What if your cholesterol looks normal, your 10-year risk score is just 2.3%, and you're still a ticking time bomb? Josh Wageman, PhD, DPT, a clinical lipid specialist, physician assistant and author of The Home Security System and the Lipid Neighborhood, joins Dr. David Spiro on HuMed to tell the story of a fit, running friend whose Lp(a) and coronary artery calcium score revealed heart disease his routine labs had missed.

His friend's family history was riddled with heart attacks, yet his blood pressure, blood sugar and LDL were all normal. One conversation on a 5:30 a.m. run led to two extra tests: an Lp(a) of 128 mg/dL and a calcium score of 2,814. He needed a five-vessel bypass, and a year later he finished a half Ironman. Dr. Wageman explains why he calls Lp(a) "the felon of the lipid neighborhood," what a low-dose coronary calcium (CAC) scan shows and what it costs, and how statins, ezetimibe and PCSK9 inhibitors work, told through his mailman metaphor. It's a warm, often funny conversation about prevention, friendship, and using what you know to help the people you love.

In this episode:
– Normal cholesterol, a 2.3% risk score, and a calcium score of 2,814
– "Got plaque? Get a CAC": what a coronary calcium scan shows
– Why Lp(a) is "the felon of the lipid neighborhood"
– A five-vessel bypass, then a half Ironman a year later
– The four pillars of your heart's home security system
– Why Lp(a) is worth checking at least once in a lifetime
– Menopause, statins and rising Lp(a)
– Statins, ezetimibe and PCSK9 inhibitors, explained with mailmen
– "Prioritize protein and eat real food"

Chapters
00:00 "He was a ticking time bomb"
00:18 Meet Josh Wageman, clinical lipid specialist
01:38 Why stories stick better than textbooks
02:13 "Beyond the 10-year risk calculator"
02:41 A runner friend with a worrying family history
03:40 "Got plaque? Get a CAC"
04:01 Normal labs and a 2.3% risk score
05:05 "He picked the wrong parents": an Lp(a) of 128
05:35 A coronary calcium score of 2,814
06:20 A ticking time bomb and a five-vessel bypass
07:08 A half Ironman one year after surgery
07:57 What a calcium scan is, and what it costs
09:28 From reactive to preventive medicine
10:01 Does a calcium score show narrowing?
11:07 "You're fine till you're not"
11:58 The four pillars of your home security system
12:58 Lp(a): the felons of the lipid neighborhood
14:18 The genetic piece: one in five people
16:06 Checking Lp(a) at least once in a lifetime
17:10 Menopause, statins and rising Lp(a)
18:02 The patient whose Lp(a) jumped on a statin
19:02 Statins, plaque and the art of medicine
21:30 Beyond "HDL good, LDL bad": the mailman metaphor
22:34 Statins, ezetimibe and PCSK9, in plain English
24:18 Why metaphors and stories matter
25:30 Ultra-processed food and the fat-free era
26:28 "Prioritize protein and eat real food"
28:05 What "real food" means, and what about eggs?
30:18 Glucose "dollar bills" and your fat "savings account"
32:36 Where to find his book
33:23 Closing reflections

Josh's book, The Home Security System and the Lipid Neighborhood, is on Amazon, with links at lifelovelipids.com.

This episode is education and storytelling, not individual medical advice. Talk with your own clinician about testing and treatment.

HuMed unveils the human side of medicine, hosted by Dr. David Spiro, MD.

New episodes on Apple Podcasts, Spotify, and YouTube — please follow and leave a rating, it helps other listeners find the show.

What happens when a rural doctor opens a scan report in the middle of his ER shift, and it's his own? Dr. Peter Crane — a board-certified family physician in full-time rural practice in Idaho and host of the podcast Doctors Making a Difference — joins Dr. David Spiro on HuMed to talk about the night he read "26 centimeter, likely sarcoma" with patients still waiting, and the long road from radiation and major surgery back to full-time practice.

Dr. Crane took over the practice of the doctor who delivered him, in the town where he grew up, caring for patients "from the cradle to the grave." He describes finding the mass himself at 4 a.m., finishing his shift after reading the report, and feeling almost ashamed to be sick. He talks about the surgeon, his own medical school preceptor, who made him promise six weeks off, the two residency friends who took over his entire practice, and the moment of clarity that convinced him he would choose medicine all over again. It's a candid, hopeful conversation about compartmentalization, burnout, life without anonymity in a small town, and being the kind of doctor you'd want for your own family.

In this episode:
– Reading his own "likely sarcoma" report mid-shift
– Compartmentalization: survival skill or harm?
– The surgeon who made him promise six weeks off
– Two friends who took over his whole practice
– What really matters, and why he'd still choose medicine
– No anonymity: doctoring in a small town
– How a rural family doctor stays current in everything
– Fixing burnout with sleep, staffing, and better schedules
– "I don't trust doctors, but I trust you": trust and misinformation

Chapters
00:00 "26 centimeter, likely sarcoma"
00:17 Meet Dr. Peter Crane
01:54 Taking over for the doctor who delivered him
02:50 Jet-lagged at 4 a.m.: a mass in his own abdomen
04:09 When your practice partner is your doctor
06:41 What a doctor feels when it's his own mass
08:20 Reading his own CT report mid-ER shift
09:42 Is compartmentalization healthy?
11:56 Warning signs he missed, and feeling ashamed to be sick
13:07 Biopsy, waiting, and a rare diagnosis
14:41 His surgeon: his own medical school preceptor
15:43 What really matters in life
16:42 "If I got to do it again, I'd be a doctor"
18:36 How being a patient changed the way he practices
19:17 Nerve damage and the long road back
20:49 Doctor and patient in the same small hospital
21:55 A rash check on aisle 13: life without anonymity
23:29 Why every doctor should practice rural for a while
26:16 How a rural family doctor stays current in everything
28:02 Six weeks off, and the friends who covered his practice
30:36 "I just do everything every day"
31:31 When helicopters can't fly: tele-critical care
33:45 Burnout before the tumor, and what fixed it
36:58 Misinformation and vaccine hesitancy
38:19 "I don't trust doctors, but I trust you"
39:19 Why we need more doctors making content
40:36 Closing reflections

HuMed unveils the human side of medicine, hosted by Dr. David Spiro, MD.

New episodes on Apple Podcasts, Spotify, and YouTube — please follow and leave a rating, it helps other listeners find the show.

He looked fit, ate well, exercised, and had a calcium score of zero six months earlier. Then, at 34, Dr. Stephen Hussey had a widowmaker heart attack.

Diagnosed with type 1 diabetes at age nine, Dr. Hussey, a doctor of chiropractic with a master's in functional medicine and author of Understanding the Heart, spent his adult life trying to do everything right. In this episode, pediatric ER physician Dr. David Spiro talks with him about the heart attack he suffered alone during COVID, the frustration of feeling unheard in the hospital and being labeled noncompliant, his decision to depart from the standard medication plan, and the stress he believes set the stage for it all. David also presses him on the hard question: how can he know what actually drove his recovery? The episode ends with what nearly dying at 34 changed about his life and purpose.

CHAPTERS

0:00 "I had a widowmaker heart attack at 34"

0:16 Meet Dr. Stephen Hussey

1:39 Asthma, allergies and type 1 diabetes at age nine

2:53 "I felt like a pincushion" and the nurse with the magic kit

4:19 Giving bad news to children and families

7:25 From patient to health practitioner

9:17 What "avoiding toxins" means to him

10:33 Sauna, sweat and microplastics

14:13 A heart attack despite a zero calcium score

17:53 What a widowmaker heart attack felt like

21:28 Alone in the hospital during COVID

23:30 Labeled "noncompliant"

25:23 Why he declined the standard medications

27:00 A new blockage in his leg

29:04 Light, sauna and circadian rhythm

33:58 Semmelweis and challenging medical dogma

35:17 How does he know what worked?

37:43 Stress and the nervous system

41:38 The 36 hours before the heart attack

43:28 Heart attacks without blocked arteries

45:44 "Stay in your lane": answering his critics

47:55 Heart disease, obesity and insulin resistance

51:43 What nearly dying at 34 changed

54:44 Closing

Watch the full video on YouTube: HuMed with David Spiro, MD

Follow HuMed on Instagram: @humedpod

HuMed unveils the human side of medicine through real stories from clinicians. Guests share their personal experiences and views, which are their own. This episode is for storytelling and education, not medical advice. Talk with your own doctor before changing any treatment.

After years in emergency medicine, Dr. Vassily Eliopoulos (Dr. Vass) coded a man in a rural Wyoming ER who was his age, had no other risk factors, and looked exactly like him. That night pushed him from the ER toward longevity medicine and cardiovascular prevention.

In this episode of HuMed, pediatric ER physician Dr. David Spiro talks with Dr. Vass about why doctors neglect their own health, the "golden handcuffs" that kept him stuck, how therapy and CBT-I helped him heal from years of night shifts, and why he believes disease care and true health care are two different systems. He also walks through his longevity pyramid, built on community, purpose and sleep, not supplements and saunas.

CHAPTERS

0:00 He coded a man who looked exactly like him

0:28 Meet Dr. Vass: ER doctor turned longevity physician

2:05 The code in Rock Springs, Wyoming

4:48 Why doctors neglect their own health

8:13 The lost art of healing

11:03 "We're training technicians, not physicians"

15:07 Trapped in a broken system

18:18 The golden handcuffs

20:44 Healing from decades of night shifts

28:30 Disease care vs. true health care

35:37 Why no one told Dr. James Wittig he was sick

39:04 Advice to his younger self: don't let fear decide

42:32 Dr. Vass's longevity pyramid

44:55 What dying patients talk about

47:51 Purpose: the old dog and the rabbit

51:21 A quarterly "board meeting" with his kids

53:16 Fasting, thermal springs and community

57:54 Closing thoughts

Watch the full video on YouTube: HuMed with David Spiro, MD

Follow HuMed on Instagram: @humedpod

humedpod.com

HuMed unveils the human side of medicine through real stories from physicians. This episode is for education and storytelling, not individual medical advice.

"I did healing for myself first, so I could become a better healer."

Before Dr. Melissa Mondala treated patients with lifestyle medicine, she needed it herself. She lived with IBS and reflux from her teens, and during her training at Loma Linda she was diagnosed with an atypical breast cancer. Changing how she ate, moved, slept and handled stress changed her health, and her husband's, and it reshaped how she practices medicine.

On this episode of HuMed, Dr. David Spiro talks with Dr. Mondala, a double-boarded family and lifestyle medicine physician, fellowship-trained in integrative psychiatry and integrative medicine, about the patients who shaped her: a young single mother of three with pancreatic cancer who kept running for her kids, and a fashion designer with an autoimmune disease who got her life back layer by layer.

They also discuss:

• Lifestyle medicine vs. integrative medicine, and where they overlap
• Why ferritin matters even when hemoglobin looks normal
• Her approach to adult behavior change: one habit, SMART goals and habit stacking
• What medical training leaves out about nutrition and sleep
• Advice for frustrated, burned-out physicians who feel stuck practicing reactive medicine

Dr. Mondala earned her MD at Chicago Medical School at Rosalind Franklin University. She is co-founder of the Doctor Lifestyle Clinic, a direct care practice, and author of Embody Lifestyle Medicine: How to Build a Successful Direct Care Startup.

HuMed unveils the human side of medicine through honest conversations with physicians. Follow the show so you never miss an episode.

Chapters

00:00 Cold open

00:22 Introducing Dr. Melissa Mondala

02:25 Her own health story: IBS, reflux and food as poison

04:21 Loma Linda and the Blue Zones

05:30 A breast cancer diagnosis during training

07:00 The pillars of lifestyle medicine and her husband's autoimmune disease

08:49 The young mother with pancreatic cancer

13:53 Lifestyle medicine vs. integrative medicine

18:50 A patient with autoimmune disease and a difficult cycle

27:36 Why ferritin matters

31:45 What standard medical training leaves out

36:48 Night shifts, sleep and processed food

40:09 How to change adult behavior

44:12 Accountability, SMART goals and habit stacking

47:05 Lifestyle medicine and autism spectrum disorder

50:54 Advice for frustrated, burned-out physicians

53:31 Closing

Dr. Rick Pescatore was driving to Pittsburgh with a woman he had met on Hinge, describing a kind of patient he sees every ER shift: pain, nausea, vomiting, and tests that all come back normal. She said the person he was describing "sounds exactly like my mom." A few weeks later her mother was dying in an ICU, and nobody could solve her mystery illness. The missing piece turned out to be vitamin B1 (thiamine). The woman from that drive is now his wife, Katie.

Dr. Pescatore is a board-certified emergency physician. He went through the U.S. Naval Academy, studied aerospace engineering, and served in the Navy's submarine force before medical school. He trained at Cooper University Hospital, served as Delaware's chief physician during the COVID-19 pandemic, is editor-in-chief of Emergency Medicine News, still works shifts in a community ER, and co-founded Belly MD.

In this conversation with Dr. David Spiro, he talks about helping diagnose his future mother-in-law, why so many ER patients are told they are normal when their lives are not, and how that pattern helped burn him out of full-time emergency medicine. They also get into what night shifts cost physicians, his Navy call sign, his time leading Delaware's pandemic response, and why an ER doctor who used to roll his eyes at supplements now sells them.

In this episode:

– The drive to Pittsburgh: "sounds exactly like my mom"

– An ICU stay nobody could explain, and the vitamin B1 answer

– "We tell them that they're normal, but their lives aren't"

– Disorders of gut-brain interaction and the ER

– Why he calls GLP-1 drugs some of the most revolutionary in history

– Burning out of emergency medicine, and the night-shift toll at every age

– F-18s, submarines, and the call sign "Aquaman"

– Chief physician for Delaware during COVID-19

– An ER doctor selling supplements: his answer to the eye-rolls

Chapters

(00:00) Cold Open: "Met a Girl on Hinge"

(01:05) Welcome & Meet Dr. Rick Pescatore

(03:16) The Drive to Pittsburgh: "Sounds Exactly Like My Mom"

(04:30) Decades of Symptoms, Then the ICU

(06:19) Vitamin B1 and Gastrointestinal Beriberi

(07:03) "We Tell Them That They're Normal"

(08:12) Saving Her Mom's Life With a Vitamin

(10:03) Belly Pain: What the ER Can't Fix

(11:27) Disorders of Gut-Brain Interaction

(13:09) Should Emergency Medicine Change?

(14:21) Diet and the American Food System

(16:47) Sulfite Preservatives and Vitamin B1

(19:31) GLP-1s, Falls, and the Toenail Question

(22:50) The Naval Academy, F-18s, and the Call Sign "Aquaman"

(27:24) "I Burned Out of Emergency Medicine"

(29:26) The 3 a.m. Problem: Night Shifts and Physician Health

(30:40) Dr. Spiro on Night-Shift Anxiety

(33:04) Chief Physician for Delaware During COVID-19

(35:57) Building Belly MD

(40:33) Supplements: "I Used to Be That Guy"

(44:12) An ER Doctor Selling Supplements?

(45:43) Testing for Vitamin Deficiencies

(47:47) Closing

Learn more about Dr. Pescatore's work: bellymd.com

Check out the Inside HuMed Newsletter: https://www.humedpod.com/inside-humed

This episode is one physician's personal story and is not medical advice. Dr. Pescatore co-founded Belly MD, which sells supplements, as he discusses in the episode.

If this episode meant something to you, follow HuMed on Apple Podcasts and send it to one colleague who needs to hear it.

A Monday morning, 6:45. Dr. Kim Blankshain is changing her infant son when she hears a crash in the next room. Her husband is sitting on the edge of the bed, bleeding from a gash in his forehead. She expects a few stitches. Hours later an ER physician says the CT scan came back and he is being sent downtown to see neurosurgery right away. "What is happening?"

Dr. Blankshain is a neuro-ophthalmologist in the Chicago suburbs, a specialist in vision problems that begin in the brain and nervous system. She was in fellowship, trained to read MRIs and CTs, when the scan on the screen was her husband's: an epidermoid cyst pressing on his brainstem, and brain surgery set for the next morning. She joins Dr. David Spiro to talk about being the doctor in the waiting room, and how it changed the way she delivers bad news to her own patients.

In this episode:
- Why knowing the medicine made it harder, and the moment the neurosurgeon asked, "What do you do for a living?"
- The waiting-room buzzer three hours into a four-to-six-hour surgery: "That can't be good"
- Receiving bad news as a physician: "I wasn't really hearing what he was saying"
- How she gives hard news now: slow down, say it more than once, and sit in the silence
- Going back to work the day after her husband came home, with her time off for the year already used on six weeks of maternity leave
- Parental leave in medical training, and why she calls the culture "cruel"
- Working-mom guilt and the "have it all" lie: "Something has to give on any given day"
- Marriage after a baby: feeling like roommates, a year of couples therapy, and TV-free Thursdays
- What she tells pre-med students: "It's still just a job"

Dr. Spiro also shares how he gives bad news to families in the pediatric ER.

Chapters
00:00:00 "What is happening?"
00:00:20 Meet Dr. Kim Blankshain
00:01:50 What a neuro-ophthalmologist does
00:02:22 A crash in the next room
00:04:10 The ER and the CT scan
00:06:08 Rush University: the MRI and the neurosurgeon
00:07:27 "What do you do for a living?"
00:08:14 Brain surgery, tomorrow
00:08:53 The waiting room: "That can't be good"
00:09:43 Six weeks of recovery
00:10:13 How it changed the way she sees patients
00:11:45 On the other side of bad news
00:13:04 Slow down, repeat it, sit in silence
00:14:17 Dr. Spiro: bad news in the pediatric ER
00:15:25 "You are so lucky that you came to me"
00:16:36 Back to work the next day
00:19:41 Parental leave in medical training
00:22:43 Balance with a five-year-old
00:23:58 The "have it all" lie
00:24:39 On call on the Fourth of July
00:26:37 "It's still just a job"
00:27:50 Marriage after a baby
00:29:23 Couples therapy and TV-free Thursdays
00:32:33 Why she believes in therapy for physicians
00:33:44 "Nobody says that to a mechanic"
00:34:08 Why she reached out to HuMed
00:35:31 Closing

Check out the Inside HuMed Newsletter: https://www.humedpod.com/inside-humed

This episode is one physician's personal story and is not medical advice.

If this episode meant something to you, follow HuMed on Apple Podcasts and send it to one colleague who needs to hear it.

A resident on night call writes one word in a chart to describe his patient's husband, a man in his 90s: "senile." He thinks it means "very old." The note gets corrected, but the word stays in the edit trail, and a few days later the record shows the patient has read it. Every instinct tells him to leave it alone. He calls the family to apologize anyway.

Dr. Aditya Pawar is a transplant nephrologist at Beth Israel Deaconess Medical Center and Harvard Medical School. That phone call became "Safe Space," his essay in The New England Journal of Medicine. He joins Dr. David Spiro to talk about what the couple said to him on that call, why it took him years to understand it, and who a clinician's "safe space" really protects.

In this episode:
- The apology he almost didn't make, and why he says it would be just as hard tomorrow
- Why "safe space" in medicine often protects the doctor, and what a "brave space" with patients looks like
- Telling a patient you don't yet know the best approach
- Practicing in India versus the U.S.: five-minute visits that never really end, and seeing your patients at the grocery store
- Why he calls paternalism "a protective mechanism"
- What he says to kidney patients who won't let their own child donate
- What he tells first-year medical students about the 20-minute visit that needs an hour and twenty
- His uncle's lesson from Sunday evenings seeing patients in a village in India: "As a physician, we've always lost"
- Six hugs from a grieving family after one of his first codes

Dr. Spiro also shares what it was like to lead his team's debrief after a child died in his pediatric ER.

Read the essay: "Safe Space," N Engl J Med 2026;395:840-843. https://doi.org/10.1056/NEJMp2518528

Chapters
00:00:00 "As a physician, we've always lost"
00:00:20 Meet Dr. Aditya Pawar
00:02:03 "It started from a mistake"
00:02:33 Night call, a couple in their 90s, and one word
00:04:27 The phone call he almost didn't make
00:05:11 What the couple meant by "safe space"
00:06:37 Parents in the room during a resuscitation
00:08:20 Who is the safe space for?
00:10:03 From safe spaces to brave spaces
00:12:55 Medicine in India versus the U.S.
00:15:11 Sharp boundaries, and crossing the line
00:17:43 "Every single cell of my body is telling me don't do it"
00:21:14 What safe space meant as a child in India
00:23:10 Family, elder care, and what gets lost
00:28:16 Organ donation: "Do not take away that decision from me"
00:30:00 Teaching first-year medical students
00:34:26 Dr. Spiro: the debrief after a child dies
00:38:06 His uncle, Dr. S.S. Jamwal
00:39:49 One of his first codes as a resident
00:41:11 "This concept of death, you have to get comfortable with it"
00:42:11 Six hugs from a grieving family
00:42:44 Closing

If this episode meant something to you, follow HuMed on Apple Podcasts and send it to one colleague who needs to hear it.