In this episode of Must Know People, host John Ryan revisits a life-changing incident – his sudden heart attack. Joined by esteemed cardiologist Dr. Suzy Feigofsky, the discussion delves into the importance of recognizing heart attack symptoms and how they vary between men and women. Dr. Feigofsky shares her expertise, detailing how immediate medical intervention saved John's life and the crucial differences in cardiac care for each gender.
SPEAKER 01 :
It's Must Know People. I'm John Ryan with you, and today we're going to do a special follow-up podcast on one we did a while ago. My wife and I sat down and recorded a podcast about my heart attack that I suffered over the July 4th holiday weekend, one of the scariest moments I can ever remember. I've never had any real health issues before, but that one just kind of came at me all of the sudden. It seemed like anyway. But I think we're going to find out differently here as we go on with our interview. But I can tell you two and a half months later, I feel great. The doctors did a tremendous job in treating me immediately here at St. Anthony's in the emergency room. I was life flighted to Mercy in Des Moines. They did a phenomenal job, about a 45 minute procedure. And I had a new stent in my heart and I could immediately tell the difference. So again, a terrific, terrific job by all the medical personnel. And I can tell you one thing. We wanted to follow up and talk more about this because we got a ton of feedback on that podcast about the difference that men and women have in presenting with cardiac issues. So we wanted to talk to a cardiologist. And just so happens that even when I was in the emergency room here in Carroll, when I was at Mercy in Des Moines, They said, who's your cardiologist? And I said, it'll be Dr. Feigofsky here in Carroll. And everybody praised her immediately. So you come very highly recommended. It's Dr. Susan Feigofsky joining us here this morning. So again, thank you so much for taking the time. We appreciate it. Thank you for having me. It's a pleasure. Yeah, it's nice to hear nice things about yourself, isn't it? It is.
SPEAKER 02 :
I'll be sure to keep sending those checks in the mail.
SPEAKER 01 :
No, everybody had rave things to say about you. So let's talk a little bit about you, first of all. You are a cardiologist, correct?
SPEAKER 02 :
Yes.
SPEAKER 01 :
Talk about your training, where you went to medical school, things like that.
SPEAKER 02 :
Okay. I grew up in New York. My dad was NYPD. And like all New Yorkers, when he retired, we went to Florida. That was my senior high school. So I did all of my training at UF in Gainesville. So undergrad, med school, residency, fellowship. So I did that there. And then I also did a year of sub-fellowship. So I'm an electrophysiologist, which is a heart electrician. So the plumbers do the stents, and then the electricians do the pacemakers and defibrillators.
SPEAKER 01 :
See, that was going to be one of my questions. What differentiates you between the person who did my surgery and what you did following up with that? So that kind of answers that a little bit. But always cardiac issues? Is that you always knew you wanted to specialize in that?
SPEAKER 02 :
No, I wanted to be a surgeon when I, well, actually I didn't know. I didn't have any physicians in my family. I'm the first one to go to college. So for me, I had a very old fashioned view of what a doctor should be. And so I went in with a very open mind and was attracted to surgery initially, and then really wanted to have relationships with patients and cardiology is the closest thing to that.
SPEAKER 01 :
So that was the reason it steered you away from surgery was just the relationship you had talking with patients?
SPEAKER 02 :
Yeah. Yeah. I think I like getting to know people. I like having that continuity. And I wasn't sure I would get that as a surgeon. I think maybe if I was a vascular surgeon, I might be able to do that. But I like the internal medicine part too. I really like solving a puzzle, figuring out what's going on. And I think I'm invested in that. And I think that's why a lot of my patients and referring doctors like me
SPEAKER 01 :
So why cardiology especially?
SPEAKER 02 :
People get better. That's the easiest way to say it. It's immediate gratification. It's one of the few specialties in internal medicine where you can really make a difference in someone's life. And that's really palpable and empowering and impactful. And I really like that.
SPEAKER 01 :
How many years have you been practicing?
SPEAKER 02 :
I finished my training in 2004, so we're at the 20-year mark.
SPEAKER 01 :
Okay. And how did you wind up? You're from New York. You went down to Florida. You end up here in Carroll, Iowa.
SPEAKER 02 :
And then I went to California where I met my husband, Ken, on Yahoo Personals in 2004. We got married in 2008. And then I got really burnt out in California, seeing patients every 10 minutes, traveling to eight different hospitals, not seeing my daughter awake. And so he's from Carroll and that is how I brought him back kicking and screaming a little bit, but, um, had to drag him away from the nicer weather. And he had a lot of friends here who were on the hospital board when we would come back for holidays would take me and tour me around St. Anthony. Um, and I enjoyed it here. It's a nice community and I wanted a different change in pace and being able to see my family.
SPEAKER 01 :
I suppose you get to spend a lot more time with patients here than you did out in California.
SPEAKER 02 :
Yes, although with the changes since COVID where everyone is short-staffed, it's not as luxurious as it used to be. But I enjoy seeing people around in the community. I think COVID was especially hard for me because I did know my patients so well. And so when we did lose people, it was really hard. So yeah, I do enjoy the community part of it.
SPEAKER 01 :
Yeah, that's great. Well, we're glad to have you. Thank you. Like I said, everybody from the emergency room on down said, terrific doctor. You got the best. So let's talk about it. Again, we said that immediately after the podcast, people started messaging me and people I didn't know emailing me saying they had very similar events. And other people said mine was totally different than that. And one letter said that heart attacks present differently in women than they do in men. So let's kind of start by saying, technically, what is a heart attack? Define what a heart attack is.
SPEAKER 02 :
So a heart attack is when you have a blockage in the arteries that supply blood flow to the heart. So they come off of the aorta. Typically, the mechanism most commonly is that you have a cholesterol plaque that ruptures and then clots off the vessel. And then the heart muscle doesn't get oxygen and starts dying. And that's what causes a heart attack. So in a lot of commercials on television, you may hear door to balloon time. So the faster you get the vessel open, the faster you can save the heart muscles. So in training, we talk about time is myocardium. So the sooner you get oxygen to the heart muscle, the better outcome you'll have.
SPEAKER 01 :
And not all heart attacks are the same.
SPEAKER 02 :
No, not all heart attacks are the same. It really depends on risk factors. And I guess what we're alluding to is there are gender differences in presentation and mechanisms of heart attack.
SPEAKER 01 :
So kind of describe, I had a blockage of the LAD artery. They called it the widowmaker, 95% blockage. It seems crazy for me to even sit here and say that, but how severe is that? Clearly 95 sounds bad.
SPEAKER 02 :
Oh yeah, we don't use the term widowmaker because I think if you had a 95% blockage in any of the three major arteries to the heart, that potentially could be a widowmaker. So there's the LAD, which stands for left anterior descending artery. That goes down the front of the heart. There's the circumflex, which goes around the side of the heart. And then there's the right coronary artery that goes to the right side and on the bottom of the heart. So typically, the right coronary, I think, would be less likely to be fatal, but it has its own set of complications with a blockage. So I think the most crucial thing is recognizing symptoms early and getting medical treatment early. There are nuances. What I tell people is the nerve endings on your organs aren't as sensitive as what's on your skin. So when you have an itch, it's pretty obvious where exactly it is on your body. When you have discomfort in the organs, the nerve endings are not as close together, not as sensitive. So it's hard for the brain to tell, is this my heart? Is this my stomach? And so that's where I think a lot of delay is that people tell, oh, it's just heartburn or indigestion. I'm not going to worry about it.
SPEAKER 01 :
That sounds really familiar.
SPEAKER 02 :
And I don't even know your story. But it is very common. And so it gets ignored until that indigestion doesn't go away and you start feeling really horrible. So I think the part of education and doing things like this is to let people know to be aware. And it's always better to err on the side of being more cautious than it is to just say it's probably nothing. Because I always think about what's going to kill you. If it's a heartburn, probably not going to kill you. But if it's a heart attack, there's a 20% chance that'll kill you.
SPEAKER 01 :
It's crazy how some symptoms can mimic a lot of other things. And I had the symptoms for a long time. And I told you about that, our one visit that we had. And I said, you know, this came out of nowhere. And you said, no, it didn't. You just told me all the symptoms that you had. I just wasn't paying attention enough. So is that the only kind of blockage is just kind of a soft blockage?
SPEAKER 02 :
Well, you can have calcified plaque too. So that's where a lot of the calcium scores that we're doing now are looking at calcium on the artery. In theory, those should be more stable plaques because you can see calcification. So why we are so aggressive with cholesterol management is that if you have very high cholesterol, your plaques are softer and mushier and more likely to rupture. And so I get a lot of pushback about cholesterol medicine all day, every day. The reason for that is not that we're in the pocket of medication companies. It's because it helps to stabilize the plaque or even reverse plaque. And that decreases your risk for a heart attack.
SPEAKER 01 :
And I had the soft kind of blockage that was in my heart. You said the blood would kind of shear it off and it would grow quickly outside of that. So it's something that could develop and get really bad within months. Is that the time frame? It can.
SPEAKER 02 :
It can be months generally. It depends on what the blockage was before. So a difference between men and women is men will have that soft plaque that shears and bleeds a little and then clots off and then shears. And so you get... gradual narrowing of the vessel, which also allows time for what we call collaterals or natural bypasses. Women, the plaque erodes, so it could be a 20% blockage that just erodes and then it's blocked off immediately. So you may not have that progression of symptoms all the time.
SPEAKER 01 :
So it could go very quickly in women.
SPEAKER 02 :
It can. It can also go quickly in men. I think it depends on how in tune you are with your body, I think. And also inflammation is a big factor in heart attacks. So in COVID, we saw a lot of heart issues and inflammation triggers plaque rupture.
SPEAKER 01 :
Inflammation of the heart?
SPEAKER 02 :
Inflammation in the body. Anywhere in the body.
SPEAKER 01 :
Yeah.
SPEAKER 02 :
So there are a lot of markers that we can check. So not all cholesterol is the same. So there's inherited high cholesterol. There's lipoprotein little a, which I think there's been some advertising for on social media and on television, which is a marker of inflammation increases your risking of having a heart attack. So there are things that we can look for. to try and help stratify risk. And we also have risk stratification tools that we can use, which I use all the time in my office. I'm a visual person, so if someone has risk factors, I pull up the risk stratification score, which gives a risk of a heart attack or stroke in 10 years. These are your risk factors. Do you smoke? Do you not smoke? Show them what their 10-year risk is compared to what optimal risk is. And then change the risk factors. Quit smoking, which is usually the most dramatic. You can reduce your risk of heart attack in half just by quitting smoking.
SPEAKER 01 :
We could really do a deep dive into all that. I know.
SPEAKER 02 :
I know.
SPEAKER 01 :
Let's talk about symptoms, first of all, because I felt the symptoms coming on for months just very briefly, but it would get a little more frequent. But it all started with a little bit of chest pain or pressure. Is that the same between men and women?
SPEAKER 02 :
Yes. So most common symptom for both men and women is chest pressure, tightness, heaviness. Okay. The location of that doesn't necessarily matter. It's more when it occurs. So we see a lot of consults for pre-endoscopy, for instance, for indigestion. That's exertional indigestion. You know, every time I go for a walk, I get heartburn. That's a red flag for a cardiologist. So symptoms with exertion that go away with rest, whether that's pressure, stabbing, burning. I think the quality of it doesn't matter so much as what triggers it. If that makes sense.
SPEAKER 01 :
So it could be a lot of different kind of pain because I only experienced like pressure.
SPEAKER 02 :
Yeah. So some people get burning. Some people describe it as stabbing. Some people describe it as heaviness or soreness, like a muscle ache. And I think that just as maybe how you interpret discomfort. So I think the other difference between men and women, even though chest discomfort is the most common symptom, it's the description of it. I think that's different. And women tend to focus more on some other symptoms that they have that men don't always present with, which is more of a flu-like illness, where they're feeling very fatigued, short of breath, exhausted. And they're also having the chest discomfort, but the other symptoms worry them more. So it tends to get put further down on the list, and I think that's where it gets missed a lot. So in women, heart attacks are not diagnosed as efficiently as they are in men. Sometimes it depends on physician bias, which can happen where physicians think, oh, she's too young. There's no way this is cardiovascular disease and don't even have it in the differential. So if you don't think about it, you can't diagnose it.
SPEAKER 01 :
Yeah. Also, sweating is another symptom that comes pretty commonly with a heart attack in both.
SPEAKER 02 :
So what we ask about when you come into the clinic to see me is not only what symptom are you having, but what associated symptoms are you having? So we always ask for sweaty. Do you feel clammy when you're getting this tightness? Does it make you feel sick to your stomach and queasy? Are you lightheaded? And then does it move anywhere? Is it going down your arm, up to your jaw? So a lot of times people will think they're having TMJ, having heartburn, and it's just refluxing into my jaw. And that's typical angina or chest pain. So it's really teasing out the history. Unfortunately, women get dismissed a lot. And so sometimes we don't take enough time with women to really understand what's going on.
SPEAKER 01 :
That was the kicker that kind of got me. Every time I would Google symptoms, because I was Googling it the whole time when I was suffering with this stuff. You know, there's no pain in my left arm. There's no pain going up to my jaw. Nothing. So I made the excuse right then and there. It can't be a heart attack.
SPEAKER 02 :
Dr. Google, is it always right?
SPEAKER 01 :
Yes. Dr. Google is wrong a lot of times because people interpret that in different ways.
SPEAKER 02 :
And I think that is one of the downsides of social media is I think that it has falsely let people believe that everyone's an expert. So if I read about it on the internet, my symptoms don't really, I'm going to just play doctor for myself and assume it's nothing. And I think we've gone away from, oh, this is new. Let me go check in with my primary or go see a specialist to make sure that I'm okay. I don't know where the shift happened, but I feel like that's a big shift.
SPEAKER 01 :
What are some of the other symptoms that may be a little less seen, but certainly are causes for concern?
SPEAKER 02 :
I think exercise intolerance is another one that we don't talk about a lot. So what I ask is, compared to six months ago, compared to a year ago, what activities were you doing? Are you having to stop and rest because you're short of breath, or you're getting dizzy, or you're feeling weak? Those are a lot of the ones that That I ask about that often get missed. So, and it's subtle. So if you're having a gradual narrowing of the vessel, the symptoms can be pretty gradual and maybe not perceptible until it's a 95% blockage. And then you're like, whoa, something's wrong here. For like, for RAGBRAI, for instance, you've done RAGBRAI. And so it would be noticing that you're not able to ride your bike as far or as long, or you're tiring, or you're getting this heartburn on your bike. And you're like, I don't know what's going on. I must've had one too many walking tacos today. Those are things to pay attention to.
SPEAKER 01 :
So wish I talked to you before July 4th. You know, it's funny.
SPEAKER 02 :
I think I met you on RAGBRAI when I first moved here. Is that right? I am pretty sure that we met randomly and had a conversation.
SPEAKER 01 :
Wow. Okay. That's interesting. Let's talk about other things that contribute to heart issues. Age. There's also other comorbidities. Things like that. What else is that people might have?
SPEAKER 02 :
So there are risk factors. And most of them are what we call modifiable. So there are things that you can do in your lifestyle to decrease your risk. And then there are non-modifiable risk factors. So the non-modifiable risk factors are your gender at birth, your parents, your family history, and then your age. So the older you are, the more likely you are to have coronary disease. For women, estrogen is protective. So menopause and perimenopause are a big increase in risk for cardiovascular disease. Diabetes is a risk factor, obesity, physical inactivity, smoking, high blood pressure, and high cholesterol. Those are the big ones. And then I would put vaping in the smoking category at this point.
SPEAKER 01 :
Vaping just as bad as smoking?
SPEAKER 02 :
Yes. It may be even a little worse. And I would say even chewing. People chew around here a lot. So any tobacco, I'm sorry, nicotine product, tobacco product is a risk factor.
SPEAKER 01 :
Talk about some of the other factors that women especially, I mean, why don't they seek treatment as much as they should?
SPEAKER 02 :
Well, they're taking care of their husbands and their children and the house. I mean, that is it. So I think historically women put themselves last. And now as a mom and a wife, I can see that, that I always put myself last. I make sure everyone's taken care of. And so also women just feel like they don't have the time because they have these additional responsibilities at home. I mean, not trying to make a man versus women point about it, but I think that's socially how our construct has been for so long. So I think that most women just don't even think about it. We have so much advertising and education about cancer and breast cancer and cardiovascular disease is actually the number one killer of women. It's not cancer. And I think that gets a lot one in eight women. suffer from cardiovascular disease.
SPEAKER 01 :
So other than them experiencing symptoms, they come in and they say something's not quite right. How do you predict that they're going to have some type of cardiac issue?
SPEAKER 02 :
Well, it depends on the history. So a big part of, first of all, getting to know someone, but also figuring out what's going on is the history. And then we use the risk score that we talked about, which includes all of those risk factors. And then we'll do some form of testing. So if we're concerned about a blockage, then we will do a stress test. We usually do an echocardiogram, which is an ultrasound of the heart to look at the structure of the heart. And then the stress test, depending on how functional you are, we can do a chemical stress test if you can't walk on the treadmill or we put you on the treadmill. And what we talk about is pre-test probability. So in order to increase the accuracy of a stress test, you have to have a pretty good chance that you're looking for something. So doing a stress test on someone who you don't think has cardiac disease actually can increase your false positive rate. So then you're thinking someone has a problem and then you open Pandora's box and you're going down a road you never needed to go down. If you're not sure if it's cardiac or if the stress test is normal, but they still have risk factors, then you can do something called a calcium score, which is looking for the calcified plaque in the vessels. And what that does is it changes our cholesterol target. So we get much more aggressive about managing cholesterol.
SPEAKER 01 :
How many people have those screening tests? Enough?
SPEAKER 02 :
I don't know. I feel like we now have them locally in the community. So they're definitely, I would say in the last four to five years being ordered much more frequently by providers in surrounding communities as well. Not everyone knows to do with the information when they get it, but generally if you have a calcium score above a hundred, we generally want to see you in the cardiology clinic. We also at Iowa heart and Carol have a prevention and wellness clinic that So that's where we work on modifying your risk factors so you don't have a heart attack. And that's a pretty popular clinic.
SPEAKER 01 :
Again, the cost of all of that, is that a prohibitive factor for some people?
SPEAKER 02 :
Not for the calcium score. I would have to look. I believe Stuart Memorial is the one that does it locally. I'm sure it's under $100, which can be prohibitive for many people. Insurance will cover it. If you have symptoms of chest pain and risk factors, it does get covered.
SPEAKER 01 :
Does anything like income or education play into this risk factors?
SPEAKER 02 :
Yes. And access to health care. So we see this across all aspects of medicine and especially in cardiac disease. Disparities in care is huge in outcomes as well. So having access to a doctor, having access to healthy food in your community, having the resources to be able to take off of work. To be able to go to the doctor, being able to find child care so you can go to the doctor. I mean, these are a lot of barriers to getting to health care. And unfortunately, healthy food has become almost cost prohibitive at this point. When you can spend $10 on a salad or get a $5 meal or $5 anything. Cheeseburger with fries. Yeah, I don't know. See, I don't go there. So I don't really know. But I think that as a society, lots of things need to change about health care in general. But disparities in health care and outcomes for not just heart attacks and stroke, it's for everything.
SPEAKER 01 :
Over your 20 years of being a cardiologist, how much has the treatment changed for people with cardiac issues, with heart attacks? Has it changed dramatically or not?
SPEAKER 02 :
Yes, in that we have learned that the faster we get a vessel open, the better. I think our cholesterol medicines have really changed dramatically so that we're able to get cholesterol lower. We used to worry that there was too low and that would be unhealthy. That's really been disproven at this point. The lower we can get your cholesterol, the better. And I think testing has gotten better. We now have a calcium score, so we have more predictive tools available than we did 20 years ago. I think the stents are better now. We didn't have drug-eluting stents when I started in practice. And the bare metal stents used to clot off much more frequently than the drug-eluting stents do. So the technology has gotten better. I think we're able to take care of sicker patients easier now with better outcomes. So, yeah, medicine is always evolving, which is another reason I enjoy it.
SPEAKER 01 :
What shocked me? I couldn't believe this. I was done. I was wheeled into the cardiologist or cath lab. Cath Lab, there you go. 45 minutes. I was done. And they're basically like, you're fixed.
SPEAKER 02 :
And it was probably through your wrist and not through your groin. So that recovery is a lot safer and better for our patients. There's a lot of data about cardiac rehab, improving outcomes after you have a cardiac event. So we're fortunate to have that here at St. Anthony. So, yeah, things have changed quite a bit. I mean, 50 years ago, we used to keep people in the hospital for weeks at a time and tell them not to move. We do the complete opposite now. We get you up moving quickly. We have you in cardiac rehab. Generally, you're out the next day. And so things have changed quite a bit.
SPEAKER 01 :
And shockingly, my life would just kind of fell right back to normal the way it was. The only thing that was different is I take a low dose aspirin every single day. And that's kind of changed, gone back and forth over the last 10, 20 years, hasn't it? First, it was all about take a low dose aspirin, then don't take it. Now it's kind of back the other way, right?
SPEAKER 02 :
It's you're talking about two different things.
SPEAKER 01 :
Okay.
SPEAKER 02 :
So aspirin for prevention, what we call primary prevention, aspirin, there's the risk of bleeding when you're older than 70 outweighs any benefits. So generally for over 70, you've not had a heart attack or stroke. We typically will take you off of that baby aspirin. If you've had a stent or a heart attack, um, you will be on aspirin forever. That doesn't go away.
SPEAKER 01 :
Yeah. And that's for what reason for.
SPEAKER 02 :
to help keep the stents open so it prevents your platelets from sticking to the inside of the stent.
SPEAKER 01 :
Okay, and the other thing I'm on is just a statin. They said to keep my blood platelets slick so they don't stick to the stent.
SPEAKER 02 :
The statin is the cholesterol medicine. So you are probably on another anti-platelet agent, Plavix, Berlinta, Effient. Those are the three most common ones that we use. And those are generally for a year after you have the stent. And then once it endothelializes or you get sort of like an internal skin around the stent, then you can stop that other one.
SPEAKER 01 :
I mean, that literally was about the only thing that changed in my life after all this stuff. So again, can you kind of review, like I said, especially for women, what are the symptoms that they really need to be watching for?
SPEAKER 02 :
So chest pain, first of all, with activity, goes away with rest. And then it's the fatigue, the shortness of breath, the neck aching, the muscle aching, flu-like symptoms. So I often, women often describe it going upstairs. I don't know why, but women tend to notice this overwhelming fatigue going up the stairs. But again, it's with activity goes away with rest.
SPEAKER 01 :
That's really the biggie right there is the chest pain and the fatigue and the short.
SPEAKER 02 :
Yeah. So, you know, shortness of breath, I think both men and women have pretty commonly. Um, but it is, I would say any new symptom with exertion or activity that goes away when you rest. And then, especially if it's taking less and less of that activity to reproduce the symptoms. also another reason to get evaluated. I'm curious how you felt in hindsight looking back after your stent. Did you notice that you maybe weren't feeling well and just didn't pay attention?
SPEAKER 01 :
Honestly, when I look back now as compared to what I felt like afterwards, I felt great. I mean, I could get on my bike, my exercise bike, and I just didn't feel like I wanted to get off right away because I was doing that for months. I had back surgery back in February. So I thought, well, it's just because I quit exercising after that. I wanted to rest my back for a while. I just wasn't in quote unquote shape, which I'm not in great shape anyway, but I just attribute it to that. So I kept making excuses. For all this stuff, it's just heartburn. Because I kind of was under the assumption a heart attack would strike and strike hard immediately. It wouldn't be a kind of a gradual buildup of symptoms.
SPEAKER 02 :
Most commonly, it is gradual. Most commonly. The sudden ones are sometimes you see sudden death where we have someone coming in and out of hospital arrest that ends up being a heart attack. If you look at marathon runners or athletes who have heart attacks, you often see across the finish line someone collapses. It's a heart attack. When you talk to those runners, they have been having angina for months and months. It seems sudden, but they also were ignoring their symptoms. Because they're so fit, there's no way I can have heart disease.
SPEAKER 01 :
Yeah. Bob Harper from The Biggest Loser is the best example I can think of that.
SPEAKER 02 :
Yeah. And again, some of it is genetic, but most of it is stuff you can control. And for you, I'd be curious, you know, you had back surgery, that's inflammation and that can be a trigger for plaque rupture. So there's usually some correlation, especially if your symptoms started after that.
SPEAKER 01 :
Yeah.
SPEAKER 02 :
Just theoretical, theoretical, but that's what we learn. Yeah.
SPEAKER 01 :
There's a lot of different things, but the treatments have gotten really good. The doctors are great about it now. So I tell you what, there's no reason to not come in and get it checked out. I know that they were going to set me up with an EKG, a temporary one, like for 48 hours. I never got there. I had the heart attack before any of that happened. So that was on me. That one was totally on me. But thank you so much for spending some time with us. We appreciate it and appreciate you taking time away from your practice for all this stuff and giving us some great information.
SPEAKER 02 :
Thank you. It was my pleasure. I appreciate it.
SPEAKER 01 :
All right. Dr. Suzanne Feigofsky joining us here on Must Know People.
