[00:00:00] Speaker A: Welcome to the Heart Rate Variability podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness.
Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and optimal HRV. Check us
[email protected] dot. Please enjoy the show.
[00:00:32] Speaker B: Welcome, friends to Heart Rate Variability podcast. I am Matt Bennett. I'm here with somebody I've grown to consider a friend, Doctor Ralph Harvey, who I met at the is in our conference about a month or so ago now, and we spent hours just talking about his thinking, his questions, my questions to him about heart rate variability and his role in thinking about it as an MD. And so, Doctor Harvey, I want to welcome you to the show. I would love just to just kind of give a little bit of an introduction of yourself. And what brought you as a medical doctor, what sparked your interest in heart rate variability?
[00:01:16] Speaker C: Okay, I'm an unusual doc in that before I went to medical school, I worked in drug abuse, youth counseling, crisis counseling centers. All the way through college I was director of a community counseling center. So when I entered medical school, I had probably 6000 hours of counseling experience been trained. My first training was Carl Rogers encounter groups, non directive, but I've had training in gestalt, bioenergetics, reality therapy, a whole variety of things. Yeah, then I left that when I went into medical school, psychiatry was a natural place for me. Now the idea of heart rate variability, and basically the heart rate goes up as you breathe in, the heart rate goes out as you breathe out. But there's a hell of a lot more involved in that. The only place I saw that originally was in obstetrics. So when a woman is pregnant in the second and third trimester, you listen to heart tones and you do not want to see a steady heartbeat, you don't want to see a metronome, you want to see variation. And basically if the fetus did not have a ten point variation in 1 minute, something was wrong. It could be the baby was asleep, it could be the mom was low on sugar. So we had some interesting things. Give the mom a glass of orange juice and take two spoons, turn one over the mom's belly, take the other one and wrap it and make, you know, click, click, click, click it, wake the baby up.
[00:02:54] Speaker B: Fascinating.
[00:02:55] Speaker C: But if that didn't work, then you started digging into it, you might get an Ob specialist. And sometimes, sometimes that led to urgent c sections. So lack of heart rate variability was important only in obstetrics.
Now, when I finished my residency training, I had patients with irregular heart rate, fast heart rate. So I would put on a whole tra monitor. So I arranged to have them in my office. My staff would put them on, then we'd ship it to the cardiologist, he would interpret it. Then later, I worked with two different cardiologists in two different systems. And then my cardiologist, the guy was working with, left town, and so I was. But I had a holter monitor that I had gotten as part of a research project I never used. So I learned how to use it, taught my medical. My physician assistant. So he would do the recording, and I would review it. And as I'm looking at the reports, every one of those reports in the. Literally the upper right hand corner had a section of HRV variables.
[00:04:12] Speaker D: Yeah.
[00:04:12] Speaker C: And I had no idea what they were. And so I talked to multiple cardiologists saying, what is this? And what do you do with it? And all of them told me, oh, I ignore that. That doesn't really have anything to do with medicine.
Okay, fine.
I'm still following standard cardiology. Heart rate variability can be measured. But I absolutely knew nothing about it until I went to an is and our conference background. I saw my son do what now? I would consider very simple neurofeedback training and went from three Adderall a day to none in six training sessions.
[00:04:58] Speaker A: Oh, wow.
[00:04:59] Speaker C: Oh, this works.
[00:05:00] Speaker D: Yeah.
[00:05:01] Speaker C: I don't know how. So I started taking training. I took a weekend course with one system. I took a three day course in Colorado with a second system. And then I went to an international conference, and I heard one guy talking about how children with a irritable bowel syndrome. So these are kids with missing school because of diarrhea, constipation, abdominal pain, cramping.
They were sent to the GI group. They were scoped down the throat, up the rear end. They had blood work done, and these were. The children had nothing structurally wrong. There was no illness. It was just what they call irritable bowel syndrome. And they were offered the choice of anticholinergic drugs for the rest of their life, or what turned out to be HIV training. It was real simple. They took them through a lab, figured out their optimal heart rate, the breathing rate for their optimal hrv, and they trained them and gave them a little trainer. Breathe this rate 20 times, 20 minutes a day, seven days a week.
At the end of six weeks, 70%. Seven 0% had complete resolution of symptoms. The other 30% had at least a 50% improvement. There was absolutely no drug that's ever been made that has that kind of improvement. And he followed it out a year, and at one year, the kids were still doing that. And he said, the kids said, I am happier. I like myself better. The ones with add said, my add score is better. I'm performing better. And the parents all said, oh, we like this. Our child is happier. And he said, some of the parents actually started learning to do the same kind of breathing.
But at the same conference, I heard a neuropsychologist from the Cleveland clinic doing a talk using the same kind of heart rate variability training with end stage heart disease patients. So these are the patients waiting to get a heart transplant, and they have very little heart rate variability. Basically, their heart is failing.
One part of the body is flooding the body with adrenaline, saying, come on, heart, beat harder and beat faster. The heart says, I can't.
To give you an example, these are the people, when they get up in the morning and they want to walk 30 steps from the bedroom to the kitchen, they walk 15 steps and sit in a chair because they're exhausted.
So they did the HRV training.
Then when they did the heart transplant, it was interesting. At Cleveland clinic, they automatically had a psychiatric interview the night before surgery on all transplant patients, because it's a stressful thing to go through.
Blinded to the study, the psychiatrist didn't know about it.
They commented about those people that they seemed more relaxed and more prepared for their upcoming heart transplant.
Then when they took the heart out, they had, as I recall, a research lab right next to the operating room. So they take the heart out, they take it immediately to the research lab, and they tested the contractility of the heart. How well does the muscle contract?
And it was much better. So that heart had strengthened. You know, they said some of this on some of the patients. The surgeon said, this does not feel like a floppy heart I should be taking out. Wow. Feels healthier. But when you got the chest cut open, it's a bit too late to reverse.
And when they went back and interviewed the patients and they looked at the data for a lot of the patients, their heart rate variability had improved with the training, but some of them had said they could walk twice as far. Now, I like to joke, if you're a marathon runner, and I said, I got this great technique, take you 20 minutes a day, and you can run 15 steps more. Marathon runner probably would ignore it, but if you can only walk 15 steps without resting to walk 30 is life changing.
Blew me away.
So I then took a three hour course on HRV and realized that I'm definitely not a math major and trying to understand all the different ways we can calculate it.
I'll let a computer calculate it. Thank you very much.
[00:09:50] Speaker B: Yeah, me too, me too.
[00:09:52] Speaker C: But I came home and I bought some devices that helped train people in HIV breathing and ways to relax the brain. Because as you increase heart rate variability, you're increasing parasympathetic tone. When you increase parasympathetic tone, you change the brain waves so you can help people move into an alpha rhythm, which is a more relaxed state. So I said, great.
I was in a practice with 7000 patients, a lot of them with heart disease. I sent a letter out to 50 patients with congestive heart failure saying, I've got these new techniques, new approaches.
I'll be doing training programs Tuesday and Thursday afternoon, no charge.
And out of 50 patients, nobody showed up.
Now, in some ways, I've been trying to teach slow mindfulness breathing to people since the early 1970s, but it wasn't until 2012 that I started to get some idea of what the technology is. Yeah, before it was just breathe slowly and somewhat successful.
A while back, there was an app that I loved, worked really well, just a picture of the lungs. You could set it for 4.5, up to seven breaths a minute, and you just see this diagram outline of the lungs, and the lungs would fill up and the lungs would go down, and all you did is breathe with the picture. Sadly, it's no longer working. They didn't keep up with the newest, newer versions of iPhone and Android. But of the patients who, when I talked about it, half the patients actually downloaded the app. And all the ones who downloaded it, 30%, were using it.
The 30% who were using it all said they felt so much better, they were more relaxed, their anxiety was better, their constipation was better, a whole variety of conditions were better when patients could learn to do that, mindfulness, relaxation, breathing in a way that would likely increase hrv.
But the hard part is, it's one thing to talk about slow breathing, it's something else to be able to easily measure it. So I have one piece of equipment that's sitting on a shelf that can easily measure heart rate variability. That was about 2000, but I really need a technician to do that, and no insurance company will pay me for that.
I was using another device that went onto the finger that would measure HRV.
That worked really well until the units broke. And then I called the company and they said, well, we're not making the devices anymore. We're just focusing on the software.
So, for a couple of years, I was measuring heart rate variability on all of my patients as a vital sign.
I miss a few people, just like there is sometimes.
If somebody comes in with a fever of 104, coughing and wheezing, I may not have them stand up to get their weight. But it was interesting checking HRV in general. HRV is higher in somebody who's younger and more, has more cardiovascular fitness, and it goes down with age.
Now, one of things that I was doing is measuring the HRV and then having them fill out a little. We call it liquid scale, five point scale. It's from two frowny faces, to one frowny face, to neutral, to one happy face, to two happy faces.
[00:14:00] Speaker D: Yeah.
[00:14:02] Speaker C: And the interesting one is I saw no correlation between their HRV score and their ranking of their happiness or stress level.
Now, I later had one patient who said he was fine. He has a history of bipolar depression, but he said, I'm fine. But his HRV score was one of the lowest I had ever seen. Now, this company made up, put it on a scale of one to 100, 100 being the highest. He was a nine. Wow. Most of my patients were at a 2025.
[00:14:40] Speaker D: Yeah.
[00:14:41] Speaker C: So I had fun with him. I said, if you got some time. So I took him to a different room and I did some neurostimulation to try and decrease the stress level and basically make him more relaxed. So his HRV measurement was nine out of 100.
So I had him just sit and watch a nature video, and I stimulated the brain. And I came back and he was sitting with this silly grin on his face. And he looked at me and says, I had no idea how stressed I was.
[00:15:20] Speaker D: Yeah.
[00:15:20] Speaker C: And his HRV had tripled. Wow. In 15 minutes.
Now, as a vital sign, it's more helpful when I can see what it's been over time.
[00:15:35] Speaker D: Right.
[00:15:36] Speaker C: So if somebody has been using that one to 100 scale at a 30 and now they're at a ten, that body's really stressed out. And that could be they've got the flu or they're coming down with the flu, that could be emotionally stressed. It could mean they didn't sleep last night. But it would tell me there's a change. Now, there is. One interesting one is probably at least ten times in the last three years. I had older patients with a very high HRV.
[00:16:14] Speaker D: Yeah.
[00:16:15] Speaker C: This is the level that I would expect an elite athlete who practices mindfulness to have. Mm hmm.
I would listen to the heart, and sometimes the heart would sound okay, just. But that's just with my ears. I do an EKG, and they're either in atrial fibrillation, atrial flutter, or. A couple of them were intermittent. First degree, then second degree block with multiple premature atrial beats, premature ventricular beats.
And this became a patient. I got into the cardiologist the next day.
On one occasion it was, oh, you're doing okay, you think? But I think it's time to call 911, because this is an unstable heart rate.
But none of those patients were complaining of anything cardiac related.
So as a vital sign, I probably measured HIV on maybe a thousand patients, and on ten of them, I picked up a significant, potentially life threatening cardiac arrhythmia that I would not have picked up otherwise.
[00:17:31] Speaker D: Wow.
[00:17:31] Speaker C: Now, I would have picked it up if I did an EKG, but there was reason to do it.
Now, one of the things that we do, I have a very small practice, not a lot of patients, but we do call a cardiac monitor. And it's a little device that just is on a strip about six inches long at one inch wide, that goes over the sternum, the upper center of the chest. So you stick it on, and they can push a button if they feel something irregular.
It's a great device for picking up cardiac arrhythmias, but they actually include an eight second where they're measuring the beat to beat variability in milliseconds.
But they don't calculate any HRV measurements.
Actually, I had a new sales agent called me last week, just introducing himself.
He's going to be my remote in the office resource.
So I asked him, I said, you guys measure HRV, or you measure the beat to beat variation?
Why can't you calculate HRV?
Well, he's a salesman. He'd never heard of it.
Actually sent him a little one page thing on my. Thing of what? This is what HRV is. And then I included all the different standard measurements, which I can never remember. RNN, SMDD.
[00:19:16] Speaker B: All those acronyms?
[00:19:18] Speaker C: Yes, all the acronyms and saying, would it be possible to do that? But I go back and I told them the standard holter monitors, which was a standard holter was actually named for a doctor holter, who came up with a 24 hours recording device. So I think it was three, maybe five leads.
It was a pain to wear because you had three to five patches on your chest.
Those wires go to a little device you have to keep next to you. You can't take a shower, they get tangled in things.
But again, every report I saw, and that was from probably four different manufacturers, all included the same standard measurements, including the triangular index, which was visually great to see.
I have read probably 500 culture monitor reports over the years. Over the decades, not once did I ever see a cardiologist say anything in the report or communicate anything to me.
So in the last couple years, I was at my old practice. After I learned about HRV, I started commenting. You know, this is the heart rhythm. This. You know, there's, from a cardiology perspective, this and this, and your patient's heart rate variability is low. And there are things we need to check to improve that.
Now, will I be able to change one of the major companies in the country that does cardiac recording? I don't know. I'll take my shot.
Now, since I got your device last month, I'm playing with it.
I've recommended a couple of patients get it for use.
I'm trying to persuade my medical assistant to download it on her iPhone and then figure out how to set it up. But you and I need to talk. How does she, how can she do recordings without having to pay a membership fee?
Technicalities.
[00:21:37] Speaker B: Yep. There you go. So, I've got a question I would love to ask you about.
What do you think with the medical profession?
What has sort of prevented even cardiologists from. I mean, there's so much good science behind heart rate variability. It's not necessarily a controversial metric. But what is prevented? I think maybe cardiologists more and more know about it because it's on people's apple watches and it's more the thing, but still, a lot of EMD's and others haven't heard about, much less using it as a vital sign, which I'm a huge advocate for.
[00:22:16] Speaker C: I don't.
I have asked probably ten cardiologists in my town, and, I mean, I, the Lansing, Michigan area. So we have two large hospital systems.
When I came here in 1986, we had four hospitals. Now we have two, and they're both part of networks. Yeah, I've asked a number of cardiologists.
The data is on a standard holter monitor.
What does it mean to you and how do you use it? And basically the answer is, oh, I don't pay any attention to it.
Now, one of things I learned, there was a study, I think, 1981, where they calculated HIV the day somebody was discharged from the hospital after having had a heart attack.
Now, our treatment of heart attacks in 2024 is an awful lot better than it was probably 1979 and 1980, because the paper, I think, was published in 1981. So you're publishing on data in the past.
And they divided people with HRV into three groups, the lowest, the middle, and the highest.
And they looked at people over a 16 month period.
The group with the highest hrV, 9%, were dead from cardiac related event.
The people with the lowest hrV, 27%, were dead. Three. And you could predict at hospital discharge, a threefold difference in hrV, I mean, in death rate based upon heart rate variability. But that assumes, like, for the cardiologist, the biggest problem is, what do they do to increase HRV?
[00:24:14] Speaker D: Yeah.
[00:24:15] Speaker C: Well, that means you need to talk to somebody about mindfulness thoughts.
And psychiatrists don't. Don't care about mindfulness.
When I was a medical student, first rotation on internal medicine, where you're taking care of people admitted to the hospital, and one of the common things we had were people admitted for chest pain. So they come into the ER, they get chest pain. They do the initial tests, blood tests, x ray, ekg. They're normal. They keep them overnight. The next morning, you repeat the tests.
And so then the internal medicine, the doctors would go in. So it was the resident, and I'm the medical student and one of the first patients, 45, 50 year old, and we call chest pain rule out mihdhdhehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehe myocardial infarct, low probability. And so all those tests were fine. And he pointed the residence at where's your chest plan? And he pointed to his left chest, just above the left nipple. He goes, this is where it hurts. Well, cardiac tends to be subbed in the middle. So my resident, who was an osteopath, so better training in musculoskeletal medicine, takes his thumb and pushes on that spot, and the guy goes, oh, ouch. That's my chest. That's my chest pain.
And you look at the ER notes, and nobody examined the chest, the chest wall.
So we presented. Now, my.
The internist who was rounding was, in fact, a cardiologist, and he liked to make it clear every three paragraphs that he graduated from Harvard.
Most of the time, he's talking with a midwest accent. Most people would say Harvard, but he said, ah, went to medical school, residency, and then his cardiac fellowship, and he looked. When we. My resident reported that he goes, oh, yeah, you're a. Do you take care of muscles and ribs and those bones, that kind of thing? I'm a cardiologist. I just take care of the heart.
Now.
I sort of joke, you know, I've never had a heart walk in my door, I'm still waiting for this heart to walk in with a little feet. I love to work with a cartoonist to create that. Every heart walks in my door encased in a human body.
And the cardiologists don't like to think that there's more connections going from the brain down into the heart.
[00:26:53] Speaker D: Yeah.
[00:26:53] Speaker C: Feedback from the heart and all the other organs back up the vagal nerve into the solitary tract and into the amygdala.
So most cardiologists are not going to want to get into teaching, trying to understand emotions and breathing rates and teaching that. And it's not easy. It's time consuming.
In my office, if I ask somebody to take a big breath, what I will see is the chest going straight up, the shoulders going up.
Very few will breathe through the belly where the abdomen goes out, which allows the diaphragm to come down. The lungs can expand, but you get with that a slower breathing rate. When people are breathing roughly six breaths per minute, that is a parasympathetic tone.
Now, in the brain, we have a little area the size of a walnut deep in the brain called the amygdala. And the amygdala's job is to decide, are you safe, or is there a threat? And I tell people, you have to underline. It's not just obvious threat, it's possible threat.
And if you're driving down this, if you're driving down the freeway, are there obvious threats? While you can look at it and say, okay, that guy up there is weaving, or, I got a car behind me that's doing 110, I got to watch for it.
But if you're already an anxious person, you can be thinking, well, that truck two lanes over, it's full of steel beams. He could blow two tires, and this truck flips, and those steel beams come down on top of me. Or the list is insane of what could happen, right? And if your brain is stuck in that, everything could happen.
You're in a high, sympathetic tone, and you're stressed and you're anxious, and the cardiologists do not think about that. Now, the only way I know of without drugs to change the signal going into the amygdala, and the amygdala is getting input from everything you see, smell, taste, vibration, many, many times a second. The amygdala is taking in everything going on around you, which means also everything you see and everything you see that reminds you of something, or every sound that reminds you of something.
The only way of changing the amygdala is that slow breathing, that mindfulness breathing, it sends a parasympathetic signal up the vagal nerve and into the brain.
But cardiologists don't look at the brain, and sadly, most psychiatrists don't look at the heart or the heart. So I use drugs to slow down an overactive, overstimulated heart almost all the time.
But I've only found one psychiatrist in 100 who will use those same medications.
[00:30:04] Speaker B: And do you think it's like. I mean, there's two things in my head. One, it's like, well, Ralph, you and me got to do a better job getting the word out there. Two is, are we trying to interject something that may not have a, for lack of a better word, a cost or revenue benefit into a health system that is.
I think I can say this without being too cynical, but very much capitalistic cash? You know, we're trying to make money, basically, and maybe there's not as much money in HRV, but, like, I would still think a cardiologist who learned about HIV and got, even if they don't do the biofeedback that you like, using it as a vital sign, it would give them a piece of information to provide better care, I would think.
[00:30:59] Speaker C: That's not how they were trained.
[00:31:01] Speaker D: Yeah.
[00:31:02] Speaker C: And we are creatures of habit.
[00:31:03] Speaker D: Yeah.
[00:31:04] Speaker B: It's big.
[00:31:04] Speaker C: One is, well, the american health system is built around the drug industry.
[00:31:13] Speaker D: Yeah.
[00:31:15] Speaker C: Recently. Well, actually, last December, I was in a.
I had to do study groups to maintain my board certification. I did one on chronic pain, which is a major issue. Yeah.
Out of 50 questions that we were answering as a group, one of them actually did talk about biofeedback or actually electrical stimulation, but that was one of.
It was like, what might help in this kind of pain? Six options, and the answer was all of the above.
The majority of the correct answers were drug related. Yeah. Nothing. There was one of, I recall, patient with chronic constipation, and they've taken a stool softener.
You know, what's the next step? Well, and the next step was a drug not covered by insurance or not. Well, it costs about dollar 300 a month.
You could easily look at, say, well, I'm going to talk to the lady about her diet and see how much fiber is she actually eating? Standard recommendation is people eat 30 grams, but most people eat about ten.
That takes time, and I'm not getting paid to talk about her diet. I could talk about artificial fiber supplements. I could talk about are you getting adequate magnesium? And actually measuring that.
But most people don't think about magnesium levels and I constipation, although it's a major factor, and they sure don't think about stress level.
But there were so many things that I'm more of a functional medicine doc that I would do. But the correct answer was prescribe a 300 $400 a month drug.
That's the mindset at least.
I'm estimating about 70% of the questions had to do with what drug do we use?
[00:33:34] Speaker D: Yeah.
[00:33:36] Speaker C: And I don't know how to get out of. I don't know how to change that.
So the science is mostly driven by what drug companies pay for studies.
The funny, beautiful study showing that mindfulness breathing helped with irritable bowel syndrome. And Richard Gervonts published on that. Twelve years ago, I have asked 30 different gastroenterologists, what do you know about mindfulness breathing? HRV breathing for irritable bowel syndrome? And they all have said, what's that? Yeah, they've never heard of it.
I was actually in a lecture yesterday by a pain psychologist who works for Michigan State University peds department on chronic pain.
She had never heard of heart rate variability.
The funny one, she had actually done some studies on brain scans and difference in the activity, the overactivation of the amygdala and a few other parts so that she sort of had. But she had never heard of mindfulness breathing, especially that which is directed by HRV.
Can break, can improve pain scores.
[00:35:11] Speaker B: Right.
[00:35:14] Speaker C: So I now, I then asked her, are you interested in learning any?
So when I catch my breath, I will be sending off a few articles and may try and sit and offer that. Some years ago, I tried to talk with the chair of mission state neurology department. Now, that was not about HRV directly, but it's more on Neurofeedback, and it's used for treating seizures.
Really good evidence.
Joel Lubar, published in 1981. You could do simple neurofeedback and bring down the number of seizures, in fact, making some people seizure free. So I'm checking, and Michigan State has a large neurology department. And I asked him, what do you know about neurofeedback for seizures?
And he says, I've never heard of this before.
The science of that is built upon a QEG, which is taking the raw data and running it through a database to compare it. So you can compare this person's brain with others the same age and sex. He had never heard of it. He says, oh, talk to my seizure specialist.
So a few weeks later, I was on the lecture. Talk to the seizure specialist. What do you know about neurofeedback for seizures? Oh, that's. That's worthless. That's. That's not real science. That's something that psychologists play with.
Now, there is a neurologist who's deep into neurofields to. Into and neurofeedback and that kind of analysis. And I said, how do I talk to the chair of my department? Because I'm Michigan state graduate, and, heck, I'm officially faculty. I'm still adjunct faculty.
How do I talk to him? And he said, well, wait till they've been dead 17 years. Then the brain may become a little bit more plastic.
I have tried talking to cardiologists and gastroenterologists and neurologists.
The best I've gotten, it was one guy at University of Michigan, which is the other big university in Michigan, and he had published an. There was a line in a University of Michigan neurology about this new computer program they were using to analyze EEG data. So, oh, he's getting into my world. So I actually got ahold of his, you know, sent him an email, and he called me back, and he said, oh, I know the kind of stuff you're talking about. This QEG to analyze brain activity. I've heard about that. I don't know anything about it, but that's not what I do. We created a computer program to just look at the raw data to pick up individual seizure spikes in case the doctor missed it. If you're sitting looking at a half hour or 2 hours worth of EEG data, are you going to see one little blip?
[00:38:40] Speaker D: Right.
[00:38:43] Speaker C: But american medicine is, on one level, we have so much advances. On the other, there are so many core pieces that just aren't believed.
[00:38:56] Speaker B: Yeah, I'd love to ask you, after using HRV as a vital sign, I'm curious. I mean, you talked about some of those outlying cases, that it was a. A great diagnostic tool for those with problems. I just kind of wonder if there was any other insight of having that data that informed the care you provided. Recommendations. I just love to get other insights that you may have gathered along the way.
[00:39:31] Speaker C: Well, the first, watch out for somebody who's not cardiovascular to be fit with a high HRV.
And one of the things it would be hard for a general physician like me or a cardiologist to think about all the things that can affect it. Yeah, I have to think, what do I do with a pulse rate? Well, if it's in a normal range, but if your pulse is really slow or it's really fast. Then I have to dig deeper.
So, I mean, take homes.
If somebody has a really high HRV and they're older and not physically fit, watch out.
The other one. The confirmed research I've seen on kids in pain, that how somebody ranks themselves on a scale is pretty, well meaningless.
[00:40:35] Speaker D: Yeah.
[00:40:36] Speaker C: Yet in.
In the psych world and primary care, to meet all sorts of quality measures, we're supposed to be asking short questionnaires.
[00:40:48] Speaker D: Yeah.
[00:40:49] Speaker C: So we should be asking everybody every year, you know, have you been feeling down or suicidal, you know, over the last two weeks?
[00:40:59] Speaker D: Yeah.
[00:41:00] Speaker C: Well, it's a great idea. It means you can move a click, a little box to say, I provided quality care, but it's meaningless. Right.
I recently had, as a new patient, a young man. He was in a group, and he's very shy, so the group sang him happy birthday, and he hated that. He hated people paying attention to him.
He made a statement as a joke. You know, you guys sing that to me. Sheesh. I wish I was dead.
An adult heard it, and because of the rules and regulations, had to take it at face value, that kid ended up admitted to the psychiatric unit.
[00:41:52] Speaker A: Oh, geez.
[00:41:55] Speaker C: Now, another patient that I knew, patient a few days ago who's originally from Africa, so her native language are two tribal dialects that I can't even pronounce. And then she. But she's very fluent in English, but it's a very strict british English, so she was actually in the emergency room needing a blood transfusion.
So severely anemic, and in the process, somebody gave her, us a set of nine questions for depression.
Well, she didn't understand half the words they looked at and said, you're depressed.
She said, they never. And that diagnosis went on to her medical chart in the hospital.
But nobody ever asked you, are you depressed?
But now some of the questions. Have you been feeling tired, you know, more sluggish? Yes.
A woman is severely anemic. Needs to be. If you're severely anemic, you will answer positive to all half the depression questions.
[00:43:16] Speaker D: Yeah.
[00:43:17] Speaker C: Not because you're depressed.
When I was in my larger practice, drug companies, drug reps would leave little cards to fill out. And it's like. It was like ten questions. You might be.
If you answer yes to three or more of these, you might be depressed.
But another company used the same ten questions just to say you might have low thyroid. Another company used to say you might have low testosterone, but it's easy to ask the questions, and then you get a diagnosis, which I think is completely wrong.
But if you look at what are all the things that affect HRV, it's mind blowing.
And most, most of american medicine is going into subspecialties.
[00:44:15] Speaker D: Yeah.
[00:44:21] Speaker C: I am a generalist. So once I learned about HRV, the idea of adding that as a vital sign, I wanted to do it, but it took a while to find a unit. Now this was the unit I was using. Loved it. You could just stick it on the finger and get the measurement, then it broke.
But what I use, your device works almost as. It's easy, it takes a few seconds longer to put on, but other than that, your software offers a lot more choices than the other one. Sadly, the other device was marketed for elite athletes and athletic teams. And there, when I talked to an inventor and he was talking about athletic teams that would use it, so each athlete would have their own little monitor.
So you know what their base, they would have their baseline. So if you come in today for a workout and your HIV is high, higher, you know, in your normal high range, then fine, we push it really hard. So, but if you come in and your HRV is low, that would be a day you'd back off, maybe focus on stretching and, you know, that's it.
Non, non contact kind of, kind of thing. So you use it to judge that individual's cardiovascular readiness.
That's a whole different. I'm using it in a whole different framework. Right.
And it's sort of interesting. So far I haven't found anybody else who's done it.
The guy that made the other device, when I asked him about it, and he's basically said, well, we're not designed to do that, I said, okay, is there any reason I can't?
And it was like, no, but what do you think you're going to get out of it?
Even for somebody who was a special HIV specialist?
[00:46:51] Speaker B: Yeah. Didn't get it.
[00:46:52] Speaker C: Didn't get it.
When I've asked a couple of my, I think of my HIV professor mentor, have you ever seen this used in a general medical clinic? And they basically said, no, we've seen it used in research studies. We do.
So I actually, I had my data of the first hundred and some odd patients. I had a medical student or a pre med student who was very good with Excel and running statistics. So actually she came into my office, she did all the data entry and she was going to come over and we'd start the analysis.
The day she was going to come over was the day the whole thing with COVID blew up and she decided she was going to isolate and she didn't want to come into my office and it's. I still haven't done it.
[00:48:00] Speaker B: Well, why don't we do this, because we're hitting about time right here. I really enjoyed getting to know you. And now to share this with you, we got to get that data set into some students hands somewhere, so maybe we can strategize about how to do that. But Doctor Harvey, I just, I appreciate you. I was so excited to share your story and your work with our audience because I really think you were doing a lot of the things that I could visualize as somebody who's kind of HRV for everybody, not just the elite athletes or people that can afford four dollar 500 watches. Like how can we get this and use this with the population? And I thought, I really believe your thinking on this is going to be part of that solution. And getting it into the medical arena is so crucial. So I appreciate you, I appreciate your work. I can't wait to continue our conversation. Let's get that data set analyzed one way or the other. So we'll put some more information about Doctor Harvey in our show notes that you can
[email protected]. dot. And I'm excited my friend, to have you on your app and you're already trying to figure out how to hack the system to avoid the membership cost, which I can appreciate, my friend, I can appreciate. So hey, thank you, thank our listeners and we'll have to have you back and continue the conversation.
[00:49:25] Speaker C: Okay, sounds good.
