Unlocking the Secrets of HRV and Autonomic Health w/ Dr. Andrew Holman, CEO of Inmedix

In this episode of Living Chronic, Brandy Schantz speaks with Dr. Andrew Holman, CEO of InMedix, about the groundbreaking HRV technology that measures the body's stress response. They discuss the importance of heart rate variability (HRV) in understanding chronic illnesses, particularly dysautonomia and autoimmune diseases. Dr. Holman explains the role of the autonomic nervous system and how low HRV can indicate health issues. The conversation also touches on the challenges of diagnosing dysautonomia, the impact of COVID-19, and the need for collaboration among healthcare providers to improve patient care. Dr. Holman emphasizes the significance of innovative testing methods and the connection between the gut and the brain in managing chronic conditions.

Transcript

Brandy Schantz (00:00.854)
Welcome back, this is Living Chronic, I'm Brandy Schantz. And today I'm here with Dr. Andrew Holman, he is the CEO of InMedix. And he has some really great information to share. Certainly if you have an autoimmune disease or especially those of us with dysautonomias, this is gonna be a great conversation. So welcome, thank you so much for coming on the show.

Andrew J Holman MD (00:24.665)
Thanks for having me, it's a pleasure.

Brandy Schantz (00:27.372)
So tell me a little bit about NMedics and what this does. You have developed the first FDA cleared cloud HRV platform to measure the body's stress response. This means nothing to a lot of people, but for those of us living with dysautonomia, we're starting to hear some buzzwords. So tell me a little bit more about it.

Andrew J Holman MD (00:49.293)
Yeah, so anyway, thanks very much. So I'm a in the trenches rheumatologist. So I take care of autoimmune diseases. People who listen to your podcast probably, unfortunately, may have a rheumatologist. And so I was practicing for about 25 years in Seattle and then founded in MedEx to really solve a solution, solve a problem, bringing autonomic testing to the doctor's office so that we can understand

Brandy Schantz (00:55.246)
Mm-hmm.

Brandy Schantz (01:02.222)
Yeah.

Andrew J Holman MD (01:18.891)
a lot more about how the body working and how these factors may affect our performance as your physician and also understand what you're telling us. So, InMedix is basically a Seattle-based startup by me and a few other people. We've been under the radar a long time. We've licensed some technology that we were able to test in clinical trials about 20 years ago, looking at five-minute heart rate

variability, HRV. Now, a lot of people know about that because they know about whoop or a ring or Fitbit or Apple Watch or Garmin. And they're tracking at least the autonomic indices that they're able to provide without FDA precision. This is a very precise tool that in clinical trials, we can talk about what it did that led me to say the time is right. It's precise enough.

Brandy Schantz (01:57.708)
Mm-hmm.

Andrew J Holman MD (02:18.157)
to take it to FDA. It got FDA cleared in January, launched it in June. It's in doctor's offices and now we're scaling to make it as available as we possibly can throughout the country. So we measure the autonomic nervous system as a vital sign in five minutes in the doctor's office, non-invasive. We can talk about how you do it and it's reported immediately. So someone like me can know a lot more about what you're telling me.

Brandy Schantz (02:19.95)
Mm-hmm.

Andrew J Holman MD (02:46.187)
about what's affecting you and I can understand it and quantify it without guessing. We don't like guessing as physicians and we're forced to all the time.

Brandy Schantz (02:46.604)
Mm-hmm.

Brandy Schantz (02:55.138)
Mm-hmm.

Yes, you know, it's interesting because as a non-medical professional, I, you know, I always joke that I'm not even science adjacent, you know, in college. cannot, the only science classes I can remember taking was exercise science because, well, you know, athlete. Other than that, I was all political science, business, you know, we didn't go that direction in my life. So this is all very new.

to me coming into this life as a chronically ill person. And one of the things that shocked me the most was really figuring out as a healthy person, you always believe that you go to the doctor, there's a test and then voila, a treatment plan and a diagnosis. And I learned that I was going to different doctors, getting different opinions because it's really a soft science based on hard science. And I'm looking for the right analysis to figure out what the heck is going on with me.

And I think that's one of the biggest sticking points really with patients, honestly, what I've learned is, you everybody's like, what is this doctor doing? And it's because we don't understand that they're just trying to do an analysis to figure out what could be wrong. And there has to be things that are eliminated. And of course, you know, we learn every day, HRV, I love to talk about that because it was brand new when it showed up on my garment. And I thought, well, another piece of data. I love data.

I do love data. But I didn't know what it was. And I remember when I suddenly couldn't exercise any longer. At first I thought it was just overtraining syndrome. Then we realized, no, we're not getting better. And I saw this new metric from my garment, HRB, heart rate variability. And it kept telling me my heart rate variability was low. And I would Google it and Google told me I was dying.

Andrew J Holman MD (04:51.772)
no.

Brandy Schantz (04:51.8)
So I kept saying to my doctor, look, see, Google says I'm dying. And then I would hear, it's probably not accurate. You're getting older, HRV just goes down. That's not it. That's not it. Let's do another test, a series of tests with blood work. And it turns out when I finally did get my diagnosis of dysautonomia with POTS and small fiber neuropathy, that alas, that HRV meant something.

Andrew J Holman MD (05:19.353)
You're exactly right.

Brandy Schantz (05:19.424)
and I still don't exactly know what it means. I just know that I track that data and it does coincide with me feeling good or bad. But for everybody out there who is using their device of choice, how can we better understand HRV and its relationship to how we feel?

Andrew J Holman MD (05:22.221)
Okay.

Andrew J Holman MD (05:42.125)
Yeah, well, everything you say is spot on. I was an immunologist, rheumatologist, not a neurologist, not studying heart rate variability. It's not on my board exam. But I got interested in fibromyalgia mostly because these individuals had a terrible problem that was very common. It was a puzzle. And autonomic state turns out to be the driving force behind it. So we can go into that as well. We definitely want to share some things to help people with fibromyalgia.

Brandy Schantz (05:52.983)
Mm-hmm.

Andrew J Holman MD (06:11.713)
HRV is heart rate variability is a normal physiologic concept. So in a normal healthy person, when they breathe in, they change the pressure in their chest to draw in the air, right? That stretches out the lung, right? But it also has a pressure effect on the aortic arch. So we'll get a little in the weeds here, not too bad. Where that tube full of blood has baroreceptors in the wall that very closely look at

Brandy Schantz (06:26.478)
Mm-hmm.

Andrew J Holman MD (06:41.219)
changes in blood pressure. As you breathe in, you stretch those and the baroreceptors read that as a slight decrease in blood pressure. So they tell the brain very quickly, speed up the heart just a little bit. And when you breathe out, the opposite happens all because of the pressure phenomenon on your chest, which is absolutely completely normal. So the heart rate varies. So anyone who has a pulse of 60 does not actually have a heartbeat every second.

Brandy Schantz (06:52.974)
Mm-hmm.

Andrew J Holman MD (07:07.033)
They have one 1.1 second for a while, then 0.9 second and 0.1.1. So you get this variability, very natural, very appropriate. What was discovered though, many, many, many years ago, was that under stress that variability disappears. It just locks up like a metronome, the heart rate. And it's associated with a brain activity called the sympathetic nervous system, which is the fight or flight response, which all of us know happens all the time.

Brandy Schantz (07:35.566)
Mm-hmm.

Andrew J Holman MD (07:37.123)
Sometimes it happens a lot in a movie or whatever or in life, unfortunately. If your brain that manages that, it's called the autonomic nervous system, is wired so that you are just born with a sympathetic predominance where it's just kind of more on. It's like having a car with higher RPMs all the time. It still drives fine, but you may be wearing out the engine a little bit. The other half you want to know about is the parasympathetic. That's the good stuff.

Brandy Schantz (07:58.552)
right?

Andrew J Holman MD (08:06.733)
The parasympathetic is the half of this autonomic construct that promotes health, restorative, healing, predominantly asleep, as you might have meant, growth hormone. So it turns out the sympathetic and the parasympathetic are always on all the time and they're jockeying for predominance depending on what is happening to you at the moment. If you're dehydrated, the sympathetic turns on to keep your blood pressure up. If you're scared, same story. If your tension, stress, sympathetic's off.

Brandy Schantz (08:18.146)
Mm-hmm.

Andrew J Holman MD (08:36.299)
Everybody knows what that feels like. What people don't know what it feels like is when the parasympathetic predominates, and that's when you were five years old and you sleep really well and drool on the pillow. But that's when all the good restorative things happen in the body. So there are people that have a more sympathetic activity, and it's very important for us physicians to know who they are. And you're right, it correlates with, am I doing? Because the autonomic nervous system doesn't do everything.

Brandy Schantz (08:44.75)
Hmm.

Brandy Schantz (08:58.498)
Mm-hmm.

Andrew J Holman MD (09:06.061)
But it plays a role in nearly everything. It affects your digestion. It affects your blood pressure we just talked about. It controls your sleep quality. Your mood issues are significantly affected by your fight or flight response, right? Breathing, if you want to try to hold your breath, you know you can't. That's your sympathetic nervous system kicking in, making you breathe. And that's what turns on in sleep apnea. Constant triggering of the sympathetic, which causes heart problems. That's why we...

Brandy Schantz (09:09.954)
Yes it does.

Andrew J Holman MD (09:35.307)
study sleep apnea and treat it. But it also affects the immune system. So the fight or flight response is supposed to help you survive. If there's a lion, right, you got to run faster than the next zebra, right? And if you do, you survive. If you don't, it doesn't work as well. You know, the lion gets you. The problem is you can see a lion every day, and that system is adaptable. So if it sees threats, it just ratchets up in intensity.

Brandy Schantz (09:48.558)
Mm-hmm.

Andrew J Holman MD (10:04.121)
And sometimes it gets up so active that it doesn't turn off. That's what happens in fibromyalgia, where it affects sleep. In positional orthostatic tachycardia syndrome, POTS, you mentioned, it just misbehaves in just remarkable ways. And the main centers for that are Mayo Clinic and Brandebil. There are people working very hard on that, but it's one of our toughest, toughest challenges. And that's because it's a dysautonomic problem.

Brandy Schantz (10:08.259)
Right.

Andrew J Holman MD (10:32.001)
We are the autonomic nervous system is the frontier of medicine that maybe infectious disease was in the 1930s. It's like, my goodness, we might be able to kill bacteria. And look what happened. You know, we got some of those results that you were asking for. We'll go to the doctor, do a test. Here's a pill. You don't see me again. You're fine. Your bronchitis is fine. I wish it worked every time, but it works a lot. Right. And we get used to those solutions, but medicine is really hard. Medicine is really hard, not just to go through med school and get trained.

Brandy Schantz (10:38.638)
Mm-hmm.

Brandy Schantz (10:55.927)
Yes.

Andrew J Holman MD (11:01.145)
It's just really hard. And rheumatologists are called the consult of last resort for a reason. Because you see everybody before you see us. And there only 3800 of us practicing. So we're the detectives. So we tend to deal with diseases that make no sense. Like lupus, affects your heart, affects your kidneys, your joint, your skin, your brain. rheumatoid arthritis affects most of the joints, but it affects other things. psoriatic arthritis.

Brandy Schantz (11:02.691)
Yes.

Brandy Schantz (11:14.638)
Mm-hmm.

Brandy Schantz (11:19.223)
Right?

Andrew J Holman MD (11:28.609)
A skin issue that's associated about 15 % of people with crippling arthritis. Vascularitis, where your immune system just attacks your blood vessels. That's a bad one. And then we have a whole lot of other ones that are on the board exam, which sometimes you see in your life and sometimes you don't. There are some diseases I've only seen once in 25 years. But we have to be ready for that because we're the last person to see it. We're the immunologists as well. So that's a very long-winded answer about HRV.

Brandy Schantz (11:49.432)
Wow.

Andrew J Holman MD (11:58.775)
But I want people to realize that it's normal to have variability. And when your availability number goes down, you're in a more sympathetic fight or flight mode. So I'll let you ask a question. there's more to it in terms of the difference between precision FDA cleared and consumer fitness tracker. But thank goodness we're talking about it.

Brandy Schantz (12:10.286)
Mm-hmm.

Brandy Schantz (12:24.32)
Yes, thank goodness we're talking about it. I can't believe how much I've learned in such a short period of time. I also can't believe how, you know, as you were, and thank you for that explanation because I think it was a really great explanation. And I know everybody who's been dealing with POTS, orthostatic hypotension, any kind of dysautonomia suddenly started having a lot of things click because you're told you have these things. And I know I'm not alone.

I thought the doctor was crazy. I was like, excuse me, MD, but here I am. You know, I was an athlete. Suddenly I can't exercise. I'm dealing with severe migraines. I'm having trouble swallowing. I'm a Crohn's patient. So me and my GI thought this was go time, trouble swallowing, terrible GERD, gastroparesis. It's cancer. Nope, wasn't cancer at all. My GI was confused. Hmm. This is your best colonoscopy in years, Crohn's disease patient.

I had bladder dysfunction. I mean, there was, I couldn't think of a thing that wasn't wrong with me. I truly believed I was dying, trouble breathing, my heart doing, know, rushing up to 180 sitting on a couch. So when the doctor said to me, eat salt, I thought you are nuts, sir. There's something else here. I don't even understand what you're saying.

I understand nothing that you're saying. I'm dying. I'm surely dying. But understanding what you just explained, that makes sense. That really does make sense. And, oh no, go ahead.

Andrew J Holman MD (14:01.657)
Well, my career, yeah. So my career was immunology. You know, you have to have an encyclopedic knowledge of things. just, that's the rules. You got to pass the board exam. And then there's all this, we don't know what to do about this, but we have to do something, right? So that was our job. And then fibromyalgia showed up at least on my doorstep in 92. And we were told it wasn't real. Well, that was nonsense. Of course it was real. But you know, doctors really didn't.

Brandy Schantz (14:18.99)
Mm-hmm.

Andrew J Holman MD (14:31.009)
looked very good. And so just personally, I'll let you know, I don't come from a family of doctors. I'm the black sheep of the family. I come from a of lawyers and judges. So when I got when I got into medical school, my dad said, Finally, someone's getting a decent job around here. So he was like a pro bono lawyer. But when your brain works like that, and the family dinner table and Sunday dinner is like talking about constitutional law and crazy stuff like it's very timely now.

Is and then you go into science you tend to take an approach that okay my My my person on the stand here so to speak in the patient room giving testimony is telling the truth You know, I promise I'm telling the truth and we have to figure out what they're talking about and it makes sometimes no sense at all and then and of course it does after we're smart enough to understand it. it's so simple. Yeah, so yeah

Brandy Schantz (15:26.487)
Well, hindsight always is, right? I mean, the first person to do something, they did the hard work. Those of us that come after them, easy stuff.

Andrew J Holman MD (15:31.193)
Right, right. that's and I'm just following the breadcrumbs from from very brilliant people who started with the patients telling the truth. That's the part I started with too. OK, I believe you. I'm trying to understand. I'm trying to do something about it. But, you know, I'm not going to tell you to eat salt, but that is what the book says to do. Yeah. So the bottom line is it starts with listening to the patients. Trying to.

Brandy Schantz (15:42.83)
Mm-hmm.

Andrew J Holman MD (15:58.893)
do the detective work and figure out what are they telling you? Unfortunately, you usually get a series of patients and you can pull together what they're saying in common. You wish it weren't true. You wish only one who had the terrible problems you described, but usually it's quite a few. And then you start to make some progress if you look outside the box. The autonomic nervous system is an amazing part of the brain and it's very primitive. And when it works, you don't think about

But when it fails, you're right. It affects the bladder, it affects the bowels, it affects the breathing, it makes your heart go crazy. It affects fatigue and sleep, and then sleep affects a whole bunch of things like cognition and muscle function recovery. So having a way to finally measure it with FDA level precision is really like a vital sign. It really gives us insight into, oh my goodness, we can measure it.

Brandy Schantz (16:41.922)
Yes.

Andrew J Holman MD (16:58.861)
The fitness trackers are doing a wonderful job of bringing the public up to understand that HRV is real. So when you say they've heard of it, but they can only be so accurate. They just can't have the precision. You notice they're not through FDA. Now, some are Apple and Whoop are actually pursuing some FDA level stuff, but not there quite yet. And Medics has done all that work already.

Brandy Schantz (17:09.006)
Mm-hmm.

Brandy Schantz (17:17.228)
right?

Andrew J Holman MD (17:27.449)
which is nice. So we have credibility in terms of measuring it. And what the Inmedix product does is it measures the sympathetic and the parasympathetic. Turns out, even with the greatest technology in the world, we could only measure the parasympathetic. And we had to kind of guess what the fight or flight was doing, even though you know that it played a major role in how you feel. It causes most of the symptoms. Now you can measure the sympathetic with FDA level.

Brandy Schantz (17:45.507)
Hmm.

Brandy Schantz (17:51.618)
Yes.

Andrew J Holman MD (17:57.026)
So doctors will decide what to do, but it's a five minute test and the office is very simple and very straightforward. I don't mean to do all the talking here. just sharing information might help you.

Brandy Schantz (18:06.09)
No, I love the information. is so amazing. And I love that we're doing this in October, which is Dysautonomia Awareness Month. There's so many people suffering from various illnesses associated with dysautonomia or just these imbalances. I love getting the information. And I actually really, really appreciate how well you explain things.

You know, I always say to people, I'm not stupid, but then again, I never, this is my first time learning about any of this. I'm not a science person. I, you know, I'm more like the rest of your family. Let's talk constitutional law, please. That's my lane. This is brand new. It's,

Andrew J Holman MD (18:50.275)
Hey, I love it too. I'm just not very good at it.

So I'm better at this.

Brandy Schantz (18:58.488)
But you know what I love that you are because for me thinking about it took me, and of course there was a lot going on with me at once. I was also having a reaction to my Humira drug-induced lupus, but it just happened to coincide with this sudden autonomic dysfunction. And it took me overall four years to get diagnosed. And I've been told multiple times, congratulations, you did a great job.

Andrew J Holman MD (19:26.029)
Well...

Brandy Schantz (19:26.592)
attribute that partly to tracking a lot of data, partly to me being very pushy. And I think partly because I did, yes. And I think partly too, because I had so much data because I was an athlete and they were able to, you doctors were able to look and see, this woman was very active, a performer. And suddenly now she can't walk. That's, that's a problem. We just don't know what the problem is, but at least

Andrew J Holman MD (19:29.293)
Yeah.

Andrew J Holman MD (19:33.145)
Thank goodness. Thank goodness.

Andrew J Holman MD (19:49.209)
Mm.

Brandy Schantz (19:54.656)
We knew I had a problem and I know many people are going to doctors and being dismissed entirely. You know, there's nothing in your blood work, you're fine.

Andrew J Holman MD (20:00.441)
Yeah, I'm really sorry about that. We're really sorry. We wish we could do better. Some people don't really explain, I don't know very well. And doctors need to be able to do that just to be human beings. I remember in 1995 or so when I didn't know what to do for fibromyalgia. And I had paced out trying everything I could think of. I we're as off label as you can get. Eventually figured out how dopamine runs that, most of that problem with some other colleagues.

Brandy Schantz (20:11.106)
Yes.

Yes.

Brandy Schantz (20:27.182)
Mm-hmm.

Andrew J Holman MD (20:29.037)
But I had to tell patients that I don't know what to do, but I want to see in four months because I'm going to meetings, I'm reading, I'm doing everything I can. I want to report back to you what I've learned. I'm not dismissing you. just, I don't want to experiment with you until I have some idea what to do. And that was really tragic because no doctor wants to say something like that. But I did at least, they did at least know that I was on their team. You know, I wasn't abandoning them. And you know what? We made progress. We got there. And now it's autonomic, dysautonomia, we're getting there too.

So again, patience.

Brandy Schantz (21:00.498)
It's there's been a lot of progress, but I see right now looking at what you're doing within medics. If that could have been at my doctor's office when I went in to get my vitals taken, it would have saved me a lot of time and a lot of heartache, honestly.

Andrew J Holman MD (21:15.533)
Well, yeah, and that's what we're learning. We only have it in four offices because that's all we could afford to do. We're just an angel funded little startup in Seattle. We're not venture capital. Not that stuff. No, we wouldn't mind being, but the ideas. Where's? Where's where's well?

Brandy Schantz (21:31.126)
And say, we can find some venture capitalists. I'm here on the East Coast. There's nothing but money up and down this place.

Andrew J Holman MD (21:38.659)
call me later. The bottom line is, you're right. This is a precision instrument that came from professional sports. Half the NFL was using it. The US Special Forces uses this level of HRV. Leno Messi, I've been told, Premier League, they all do. We just happen to have the exclusive license for its medical application worldwide. And we did clinical studies. So in terms of bringing this, we're very proud of what we've done. It's especially after 10 years trying to get going through FDA.

Brandy Schantz (21:40.203)
Hahaha

Brandy Schantz (21:55.512)
Mm-hmm.

Andrew J Holman MD (22:08.601)
It really is a wonderful situation and it's covered by insurance, which is wonderful. And so it's not a burden to patients or doctors to do. Five minutes, non-invasive, lie on the table, pads on your wrists and ankles with a very, very powerful EKG that's more precise than any hospital system. It has to be very accurate to measure where the beat is so you can measure the millisecond difference between beats.

Brandy Schantz (22:28.526)
Mm-hmm.

Andrew J Holman MD (22:34.369)
And then in 10 seconds, it comes down from the cloud. Here's your report. Doctor walks in. I can see your parasympathetic sympathetic. So you don't get called back with a blood test or something like that. So it couldn't be easier. I made it so my staff and me as a customer and the patients I took care of, we're all taking care of it happy.

Brandy Schantz (22:46.05)
Right.

Brandy Schantz (22:56.494)
So let me ask you the question that would really make a lot of people happy. And I'm sure that there has to be other types of tests done, but could this in any possible way replace what I like to call the tilt torture test, what other people call just a tilt table test, but we know it's torture.

Andrew J Holman MD (23:15.961)
Every time you see say tilt table. think of Frankenstein on a tilt table. I mean, it's it but I mean, it's like torturing somebody right Yeah, let me let me explain the answer is as a screening test I believe that's very very likely and in fact, we work with Johns Hopkins a one wonderful rheumatologist there who's interested in dysautonomia And she was telling me that the waiting list to have the full autonomic workup at Johns Hopkins

Brandy Schantz (23:20.27)
off.

It is torture.

Andrew J Holman MD (23:44.345)
is over a thousand people long. And she suggests.

Brandy Schantz (23:46.816)
and they're no longer taking patients on the list. I think they just stopped within the last few weeks, I think, but it's long.

Andrew J Holman MD (23:53.443)
Yeah. She said that they don't know who needs to jump the line. They can't tell. But they thought this test might be a very good way to pick out the people who really need to go to the front of the line today. And that's a very good use of five minutes of time. And $235 test. We priced it low on purpose because we want it to be something you can do repeatedly because let's you go work on something and you want to say, how am doing?

Brandy Schantz (23:59.48)
Yeah.

Brandy Schantz (24:04.716)
Yes, that's great.

Yes, absolutely is.

Brandy Schantz (24:15.368)
thank you.

Brandy Schantz (24:21.998)
Thank you.

Andrew J Holman MD (24:23.063)
Yeah. So that's the idea. so the answer is, there are two autonomic approaches. We take a completely different approach. The old approach is to say, how does your autonomic nervous system work when we challenge it with gravity, with all kinds of stuff, can it respond properly? And the answer is usually no. Right. but it quantifies the dysfunction of the autonomic nervous system, but doesn't tell you how you got there. just sort of says, well, how bad is it?

Brandy Schantz (24:37.88)
Mm-hmm.

Andrew J Holman MD (24:52.919)
What we do is we look at it different way. We look at it more like blood pressure where we measure it just at rest in the doctor's office. We used to measure blood pressure 24 hours at a time thinking that big data would be helpful to know what happens to the blood pressure when you go up the stairs and all that. Turns out not to be any more predictive of stroke and heart disease than just the three, the test in the doctor's office. So that's why we don't do 24 hour blood pressure monitoring really anymore. So we thought, well, at rest,

Brandy Schantz (24:53.006)
Mm-hmm.

Brandy Schantz (25:15.502)
Mm-hmm.

Andrew J Holman MD (25:22.859)
if you're in a sympathetic position, as you move around, it's just gonna get worse. So the question is, how good can you be at rest? And that turned out to be sort of the magic part of the secret sauce. It works like blood pressure. In our clinical trials, we find that a five minute test of these two parameters are very, very helpful. And the doctor determines exactly what they do with them. That's part of the FDA clearance to start with. We'll have more later, but.

Brandy Schantz (25:38.883)
Mm-hmm.

Andrew J Holman MD (25:52.761)
But in terms of the research that has been done, very much discriminative. Just asking, what is the person's autonomic state lying on a table at rest in a quiet doctor's office? Now, as you might imagine, it can't tell me how you'll respond to something if we put you on a tilt table, but maybe we can just eliminate that part. Maybe we can just go after it and screen you this way and start talking about how did you get here and how do we fix it?

Because there are, part of that answer I'd want to talk with your audience today is how do we fix it? There's more going on to this that has nothing to do with in medics. But I'm a practicing physician. The only reason we're doing this is to get people well. mean, my investors want more. But I'm just saying that most of us, we really are just excited about the science. We're a bunch of nerds, that's what.

Brandy Schantz (26:22.723)
Mmm.

Brandy Schantz (26:27.608)
That's what we want to know.

Brandy Schantz (26:43.66)
Yes. Well, I love nerds. I am one myself in my fields and I love, like I said, I love data and I love trying to fix a problem and I'm a little crazy and I've been doing so much over here to try to find my way back to something that looks like health. I miss being competitive. If I could.

Andrew J Holman MD (26:48.569)
you

Brandy Schantz (27:06.592)
If anybody could find a way to make me competitive again for my age, under, know, every, every doctor has been very quick to tell me how old I am as I've been going through this. but get me back to competitive for my age doc. you know, and I've just been doing as best as I can using zone two heart rate training, breathing exercises, lots of strength training. This old lady can sit in a 10 minute plank without even breaking a sweat now.

Andrew J Holman MD (27:15.171)
I'm sorry. I'm sorry.

Andrew J Holman MD (27:35.277)
Good for you. That's more than I can do.

Brandy Schantz (27:36.472)
But what else? I'm trying, I'm trying hard. What else can we be doing? How can we fix ourselves?

Andrew J Holman MD (27:40.749)
I'll know you. I know you.

Andrew J Holman MD (27:46.689)
Yeah, it's all the reason I can do anything as a physician is I have to have proper diagnostics, I need to know what's And if we don't, we're just throwing stuff at the wall, see what sticks. Used to do that with antibiotics, and you give someone really powerful one, especially a little baby, you don't have time to do the cultures, you got to save their life when they're three weeks old. And and you hope that it sticks and most time it does. But we'd like to have precision personalized medicine.

Brandy Schantz (27:55.182)
Mm-hmm.

Andrew J Holman MD (28:15.937)
So if we know your autonomic state, the other question we say, this is a person with sympathetic drive. Let me take a, let me be very careful here. Let me take my enematics hat off. I'm a licensed physician. Let's go by my practice and license. So I'm at, let me talk as a rheumatologist for a moment, not as an enematics CEO. If, if someone were seeing me. So I give you my own opinion a little bit. So what we looked at is what could, happened to these poor people? Cause they were fine before, right?

It's not a bacteria, it's not a virus. It turns out that there are two things that your audience need to know. And you've actually said a lot of the clues already. One is there's a subset of the population who has a tendency to have a more active, more powerful, more engaged, sympathetic response to life. And they have Ehlers-Danlos type 3 hypermobility syndrome. Now, when it's severe, it's a small number, but it's about 20 % of the population who can do like this. So everybody on T-Home, do it

Brandy Schantz (29:01.358)
Mm-hmm.

Brandy Schantz (29:06.19)
Yes.

Andrew J Holman MD (29:14.467)
doesn't mean you're weird, just means that you have some joint laxity that runs with this incredible trait that gives people a chance for their sympathetic drive. What does that mean exactly? They can twist their ankles, they can get shoulder dislocations, they can have problems with pregnancy, can have patellar pain going up and down stairs. These are all things that go with the ligament parts. But they also get palpitations and they don't sleep very well and they get fibromyalgia all over the place.

Brandy Schantz (29:41.154)
Mm-hmm. Yeah.

Andrew J Holman MD (29:42.659)
But they're also your most hard driving successful people on the planet. I like to say that 20 % of the population gets 80 % of the work done. And I don't know if that's an exaggeration. They tend to be all the athletes. tend, on Olympic level, they tend to be doctors, nurses. If you run a McDonald's, you better be hypermobile because you can't multitask and do that job without it. So the brain goes, goes, goes. Unfortunately, sometimes it can go too much.

Brandy Schantz (29:51.725)
Yeah.

Brandy Schantz (29:57.518)
Yeah.

Andrew J Holman MD (30:11.307)
And they can be susceptible to other things that tip them over from super productive super person to like can't sleep at night. Everything's falling apart and the autonomic and they get pots and all that stuff. There are many causes probably of pots we don't know. But in terms of the people who quite but who have dysautonomia, LSD animals type 3 is really common. So if you did gymnastics as a kid, you could sit with a W position with your legs out wide when you're three years old. Again, this is really common. You got to watch these folks.

to make sure that their motor up here doesn't run too fast. Kind of calm everybody down a little bit. What that does, it sets people up. The next thing that seems to happen came out of UCSD in 1998, where people have an injury to their cervical spine. The chiropractor has been telling us that alignment matters, but we don't see it on the x-ray. Well, you see it on the MRI. So what Don Resig did,

Brandy Schantz (30:44.792)
Mm-hmm.

Brandy Schantz (31:06.2)
Mm-hmm.

Andrew J Holman MD (31:08.821)
is he said, why do we look at the neck in just a neutral position and expect that to be informative? Because you move your neck all over the place. So he said, let's check the neck inflection and extension and neutral in older people who just simply have some arthritis in their neck. And let's see if the tube inside called the spinal canal that protects the cord that's surrounded by fluid, it's not supposed to get bumped, right? It's like, you know, bump your brain, that's called a concussion, right? You know, concuss your cord.

Brandy Schantz (31:17.358)
Right.

Brandy Schantz (31:35.726)
Mm-hmm.

Andrew J Holman MD (31:37.525)
And what he showed was that, my goodness gracious, if you extend the neck, often bump into the spinal cord. And when you open it, it tends to widen, but on the neutral view, you don't see the bumping unless you look at the extension view. said, well, that's interesting. We went to Valley Medical Center and I asked the radiologist, can you do this? And I said, well, we have the machine, right? But we have a problem. I said, what's the problem? This is back in 2003.

We won't get paid. I go, what do you mean? We get paid for an MRI, but we won't get paid to like pull people out, change their position, pull them back in, take another position. And I go as a rheumatologist, well, how about we do like one person? Can we do one? So Ken Rigger gets all the credit at Valley Medical Center. He's still there. It's done over 3,000. The NIH called that say, hey, can you tell us how to do this? We published it in the Journal of Pain. It actually was the cover images, these special MRIs on the cover, on the Journal of Pain that

But we like to joke it's not the cover of the Rolling Stone, but it's the best a rheumatologist can probably hope for. So it turns out that in animal models, I was told by some very famous people, Andrei Krasikov, who was one of the Paralympic doctors in Canada, again, close to me in Vancouver, that if you touch the cervical cord in an attestatized rodent, it turns on the blood pressure and heart rate. It's a sympathetic arousal. I go, I'm very interested in sympathetic arousals getting the way of sleep in fibromyalgia patients.

Brandy Schantz (32:54.029)
Mm-hmm.

Andrew J Holman MD (33:08.128)
70 % of patients with fibromyalgia who don't sleep, who have autonomic arousal, right, have this cord compression. And so you can't see it. It's missed 80 % of the time unless you get an extension view. So it's available a lot of places, but not enough. And then we did a prospective double blind study to say, it in humans, a sympathetic arousal? And the answer is yes, it's the first time in history. And we haven't published that paper, but we did present the abstract at the national meeting.

Brandy Schantz (33:16.298)
Interesting. Wow.

Andrew J Holman MD (33:37.305)
So we got to write that paper up. Um, so basically if you put your neck back in a hairdresser's sink, or I should say a stylist, I'm an old, I sound like a dinosaur. Um, and you don't, and you don't, and you don't like it. It's a very strong likelihood that you're bumping into your spinal cord. If you're hypermobile, it's easier to do that. If you're a former athlete, it's easy to have worn out a disc and a ligament and like, surprise. And if you simply just have this positional cervical cord compression, again, has nothing to do with the medics.

Brandy Schantz (33:46.968)
Well...

Brandy Schantz (34:00.354)
Yes.

Andrew J Holman MD (34:07.097)
It's a potent sympathetic arousal that can drive your brain to mess up all these autonomic symptoms. And it's treated non-surgically about 85 % of the time. But you gotta have a diagnostic, you gotta know. The other sympathetic arousal, is more appropriate to longevity, is never miss sleep apnea. We know that sleep apnea is a potent sympathetic arousal, thank goodness, it keeps you breathing at night, even though you're having trouble.

Brandy Schantz (34:19.224)
Really? Right.

Brandy Schantz (34:28.366)
Mm-hmm.

Brandy Schantz (34:35.512)
Yes.

Andrew J Holman MD (34:36.601)
So you don't die. Good. That's a win. But after a while, all that sympathetic output, second after second after second on the heart can lead to cardiovascular consequences, including sudden death. So that's why treatment of sleep apnea is so important. Obstructive sleep apnea. You may not realize, and I didn't, that 54 % of Japanese women with rheumatoid arthritis, autoimmune disease, have unexpected sleep apnea.

because a guy in Japan did a crazy study, and 95 of them, I don't know how he got it paid for. And yeah, they don't snore, they're not tired, they don't give you any symptoms at all. But they have a sympathetic arousal, which affects their immune system, which drives the disease, autoimmune disease, to be untreatable. And when you put the CPAP on to treat their cardiovascular risk, right?

Brandy Schantz (35:06.147)
Wow.

Brandy Schantz (35:31.97)
Mm-hmm.

Andrew J Holman MD (35:32.469)
After five months, the swollen tendon joint count and C-reactive protein, which is an inflammatory test, went down 35%.

Yeah, got my attention. Got my attention. So again, this is one doctor talking, my opinion. We got a lot of sleep studies and people who nobody would order one. And we found the prevalence of sleep apnea informally in ankylosing spondylitis, which is usually pretty skinny men of young age, to be at least 45%. Just from checking the practice and reporting that in 2004. Now these are, these are, these are.

Brandy Schantz (35:41.902)
That's amazing.

Brandy Schantz (36:02.7)
Wow.

Andrew J Holman MD (36:09.465)
publish things. I give grand rounds at Harvard and hospital special surgeries. So I mean, I have some credentials, you know, I know what we're talking about. So there are papers that can support all this for people's doctors. They want to see I want to see the evidence. There's just some guy's opinion. Yeah, there's all published. So but in terms of where does it lead us? Where are the breadcrumbs taking us? Don't forget about the autonomic nervous system and how hypermobility syndrome can make you really good at life.

Brandy Schantz (36:24.023)
Yes.

Andrew J Holman MD (36:39.513)
but get in your way later. Don't forget that things can turn it on, especially if you're susceptible, like the cervical spinal cord, and that your doctor, even under the best of circumstances, may not have the diagnostics in their hand to see what we were able to see, because Ken Rieger was willing to do those MRIs. I was very lucky guy. I surrounded with people who were also puzzle people, and were happy to try to help out. So that's a very long story. So at least for your audience,

Talk to your doctor about Ehlers-Danlos type 3 again, and then make sure they understand about the autonomic. Watch out for that hairdresser's sink. then sleep apnea is just important, just for everybody. So there you go.

Brandy Schantz (37:19.682)
Yes.

Brandy Schantz (37:25.398)
You know, that was a very, well, that was an aha over here because I have now a number of neck and spine issues that cropped up, but you know, I'm not getting any younger and I'm a lifelong athlete. nobody, we were just like, well, it happens, you know, and I did what I do. I just said, well, fine, I'll rehab it with exercise. That's what I do.

Andrew J Holman MD (37:37.357)
You're tough.

Andrew J Holman MD (37:47.929)
And that's kind of what life has taught people. I have two Division I daughters. One was 100 meter hurdler, one was a volleyball player. so, you know, athletes are tough. And D1 is like, ugh, it's a profession. I mean, I don't have enough sympathetic drive to make me do that, but I had enough to get through, you know, med school, residency, fellowship, know, internship, and every fourth night calling. So that's where I used mine. But only people who have that...

Brandy Schantz (38:04.674)
Yes.

Andrew J Holman MD (38:17.827)
sort of wiring go into those professions. So what was your sport?

Brandy Schantz (38:21.004)
Right? I always call soccer. And I'm a leg sport girl. I'm a leg sport girl. Yeah. Love to run.

Andrew J Holman MD (38:25.049)
okay, well you... There you go. Yeah, the soccer girls were always really fit. amazing. Yeah.

Brandy Schantz (38:33.942)
Yeah, you gotta get out there and run a lot. It's a lot of movement. It's a lot of movement.

Andrew J Holman MD (38:36.121)
I love women's soccer. guys, maybe the men will catch up sometime.

Brandy Schantz (38:41.486)
well, we'll give them some grace, but you know, it's, it's, you know, it's, it's for us, I always say soccer is our way to be really physical, you know, because women in the United States particularly pay, play a more physical form of soccer and it's, and then it attracts people like me, you know, you're just jam packed with type, I call us the type A plus types, you know, we just, we have to more better er, go for it, you know, I was an army officer, you know.

Andrew J Holman MD (38:44.153)
You

Andrew J Holman MD (38:50.263)
Yeah!

Andrew J Holman MD (39:00.375)
Right, right.

Andrew J Holman MD (39:07.097)
20 % of population 20 % of population gets 80 % of the work done. Yeah. So you guys are. Right.

Brandy Schantz (39:12.012)
Yeah, you know, it's just part of our personality. So it's interesting to put that together in that way, especially because I've had a lot of questions around it when, you know, we'll talk, you know, touch on this very briefly, you know, but obviously this has been on the rise with COVID. And before I knew that I had autonomic dysfunction and I was just, you know, trying to figure out what was wrong with me. I was, what I was doing is I was

cold calling studies that were studying people who had symptoms that looked like my own. And I kept noticing that my story, I was training for Ironman Chattanooga and then bam, I couldn't exercise, was not unusual. And I kept finding people with my symptoms who were especially endurance, distance, runners, and triathletes. And I thought there must be something to this. As a matter of fact, even after I was diagnosed, I did this past year, I did the

Dysautonomia Advocacy Day on the Hill. And one of the people there with me advocating, she was there representing her sister who just did not have the physical capacity to do that because she was bed bound now with POTS. And she had been a D2 athlete, graduated number one in her class in accounting. And then all of a sudden, bam, she's bed bound.

Andrew J Holman MD (40:33.196)
Hmm. Hmm. Hmm.

Brandy Schantz (40:38.274)
And I thought, my goodness, and it was around the same timeframe that I went down and I thought, my gosh, you know, so many of us who were so high performing suddenly can't move. And it's so stark to take somebody who was so high performing and suddenly they can't do anything. I think just the juxtaposition of that kind of.

ability. It's really striking to me that there were so many of us like that. So understanding better how this happens and what causes it. I think that's really informative for us to understand how maybe we got here because it was always a big question. Now, when it comes to COVID, that's the question, right? Because a lot of this has been coming induced by COVID. Suddenly you have, and it's mostly women, it just...

We get everything. I would love to hear your ideas on that too. Why it's 80 % of us are autoimmune disease patients. And of course we've been disproportionately, I think it's 90 % of POTS patients are women. we're just overachieving in a place I don't want us to overachieve. So what are you seeing in regards to women being so overrepresented in this and COVID and autonomic dysfunction?

Andrew J Holman MD (41:58.765)
Well, I probably have to just give you more of a personal opinion. I wish I could quote a paper, but you're exactly right on the statistics. It's really only ankle-losing spinalitis, is very common in my practice more in men. I suspect that, and other people are starting to come to this idea too, that the autonomic dysfunction precedes the autoimmune disease. That looks like it's maybe true in rheumatoid arthritis, where we have more studies, I understand.

Brandy Schantz (42:26.318)
Hmm.

Andrew J Holman MD (42:28.651)
And so what is about women who get more autonomic dysregulation first, even before they get pots, you don't get that far, you know. What is it that keeps them from sleeping at night and so forth? Physiologically, you sometimes we kind of go back to, well, if it makes sense for a caveman, maybe it's true. Is it possible that because women hear children and childbearing that maybe they're more autonomically alert and in tune?

Make a lot of sense. That's true for me with kids. I never woke up until they're screaming when they're babies. We had a baby when my wife and I were both residents and were on call every fourth night. So I had every fourth night by myself with Jonathan. And I couldn't believe this little baby would wake up with red face screaming like, what's a strange way to wake up? Whereas my wife, you he rolls over, she wakes up. It seems that women are more autonomically responsive in tune.

Brandy Schantz (43:21.011)
wow.

Andrew J Holman MD (43:26.615)
And it may be an advantage, you know, that has to do with childbirth. I we just wonder it just seems like a pattern. I hear a lot of people's stories just kind of wonder if they're set up so it takes less the tip the autonomic nervous system due to a dysfunctional space. That's why wonder. And that if that's true, then that would explain a lot of why they get more autoimmune disease because it's the sympathetic arousal that affects pro inflammatory cytokines t cells and all the mechanism that causes the autoimmune disease. You know why your immune system attacks the bowel

Brandy Schantz (43:40.546)
Mm-hmm.

Brandy Schantz (43:54.702)
Mm-hmm.

Andrew J Holman MD (43:56.857)
Is one reason how hard it attacks seems to be driven by the autonomic nervous system so You could have that's why some people have very subtle disease and they didn't they didn't have any symptoms to tell you and they but they had the joints and We thought was rheumatoid but no is Crohn's because for whatever reason they just but if it was full-blown Far-five alarm fire. Well, the bowels were telling you a story too. So you get the whole story so it's a matter that we kind of look at the

Brandy Schantz (44:03.276)
Wow.

Brandy Schantz (44:14.136)
Right?

Brandy Schantz (44:20.162)
Mm-hmm.

Andrew J Holman MD (44:24.345)
big picture that way. How does the autonomic nervous system affect the symptomatology and the future of this person? With respect to COVID, a very remarkable rheumatologist in Aventura, Florida, Dr. Norman Gaylis, he's very famous guy. He's had our prototype for a while and he's actually presented at the American College of Rheumatology twice abstracts on long COVID using HRV and this advanced version of HRV.

Now again, this is not FDA cleared for treatment of HRV or anything that. I'm just explaining that he has an expert in this field. So it's on our radar to understand why do these people with long COVID have an autonomic nervous system that's just upside down and dysfunctional? What could have happened to them from a virus? I have theories and ideas on that, the four million hypotheses. I just can't help it. It's like, you know, I can't help it.

Brandy Schantz (45:22.158)
Thank

Andrew J Holman MD (45:24.025)
But I don't have anything that I'd want to tell people to get them on the wrong track. But we're working on it really hard. Chronic fatigue syndrome turned out to be not fibromyalgia, different problem. And it may have a similar etiology that we're thinking of in long COVID that may affect the base of the brain stem and so forth and fluid movement through there. Again, work has to be done. But some very, very smart people are working on it and we'll get there.

Brandy Schantz (45:31.683)
Yes.

Brandy Schantz (45:44.971)
Okay.

Andrew J Holman MD (45:52.749)
The first thing is characterize the problem. What's wrong with these people? Dysautonomia has been reported about 30 papers. We have the only one where we do the sympathetic in addition, but the bottom line is people are on it. And then those of us who are interested in autonomics are figuring what happened to them. And so I don't have an answer for you yet, but they're exactly right. The autonomic nervous system seems to be a major contributor to these poor people's situations. But

Brandy Schantz (46:02.435)
Mm-hmm.

Andrew J Holman MD (46:21.003)
I'm an optimist. If you can ruin it, maybe you fix it. So we've done it before. Let's try to fix it. Take away the trigger.

Brandy Schantz (46:25.902)
I like that.

Brandy Schantz (46:29.902)
I like that attitude. I tend to move between being in a place where I'm having a complete breakdown and trust nothing and I'm never getting better and life is terrible to extreme optimism and no, don't worry, I'll figure it out. I got this. The doctors are on it, the scientists are on it. So I kind of, go between despair and optimism every day, I think. But.

Andrew J Holman MD (46:56.779)
I hear you.

Brandy Schantz (46:58.092)
You know, knowing what you've done and how much I've learned, I think there is hope. You tripled remission rates in rheumatoid arthritis patients. That's a big deal.

Andrew J Holman MD (47:10.873)
Well, yeah. And we published some data on that. You know, I saw that sleep study business in RA in 2003. It was a little abstract in a national meeting, one of like 2000 abstracts, but you know, caught my attention. So we started doing sleep studies, treating the sleep apnea, watching the same thing happen. And so what we were doing for RA was now working much better.

We had some preliminary data and I have to be very careful here. This is not promoting in medics. You're just asking about one of my research studies. Yes, we added drugs for restless leg syndrome, that kicking business, which some doctors think is a sympathetic burst, little tiny ones. And we added those to a Tannercept, which standard rheumatoid arthritis treatment. And it showed very promising results at the open label.

Brandy Schantz (47:47.022)
Mm-hmm.

Andrew J Holman MD (48:03.865)
pilot study, not blinded. Again, we need to double blind placebo control proper study, but the preliminary exploratory study, yes, that's what we found, that the disease control went up from 25 % to 79%. And in that group of 60 patients, 75 % discontinued methotrexate, which means they can have children again, which is a big deal. And 62 % were off steroids entirely. So it appears that

Brandy Schantz (48:23.305)
wow.

Andrew J Holman MD (48:30.573)
this thing called immuno autonomics. And again, I'm speaking as a physician now, not in medics CEO is a very, very important linkage between the brain's autonomic center and the immune function. What supports that and what you're very interested is that set point medical has worked very, hard for many years, and are now FDA cleared for Vegas nerve stimulation, a little implant in the Vegas that actually does the same thing.

Brandy Schantz (48:35.234)
Yes.

Brandy Schantz (48:44.333)
Yes.

Brandy Schantz (48:54.093)
Yes.

Andrew J Holman MD (48:57.913)
They they were not able to do a study to combine it with like a tanner scepter something that'll be their next thing to show that the combination Gets where they need to be but all by itself and people who had failed a couple of you know big-time biologics Showed enough promise for the FDA to give it clearance. So that's now available in the last six weeks It's now out there. So it's called set point medical people to look at it I'm not advertising for them, but full disclosure the guy who founded that Kevin

Brandy Schantz (49:15.502)
That's amazing.

Andrew J Holman MD (49:25.747)
Tracy, who's the president of FinC Institute in New York, who may very well get a Nobel Prize for discovering the off switch the immune system, which is his Vegas business, published in nature in 2002. He's on our board directors. So we follow those guys. We're big cheerleaders, anything that can help the patients and understand this idea of what's the brain doing? Because and so I go all the neurology meetings. I'm sort of the only rheumatologist there.

Brandy Schantz (49:33.006)
Hmm. Yes.

Brandy Schantz (49:40.142)
Mmm.

Andrew J Holman MD (49:53.997)
There's an American Association of Autonomic, American Association, what is it? The Autonomic Nervous System. They're meeting every year. I go to that one. Very dedicated docs who deal with POTS and they are trying so hard and they're pretty much got the toughest thing out there, know, short of cancer. So there's a lot of people working really hard.

Brandy Schantz (49:54.35)
Well, I appreciate that.

Brandy Schantz (50:15.278)
I'm so appreciative of it, truly. And you know, I may not know much about science, but as somebody who spent a good amount of time in the intelligence world, particularly during 9-11 and in the post-9-11 years during the global war on terrorism, we realized very quickly that much like in medicine, we had one specialist here, another specialist here, everybody was siloed off doing their own thing. And the only way we were going to really combat terrorism and figure out what was happening in

Andrew J Holman MD (50:27.64)
you

Brandy Schantz (50:44.408)
be predictive in an accurate way, was if we did cross-functional work and move people together. And I think of that when you start talking about this, and especially from my own experience, and I'm not alone, get to, one of the best parts of having a podcast is I get to meet people just like me all over the world. And I keep seeing a pattern of sorts. There's a ton of people like me with Crohn's disease or ulcerative colitis who also have another rheumatoid

Something and going on in their life, whatever it might be. They're doing something there's you know problems with the Immune system all over the place and now suddenly we have this weird thing called dysautonomia So I'm not alone there's tons of us out there and I've been told by multiple doctors. They call my gut the little brain, you know, and there's a link between my gut and the brain and I see the people that

I see most in my life are my rheumatologist, my neurologist, and my GI doctor. And when I see one, they always have to talk to the other one. I just saw my neurologist on Monday. I, well, we got to have a conversation with the GI because, you know, we need to get this on the right page because we can't, you know, be doing one without the other. Thank you, doctor. That's the work. Yes.

Andrew J Holman MD (52:06.233)
And that's important. Yeah. It's like, I can't run in medics all by myself. I have some amazing people who helping me bring this to the market. mean, yeah, it's team. When it's complicated, it's a team. My mother, she passed away years ago, a remarkable mother, and she would say, how come I can't just see one doctor? Of course, I was like in medical school in the 80s. And I said, well, mom, you could if you want like 1960 medicine.

Brandy Schantz (52:18.337)
It is.

Brandy Schantz (52:29.729)
Mmm, yum.

Andrew J Holman MD (52:35.789)
But you can have one person.

Brandy Schantz (52:38.69)
Well, 1960 medicine, at least that doc would give her a sleeping pill and she could forget about it, right?

Andrew J Holman MD (52:42.777)
or something. I said, it's kind of like asking one engineer to make the space shuttle. I mean, there's a whole lot, the body's really complicated. So your son is like specializing in this little tiny wedge called rheumatology and autoimmune and immune system. But to be able to be good at it, that's what it takes sometimes. I mean, I can't do surgery. There's a lot of stuff I can't do. But we have to work together like we're a team.

Brandy Schantz (53:03.011)
Yes.

Brandy Schantz (53:07.17)
Hey, I mean, I, know.

Yes, absolutely. It's so important.

Andrew J Holman MD (53:14.536)
Or just fix it. We had stuff that we have had things in life, we've just fixed it, know. Like hepatitis C was, we didn't know what it was in the 80s. We called it non-A, non-B, because it wasn't A, it wasn't B, we didn't know. And then before my career ended, you have a pill now it's cured in three weeks. End of story. I mean, my view on medicine is I just like to fix it.

Brandy Schantz (53:20.494)
Mm-hmm.

Brandy Schantz (53:32.269)
amazing.

Andrew J Holman MD (53:39.385)
That's just my view. And then you can be what you should be, was a boring patient. Boring. We want you to be boring. Yeah, what they in med school is you don't want to be a good case. No. Be boring. We try to help you be boring. Go live your life and enjoy it.

Brandy Schantz (53:41.272)
I appreciate it.

Brandy Schantz (53:45.142)
I've always wanted to be born. It never works.

Yeah, no, not at all. Yes, that's what I, you know, and that's, that's, think what we all want. It's probably the biggest theme on this podcast. We just want to be boring. We just, we want a quality of life. I don't want to see my doctor. I don't want to know my doctors as well. I send Christmas cards to my doctors. my gosh. That's, know, nobody wants that.

Andrew J Holman MD (53:58.883)
Yeah. Yeah.

Andrew J Holman MD (54:06.741)
Exactly. I know. I know. You know, I'm so-

Well, hopefully today we got some good information out there. And, and this is all real peer reviewed stuff like that. So it's not just somebody's opinion. It's not like I'm gonna write in a book about it or nothing. It's just, we're actually doing clinical research and we were, it's all based on precision and evidence. That's how we run it in medics, how we do it.

Brandy Schantz (54:18.214)
Absolutely.

Brandy Schantz (54:35.202)
I greatly appreciate it because not only did you share a lot of really great information, but you explained it so well, something that's so complex. I think it's been made very understandable, especially for the many, many, many of us out there dealing with these kinds of problems who, know, frankly, it's overwhelming. Sometimes you walk into a doctor's office, there's a bunch of big words flying at you, and then suddenly you're told that your, your cure is, well, there's no cure, but you're

Your medicine is salt. And it's a very confusing moment for patients. So having that kind of an explanation is greatly appreciated. Thank you so much for coming on the show.

Andrew J Holman MD (55:05.049)
in the

Andrew J Holman MD (55:14.455)
My pleasure. This was a lot of fun. Hope it helps some people.

Brandy Schantz (55:16.576)
thank you. You absolutely did. Thank you so much, Dr. Andrew Holman.

Andrew J Holman MD (55:22.873)
Thank you.