What types of plaque are there? What are you looking at in those scans? Yeah, so we're looking at like two categories. We've got the kind of the more easily detectable calcified plaques.

So as plaque builds up, they sort of get this reinforced with calcium, which in part stabilizes those plaques. Your health is shaped by more than symptoms.

Through real stories and expert insights, we explore how your genetics, environment, and daily choices affect your wellbeing. We uncover root causes and share practical tools to help you find the healing you need.

Welcome to the Forum Health Integrative Medicine Podcast. Welcome to the Forum Health Integrative Medicine podcast. I'm your host, Amanda Grabeau. I've been immersed in the functional and integrative medicine space for over a decade as a researcher, business consultant, and certified coach.

In this episode, I'm joined by Michael Sermin, a board certified physician assistant with a master's of physician assistant studies, specializing in cardiometabolic and preventative cardiovascular care at Forum Health Medicine.

Michael works with patients who want to go beyond standard labs and take a truly proactive approach to heart health. Using advanced imaging, precision risk assessment, and personalized treatment strategies, he has extensive experience helping patients uncover hidden cardiovascular risk, even when traditional cholesterol numbers look normal.

In this episode, we're focusing on one of the most powerful tools available today for early heart disease detection, the CLEARLY scan, an AI-driven coronary CT angiography that allows clinicians to directly visualize and quantify plaque in the arteries.

Michael uses this technology to help patients understand their real risk and intervene years, sometimes decades, before a heart attack or stroke occurs.

If you've ever been told your labs are fine, but still wondered about your heart risk, or if you're a clinician interested in more precise prevention, this conversation will be incredibly valuable.

Let's dive in. Welcome back to the Forum Health Integrative Medicine podcast. My name is Amanda. I'm your host today and I'm joined by Michael Sermon.

He is our PA in our Madison location. I'm so excited to have you here with us today. Mike, we are going to be talking about cardiometabolic health and the CLEARLY scan.

So, heart disease is still the number one killer, and many patients think if their cholesterol looks normal, they're safe. And the truth is, many people with normal cholesterol still get heart attacks.

But new tools like the CLEARLY scan can actually show whether plaque is building up in the arteries long before a heart attack happens. Today, we'll unpack cardiometabolic health, cholesterol misconceptions, and how imaging can change prevention.

Mike, thank you so much for being here today. You know, many of us grew up hearing cholesterol causes heart disease. What's true and what's misleading about that?

Yeah, that's an interesting point you bring up. I wish it were that simple that we could just lower cholesterol and heart disease is fixed. Clearly as the number one cause of death among Americans of men and women, we still see this high rate of heart disease as the number one killer.

So what are we missing, right? If it was just about lowering LDL, cholesterol, you know, we'd see pretty good improvements in rates of death from heart disease, but we still continue to see it climb.

So there's many different factors we have to look at. And so part of a comprehensive view of heart disease is not only looking at cholesterol, but looking at the other factors that contribute to heart disease, whether those are non-modifiable risk factors, things like our age and our sex and our ethnicity, things like genetics and family history.

Although we can't necessarily change those kinds of things, those are factors we have to weigh in with that. outside of just cholesterol. And then you've got the modifiable risk factors, which is let's not smoke and let's exercise, let's eat right, anti-inflammatory diet, let's make sure that we're controlling our blood pressure, make sure we're trying to keep our weight managed.

Those are some modifiable risk factors that we can actually take action to help improve our outcomes. cholesterol got labeled as the bad guy, but it's not the full picture.

There's so much more to look at when it comes to your heart and your health. And I think that that's just a big misconception is, you know, oh, I've got high cholesterol.

So let's just take this. And if that gets corrected, I'm in the clear. And that's just not the big picture. That's not the whole picture, right? Exactly.

I have so many different patients that I've run hundreds, probably thousands of cholesterol panels at this point in my career. And to see that a patient has what most people would call in the medical world, a very good cholesterol panel.

And so we're sitting there going, hey, on paper, you should be good to go. Like your cholesterol is very well controlled. yet we get more advanced imaging on them and we find plaques all over.

We're also sometimes moderate to severe and I've been very surprised. On the flip side, I've seen really what should be terrible cholesterol panels and they have squeaky clean vessels when you do imaging.

So we know that that's way more nuanced. Yeah, it just goes to show that we're all individuals. Yep, everyone's different. And you've gotta just, you gotta look at the person, you gotta talk to the person, look at it from multiple angles.

Yeah, I've, I've learned through my experience to not trust just lab labs. You got to look a little bit deeper and get a nice, thorough history. You know, if there's a family history there, that's a significant risk factor.

You know, you look at certain types of genetic markers that can really set us up for heart attacks and strokes. And so a really good comprehensive view of it is looking at all those lifestyle factors.

Absolutely. Yeah, I love that. And the CLEARly scan, so you joined our Madison practice earlier this year and we were so, and are so grateful to have you part of our practice because you really added something really special to our Madison location.

You come with a really extensive background in treating cardiometabolic cases. and having that functional lens to it in that specialty. And so we're so, so honored to have you part of our practice.

And when you came, we started utilizing this scan, the CLEARLY scan. So what is the CLEARLY scan and how can it help patients take control of their heart health before it's too late?

Yeah, that's a good question. So I've been using ClearlyScan for probably about four to five years now. It has not been around a super long time. When I was introduced to it, I was kind of in this area where I wanted to see more and I didn't want to wait till people had a heart attack before we did something about it.

I appreciate that. I want to be proactive and preventive, you know? You hear these horror stories of people just dropping dead from a heart attack and they have no signs or symptoms.

They look good on the outside, their lab work might look pretty good and yet they're still dropping from a heart attack. And so my introduction to clearly was just, my mind was blown when there was technology out there that could actually look a little bit deeper.

quite extensively deeper to see what is the plaque burden and did it matter what types of plaques were in there? Did it matter? Did it really make a difference to know ahead of time, almost like the crystal ball?

Would it change outcomes if I knew ahead of time that, hey, you've got some blockage here upstream that is not bad enough for a stent or bypass surgery, for example?

could have gotten there it could get there and so it's those early interventions to avoid the need or necessity for a stint or to have an event happen when you're not nobody is prepared for an event to happen or wants that but At Forum Health, we uncover the why behind your symptoms.

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Learn more at forumhealth.com and explore supplements at shopforumhealth.com. How could I call myself a provider that wants the best for my patient when I tell them, you know, we're going to do the watch and wait method and let's just wait till you have a heart attack and then we'll get really busy.

Then we'll get really aggressive and treat you and hopefully not have another one. My approach has been, what if we could catch that? early on, so you never have to have that heart attack.

Yeah. And that's kind of the challenge we're faced with of how do you prove that you prevented something that never happened? Right. And so, you know, we feel and I feel that clearly has taken it to the next level outside of getting a cardiac catheterization to see, you know, get in the camera and see is there a blockage?

Yeah. But the CLEARly is basically AI assisted technology that takes a standard test called the coronary CT angiogram. And this can be done at any major radiology center.

What they do is this CLEARly scan, the CLEARly company has a software program that uses AI to analyze this information from the CT scan and it can develop images that are, you know, 3D images and it can start to characterize these plaques.

So not only can you see what the plaques are, you can see how much volume is there, how much burden is there, how much is built up, but also characterize them.

So now we can say this is the type of plaque that it is. Are these super risky plaques? Are they more prone to breaking off and rupturing and heading somewhere to plug up the river?

Right. Or is this a stable plaque that probably been there for a while and we can maybe take some action to keep them stable? Yeah. If not be able to reduce them.

That's great. It's been a really cool tool to help us to stay ahead of the game. Yeah. So it's been a game changer for That's amazing. I'm all about prevention.

I think a lot of our network is, I know all of our network is all about prevention too, and our first choice is prevent something from happening. And this just sounds like one of those tools that gives you such a better picture of the innards, of the heart for those people.

One thing that I thought was interesting that you said was what type of plaque is it? What types of plaque are there? What are you looking at in those scans?

Yeah, so we're looking at like two categories. We've got the kind of the more easily detectable calcified plaques. So as plaque builds up, they sort of get this reinforced with calcium.

which in part stabilizes those plaques. But just like any river, if you put a big enough dam on that river, as it grows and gets bigger, it's going to start to restrict flow.

And so we call that stenosis. So one of the cool things that this clearly can do is tell us if it's a calcified plaque or if it's a soft plaque or what we call a non-calcified plaque.

the soft plaques are kind of what we what we think of as earlier plaques that are still forming and they haven't quite matured yet yeah and so in either case we could see blockage yeah of that stream right and so the thing with non-calcified plaques is there's another subcategory of these highly unstable plaques that are kind of more likely to break off kind of rupture through the endothelium in the inner lining of the vessel.

So a smaller non-calcified plaque that you look at that has the risk. They're more likely to rupture and head to somewhere down the stream and plug something up.

That's the type of that happens. It's sudden. Like a stroke? It's a sudden stroke or heart attack, depends on where that thrombus ends up, where that clot ends up.

Terrifying. Yeah, yeah. So yeah, it's kind of just a unit, you know, I'm not a cardiothoracic surgeon. I'm not a cardiologist. You know, I don't claim to be at all.

I mean, there's always a need for that type of care. You know, let's say I do a clearly scan and I see you know, a blockage of 80%. That's where we must team up with a cardiologist that can go in there.

Absolutely. Collaborative care, it takes a team. Or does it need surgery? That's where we hand off and say, hey, you need the subspecialist to treat this.

So this just helps us to kind of sort of expedite the process so that when I send someone to a cardiologist, they could be confident that, hey, there's evidence that they've got some blockage that we really need to take care of.

And I can tell you about a perfect example of how this has really impacted my patient's lives. I had a gentleman, probably in his upper fifties, he showed up to the clinic to see me and very healthy lifestyle.

great, you know, was not overweight, was eating healthy. He was an herbalist, just super fantastic person. He was, you know, his cholesterol numbers looked really good.

But he mentioned at the end that, you know, I get a little bit of chest pain, a little bit of a pressure when I exercise a little bit. And I'm going, oh, tell me more about that.

Yeah, please. Right at the end. By the way, I'm really healthy and… I'm like, okay, let's talk more about that because that doesn't sound normal. It's like, I think it's just indigestion, you know, and, you know, I think us typical guys is kind of brush off that stuff.

And, you know, when he said that, I was like, you know, I'm not feeling too good about that. You know, I know, you know, this gentleman did have a family history and you know, who knows what happened earlier in his life.

Absolutely. So I said, you know, let's just be safe. Healthy today doesn't mean they were healthy the whole time. And there's still stuff you have to undo from previous habits in life.

And there's genetic factors too that are completely out of our control. So this gentleman, you know, we decided, okay, let's do a clearly scan. I also had a good relationship with a cardiologist in town that really helped too to Yeah.

To sort of push this along. But so I did a clearly scan. As soon as I got the results, the cardiologist called me because he looked at him too. Yeah. He had access to that through this clearly center.

And he's like, did you see this clearly scan? I'm like, not yet. I'm just about to. Yeah. He's like, this gentleman has almost 100% blockage, about 90% blockage in his one of his arteries.

And then he also noticed there was actually two blockages at the end. And he's like, this guy was a ticking time bomb. And that's kind of what that like, that's like the Widowmaker kind of like, that's the stuff that happens.

Yeah, so he had about a 75% blockage in LAD, and then he had a… like 90% blockage in his circumflex artery, which these are just arteries of the heart.

Your heart needs blood too. So when they don't get perfused, you can end up getting those chest pains because your heart's just, okay, I need some blood.

So this was just an eye-opening experience for me because he didn't meet all the criteria for the modifiable risk factors. He was doing really well. but yet he was this close to going for a hike in the woods and not coming home.

So this was the cool story, this even cooler part of the story is he comes to me about four to six weeks status post, right after his stents were placed.

He had two stents within about a day or two. He already had stents in and was treated and feeling wonderful, no longer have a chest pain. He came and saw me after about four to six weeks after and he's just like, can I just give you a hug?

And I was like… Why? I didn't do anything. The cardiologist fixed you. He's like, yeah, but you ordered to clearly scan. And this was a game changer for me.

And he, and this is the cool part. His kids, um, his adult kids wanted to go, they want to go on a hike every year. And this is a huge, long, I don't remember how many miles, but a large number of miles.

It's very aggressive. And that year, and he had mentioned that. Hey, they told me they canceled. They had to cancel this year. And he's like, Mike, I don't think I would have survived if I went into this hike with this stuff going on.

It's like… I don't know. We don't know, but. But I'm glad we didn't play that game. Yeah. It's not a game you want to play. Right. Not in this case.

Right. And I don't know if he's listening, but I'm sure he'll agree that this test saved his life. Yeah. Yeah. And I think that is because too, you know, like you were saying, he didn't fit the criteria, lived a healthy life.

He was definitely somebody that a lot of people would have not asked him to advocate for himself. Like, oh no, it's probably just indigestion. Most of us probably would brush that off.

I'm just so grateful he said something and that we were able to do something that was meaningful and gave us that bit of a crystal ball and that cardiologist was just so great to work with.

I just love that collaboration of like working with the people that do the best at their job and we work collaboratively to just have better outcomes.

So I'm just so grateful that this is a movement with functional medicine. It's not supposed to replace the traditional medicine and specialist. It's meant to fill in the gaps that are missing It's meant to add more light to what's already there.

And so it's really cool to team up and provide that holistic, just broader view of how we can actually make impactful decisions for our patients together with them.

So yeah, it's been a cool addition to my practice because he's not the only one that's been saved by this. I have colleagues all over the country that would give similar stories that saving people's lives is making me just fall in love with the medicine even more.

Absolutely. What's one takeaway for patients that you would want them to know either about the CLEARLY scan or their cardiometabolic health? Yeah, so like you were saying, knowledge is prevention, you know, and we could be proactive.

So let's say we have someone with a clearly scan that looks pretty good, or if it has just a little bit of plaque, we do have some strategies on how to stabilize and reduce even some of those plaques.

And we've done pre and post testing to see, hey, is there any reduction in these plaques and there's really cool science going on right now there's lots of cool stuff in the horizon to like reduce these plaques so I'm really excited about that and oh that's awesome there are some really cool supplements out right now and yeah sounds like we have to have another I won't get into any names of things but there are some really cool herbals and plants and yeah vegetables and antioxidant support.

There's lots of things on the horizon that are in development. There's a rare green seaweed that contains a polysaccharide that helps to sort of reduce and chip away at these plaques over time.

And after doing a few cases where I've done my own pre and post, we've actually seen some reductions. It's promising that we could make make real difference and you know, and I will say like Pharmaceuticals are not out of the question, right?

Yeah, absolutely. There's time and place for a statin or any other type of cholesterol lowering medication Yeah, so we I'm not afraid to utilize You know traditional treatments for for Absolutely helping to stabilize plaques and there's some anti-inflammatory effects to some of those and so there's some pretty good data on that Yeah But yeah, it's excited to see like what's in the future for this and more aggressive but safe ways to really reduce these plaques.

And when it comes to the heart, test, don't guess, right? Test, don't guess. See if the therapies are working, make sure you're safe. And we've got this technology.

Let's use it. So, but yeah, to answer your question, like what's, what are a few things that I would recommend is just like get a good healthcare team that, that is able to do a deeper dive into your cholesterol panel.

Let's look at the particle numbers and the sizes. And this is a growing movement. More people are wanting more and more information. Like people are walking around, they're studying.

I have patients that. Honestly, probably no more than me just because I do so much research. Yeah, I've I've I've Encountered a lot of people that just want to know more.

Yep. And so we have to keep up with that and Luckily, we've got lots of resources to help us with that to them to objectify some of that data so we can test not guess Yeah, absolutely.

So, you know, I would definitely get a good team working with you and Eat real whole foods. There's, there's nothing that replaces a bad diet. Lack of exercise, stress, sleep, get good sleep.

If you have sleep apnea, get it treated. If you're overweight, work on it, work with us on that. It's not just a. It's not just a cardiac problem. It's a whole system problem.

It is. And it starts with inflammation. So if we can really get inflammation down and really help people manage all those lifestyle factors to really optimal levels, people thrive.

Even hormone optimization shows a lot of promising research in cardiac prevention too. Exactly. So I mean, it's really a whole body approach. Yep. So yeah, so yeah, there's lots of cool stuff on the horizon.

I'm excited to be part of it. And yeah, just we just have to be hungry for that learning and that knowledge. And I think we'll just get better and better at this.

And I hope someday that we can someday, you know, say the number one killer of Americans is not heart disease anymore. That would be the I certainly don't want to replace it with anything, but No, no, but let's get those numbers down because we have the tools.

We can do this. Knowledge is prevention and it can be the, make the biggest difference literally of somebody's life. I want to thank you so much for being here today.

I think that our listeners should go and check out the Clearly scan. And if you're interested. connect with one of our form health locations. Mike is in our Madison location.

And this was such a great topic of discussion. It's so important. And cholesterol isn't the full picture. Heart disease comes from the plaque and arteries, not just cholesterol levels in the blood.

So you can't always just go off of those traditional lab markers. And the fact that we spend time and we listen and we're able to pick up on those small little nuances like, hey, my chest kind of has some tightness.

Like it takes that time, that attention and that listening to people outside of the labs to get there. And this clearly scan is a heart window. It's a safe CT scan that uses special AI software that can see, measure, and categorize the plaque inside your arteries.

Again, something that the blood work can't do for us, and it just adds that extra knowledge for prevention. And if plaque is found, you and your provider can make changes to the modifiable stuff, the nutrition, the exercise, the stress, the sleep.

and to stabilize or shrink and just protect you. Take those preventative measures. So I'm so glad that we had you on here today. Don't wait until your heart attack to find out if you have heart disease.

The CLEARLY scan lets providers see plaque building up early while there's still time to act. Even if your cholesterol looks fine, plaque may still be there.

The good news is with diet, exercise, stress, care, sleep, and sometimes medications, you can stabilize plaque and protect your heart for the long run.

Thank you so much for joining us for this week's episode and stay tuned for next week's. Thank you for joining us on the Forum Health Integrative Medicine podcast.

Each episode, we help you understand your health from every angle and inspire your lifelong wellness journey. Follow the show, share it with someone who needs hope, leave a review, and take the next step toward feeling your best at forumhealth.com.

The Cleerly Scan: Seeing Heart Disease Before It Strikes

Amanda Kuehn-Grabot

Michael Sermon, PA-C, MPAS

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