Full Transcript Introduction to Part Two 0:00 This is the ultra marathon of marathons. 0:03 It's having the aging process go more smoothly than it would otherwise if you were just reactive. 0:10 it's about being very proactive and taking care of as much as you can for as long as Welcome back to Think Well, Age Well. 0:20 This is part two of my conversation with Dr. 0:23 David Merrill. 0:24 In this episode, we shift from personal experience to professional expertise, as Dr Merill shares what he's learned on the front lines of practicing geriatric psychiatry, 0:34 brain health promotion, and dementia reversal. 0:37 If you haven't listened to part one yet, I encourage you to go back and hear the beautiful insights shared by Dr. 0:43 Merrill's mom, Elaine, about her time at Marama and her own experience of aging well. 0:49 You'll also get insights from Mike, her husband, who's been uber supportive of her process. 0:55 Without further ado, let's dive in. 0:57 So I want to switch a bit to talking about your professional perspective and research, Dr. 1:03 Merrill. 1:05 You have an MD-PhD in neuroscience. 1:07 Can you talk a little bit about you research? 1:10 You know, in a nutshell, my life in relation to dementia, Alzheimer's, try not to dwell too long on it, but it really was the origin stories is, 1:23 I think it's of note. 1:27 When I was very young, my mom's dad was struggling with Parkinson's, evolved into Alzheimer's.
Dr. Merrillu2019s Personal Dementia Story 1:32 And then as I became a little older, My dad's Dad also got diagnosed with Alzheimer. 1:39 You know, that one, I Was actually about 12 when my paternal grandfather got Diagnosed. 1:47 The event, it was 4th of July. 1:49 We were having a family picnic and he needed to run out and grab a bag of ice. 1:55 and I went with him. 1:56 On the drive back, we got in a pretty dramatic car accident that he was at fault for and I was the only passenger. 2:06 And so that basically unearthed the problem for them. 2:10 So he ended up getting evaluated. 2:13 He lost his driver's license. 2:16 I learned really quickly that there's such thing as Alzheimer's disease. 2:24 You know, set me on a path to learn about this and figure out, you know. 2:29 I guess psychiatrists are like, well, my life has been a process of trying to undo stuff. 2:35 But, there's some things you can't change, but through applying like a persistent effort to learning about things, including the biology of aging and Alzheimer's, 2:51 that's really what it's been about. 2:52 It started as a personal story. 2:55 for these conditions of de-menting illnesses affecting my family members, and then became a professional pursuit as I was drawn to the field. 3:04 As a fast-forwarding, as an undergraduate at Cal, I worked in adult day healthcare for Alzheimer's at a place called ASEB, 3:14 which I think is still around, Alzheimer Services of the East Bay. 3:17 It was a miraculous experience for me. 3:22 two or three years of working with persons living with dementia at the moderate to severe stage. 3:27 And I remember like, you know, walking with clients and talking with them and just seeing the richness that remained in their lives in the face of being 3:37 in a, what some would consider a late stage of dementia. 3:41 While I was doing that, I'm working in my lab trying to figure out what was causing Alzheimer's in these patients and to some extent, 3:50 That's still where the field is hung up. 3:53 When I started grad school some umpteen years ago, a long time ago. 3:58 I remember being told that it was great that I was interested in Alzheimer's, but unfortunately I'd come along at the wrong time because it's about to 4:07 be cured in a couple years and that within five years it just really wouldn't be Alzheimer. 4:13 That was 1996. the first amyloid, anti-amyloids, it was actually an active vaccination process at that point. 4:22 The first immune therapies for Alzheimer's were being started with great confidence and huge investment. 4:30 Kind of the whole field got taken over by the amyloid hypothesis and a silver bullet approach to fixing, to beating the enemy of Alzheimer and that amlyoid 4:41 is the I don't know, by one way or another, I kind of sidestepped all that professionally. 4:50 I studied the neurobiology of aging, trophic factors. 4:56 One of the early investigators looking into brain-derived neurotrophic factor. 5:00 Before it became popular. 5:04 Now it's kind of a way that people sell products. 5:06 It's like, oh, your BDNF is going to go through the roof if you drink my thing. 5:11 Lo and behold, the best way to increase your bDF enough is to exercise, which is wonderful because that's actually usually free or can be a free activity. 5:23 So I studied the neuroscience of aging, The importance of trophic factors and not just development, but in neuroplasticity in older adults and cell survival, 5:34 in particular the memory centers of the brain. 5:37 And so it's led into, after my graduate training and medical school, I went into human studies of healthy lifestyle activities, 5:49 such as diet and exercise, or how those activities affect the trajectory of aging. 5:55 Now we all talk about and know about, you know, as opposed to lifespan, What is the expected health span for an individual? 6:04 And most recently, what's your brain span expected to be? 6:08 Your brain healthspan. 6:09 Can we maximize the vitality of your healthy brain aging through adoption of one or more modifiable risk factors in a positive way, 6:19 things like adopting regular exercise habits, getting on a brain protective diet. 6:26 It goes down the list of the Lancet Commission. 6:28 I know you're aware of, Heather, there's 15 or more modifiable risks for developing Alzheimer's that we now know.
From Amyloid to Lifestyle and Precision Medicine 6:36 The more of those factors that you address, the lower your probability of developing alzheimer's in the first place, in spite of or regardless of non-modifiable 6:45 factors like age, or genetics, even with so-called, you know, quote unquote, determinative genotypes like APOE4-4 or also the really truly the early onset 6:58 Alzheimer's genetic mutations. 7:00 Those families can push back onset by 10 or more years, 10, 15 years by adopting these healthy brain habits that relate to the things we've discussed. 7:13 And that's really just the lifestyle medicine half of the equation. 7:16 The other side, which is drawing me to your work, Heather, and others like our shared mentor, Dr. 7:23 Bredesen, is really the precision medicine aspect of this, where the goal becomes not to beat down, you know, amyloid is the enemy or trying to find a 7:36 silver bullet, but to keep borrowing from Dale's framework that he's laid out for us, it's the idea of silver buckshot, figuring out all the targets that 7:49 could possibly be driving an individual's dementing illness and addressing all of the potential drivers that you can to try and reach a tipping point where 8:00 the brain goes from a mindset of protecting itself withdrawing all the connections and shutting down the cell functions, 8:08 going back to one-up connection, where growth factors like BDNF and others get re-expressed and you're sprouting new cellular connections, 8:18 you are forming new memories again. 8:19 It's been a journey for me to do this both as part of a personal family journey, but then also into the professional realm, 8:31 learning about as much as I can about nerdy generative illnesses and then working in the clinic day in day out trying to help individuals achieve their 8:39 best outcomes and realizing like it's not about the prescription pad. 8:43 It's really about people getting to know themselves and getting know what their own personal habits, how those impact their aging process. 8:56 how the illnesses or the health stressors they might be dealing with, how those are impacting brain function, and how I can help them help themselves and 9:05 each other find a care team where they feel empowered to make positive changes based on data, based their personalized health data. 9:17 So sorry, that was a lot. 9:18 No, it's perfect. 9:19 I don't want to miss the opportunity to let listeners know that you basically wrote the seminal mapture paper on BDNF. 9:25 And so we're going to link to that in the show notes. 9:28 If you want nerd out and dive deep into Dr. 9:32 Merrill's work, please click on that link and do so. 9:36 And then also, I'm curious from your clinical perspective now having decades of working with dementia patients, at this stage, 9:45 what do you think are the biggest players? 9:47 And you've mentioned lifestyle, you're a geriatric psychiatrist, so you do have medications in your tool belt. 9:54 I am curious, What are, the top three or the Top 5 interventions that someone might make to protect their brain? 10:03 Well, I think the number one intervention is kind of to know thyself, to become your own quarterback in the sense that you definitely want to have a quarterback coach, 10:14 you want have general manager, owner, teammates, but really to really embrace the mantra that knowledge is power. 10:25 Getting to your know your genetics, getting to I mean, unfortunately, it's not that simple of an answer, but the more you can know yourself, 10:35 the better you'll do with the process of becoming older. 10:38 So you've taught me about the buckets that we need to address. 10:44 And Dr. 10:44 Bredesen talks about inflammatory factors, hormonal factors nutritional factors toxins and whatnot, you know, But learning about this paradigm of which 10:57 really comes out of naturopathic practices to basically look for root causes of illness in yourself and then working to correct those. 11:08 So know thyself, I think, is the number one intervention, which is very personal. 11:14 It's very specific to the individual. 11:16 it's going to be different for different people. 11:18 Like what needs to prioritized? 11:21 I Think beyond that, getting to know yourself. 11:23 The foundational lifestyle exercises, there's anywhere between five to 10 pillars depending on who's counting and how they're tallying them. 11:32 I think the diet and exercise is a strong number two that I would intentionally link together because you're not going to get away with one or the other. 11:42 You know, fitness trainers will tell you that, you know abs are made in the kitchen. 11:47 It's not about the aesthetics of your body, but it's really that unless you're fueling yourself well and then exerting yourself in a use it or lose it fashion, 11:57 it is not going to be one or the other. 12:00 You need to step away from any absolutes of like, I don't exercise and reframe that as like in the past I haven't been someone who's exercised, 12:12 because it's important that I'd be present for my child or my spouse, like I'm embracing movement. 12:20 And so really having this flexibility of thinking to change yourself and your behavior or your behaviors in regard to what we now know are evidence-based. 12:32 The Lancet Commission has these periodic updates of like what are modifiable risks for development of dementia. 12:40 So getting to know what those risk factors are, addressing them for yourself. 12:45 So know thyself, foundational lifestyle activities, health optimization through this investigation, and then really team-based corrections. 12:57 I work now at a neuroscience institute, Pacific Neuroscience at St. 13:01 John's Hospital, Providence. 13:04 And I'm really fortunate. 13:05 Like I've dropped into the middle of this wonderfully supportive a multidisciplinary team where we have hearing loss specialists. 13:15 My mom came and she saw a neuro optometrist, Dr. 13:18 Holmes, who shored up and made sure my mom's glaucoma is being treated, that the cataracts have been addressed, the division is corrected. 13:29 Even though there's a vision problem for my Mom, we haven't left it. 13:34 You have corrected vision, Mom. 13:36 That improvement in your eyeballs and that's supporting the survival of the brain cells that are being targeted due to your posterior cortical atrophy 13:47 and so on and forth, Heather. 13:48 This is the ultramarathon of marathons. 13:53 It's having the aging process go more smoothly than it would otherwise if you were just reactive. 14:01 it's about being very proactive and taking care of as much as you can for as long as learning about yourself, changing your behaviors in a way that's based
Top Brain Health Interventions 14:12 on evidence to have the most impact for your brain aging, and then figuring out what health risks or health stressors are going on that you may not know 14:22 about unless you get assessments. 14:26 hugely helpful. 14:27 One of the things I've really appreciated about working with you to serve patients is learning about the medications that are available. 14:37 As people age, there are, of course, mental health issues come up, anxiety and depression. 14:42 We've heard from your mom sort of, the fear that comes with having these incidents and with getting a diagnosis. 14:49 This can be really disheartening and depressing. 14:53 And then also sleep issues come up. 14:55 There are behavioral disorders like what happened with your grandpa. 15:00 you know, malue of medications that are used to treat short-term memory loss. 15:05 And I'm wondering if you can share at a high level and even at more specific level about how you navigate choosing medications and then of course there's 15:14 a whole issue that a lot of these medications can actually worsen cognition. 15:19 So how do you help patients navigate that? 15:22 Yeah, Heather, I am more than happy to talk about medications. 15:26 You know a lots of times there is a joke for a psychiatrist is like, It's asked like, well, what's the difference between a psychiatrist and psychologist? 15:34 Did you go to medical school, et cetera, etc.? 15:36 So yes, so I did and I prescribed, but as a geriatric psychiatrist, a big part of what I do is actually the opposite, so it's deprescribing. 15:46 There's something called the Beers List, B-E-R-S list, which is from our friends in geriatrics, geriatric medicine. 15:55 That's a whole cataloging of drugs that are relatively contraindicated. 16:00 It's not that they should never be used in anyone over the age of 60, but they're relatively counterindicated in that, they can cause more problems than 16:10 they fix. 16:12 So medications, I do want to pick your brain a little bit here because of your role as a geriatric psychiatrist. 16:19 I think this is really confusing for people and it's one of the most common questions that I get. 16:24 Is the medication I'm on causing dementia? 16:26 Is there a medication that can take that will help with my dementia. 16:29 Can't sleep but I am afraid to take this because it is addictive. 16:33 How do I off of this? 16:34 What will happen if I stop? 16:36 Who do I go to see to help me manage this long list of medications that's accumulated over the past decades? 16:42 And they seem to be added, but never subtracted. 16:45 How do you help your patients navigate all of that? 16:49 Absolutely, Heather. 16:50 And it's all within the context of a health system that is strained, where it is under stress. 16:56 So it' hard to access providers. 17:00 Even when you do succeed, the framework is that there's not enough time And there's often this subspecialization within a provider. 17:12 So I do really encourage people to try their best to learn about these things with the caveat that, you know, the information age, 17:21 as we know brings its own challenges. 17:24 So, for example, I talked about the beers criteria, so the beer's list. 17:29 You may, as an older adult, you may be on one or more drugs chronically that is listed in the beers list, and so it could be a goal to, 17:37 over time, have your provider or doctor, whomever, to help you transition off of a drug that has potential side effects, 17:47 but You shouldn't stop anything suddenly because that can trigger withdrawal symptoms or discontinuation symptoms that are worse than the problem of being 17:57 on the drug. 17:58 It's really case by case. 17:59 So the examples can run the gamut. 18:02 Anything from somebody waking up multiple times in the night. 18:08 goes to use the bathroom, they go to a urologist to get a medication to help them sleep through the night. 18:14 Well, it turns out the drug they get on is anticholinergic, which then gives them cloudy thinking, blurry vision, dry mouth, 18:23 constipation, and may actually lead to urinary retention. 18:27 So something that's well intended. 18:29 It may indeed, they don't need to get up as frequently at night to use the bathroom, but they've tipped themselves over the edge from an MCI state to a 18:37 dementia state because they're on this new drug. 18:40 And by the way, they're needing to get up at night wasn't actually from a bladder problem. 18:46 It was from undiagnosed sleep apnea. 18:48 Because when you obstruct your airway, that increases the pressure in your chest, which pushes down the diaphragm, Which makes you have the urge to go 18:56 to the bathroom. 18:58 So you're giving a drug to treat a symptom that worsens your overall health and doesn't Actually address the underlying cause of the symptom. 19:08 And oh, by the way, untreated obstructive sleep apnea is a known risk factor or driver of a dementing illness. 19:16 So by treating the symptom of needing to go to the bathroom at night, you're actually making it harder to figure out that you have sleep Apnea, 19:26 which is going to be causing you to end up with dementia even worse than the drug side effects for the symptoms you've helped. 19:33 So I guess in one way it's job security, but I don't want that kind of job. 19:40 The statistics are pretty grim. 19:43 So as far as I'm aware, it still about, there's about one of me, which is a double board certified licensed geriatric psychiatrist for every 100,000 older
Medication Risks and Deprescribing 19:54 adults just in the United States. 19:56 And so I can work pretty quickly, not that quickly. 20:03 One thing I've really learned from you Heather is like how to have the biggest impact. 20:07 I think it's important to be a health educator both of other allied professions so you don't need to Have been obsessed with being in school as long as possible. 20:19 But like me, I mean you can actually learn a lot just from Reading, taking classes, joining groups. 20:28 I think one of the most wonderful things that I've experienced in my professional work has been to facilitate, co-facilitate, 20:35 or be a participant in small group sessions where we meet weekly or monthly even to just check in about how things are going with the aging process itself. 20:47 what issues are coming up for an individual and then kind of double clicking on that issue and going as deep as possible to root out, 20:56 like why is somebody waking up in the night to go to the bathroom, getting them to get a sleep study, making sure they get off cognitively dulling meds. 21:06 And if they do end up still needing some sort of sleeping pill that it's not a sedative hypnotic, that is more something that helps the sleep architecture. 21:15 So as they're getting good oxygenation with their CPAP or their mouth guard, they are also getting deep sleep and REM sleep. 21:25 And they can use a drug to use something to disrupt the sleeping cycle that won't cause amnesia or be associated with increased risk of Alzheimer's. 21:35 The sleeping pills are, in a way, they're an easy target, but they are also a big issue. 21:42 It's obvious that the classic sedative hypnotics, things that aren't even prescribed anymore, like the barbiturates or the benzodiazepines, 21:52 which are still prescribed, those are clearly amnesia inducing and could put you at higher risk of not only falls but also Alzheimer's. 22:01 But even the non-benzodiazepine sleeping pills, things like Ambien or Lunesta or Sonata, I'm sorry to go into drug names, 22:09 but it's just easier to talk with examples. 22:12 Those, while they may be appropriate for younger adults for short-term use, what I as a geriatric psychiatrist, see people have been on these medications 22:21 for decades. 22:22 It's hard to help them both physiologically and psychologically transition off of them. 22:28 That's a lot of work. 22:29 When we're successful in that, we find that people do better. 22:33 I think there's a process of assessing what's the purpose of every item of your regimen, whether it's prescription med, an over-the-counter supplement, 22:45 a tincture, cream, salve, liquid, inhalant. 22:49 It's not as simple just saying, what meds are you taking? 22:53 It really runs the gamut. 22:55 So it is more than a full-time job. 22:59 And a lot of people are, I think, hoping that they'll be able to see a Medicare covered provider and do this through the system, 23:07 if you will. 23:08 And I thing what I've heard you say is that it's probably best, and I even actually heard your mom and Mike share this, that, 23:15 it might make sense to invest a little bit in seeing a provider that can spend more time with you, get that detailed intake that can really understand 23:24 the larger picture instead of being super specialized. 23:27 And then also maybe look for groups where maybe it's not quite as individualized, but you have it less expensive because you've got that economy of scale 23:37 of a provider or an expert talking to six or 12 people at a time. 23:41 So there's a couple of ways that are a little outside of the box to navigate this and get the help you need. 23:47 Is there any other advice that you would give people if they're looking for someone trained in the way that are or can they see someone like a nurse practitioner 23:56 or a physician's assistant who might have some similar training and a little bit more time? 24:00 Yeah, I want to endorse and say, you know, it's all the above of what you're talking about is like, finding a way, putting in the time and effort to navigate, 24:12 to improving your own knowledge. 24:15 So every encounter between a provider and a patient or client and when their family is a learning opportunity, both for the provider, 24:24 but also for their patient and their loved ones, or maybe the other way around. 24:29 It's a learn opportunity for patient in their care partners, it's also an opportunity to the providers. 24:34 And so this is something that I've worked on or worked through in my practice as well, trying to adopt something called the shared medical visit or shared 24:47 appointment where all the patients have a diagnosable problem in common. 24:52 So an easy example would be diabetes, though I'm not an endocrinologist and I don't have shared appointments for diabetes. 25:00 But the concept is that everybody who comes to the visit agrees that there more than able and willing to share with each other some self-disclosure about 25:09 their own health issue. 25:11 And then the provider who's running the show, so to speak, focuses on each person as an individual. 25:18 But as they give their knowledge in exchange to the patient, the patients themselves are learning, but also all the other members of the group. 25:28 So if you have 6, 10, 12, 20 individuals all at the same time learning back and forth, you've suddenly expanded your impact for one kind of resuscitation 25:42 of the value of like low glycemic index foods and diabetes. 25:46 You haven't just told one person, You've told 20 and it's live. 25:50 So there can be this exchange of questions and answers, real time feedback. 25:55 It's not as passive or abstract as watching a video or listening to a podcast, but there's really a true relationship that's formed. 26:05 And with the continued meetings, over time, you build this social network that goes beyond the provider-patient relationship into a shared experience where 26:21 everybody's aging together, trying to achieve successful brain aging. 26:26 It's a really powerful tool and it's something that I'm working on more and more to figure out how to do that in practice. 26:36 Yeah, I agree. 26:37 In my experience hosting the coaching program, it's been magic to watch people connect with each other, to inspire each, 26:44 other to learn from each as well as be able to, like you said, increase that impact through scale, through talking to 25 people at the same time instead 26:53 of just one-on-one. 26:54 It's really fun. 26:55 it is something that I really enjoy and hope to do more of throughout my career. 27:00 I alluded to this a little bit, but I want to talk more about the intersection between brain health and mental health, particularly as folks age. 27:10 What is your perspective on that? 27:13 Well, you know, the modern day field of psychiatry runs on a biopsychosocial, and I would add, spiritual model of ourselves. 27:24 And so this decades or centuries old, you know, split of there's the mind, there is the body. 27:31 Like, really, neuroscience is that field that is trying to bring that back together. 27:37 So, as we age, just like all the other organs in the bodies, There are changes that happen in biology of the brain and the function of brain, 27:46 which is affected by the functions of all other the organs of nervous system.
Shared Visits and Team-Based Care 27:51 you have biologically based physiologic process of aging that gets accelerated by health stressors, meaning illnesses like diabetes, 28:01 heart disease, major neurologic events like strokes. 28:05 These are just examples of the normal aging process gets exaggerated or exacerbated by Health stressor's vision loss, hearing loss. 28:15 You know, traumas, accidents, injuries. 28:17 So there's that whole biological aspect that then affects how our mental health, our psychology, there's both the grieving or the reaction to health stressors, 28:28 which is regressive in nature, brings us back to like primitive defense mechanisms, but also just affects all the circuitry that regulates things like 28:38 mood and decision-making and processing and language. 28:41 So the psychological aspects of our brain function are impacted by both, the aging process itself the health stressors that we work through and try to 28:55 fix or treat as well as possible. 28:58 And then this all, our psyche and the way we're mentalizing and thinking about things affects the quality of our relationships, 29:07 the ability of us to maintain long-term relationships form new friendships and partnerships. 29:15 And so then the social aspects of our existence end up being impacted by, it's this downstream effect of the biology is changing, 29:23 the psychological effects are happening that are impacting our social aspect of life. 29:31 And it really, you know, It's no wonder that having spiritual practices that bring kind of peace and harmony about all this that we each of us face day 29:44 in day out, regardless of what phase of the lifespan we're in, that really being thoughtful about spiritual aspects of your health end up making a positive difference. 29:55 So I've gone on so much. 29:58 Is that what you were asking me? 30:00 Absolutely. 30:01 I think that as you're describing it, I feel like I've experienced it. 30:05 We can all relate to that. 30:07 Right? 30:07 We have this accumulation of things that show up and that can be kind of disheartening. 30:12 And then we have the things lift us up. 30:14 Then we can relate some meditating or being with friends or been in nature and having that spiritual connection and feeling like, 30:20 all right, we're lifted back up, and as we navigate this, as age, it's dynamic. 30:27 And there's lots of variables that contribute to this. 30:31 And I think having a provider, you know, I thinks it's refreshing to hear from a psychiatrist, right? 30:37 I mean, many people have an experience of maybe seeing a psychologist once being told, hey, what you have is all in your head,
Brain Health, Mental Health, and Spirituality 30:42 go see a psychiatrists about that. 30:44 Then they get offered an SSRI, which, oh, by the way, there was recent research that shows that might increase our risk of dementia. 30:51 But to talk to a psychiatrist and hear that there's this perspective of multiple variables, that it's about kind of putting the person back together, 30:59 this biological, physiological, mental, emotional, spiritual being, there is more to it than just writing a prescription. 31:07 And I find that really refreshing and that I can relate to what you're describing, which feels good. 31:15 I'm curious with the time, the brief time that we have left, your work at Pacific Brain Health Center at PNI, Pacific Neuroscience Institute with Providence St. 31:24 John, what do you hope that the legacy of that is, or what are you hoping to build as the first leader of the center? 31:33 Thank you, Heather, for that question. 31:36 Essentially, we're about seven years in to the center. 31:41 We hit the ground running, the doors were open the first day, and we found ourselves in clinic trying to both treat but then also research every patient 31:52 in terms of looking at how are the interventions that we were offering resulting in improving the outcome of the patient sitting across from us. 32:03 you know, an individual session. 32:05 And so really it's the whole conversation we've had the last hour, hour and a half of how do you get to know yourself as a provider? 32:16 How do get know the patients you're taking care of to figure out what are the unknowns that could be affecting the process of the aging body and aging 32:28 brain for them? 32:33 dementing illness to either stave it off or if it does manifest to slow it down and or, you know, ambitiously yourself and others like Dr. 32:44 Bredesen report on the many, many cases where we've seen improvement in cognition where before this was a field where having a recovery was unheard of, 32:58 not seen. 32:58 I mean, I I'm very cautious and very conservative about sharing or making statements about improvement, but it's without a doubt that we do see cases that 33:15 shift diagnostic categories at times into a milder stage of illness or even, you know, I have not an insignificant number of patients and patient families 33:29 who over the years have basically express that they're cured or that their in remission or they are all better. 33:37 It's an ongoing effort, it can certainly go back the other direction. 33:42 But I think the legacy is one of hope, but hope with a roadmap and hope if not an instruction manual, certainly a toolbox of ways to go about aging more successfully, 33:57 improving the the health span of individuals with the focus on improving the brain healthspan, so people can maintain the vitality of life into older old 34:10 age for as long as they shall live. 34:11 It's not about being unrealistic, it's about trying to simplify it, or it is not a search for the fountain of youth, but it certainly is a process of instilling 34:21 hope that knowledge is empowering and that there are things we do that make a difference. 34:26 And there's always something more that can be done to help improve the quality of life. 34:32 My experience working with you is that humor is a big part of who you are and how you engage with patients and colleagues. 34:41 I want you to leave us with what makes you laugh and what brings you joy these days.
Legacy, Hope, and Humor 34:48 Yeah, that's a great question, Heather. 34:50 It's fine because I think I'm just not recorded enough or on camera enough. 34:55 Usually I am off camera, off mic when I start to make light. 35:01 I try to be self-deprecating. 35:03 it's much more funny to me when people make fun of themselves. 35:06 As opposed to others, it really is a gravely serious condition that I work in. 35:14 I guess my family origin, you know, their artists and their hospitality, one of the first physicians. 35:21 So I do try to be mindful that it actually is life and death sometimes, as opposed to for my father, it was food and beverage, 35:29 not life-and-death. 35:30 There's really a lot of happiness and joy in coming together. 35:34 And so I try bring that joy to the care I provide. 35:38 Luckily, my patients and families are not They don't hesitate to speak up or maybe I'm kind of like just getting too joyful in the moment, 35:47 but I try to use humor as a mature defense mechanism as much as I can. 35:52 And I am glad when it goes well and helping motivate positive change. 35:57 So that's about as good as going to get at this time to talk about it. 36:03 Well, thank you so much. 36:05 I know that you have to run to see patients and I am just so grateful for your vulnerability, your compassion that have for patients, 36:14 for you sense of humor and your intelligence. 36:17 And I just feel absolutely privileged every day when we get to collaborate and also I feel privileged to call you a friend. 36:24 Thank you for being here, David. 36:26 We welcome Heather and the feelings are mutual. 36:28 It's my pleasure, my privilege. 36:30 Thank you so much for listening to the Think Well, Age Well podcast. 36:35 If you enjoyed today's conversation, please take a moment to subscribe, leave a review, and share this episode with someone you care about. 36:43 It's one of the best ways to help others discover tools and inspiration for aging well. 36:50 To stay connected, get bonus resources, and never miss an episode, head over to drheathersanderson.com and join my email list. 37:01 Until next time, keep thinking well and aging on purpose.
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