And we were having these discussions because I wasn't getting enough blood to any of my organs at this point. So February 5th, 2021, they found a matching donor. So this is pretty remarkable that you would think and the physicians were my friends.

Dr. Dawn Mussallem1:16:00

So hard when you're treating a friend. You don't really start to think objectively. So he comes and he sits on the end of my bed, Dr. Patel, Perog Patel, just a delightful person. He's like, "We found a matching heart." You would think that the minute I heard that, I'd be like, "Yes." But I remember thinking, whoa, like what does this mean? Does this mean that I'm going to lose the memories of my like literally perfect childhood? The memories of my daughter being born, the memories of my husband who passed away.

I started like rethinking this whole thing. Like I don't know if I want to do this. And then the next thing he tells me is, "I have to tell you something else." And I remember just looking up like, "Yeah." He goes, "Your donor is an IV drug user with hepatitis C."

Dr. Dawn Mussallem1:16:39

I mean, I was like, "What?" And for the first time in my life, I remember thinking, why me?

Dr. Dawn Mussallem1:16:45

Like I was so mad. I was I was so like hurt. Like I what do I do with this? And the reason was is several weeks before my transplant, one of my friends who's a psychiatrist said to me, do you even want this heart transplant? I'm like, you know, we have to think about what we say. Our words are so powerful, especially as doctors, of course.

You know, and I thought, well, I don't want it, but I need it obviously. And he goes, well, aren't you scared your personality is going to change? And so when I was told that I was going to get an ivy drug user or heart, I

Dr. Dawn Mussallem1:17:16

But there's been suggestion that there's an emotional connection in some personality traits are picked up particular with heart transplant recipients.

Dr. Dawn Mussallem1:17:26

It is crazy. There's like really interesting. There was this one patient at Mayo Clinic that had never played an a musical instrument. In weeks after his heart transplant, he said to his family, I want to play this instrument. It was this very unique instrument. They later found out that the organ donor was like this very acclaimed musician with that particular instrument.

Dr. Dawn Mussallem1:17:48

It's crazy. It is crazy. So, this is what goes through my mind. Like I'm thinking I kind of like my personality. It sounds kind of He goes I'm like I just life I love people and I don't want that to change.

Dr. Dawn Mussallem1:18:01

It was so interesting. But you know Ken So I said I just had he goes think about it and you know you don't know if you're going to get HIV either because they can't screen for it. Oh my god.

So it's kind of like who wa but we could treat HIV. Same thing if we could cure hepatitis C now. So it was so remarkable though after a few hours I had this knowing this like knowing came over me like wait a minute this is meant for me and why am I judging to begin with cuz here's this woman. I don't know why she was IV drug user but for whatever reason it was beautiful that she decided to be an organ donor right

Everyone should be an organ donor.

Dr. Dawn Mussallem1:18:31

Well, you know, over 90% of Americans believe in organ donation, but only 65% actually register. So, this is a shut off.

Dr. Dawn Mussallem1:18:45

Check a box. You can sign up online. Let your family know because if you sign up and if you don't tell your family members, sometimes family members be like, "Oh, no. We don't want them to be an organ donor." And that's a myth when people say, "Oh, but they let you die sooner." They absolutely do not. If anything, they're going to try to keep you alive. They want to keep you alive for as long as possible, you know, because they want to make sure that everything is properly optimized um before they do that official organ donation.

Dr. Dawn Mussallem1:19:11

Yeah. That's

Dr. Dawn Mussallem1:19:14

And I want to be that message of hope, right? Like taking you know the die and you're you're buried you you're doing nothing. Yeah.

Right. And so if you can transform the finality of death into meaning and purpose, how powerful is that?

Dr. Dawn Mussallem1:19:33

I live every day forward like this. I am on borrow time. I need to do something really special. Love humanity. I am here to help anybody. You know that that is what this needs to be all about. That's why I love the opportunity to do these these talks that you and I have right now because it's impossible to he help each person in the world. But if the message can just give one single person hope, that's what this is all about. So I went in for my heart transplant.

My dear friend Dr. Bashar Sarapo is my heart transplant surgeon. I remember getting eye contact with him before that operation. I had no fear.

I had total knowing that within days I would wake up to like this total new life.

I'm scared just thinking about it for you. I wasn't I was like so ready. In fact, it was so crazy because I was like really with no energy. And there's even a video clip of me saying they're like, "What are we doing today?" I'm like, "You're going to take out this heart and give me a new one." And I'm like joyful. I look like I have so much energy. And actually, I I didn't have that much energy, but it was just like, "Wow, I I am going to get my life back after 18 years.

I am days away from I have like goosebumps like being fully alive like without limits and to be able to do all that I was meant to do and that's like this p like I wish I didn't have to sleep like that sounds terrible but I just have so much to do and I have so much energy and I'm so grateful.

So the heart transplant was very complicated. I remember going under anesthesia and usually before I I have had so many surgeries yeah with the heart failure leading up to the transplant and before every surgery I'm Catholic I'd always make this sign of the cross be like please God let me wake up please God let me wake up please let me live there was none of that I remember just giving gratitude to the the organ donor family like just gosh thank you so much for the for letting your loved ones share their life with me

And I am going to just do something so special with this heart And man, this that that heart was meant for me. And we can talk about that in a minute, but I had a lot of complications after my transplant. I actually had to be taken back to the operating room after they had closed me up because I hemorrhaged. They were worried they were going to lose the graft and everything. It's very after all that radiation, you just bleed so much. So, it was several days that I woke up and I remember waking up and you know, it's just like this remarkable.

Well, if you said what are the most like what was the most beautiful moment of your life? I think it's would definitely say child birth, but waking up after the heart transplant was really powerful. I just remember hearing this harmonious sound and it was my hair and it was brushing against the the crisp sheets of the hospital bed to the powerful beat of this new heart. Like my whole body was moving. I had not felt my heartbeat for years.

Dr. Dawn Mussallem1:22:16

I mean, I was so weak. It was just like barely beating. And all of a sudden, I could feel it. My body was warm. My hands were warm feeling cuz I had never had blood going to my hands really

For so many years. I

I didn't know what that felt like. And I remember just having total clarity of thought. It was just like this crisp thought process.

And I just felt like my energy was so heightened. So it's just such a gift. And you know, I feel that I don't know what she experienced in life, but it's like we just live in total harmony with one another. It's wild.

It's totally wild.

Dr. Dawn Mussallem1:22:53

I didn't. I sent them a letter. So, after so many months, you're able to send the family a letter, you know, a little bit about you and, you know, your experience with the transplant and just this, you know, immense level of gratitude that I have for the gift that I was given, but I never heard back from them.

Dr. Dawn Mussallem1:23:08

It is too bad. I I would love that opportunity, but it's not about me. It's about them. And everyone grieavves so differently. I would love that opportunity just for them to know that their loved one is like my source of inspiration for everything that I do in life. And following this heart transplant, it's helped to save so many lives and give so many people hope that it really is the power of organ donation. I'm one like every organ donor has this really truly same sentiment. So, it's been a gift.

Dr. Dawn Mussallem1:23:41

So, my especially is interesting. Integrative oncology is where I work right alongside traditional oncologists with the conventional therapies and then I add on additional therapeutics that would help to mitigate the adverse effects of the cancer treatment and or improve the cancer outcome. So you know if you look at the American Institute for Cancer Research guidelines they march out 10 guidelines things that can help to prevent cancer but the same things that help to also help survivors live their healthiest life. But then beyond that, I would do a lot with optimizing metabolic health, a lot with optimizing different nutrient gaps or nutrient deficiencies, precision nutrition, especially in this era of chemoimunotherapy where I would do a lot of precision nutrition with gut microbiome support so that individuals have the most optimized gut microbiome so their immune system could help to be more engaged with that imunotherapy to have an augmented response.

Tremendous area of research that I was excited to be a part of. Um and then of course helping people along the meaning and purpose of their diagnosis as well as just helping to mitigate that stressful um experience if you may. So I did a lot of coordinating different retreats and immersion programs with individuals. Then I used some off label drugs as well um ones that showed low harm but potential benefit to mitigate those adverse effects and or to improve the cancer treatment outcome. So it was a very exciting um career path that I was given.

I worked closely with some naturopaths as well because I was a little bit limited with my ability to do really alternative medicine. Alternative is typically when you replace the conventional therapy with an alternative medicine and integrative is where you march along some of the alternatives paths that are rooted in science with the conventional chemo, imunotherapy and and radiation. So it was a very exciting um career path.

Unfortunately insurance is challenging. They don't always want to cover this and they certainly don't want to cover time for a physician to meaningfully do it. So that's why I ultimately left Mayo Clinic. It was really hard for me. It to this day I still have sadness over it because I miss my patients and I had so many miraculous stories when you're really given the opportunity to optimize patient care, how you see patients do so much better. Um, but this is when I was given this opportunity at Fountain Life to help to democratize what preventive care and optimization of healthcare can look like.

So that's why I'm in the space now.

Dr. Dawn Mussallem1:26:41

It has to be covered. So, I guarantee they coded it wrong. So, they just need to go back in and

Dr. Dawn Mussallem1:26:55

It is an unacceptable. It has to be covered. any woman with a history of breast cancer or a high risk um gene or an elevated risk of cancer because of other things even the radiation to the chest. Anytime a woman has a calculated risk of over 40% of breast cancer or a history of breast cancer they have a mastctomy they must cover the radiation. It is it has to be covered. So they cannot make you pay for that.

Dr. Dawn Mussallem1:27:18

And then for the rest of her life it's covered. It's just one of those things that it it must be it's part of the therapy. Yeah.

So, it's just so hard for women to do these these procedures, but you know, when women are young, especially women, you know, under the age of 50, it's so hard if they do breast conservation for many of these women. And I'm not here to promote one surgery over the next. This needs to be individualized. But ultimately after breast cancer diagnosises, young women, you know, are doing mammograms and MRIs every year. Yeah. And that's a lot for some women to have to um contend with. And then of course, some women just aren't eligible for a breast conservation procedure.

Dr. Dawn Mussallem1:28:05

And then it's so hard for some women, you know, because they're given this diagnosis of breast cancer and now with breast cancer, especially some of the hormone receptor positive breast cancers, they don't need they don't need chemotherapy. She didn't get she didn't need chemo,

But they still need to go on these anti-estrogen medicines. So, they look normal and people are like, "Oh, you're lucky you didn't need to keep chemo." Well, guess what? For the next 5 to 10 years, these young women, they are on these medications. So, it is so hard for me to listen. You know, the women's health movement, you have many influencers who are physicians who are on there saying, "Women need hormones. Women need hormones." Whoa. We have this whole population of women that really aren't able to take it.

I've said this before in a podcast and I had a lot of people that came against me saying that's not true. Women with a history of breast cancer can be on hormones. Well, guess what? I'm here to say that I've been in this space for over 15 years at the world's top medical center. And when a woman has a history of estrogen receptor estrogen recep estrogen receptor positive breast cancer, we date are not yet comfortable with that woman going on estrogen. You know, at least not in that first 5 to 10 years.

Dr. Dawn Mussallem1:29:12

That's exactly right.

Dr. Dawn Mussallem1:29:19

That's exactly right. Hormone suppression. Well, you know, tmoxifen, I love tmoxifen actually because tmoxifen actually isn't reducing the estrogen in the body. It's blocking the estrogen from binding. So I like that much better because it doesn't hurt the bones. It's actually favorable to the heart. the anastrizol, the XMS, the letol or the aromatase inhibitors. Those are the ones that are plummeting the estrogen. Okay, man. Those are really hard in women who are in that pmenopause or younger age. They're still hard in women in menopause as well.

But those aromatase inhibitors, I had to use a lot more finesse to get women feeling better. And you know, one of the one of the strategies I would use, I know we've talked about so many different things, but you you inevitably have a a listener population that are either men who have had wives or relatives affected by breast cancer or you have women listening. But, you know, when it comes to optimization on those hormone antagonists, acupuncture is a real magic bullet.

Dr. Dawn Mussallem1:30:19

It is so beneficial. And again, it can be a little costly, but it is the one thing that would really help some of the hot flash control and as well as some of the the mood situations, even some of the achiness. So, I had a lot of my women doing acupuncture. When I started the integrative uh breast program at Mayo Clinic, I had acupuncturists in the same hallway with the oncologist, with the radiation oncologist, with the surgeons, and we would have that acupuncturist. That room would be filled all day long.

It was the only person's room who never got a lunch break because she was always working people in. It was a beautiful program. We still have it. We just outgrew it. So, they're on a different floor now at Mayo Clinic. But Mayo Clinic really stood behind this and we tried to get women to do acupuncture as soon as they were diagnosed because we really saw the benefit that it had. There's a lot of other things, you know, there's a lot of nutritional strategies. Um, soy is safe for breast cancer survivors and soy is great for hot flash control.

So, if someone said on those medications, what did you use for hot flash control? Well, the number one thing, even though the science really there's not these large studies, the number one thing I would lean in on would actually be soy, like having these women do some soy milk or edamame or some tofu, trying to make sure it's not genetically modified soy. But yeah, enjoying soy, one to three servings a day.

There was breast cancer data that shows it actually improves outcomes. There was a really cool study showing that after breast cancer diagnosis, soy consumption reduced the risk of breast cancer recurrence. This was published,

Yes, by the American Cancer Society. So this is not Dawn just saying what she thinks works. This is actually rooted in science um in human studies. So we know soy is never going to hurt a woman with breast cancer. It may actually offer benefit. And we know that that soy is oftenimes replacing an animal protein. And so we know that it's a safe plant protein and for women's healthy aging, there's been other studies showing that plant protein really is likely the most superior path to healthy aging for women.

So it's nice message.

Dr. Dawn Mussallem1:32:13

I know. I think I probably overtalked. I could talk to you about so much. This is awesome.

Dr. Dawn Mussallem1:32:42

So,