Episode 72 | Feb 29, 2024

Heart Health and Being a Medical Advocate, with Dr. Howard Elkin

As the healthcare landscape changes, it’s becoming more and more important for patients to become their own healthcare advocates. This week, Dr. Sandi welcomes the Medical Advocate, Dr. Howard Elkin. Trained as a cardiologist, Dr. Elkin worked in healthcare for years before finding himself on the other side of the table. After having a heart attack, despite living a healthy lifestyle and having no family history of cardiovascular disease, he realized that there were serious problems in healthcare.

Known as the Medical Advocate, Dr. Elkin’s mission is to help empower patients to embrace their ability to be in charge of their health. He has built a “patient bill of rights” and encourages everyone to be their advocate, be their own first opinion. Dr. Elkin shares his opinions on the importance of building relationships between doctors and patients, the benefits of lifestyle medicine, and how to advocate for heart disease testing.

Listen Now

Episode Transcript

Dr. Sandi: Welcome everybody to “Health Coach Talk.” It is my absolute pleasure to present to you Dr. Howard Elkin. We have so much in common. We actually connected first on LinkedIn, and I love this doctor’s mission.

He is trained as a conventional cardiologist. He is an integrative cardiologist, but more importantly, he became a medical advocate. That’s what we’re going to talk about today. He has an amazing story and amazing book, which if you’re on YouTube, you can see it’s called “From Both Sides of the Table.” He’s going to talk about his experience being both a doctor and a patient. And I’d love to get started with this conversation, so welcome, Dr. Howard.

Dr. Howard: Thank you. It’s a pleasure to be here. We did connect, and I’m just very happy and proud to be here. Thank you, Sandi, for inviting me.

Dr. Sandi: Thank you. So, you were trained back in the day as a cardiologist, and we’re doing procedures. And then you had very major health scares and, reading about this in your book, I was just struck by your perseverance, by your just not giving up, and so I’d love for you to share your journey, what that was like for you, and how you then became a medical advocate.

Dr. Howard: Great. Well, thank you so much. So, basically, I was traditionally trained but I always… By the time the ’90s came, I got more interested in… I guess they didn’t call it integrative cardiology or functional medicine back then, but I was always very inquisitive and I always wanted to learn and do more for patients.

And I actually wanted to write a book a great part of the century, and I came to an impasse. It’s like, “Okay, something’s missing here.” What was missing? I literally had to become a patient. I had, you know, to see the plight of an individual patient.

So, what happened, I had…you saw in my book, but my first hospitalization was for a stuttering heart attack. And I don’t have any family history. My cholesterol was great. Never smoked, never been overweight. I’ve always worked out. I mean, my blood pressure is perfect. But you know what? This can happen to anyone. No one is immune. So, I learned that quickly.

And then I was hospitalized, and here’s when I knew that something was up. So, when I was being discharged, two days later the cardiologist who did the procedure said, “You know, Dr. Elkin, I don’t know what to tell you. I mean, you know, you’re on your own when it comes to rehab because I never will be in the shape that you are in now.” And this is several years ago. I said, “Okay, I’m up for the challenge.”

But he said something I will never forget as long as I live, “But you know what? You have a new stent in there. You’re going to do just fine. You have a stent, and you’re going to be just great.” So, actually, I said to myself, “You know, this is pretty absurd. If I’m so great, you know, and I have a new stent, first of all, how did I get here to begin with? And more importantly, how can I prevent a recurrence?” And that was my mission. And, like, 15 minutes later, my daughter came with a writing tablet. She picked me up, bring me home, said, “Dad, it’s time to write your book.”

So, that was the first hospitalization. And it was relative. I did have a stent. It was a very mild heart attack and fortunately, I recovered very quickly from that. But what happened 19 months later, I was re-hospitalized for a different problem. My back… I had lumbar…you know, severe spinal stenosis, which I knew from 1996 and so, you know, I would have remissions or relapses. Most of my relapses would last, like, two months, okay, but then I would have a remission for a long time.

So, I did really well, and I was competing in bodybuilding. And my back went out one day, and it didn’t get better. I ended up in the hospital, the same hospital, Cedars-Sinai Hospital, and I ended up having… I had critical stenosis. I couldn’t walk. I could not walk.

And I had the surgery, but the surgery was not just less than successful, it was actually damaging. I had permanent nerve damage to my right foot and ankle. I mean, I could not put one foot in front of the other, and I had to learn how to re-walk.

And then I really learned a lot during that hospitalization because I forgot how to meditate, I forgot how to breathe. All the skills that I teach others no longer worked for me. I was in so much pain, and they treated me not like I was a doctor, just like a regular patient. Believe me, I did not get any special privileges, but I was badly broken after that and have remained so really in certain levels because I ended up having a repeat back surgery a year ago.

And I’m done with back surgery, but the truth of the matter is, like you Sandi, I’m, we’ll call it, unstoppable. I keep on going because, you know… It’s funny. When I wrote my book, I had my speaking coach. So, the back surgery was in 2008, okay, so it’s like over 15 years ago. Then I had a relapse in 2015, which was really not easy to take. And my coach said, “This is great for marketing.” I said, “What do you mean it’s great? It’s horrible.” He said, “No, because this is what life is all about. You know, you go through certain hurdles, you get to where you want to go, and then another thing happens.” And that’s what I had to learn.

And so I was a patient, and I became my own medical advocate because I learned that an aspirin or a beta-blocker was not going to be the end all be all in saving me. Now, I already had a pretty good diet and I was, you know, “What else can I do?” But I was stressed to the max back when I had my heart attack. Very, very stressed. And it’s all in my book. I have a whole chapter on stress. I have two chapters on stress: one about my story and also actually what stress can do to us. You know, it depresses our immune system. It sets us up for disease.

So, that’s what happened. And I grabbed the bull by the horns, and I really had to learn how to slow down, smell the roses, and take better care of myself. And I’m still working on that. You know, I tend to be an adrenaline junkie, so I have to really work on the zen quality. That’s why I’m so big on this vagus nerve thing. So, that’s it. I mean, I was hospitalized twice in the span of 19 months, and I had to learn how to really grab the bull by the horn and stay in the driver’s seat.

So, that’s my mission now. My mission is to inculcate onto others, to help empower others to embrace their ability to be in charge of their health. But you aren’t taught that in the medical profession, you know? And most doctors are not good role models. And it’s like, “Do what I say but not what I do,” so I pride myself on being a good role model.

And I try to be transparent. I mean, this is…I’ve had a lot of things happen in the last 14 months. And I went on YouTube, I think it was, June of this last year and I said, “Hey, this is what happened. You know, no matter what I’ve done, I still had a few issues. And you just keep going. You grab the bull by the horn, and you stay in the driver’s seat. And that’s what I’ll do as long as I’m breathing.”

Dr. Sandi: Well, that is such an inspirational story to not give up, to persevere, to keep going despite inevitable setbacks. And when you discussed stress, that really resonated with me because, as a clinical psychologist, I focused on health psychology, biofeedback, relaxation, and that’s what I would teach people who often came in with medical issues or with panic, anxiety, or just not slowing down, teaching them to just pause and breathe. Heart-centered types of imagery. Guided visualization.

And you talked about that when you were in such pain. It was your daughter who came in and was helping you with that guided imagery. And I thought, “Yes, that is exactly…” Often, like, just telling somebody to meditate, well, if you are fast moving and prone to anxiety and your head’s just going to be flooded with those thoughts as opposed to actually just tuning into your breath and just merely stopping and slowing it down.

So, I love that you created this patient bill of rights because that’s what we train our health coaches to do. They are helping people to be their own advocate, to feel empowered, and are bringing back that bedside manner, which I think so many physicians have lost. You experienced that yourself when you were having an encounter with that neurosurgeon. Like, what happened to bedside manner, which was so helpful, but the two, the combination of doctors having bedside manner and people becoming advocates for themselves.

Dr. Howard: You’re so right. And, I mean, physical exam has gone by the wayside. I mean, my partner is being evaluated at UCLA to remove his kidney robotically because of kidney cancer. And I was with a wonderful surgeon. I picked out the surgeon. He was wonderful. Very old-school. We’re talking about the surgery and then we get ready to leave. And I’m saying, “Well, aren’t you going to examine the patient?” “Why? Everything I need is here on the screen.”

It’s like people don’t listen to heart murmurs anymore. They don’t use their stethoscope. And, you know, I don’t know if it’s old-school or what, but I like that one-on-one connection with my patient. And of course, I use all the technology that’s necessary but, you know, something is lost in the meantime.

But I got to tell you a funny story. So, I had an EMG done February of 2022, so two years ago. And so the guy in charge of the EMG department at Cedars-Sinai, he just comes in after the fellow does a procedure. I swear to God, he asked me this question. I mean, you can’t see my figure right now, my physique, but I’m a bodybuilder, right? He says something that floored me. He looked at me but he did not see me. He said, “I have one question for you.” I said, “Yes.” “Are you active?” I said, “Are you freaking kidding me? You think anybody my age, you know, with muscles like that not be active? Are you kidding me?” I was floored. It was beyond being insulted. It was like this guy did not even see me. He just looked at my age, and, you know, he surmised what it was all about.

So, believe me, being a doctor doesn’t necessarily mean that you’re going to get special privileges or special attention. And that’s why, being a medical advocate, you have to be tenacious. You have to ask questions. You have to know when to ask for a second opinion. And I teach all my patients this. You know, when I tell patients, “Well, I’m your second opinion.” They look at me like, “Wait a minute. Well, who’s my first?” I say, “You are because nobody knows you better than you.”

You know, so I’m trying to… That’s been lost over the years, you know, and I think… And I don’t know about you, Sandi. I’m sure you feel the same thing. It’s gotten worse. COVID for sure has isolated people. And I see more distress, insomnia, panic attacks, all kinds of things. And now people are rushing to see doctors, and they can’t get in.

Dr. Sandi: Yes.

Dr. Howard: It takes [crosstalk 00:11:31] to get an appointment with a specialist, you know, which is why I’m in my own solo practice. I don’t have to… I mean, I’m on staff at a hospital, but I don’t have to go by their rules, so it’s so nice. I can give more personal attention, but it’s all about patient advocacy.

And I’m a patient advocate but then again… So, I was branded the medical advocate, but my prayer and my hope now is that everybody that I talk to, whether it’s my patients or followers or readers, you know, they do the same thing. You talk about you have to take charge or you’ll be left by the wayside.

Dr. Sandi: Absolutely. And there’s so much conflicting information out there too, so people are confused. They don’t know which way to turn. So, when they are… Often, they need a guide as well and unfortunately, there are very few doctors like you who can encourage them to be taking charge of their health, who are helping them to show there’s another way. It’s not just drugs and medical treatments but often they aren’t… And that is exactly why we are training health coaches, which are focused on lifestyle change as the new primary care because you are so right. The physician, the shortage, the number of people who are not entering in terms of they’re going to medical school but they’re not going to primary care, that old-fashioned relationship that you and I remember. You had a family doctor, and he knew you, and he knew your family and your history. And when you came in, you just saw that physician. Now with urgent care, which has a place but people are feeling adrift. They don’t have a doctor that they can turn to for their care that is consistent care.

Dr. Howard: And I’m sure like you, one of the things I pride myself on, Sandi, is that I actually established relationships with my patients. I mean, [crosstalk 00:13:25] who’s had a golf day, who’s got a hair day, who went on vacation and when, and someone passed away. I ask about these things, but that’s the important part of what I do. It’s not just about, you know, giving someone a medication or doing a procedure. It’s like what’s going on emotionally.

And I’m very keyed into that because, you know, that’s the gift that you either have or you don’t. But, you know, what I read recently that the average doctor spent five minutes in the room with the patient, it’s like I can barely say hello, you know, because the first thing I’m doing, I want to ask you what’s going on. I don’t say, “Okay, any change since your last visit? Any new medicines?”

You know, something definitely is missing, and that’s why I’m so glad live coaches like you… I mean, I do what you do on a medical back, but you’re right. I’m rare. I’m a rare bird, you know, so if they don’t find a coach like you, what are they going to do? Who’s going to help them? People need to be led down the path, you know, and that’s what I try to do. I really endeavor to get them involved with their own health.

I mean, I don’t need to see any more gunky artery syndromes. In 37 years of practice, I’ve seen everything there is to see. Now I want to see people, you know, taking care of themselves, and I also believe we have an innate ability to heal. Most of us don’t know how to tap into that.

Dr. Sandi: So, you talk a lot in your book about the lifestyle factors, about the importance of nutrition, and movement, and sleep, and stress management. So, can you comment on that and how that relates to heart health?

Dr. Howard: Wow. Yes. I knew early on, like, in the ’90s, when I got involved with holistic health and nutrition and exercise, that something was clearly lacking in the system. And at that time, people were flocking to HMOs, and they were getting even less encouragement and empowerment. So, I learned in my own experience… I mean, I’ve always been into lifestyle even before I had my mishaps.

And, you know, I talk about it in my book, well, the things that are most important. I talk about being your own medical advocate, what does it take to be your own medical advocate, the patient bill of rights, the patient responsibilities because we do have responsibilities as patients. And then the natural progression was… And then I talk about what’s called the five dimensions of wellness, which I, kind of, coined. And then from there, I said, “Okay, now we have to break it down into individual pieces.”

And so my meatiest chapter, pun intended, is “You are what you eat.” And I talk about various diets. I’m not usually a diet person, but there is a certain diet for everybody. It’s just individual diet for everybody. And I never believe that there’s one diet for all. So, I talk about individuality and so forth.

So, why is this important? Because the more people are involved with their diet and their exercise and knowing what supplements to take and in stress management and sleep hygiene, they’re going to live better. They’re going to live longer more than likely, and they’ll be happier and more content. Now, I’m going to tell you about the lifestyle. So, this is very interesting. So, this is Heart Month. February is Heart Month.

Dr. Sandi: Yes.

Dr. Howard: I’m doing two YouTube. I did one last week. It’ll be up… Hopefully, the YouTube will be up in the next couple of days. Actually, YouTube is but I’ll have a snippet on Instagram. So, it’s about heart disease in the 21st century, and, you know, how do you know if you have heart disease, how do you test for it. And I use a lot of different tests that most people use, so I want to get as much information as I can about a patient because I don’t really care about your numbers. I mean, I do but I don’t. What I care about is your risk. Your risk for disease is more important to me than your cholesterol level.

But the second one, what I’m doing next Thursday, the 29th, is going to be on lifestyle. So, we’re not going to talk about pharmaceuticals. We’re not going to talk about… And people may ask me in the Q&As, but I want to focus on diet, the thing I talk about in my book, because I think it’s so important because doctors don’t talk about this. And that’s why we have people like you, thank goodness, that are here to bridge that gap.

But doctors should know something about lifestyle, you know, and they don’t follow it. I went to… Cedars-Sinai has a very good cardiology conference yearly. It’s called Current Concepts and Controversies in Cardiology. So, I go every year, and there are two days of lectures. Now, I kid you not, there was one lecture on lifestyle. One lecture by a very good friend of mine, Dr. Carol Watson at UCLA. She and I are very similar in how we practice. That was it. Everything else is about drugs, drugs, more drugs, procedures, and given by a lot of doctors that were way overweight and, you know, didn’t look like they were really… They did not look very healthy to me, you know, but one lecture out of two whole days devoted to lifestyle. Does that tell you anything?

So, I want people to… And that’s why I’m devoting my next YouTube next Wednesday…next Thursday, I’m sorry, to lifestyle, how does it relate to diet and to exercise and to stress management. These are things that we all have to work on. And the way we practice medicine today and the way you and I think about it is customized. There’s not one size fits all.

Dr. Sandi: Exactly.

Dr. Howard: So, I’m very passionate about this because that’s where I think I can fill in the gaps, you know, a relationship with your patients and be, you know… Let’s encourage them to take an active role in their own health.

Dr. Sandi: So important. And the cool thing is that when practitioners start to practice in that way, it’s joyful for them because they have therapeutic encounters with their patients that transforms them as well. And I speak to so many doctors who are burned out and are leaving medicine. It’s because they’ve lost that true connection. It’s why they went to medical school. And so that burnout is real and our doctors are suffering.

So, I really applaud you in your mission for not giving up, both personally for your own health. You are a biohacker like me, and we try all the ways to stay active, to age in a pro way, as opposed to just giving up and giving into our aches and pains, and inspiring health professionals, inspiring health coaches, and most importantly, inspiring patients to be their own medical advocates.

Dr. Howard: Exactly. I mean, I’d like to think that I could inspire the doctors, but a lot of doctors aren’t really open to it.

Dr. Sandi: Yes.

Dr. Howard: A few years ago, I volunteered to revamp the menu for the doctors in the dining lounge. It was so unhealthy. So, I was doing a pro bono. I’ll just help you devise them. And the doctors are like, “We don’t want your input. We don’t want to know your diet.” You know, it’s like, boy, I was not welcomed.

But, yeah, that’s how it is. So, you know, we try to, in our own ways… I mean, you know, I have a little micro…my practice is a microcosm of what’s happening in the real world, but I do believe that little by little, if all of us do our part, we’ll have a better world to live in.

I mean, I’m an optimist at heart and I can’t cure the whole world, which is one reason why I wrote my book so that people don’t have to see me to appreciate my philosophy, that they can adopt as a patient, as their own medical advocate. You know, it’s a vehicle for spreading the word.

Dr. Sandi: Yes. Well, optimism is strongly tied to longevity and having hope, having gratitude, having humor as well as having interest. So, as we’re drawing to a close, I just wanted to comment that it really struck me that your interest in singing, and dancing, and having hobbies, having interests are really so rewarding—and healing—and can help particularly those that are involved with the community. That’s one of the things we stress when we train health coaches, the importance of community and having that social connection with others.

Dr. Howard: I’m so glad you mentioned that because when I came out… And this is back in the early part of the century. So, I had four quadrants. I like the word quadrant, right, four, so it was physical well-being, mental well-being, which is memory, emotional well-being, and spiritual well-being. And then my daughter, “Dad,” this is about a year later, “you left something out.” I said, “What do you mean?” “You left out social well-being.” I said, “Well, that’s [inaudible 00:22:13] quadrants anymore.” We changed it to dimensions but she…

Dr. Sandi: Oh, love it.

Dr. Howard: You know, we don’t live in a bubble, and I think we all learned that during COVID how detrimental it was to be isolated. Like I said, I saw elderly people with panic attacks that they had never had. Major insomnia, you know? So, I think people who need people are the luckiest people in the world…

Dr. Sandi: Yes.

Dr. Howard: …the song says, and I agree about that. And one more thing I’ll say, I wasn’t going to post this, but someone said you should post it. So, I do cold… Danny, I’ve talked about him. I do cold showers every day.

Dr. Sandi: Me too.

Dr. Howard: I do cold plunges, and I had a kiddie pool for a while. So, I was doing an ice bath in a kiddie pool every single Sunday. And anyway this is what happens to me and why this is so important to me is that, for the first minute, I’m like shivering like, “This is crazy. This is crazy,” because it’s fight or flight. But then something magical happens. I just totally give into it, and I start laughing hysterically. If you saw that last post on…

Dr. Sandi: I did. I saw that.

Dr. Howard: That was not fake. I couldn’t stop laughing. And it happens every time because, like, my vagus nerve takes over and I’m happy and I’m laughing. And I don’t know why, but it’s very special, you know?

Dr. Sandi: Yeah, yeah. And laughter will heal you. I get into a cold plunge, and I hear songs in my head, and I imagine dancing and just feel… Like, I tell myself, “This is going to feel so good,” and so it does. Well, this has been such a joy to be with you in honor of the heart-centered conversation for Heart Month. Dr. Howard, where can people find you?

Dr. Howard: Okay. Well, I have two websites, but one didn’t show up in the questionnaire. So, heartwise.com, one word, is my main website from my practice. But for my book, it’s beyourownmedicaladvocate.com. Again, beyourownmedicaladvocate.com. In fact, if you look at the book, it is “From Both Sides of the Table: When Dr. Becomes Patient,” and there’s a stripe on the bottom saying, “Become your own medical advocate.” That’s really what I want.

Yeah, it starts off about me and my story, but I’m only using me as, kind of, a springboard to how it can affect you, because it doesn’t matter whether it’s back surgery or heart attack or, you know, cancer or what the problem is. We all are going to have issues that come up in our lives regarding our health and I guess you can call them threats but I like to call them obstacles. And we just keep, you know… There’s a bump in the road. My coach will [inaudible 00:24:53], you know, “This is how life is.”

It’s educational, it’s autobiographical, but hopefully it’s inspirational because I want people to feel like they can do this. they don’t have to be a doctor or a nurse to take charge of their health, but you got to put in the work.

Dr. Sandi: Absolutely. Well, thank you so much. This has been just a joy to talk with you.

Dr. Howard: Thank you. [inaudible 00:25:16] with you is an honor.

Dr. Sandi: To be continued.

Dr. Howard: All right, thank you. Have a great day.