A Podcast Series With Dr. Cook & Dr. Iqbal Mirza: A Discussion On The Advances In Anesthesia, Medicine & More

 He was drowning in his own lungs. Three weeks later, he walked out of the hospital. I mean, and I don't do this for appreciation, I only do it because this is what I love doing. But that's the kind of, uh, exhilaration that went, Theo. He's saving somebody like that. You're listening to a Bio Reset medical podcast with Dr.

Cook. If you have questions, we'll wanna talk more about your symptoms and issues. You can always reach us at 6 5 0 8 8 8 7 9 5 0. Hello and welcome to the show. Uh, today I have a very good friend and. A long-term friend, Dr. Iqbal Meza, and I'm delighted and super excited to interview him today. He's an anesthesiologist and we've been, we've been friends for 20 years and have, uh, seen all kinds of interesting things that happen in the anesthesia community in the South Bay.

He's an anesthesiologist. Uh, I came to town and we worked in different groups and we'll talk, we'll talk a little bit about it cuz this could be super interesting. And then, uh, I ended up helping him get a job as a medical director of a surgery center. And then when I evolved into my current role, um, at Biore Reset Medical, I actually handpicked, uh, Dr.

Mariza to take over, uh, my practice, uh, which he did amazingly. And, uh, he has a super interesting perspective cuz he's a practicing anesthesiologist. He's a medical director of a surgery center and he's also an I C U doctor and has been working at the, uh, local, uh, trauma center taking care of patients with Covid and working in the I C U and managing these patients.

So, I'm delighted to have you on and I can't wait to hear about your experience and find out what's going on. And it looks like I we're doing kind of a classic two for one cuz I'm, I'm, I've got two people on the podcast. Who do we have here today? Morning or good afternoon. Good talking to you. And, uh, I'm honored that you, uh, invited me onto your podcast.

It's been a, it's been a great relationship that we've had over almost 20 years. And, uh, I know you as a young doctor just coming outta residency for the most part and now evolving in very, very experienced and mature anesthesiologist, clinician in the community. It's awesome. And I'm also very blessed to have, uh, this is a fourth of my four grandchildren.

Uh, there's Gira Eel. He is about 16 months old. Um, and I nicknamed him potato because he loves to sit on my lap. Uh, every chance he gets if he, even if his brothers and sisters are playing, he'd rather come and sit with me rather than go hang out with them, which I'm just totally honored that he loves to, to be with me.

So, uh, I'm delighted cuz he is my youngest, uh, podcast guest so far. You wanna wave to Maddy? You wanna wave to Dr. Cook? You wanna say bye? He knows how to wave. Can you say bye? Bye. You got shine. God, that's awesome. So, um, so well maybe we should just go right to the elephant in the room and kind of talk about, uh, this whole covid experience because you've had a Tell me what, tell me what your experience has been and maybe tell me a little bit about, because I, you have quite a background in ICU medicine.

So I became a intensivist, uh, after completing my fellowship at Stanford, uh, back in, uh, 1996. And, uh, then I resumed ICU practice approximately 12, 13 years ago. Got back into doing some ICU work along with anesthesia. And over the last, uh, 10 or 11 years, I've maintained privileges at Regional Medical Center where I practiced, uh, the intensive care practice.

And, uh, they even at one point asked me to be medical director, but I declined over there just because there was so much internal politics and I had my anesthesia practice that I was trying to grow. I didn't want, I really didn't have the time to dedicate to that. Mm-hmm. And, uh, so I said, I'll, I'll continue to come here and work here and support the staff and take care of the patients.

And it's been really good experience for me to be able to do that. I think it kind of really rubs me out well with my anesthesia practice. No doubt. So then take me back. I want, I wanna sort of take me back through, back into February and March when all of a sudden it, it seems like the world starts to fall apart and we start to find out that, um, there's this, this new viral illness.

What was it like being over there and, and how did the hospital respond and what was that like? It was, uh, an incredible coming together, the whole medical community. Mm-hmm. Um, to see the level of response from, uh, all the frontline people in the er, the nurses, uh, the various, uh, paramedical personnel that I'm talking about, X-ray technicians, lab technicians, everybody else.

Uh, everybody just totally got ready and prepared and were dealing with this in an amazing fashion. And, uh, it was a real privilege to work there. Uh, the, the intensivists were, were by far the most responsible group in terms of taking care of these patients, uh, initially. Uh, as you may have read in some of the, the literature, uh, the, the thought was to go with early innovation, uh, which means to go ahead and put these patients, uh, with the breathing tube and put them on the ventilator.

And, uh, subsequently the data showed that, uh, delaying ventilation or putting them on the ventilator was probably more beneficial. So we, it was actually a learning process since this was a new disease for all of us, and management of it was not like a typical, what we call a R D S, uh, adult respiratory distress syndrome.

And so it wasn't like that at all. Um, and so how, how, what, tell, so let's lean into that a little bit. What would a typical a R D S patient present like, and then how, how is this different? Typical a R Ds patient would come in and they would present with shortness of breath, uh, and, uh, with manifestations of, I can't get enough air, I'm having trouble breathing.

Um, and when we get the necessary, or the, the labate, uh, cor corroborate that it would show that in fact they were hypoxic, that their oxygen levels were low, uh, their chest x-ray would manifest, uh, ground glass appearance, top typical fogginess consolidation, a lot of fluid in their lungs. And, uh, whereas these patients were coming in and sometimes they were not short of breath.

Uh, they may have cough, they may have fever, uh, but they were also hypoxic, meaning that their oxygen levels were low, but they were not responding in the typical fashion of, oh, I'm hungry for air. I, I can't get enough oxygen. I can't, you know, I'm working too hard to breathe. So it really was a different manifestation in that regard.

Hmm. It's what they called silent, uh, the silent hypoxia. And when they would put these patients on an oximeter, they would find that these oxygen levels were really low and yet they weren't gasping for air. How, how low? Uh, even as high as the high 60%, for example. Wow. Because normally if somebody was in 60% oxygen saturation, they would feel like they're dying.

Right. They feel like they're dying. They may even be comatose, they may not be responsive. Right. But these people were awake. Uh, I remember seeing patients, uh, just a few weeks back when I was there that they were in, in this, uh, kind of hypoxic condition and I'd go and see them cause the nurse was concerned about the numbers.

And I'd go evaluate them on in the hospital room and they're talking on the phone. So they were calling up their relatives and everything else cuz they're in isolation and they couldn't have visitors. And, uh, yet they were able to talk on the phone and carrying on a conversation. Wow. So then what was, what was the cornerstones of, of your management in, in that situation?

So we would evaluate them. So they basically, we look at kind of trajectory. How are they doing? How are they progressing? If they're progressing really rapidly to where their hypoxia or their oxygen saturation was dropping quickly, uh, or the respiratory rate, which sometimes the patients didn't even know they were breathing, uh, fast.

If we noticed that all those things were happening, um, and they were developing signs of other things like low blood pressure, uh, shock, uh, other manifestations, uh, then we would intervene at that point and tell the patients, uh, we feel it's best for you to come to the icu. Um, and some patients, as we learned later on, we would ask them to self prone.

And self prone means to lay on their stomach, which helps the, the mechanics of ventilation. It helps the distribution of. Oxygen to areas of lungs that are working better than other areas and now would help alleviate, alleviate some of the hypoxia. Yeah, that I was, I found that super interesting and I wanted to kind of ask you about that cuz you, uh, you mentioned an anesthesia term called VQ mismatch, but in common terms for the average person listening, how would you explain how lying prone and, and the reason I I ask this is because I actually have a lot of patients who've started to call me from all over the world and they're at home with symptoms.

And so e explain how this lying prone could potentially help you increase your oxygenation and how that relates to blood flow. So our breathing, uh, mechanics are such that, uh, the lung has the ability to shunt blood, uh, into areas that are ventilated appropriately. Uh, and in a disease state, it's not able to do that, and thus you have areas of lung that are not as badly affected by the disease and the, the, uh, ability for the blood to go there is improved by repositioning the person.

Awesome, awesome. Did you have, did you see any, my sense is that this, once people get septic and once people get systemic viremia, my sense is that it, it can, it can have an effect on the vasculature, whether it's in the kidney, uh, whether it's in the heart with like a heart attack, or whether people, some people are having kind of a hypercoagulable experience where they're having some strokes.

Did, did you see any of those patients? We did. And so it's very interesting that there are neurologic complications, as you mentioned, the strokes, the, uh, one of the tests that we normally look at, it's called ddi. Mm-hmm. Look at the hypercoagulable state. So we would see that was elevated in certain patients, uh, and thrombosis.

And those were things that we would see on occasion. Mm-hmm. And depending on the course of their illness, uh, they would, uh, occasionally get those complications. Uh, and fortunately, a lot of the younger ones would tend to just have the respiratory or their lung problem. And, and because we would sometimes put them on, on blood thinners to help them keep from getting the severe complications from the thrombosis.

What, do you have a sense of what, what is, uh, behind the hypercoagulability? The, the increased probability of having clots? Nobody seems to understand why this virus is able to do that. Uh, and I just did some, uh, research again this morning in preparation for this podcast just to see if I could find that any more information.

And I still didn't find anything that mentioned or went into the cellular mechanisms of why this, uh, increased thrombosis, uh, is occurring. Mm-hmm. Yeah, it's, it's, it's super interesting cuz from our, it's almost like every second of every day for the last 20 years, it's like me and you we're having in, in inside our minds we're having kind of the same conversation.

It's like, oh, what's happening with the oxygen? What's happening with the blood flow? We're constantly thinking physiologically, right? So I've been really thinking of you over there taking care of these patients. Yeah, it's been a real, it's been a real honor to be able to be, uh, uh, in that position, uh, take care of these patients.

And some of the patients, as I mentioned to you previously, is that they would, uh, deteriorate quite rapidly. Uh, I can give you an example and, and, uh, so your listener can, and kind of understand the severity and what's going on. Uh, I was called up to the floor. I was the admitting intensivist for the day.

And my pager goes off and said, you know, come upstairs to one of the hospital, uh, rooms where there's a patient with known covid. She's 58 years old, Hispanic. Uh, and, uh, she is experiencing, uh, worsening oxygenation as we talked about earlier. And, uh, so I explained to her through a translator that my Spanish is, uh, limited to five sentences basically.

And, uh, they explained to her that, uh, we need to put a breathing tube in and you need to call anybody because you won't be able to speak on the phone. And, uh, so she said, yes, I wanna call my daughter, et cetera. I said, okay, go ahead, let them know. And then we proceeded to innovate her. At the time when I went to her room, her respiratory rate was about 30 her oxygen saturation with what we call high flow oxygen.

That's like 30 liters of oxygen being delivered through a nasal through her nose, cannula. And even with that, she was at 88%. And, uh, so, uh, we said this is not a good situation. And, uh, so went ahead and gave her the medication necessary, uh, to go ahead and put the breathing tube in, had her transported down to the I C U.

And when I got her to the I C U and put her on the breathing machine, the ventilator, uh, her oxygen saturation continued to decrease. So we tried many maneuvers. We tried adjusting what we call a positive and expiratory pressure. It's called pee. We, we adjusted, uh, by, uh, her. Giving her muscle relaxants known as paralytics in order to facilitate the compliance.

We did that as well. Even despite all that, her oxygen saturation continued to drop into the low eighties, high seventies. And I was doing all the things that I knew and couldn't seem to make any headway with her. And, uh, so I decided the best thing for her was to call the cardiac surgeon and put in what's known as a venous, uh, venous cannula, in essence, put her on circulatory bypass.

This is analogous to what, uh, we do for cardiac patients, and that's how everybody knows, uh, when people have heart surgery, is bypass surgery and it's bypass surgery because they're going on an external machine, which is taking their own blood, oxygenating it, removing carbon dioxide and giving it back to the patient.

And I felt this was the last dish effort. Uh, and this entailed. About an hour of phone calls with family members because they weren't allowed to come into the icu. They weren't, oh God, that's crazy. And convincing them that this was a last ditch effort that their mother, their relative, may not even survive this.

We're trying to save her life. And, uh, calling the cardiac surgeon, having him come in, he said, did you do this? He made, made me go through all the checklists, make sure that I hadn't forgotten anything before we put her on this therapy. And I said, yes, I've done everything. And then so he came on in. And, uh, we got prepared and it took about two hours after she came to the I C U that she was finally on bypass.

And, uh, we were able, it took about two weeks for her to be on this, what they call ecmo uh, machine before she was weaned from that. Wow. Yeah. And she's one of the survivors, uh, at Regional that was on ecmo. And she went through de Canulation and got extubated, got the breathing tube out, and she left the I C U.

So this, oh my God, this is an amazing story in about three weeks, what she went through and what we as a clinicians and healthcare providers went through with her. Oh my God. And is she still in the hospital or did she get outta the hospital? So I believe she's still in the hospital, but she's in the recovery phases now, Uhhuh.

And as you know, that the longer somebody remains on a ventilator is immobilized that for almost every day that they're in that condition, it takes them almost. Five to seven days of rehabilitation. Mm-hmm. So if somebody has been in this situation for two or three weeks, we're talking probably two or three months of rehab for them to get back some degree of strength and, and, uh, physicality where they can resume their normal life.

Wow. Was what, how did, how did it, did it, what was, what was, how did it, how was it emotionally for you to be in that situation where you're talking to the family and you're talking to the heart surgeon? Like, that conversation is something that me and you have done a thousand times before in an emergency.

Like, uh, normally something like that happens and we just do that all the time. It's like, just like we would do a good job. How was it? But with the pressure of kind of all in the pressure cooker of this experience, what was that like? No, it's, uh, something that we've never experienced before. Yeah, it's radically different for sure.

And, uh, you know, I always tell myself that every day is a school day. And, uh, sir William ler, one of the greatest physicians of, uh, you know, prior generations who was, uh, practicing medicine in the early 19 hundreds, uh, he said that every day if a physician doesn't learn something, if every day the physician is not a student, he's no longer a physician.

And, uh, I may have misquoted his, his thing, but in essence, that's what I remember. And, uh, so I take that, uh, to heart. I try to make every day a school day for myself, uh, try to learn from my experiences and benefit from it and grow with it. What was his name, sir? William Osler os O Oh Osler. Oh my God. Yes.

Oh my God. Yeah. So then, considering that how, you know, it was interesting for me to watch. The healthcare providers on the front lines who are, are themselves for the first time in this life and death situation. Cuz I know there's been a bunch of healthcare providers that have died Yes. And got sick. And yet you're one of the coolest cucumbers that I've ever met in my life.

So it's kind of interesting to talk to you. What was your experience of, of going into running into that burning building? Um, I basically had the attitude and my family obviously was very concerned about me as well. Cause I'm actually one of the people initially that they felt was the highest risk, the ones who were elderly and, uh, in the healthcare profession, you know, opposed to somebody like yourself, uh, in the younger age bracket, they were not high risk risk and, uh, so they were saying, you really shouldn't be working here.

I actually had one of my intensivist colleagues, uh, at Regional, uh, telling me, he says, what are you doing here? He says, you should go home and you shouldn't work. I said, no. I said, actually, I, I, this is what I signed up for and uh, this is what my whole career is all about. And I have wanted to go to situations overseas where there's medical emergencies and disasters and have done some overseas work and I felt this is my calling.

Yeah. And if personally I get sick or something happens and so be it, I'll be a martyr and uh, you know, that would be a good way to go out. Yeah, that's how I, that's exactly how I feel. That's exactly how I feel. That's interesting. Did what was, and what did you guys, so as you were there, and it's kind of amazing to, because this is at regional, this is at the big trauma hospital of San Jose, and we, we kind of live in the suburbs of San Jose.

What, um, what, what was, what standards did you guys have in terms of the p p E? What were you wearing? How did, how did that go? Uh, so we were using, uh, what they called, uh, normal mask for the most part. We had N 95 mask and eye protection. And then whenever I'd go into a patient's room that was known covid positive, uh, and had to do the intubation of the breathing tube, I would wear a pepper that's a purified air filtration unit, basically like a hazmat suit.

Uh, it has a little powered unit that I put, I put on my belt and, uh, go in with that. So in essence, I'm getting purified N 95 air that I'm breathing. Oh, okay. The, I spoke to a, a friend of mine, uh, who's the ER doc who, who was doing some, some intubations. His name's Matt Dawson. And what, um, he talked about mask, ventilating these patients and that being a little bit of a risk of spreading to other people.

And obviously he was running around in the hospital without, The the type of p p e that you, you did, what was your, what's your sense of that? How did you, did you think about that or what was your experience around that? So, you know, again, the literature doesn't bear that out actually. Oh, okay. Interesting.

Yeah. So I don't, you know, I think there's still anecdotal, I think people were obviously very concerned early on. They felt that this virus was very easily transmitted. I'm not saying it's not. Uh, and, uh, but I don't know that, uh, doing mass ventilation on these patients necessarily increased, uh, my risk of, of getting the disease.

I see. I see. The, it's. How, what do you think the infectiousness is? Do you have a sense of that? I don't know. Uh, I don't know anybody, uh, who has come down with it personally. None of the providers that I know at the hospital. Okay. And so, yeah, two of them were taken care early on of a Covid patient. Um, and they had symptoms, uh, and they were asked to self quarantine, but they never got tested.

So I don't even know if they turned positive or they had a, a coincidental, uh, viral infection or they just were quarantined for protection of everybody else. So I don't really know. I, from everything I read and what I'm sure all your listeners have, have read as well, and it's pretty easily transmissible and it stays on surface for a long period of time and everything else.

And I don't really have data to, to say one way or the other to say one. Yeah, that's kind of how I feel. What, what did you guys do for testing? So currently testing is available, uh, for the patients that were coming in, uh, to regional, we would do the nasal swab. And now as, uh, in the last I think two weeks, we've been able to get the antibody testing as available, uh, for providers if they wanna get it done as well as for the patients.

Are you gonna do it? I was thinking that I, I probably will not. And, and the reason is, is that, uh, if I'm, if I'm positive, if supposing my antibody test shows, uh, that I've been exposed and I got over it, I may become a little cavalier. Uh, and I don't wanna be that way and I might take off my mask. Um, and I don't know whether have any antibodies will in fact, uh, make me immune from a repeat infection.

Uh, and if I'm negative, then I'm gonna be behave the same way as I am right now, which is to continue to protect myself. Mm-hmm. How long do you have a sense, what's your sense of the trajectory of social distancing? Um, And the, the, the care that we're taking now, how do you think that that's gonna play out over the next month and two or three months and even six months?

So I think that's a really good question. I think the evolution, uh, is going to be somewhat where we're going to start to go back. Resuming some of our normal, uh, daily work activities and, and recreational activities, uh, with some caveats that is, that we're going to, uh, need to wear a mask because obviously the transmission is, uh, through our respiratory passageways and that's how it's, uh, somebody else may absorb it also.

Uh, so wearing a mask will minimize the amount of, uh, fluid, the droplets coming out. And, uh, distancing will help because the droplets have a certain space that they can fall down in. And, uh, that'll be very helpful. Clean hygiene, which we're all practicing. So I think all of that will help and I think we're gonna be able to get back to some semblance of normality, uh, observing these.

And I'm guessing probably in the next two months we should be back to where we, where we can do that. Mm-hmm. It's interesting cause uh, I wanted to talk to you a little bit about right now there's a lot of patients who probably need elective surgery of some kind. And they're afraid. What, um, are you, is your surgery center open and then what's your, what's your perspective around that?

Uh, and and what would, what would you say to people as if, if they, if they need to have a surgery, um, So we really appreciate the fact that they've held off and they have not stressed the system, which is really great. And, and being patient with your condition, uh, we have continued to operate, uh, and do cases whenever somebody was having, uh, uh, a possibility of disability from their injury.

People that were going outside and biking cuz they couldn't go to the gym. They were getting hurt, they were getting wrist fractures, ankle fractures. Uh, we would take care of them at the surgery center. Uh, and somebody who was having debilitating uh, pain from chronic arthritis, we would take care of them as well.

Uh, and so, but now we've opened up the centers and we practice very safe, uh, uh, standards there. Every patient is, uh, asked a questionnaire when they arrive, even before they arrive, and, uh, if they have any, uh, symptoms or have had any exposure, then we ask them postpone having their surgery or coming into the center.

Mm-hmm. Uh, we monitor their temperature. We monitor all the employees, all the physicians, every staff member, it has a temperature check upon entry into the surgery center every morning. Uh, everybody at the surgery center, including the patients, are wearing masks and, uh, so we're trying to help save it, whether I have it or a patient has it, we're trying to keep each other from infecting other people.

Mm-hmm. And we're doing all of those precautions and as soon as these patients wake up, uh, in the operating room, we put a mask right back on them. We minimize a number of visitors. Uh, so visitors are not allowed to stay in the, in the waiting rooms. We ask them to wait in their cars or go home and we'll call them when their relative or a friend is ready to be picked up.

So with all those things that we're doing, we feel that we can proceed safely, and it'll certainly make it a little bit harder to be as efficient as we were before. Uh, but we are still, we're still moving forward. Mm-hmm. God, that's interesting. Such a, so interesting. As, as you hear, as I hear that, I'm thinking, oh yeah, I used to do all of, and, and it's so interesting how quickly an entire field can change overnight like this.

Totally how you think it'll, you'll continue in that genre for the next three or four months, or do you think it'll go beyond that? I think if the, if the vaccine comes out and if they can prove that, uh, one of these antiviral therapies works, I believe that we're gonna probably loosen our, uh, standards, uh, by wintertime and hopefully we won't get hit with a second wave nor really bad influenza, uh, virus this winter.

Uh, in which case then we might have to resort to these measures again. What do you think the probability that a vaccine that's works, what do you think the probability of that is? Um, I'm, I'm. Hopeful. Um, and a good friend of mine works for, uh, the Bill Gates Foundation. I spoke with him yesterday. Oh yeah, that's cool.

Cause, uh, that, uh, the clinical trials are underway and he's very optimistic that we should have a vaccine. Uh, this by this winter is what he, okay. Yeah. So he's very optimistic. And, uh, the initial studies with, uh, with Rems Avir, uh, the Gilead drug has been shown to be effective. Uh, and again, they need to finish doing some more trials.

Even though it's been approved for use, I feel like all the clinical trials have not been completed. Uh, did you had, did you get, did you get an opportunity to use Mdes Avir? We did, and, uh, we were using it at Regional and are using it there. Um, and I conversed with the infectious disease specialist there, uh, every time that I was on shift there.

Um, and they felt that it was effective and, uh, they definitely felt it was effective if it was administered early and initially before the FDA gave approval, we couldn't do it to the very, you know, the ones who were already on ventilators because we had to obtain consent from them. So we, oh, yeah. It was one of those things where we couldn't just give 'em the drug because of the side effects, and we had to, uh, get their permission to do that.

What, what are the side effects? Uh, there's neurologic side effects and gastrointestinal side effects, liver side effects as well. Oh, okay. So that's significant. What, how, how did, how were you dosing it? Um, you know, I'm not sure I would, the ID people and, and the pharmacists do it if we, if they felt that this was a clinically indicated situation, okay.

Then we go ahead and write the orders for that. Wow. So it's just kind of like the most interesting medical moment of our lives, you know? Sure. For sure. And kind of, and then it's just such massive social ramifications and kind of watching, watching it play out is so interesting. I'm so delighted that you're, I I, I, I just want to congratulate you.

I love every ounce of your attitude. It's like, oh, this is what I was meant to be. If I go down, So be it. Yeah, I mean, like I said, I'm really, I really feel really blessed. I could have opted to not go in, I could have said I quit. I'm not gonna go to work anymore and give up my job. Um, but then I said, no, this is not what I went into this for.

And uh, I can some other time give you all the other experiences I've had where I felt like I was really blessed to be a doc and take care of people in your moment of need. And this for me, this is what it's all about. It's amazing that, like that lady that you talked about, like it would be amazing if, if she lives and you have, you make contact with her, let's have her on the podcast and talk to her.

Cuz it'd be really interesting to talk. It's like, it's interesting that's like somebody that there's no way that she would've lived if you hadn't made that decision to do that. Right. Correct, correct. Yeah. I'll, I'll just give you a little throwback. When I was, uh, doing my fellowship at Stanford and, uh, you know, it was early on, probably in my third or fourth month though, I was still like trying to figure out what to do, where to go, all that kind of stuff.

And, uh, so one night I was on call and, uh, we had this 30 something year old father of two or three children who had a R d s, as we mentioned early on in the show. Uh, and it was from probably some bacterial viral, cause I don't recall what it was. Um, and he was really sick and we couldn't, we did all the usual peat maneuvers, oxygenation, all that kinda stuff.

And nothing seemed to be working. And my attending at five or six o'clock, he said, you know, do whatever you can. If you could save this guy, that'd be great. I said, okay. So as soon as my attending left, I called the troops together. I said, we're gonna put this patient on his stomach. And we prone him. And, uh, here he is, Maddy, he's on like two or three pressors cuz he's in septic shock.

He's, he's hypoxic. And so we flip him over. And the a r d s of that day was different than the, uh, the A R D S of Covid. Uh, and, uh, about two or three liters of fluid poured out of his endotracheal tube as soon as I turned them over. Really? Oh God, really clear, watery fluid. Like he was drowning in his own lungs and we couldn't do anything.

And there's no way to suck that out with a catheter other than to turn him over. And then it by gravity, it just came pouring out that man, Maddy, uh, about a month or three weeks later, he walked out of the hospital. Oh, really thinking about those kids I so appreciative of. It's so unbelievable. I mean, and I don't do this for appreciation.

I only do it because this is what I love doing, but that's the kind of, uh, exhilaration that one feels is saving somebody like that. Biore Reset Medical is a medical practice specializing in integrativ