Ghana to Florida; Emergency Room to Home

Transcript Generated by AI.

 

Announcer: 0:00

Welcome to MedEvidence!, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts Hosted by cardiologist and top medical researcher, Dr Michael Koren.

Dr. Michael Koren: 0:11

Hello, I'm Dr. Michael Koren, the executive editor of MedEvidence! And I'm really looking forward to this session. I have Dr. Judith Abbey here with me and Dr. Abbey is a medical entrepreneur in our community here in Florida and I'm really fascinated to know about your journey, how you got there and talk about why you chose a bit of an unconventional way to serve the public, tell us about your business and, importantly, tell us about how we use evidence-based medicine and science to make things better for patients in our community.

Judith Abbey, APRN, DNP: 0:46

Thank you, Dr. Koren. It's an honor to be here with you and they may not see, but we have additional people in the studio here with us who are making this episode wonderful, so just want to give a shout out to them A little bit about me.

Dr. Michael Koren: 0:59

Don't flatter them too much because they may ask for a pay raise which we really can't afford at this point. But I appreciate you reaching out to the listeners may actually help Okay well, there we go.

Judith Abbey, APRN, DNP: 1:10

But I'm originally from Ghana, so, born and raised in West Africa, Ghana moved to the United States in December 2011. So I have been here a while Now originally, when I moved here, I was under the impression of continuing med school. So back home in Ghana, I was enrolled in medical school and that was the vision I'd always wanted to be a physician, and I think, culturally, part of it being that you become a doctor, and I think this is common across certain cultures. So you're either a doctor or you're a lawyer or an accountant, and I think it's because, knowing that those professions you end up doing well, you can take care of yourself and your family.

Judith Abbey, APRN, DNP: 1:59

But for me, it felt more like it was a calling for me, and so during my whole education, my plan was I was going to become a physician at that, and that was going to be the way for me to be a conduit for healing and for health for people. I wanted to help people make them feel better, and so when I was in first year of med school back home in Ghana, I was told I was moving to the United States. I was like, ok, how'd that happen? My brother, my oldest brother, was here with his wife and I. You know, I can't say for sure what their plan was, only maybe you know they wanted me to have a better life and a better education.

Judith Abbey, APRN, DNP: 2:45

Of course, there is more opportunities in and a better education.

Dr. Michael Koren: 2:48

I see. More opportunities in the US versus Ghana

Judith Abbey, APRN, DNP: 2:50

Of course you know the United States. It's a great country and we can see many people often want to travel here for better opportunities. And so when I moved here I was under the impression that, ok, because this is the trajectory I'm on, that's what I was going to continue on. I was informed I was doing nursing. I was like okay, but I did not understand what that meant. I think for my brother and his family it came from a place of okay. Nursing is the route where most people do nursing and the career opportunities for nursing, and the career opportunities for nursing is just unending. And I did come to understand later that there is a financial component to it when you look at what the nursing training model is compared to what the medical model is vast difference, and so I remember distinctly my brother saying to me you can go-.

Dr. Michael Koren: 3:46

And what does your brother do, by the way?

Judith Abbey, APRN, DNP: 3:48

He is a phenomenal guy. He currently works at Vystar. He is the SVP for enterprise risk management.

Dr. Michael Koren: 3:54

Oh, very nice,

Judith Abbey, APRN, DNP: 3:55

he is super smart

Dr. Michael Koren: 3:56

so he's in the banking industry for everybody.

Judith Abbey, APRN, DNP: 3:57

Banking industry, banking industry.

Dr. Michael Koren: 4:10

And your parents? Were they professionals?

Judith Abbey, APRN, DNP: 4:11

Mom was an assistant principal to a high school in Ghana, one of the most prestigious high schools. She voluntarily retired.

Dr. Michael Koren: 4:14

They have a great private educational system in Ghana.

Judith Abbey, APRN, DNP: 4:17

They do, they really do,

Dr. Michael Koren: 4:18

and your dad was?

Judith Abbey, APRN, DNP: 4:19

Dad is into social development, social advocacy. He's gone working with the United Nations. He's worked with the African Union, lots of international development organizations-

Dr. Michael Koren: 4:27

very nice

Judith Abbey, APRN, DNP: 4:27

So that was that background, okay.

Dr. Michael Koren: 4:29

Do they still live in Ghana?

Judith Abbey, APRN, DNP: 4:30

They're here.

Dr. Michael Koren: 4:31

Okay,

Judith Abbey, APRN, DNP: 4:32

They're here, we are a-

Dr. Michael Koren: 4:35

The whole family moved, yeah.

Judith Abbey, APRN, DNP: 4:36

Majority of us.

Dr. Michael Koren: 4:37

Okay

Judith Abbey, APRN, DNP: 4:37

So still have one brother back home with his wife. We were saying earlier that one part of the family is missing and we always miss them, but it's a big, it's a big family.

Judith Abbey, APRN, DNP: 4:47

It's a big family.

Dr. Michael Koren: 4:48

Sorry to interrupt, go ahead, yeah,

Judith Abbey, APRN, DNP: 4:50

Nursing school

Judith Abbey, APRN, DNP: 4:51

That was the decision. You know, not doing medicine, you're going to nursing school. I'm like, ok, didn't question it. In hindsight I know that was God's leading and that was God's doing. But I went to University of West Florida for my nursing degree. So my bachelor's in nursing graduated magna cum laude and won a couple of awards while I was there and from there I started working at a local community hospital and that was Santa Rosa Medical Center.

Judith Abbey, APRN, DNP: 5:23

So I started on MedSurg, getting used to all the different patient populations, and really that's where my experience started from. So while I was at Santa Rosa Medical Center just trying to figure out you know, where next do I go? What does the future look like for Judith? And so I enrolled at University of South Alabama and the reason I went to that particular school was they offered a dual family and emergency medicine track, which I thought that was wonderful, because once I had started in med-surg I had jumped around to ICU, I had done PACU, I had done all sorts of things, ended up in the emergency room, which I thought I would never be in ER, because ER is just crazy but loved emergency medicine. And so I thought my trajectory was going to be an ER nurse practitioner and this program was just perfect for that, because if I end up not liking emergency medicine for some reason, I could always fall back and do family practice. So I went to South Alabama and graduated with my NP. That's where I pursued my doctorate also.

Dr. Michael Koren: 6:36

Nurse practitioner degree

Judith Abbey, APRN, DNP: 6:38

Yes sir.

Judith Abbey, APRN, DNP: 6:38

Nurse practitioner degree, and so the doctoral part of it really was translating evidence into practice. So really that's what brought me to where I am currently. So I was working in Orlando at the height of COVID, in the emergency room, and there was a lot of anxiety going into work because we got to really see what the frailties of our health care system is, and oftentimes patients do not realize how tragic or how difficult it is, as medical providers, what we go through having to navigate this healthcare system. And so these are all things that contribute to healthcare practitioners always talking about burnt out, burnt out, burnt out, and I certainly felt burnt out, that anxiety.

Judith Abbey, APRN, DNP: 7:27

I had never felt anxiety or known what anxiety felt like, but I was at a point where I'm like Lord, I don't know what anxiety is, and really this was literally my conversation with God, that I don't know what anxiety feels like. But I'm pretty sure that's what I'm feeling right now and if you do not send me in a different direction, I don't know what's going to become of my career, because at that point I didn't feel like I was going into work and giving my best self to my patients. And we go into this field wanting to make a difference and wanting to make them feel better and being there for them at their worst, and especially as a nurse, the core of what we do is to be patient-centered and to be there for them, and we're not only focusing on you, the patient, we're focusing on your family as well, and Judith was going to work and Judith never felt like she was giving her best self to the reason why she wanted to help here, and so that was my prayer to God to send me a different direction.

Judith Abbey, APRN, DNP: 8:32

And I chanced into this field, I think by accident, I think in God's grand scheme it was not an accident. For now, the trajectory of what I do it's very personable, not traditional in the sense that I'm not in a physical environment, but I get to be right where my patient is.

Dr. Michael Koren: 8:56

So explain your business a little bit for people. So it's On the Go Drip, So tell us how you came up with that name. Number one and number two, tell us how your business model works.

Judith Abbey, APRN, DNP: 9:07

So number one On the Go Drip came about from my mom. My mom said I was going through her face trying to figure out what to call this business and we're throwing all kinds of names around.

Dr. Michael Koren: 9:18

So you committed to not work for an institution. Not work in ER.

Dr. Michael Koren: 9:22

You wanted to do something for your own

Judith Abbey, APRN, DNP: 9:23

wanted to do something for my own

Dr. Michael Koren: 9:24

Even though your parents weren't entrepreneurs necessarily, but maybe your brother had a little influence to say, hey, start a business.

Judith Abbey, APRN, DNP: 9:33

I feel like it came from when I was working with this other company doing the same thing and excuse me I realized that every time I would go into a patient's home, they appreciated that I was there. I actually felt like I was doing something, like I felt like I was making them feel better. So, in comparison with what my traditional ER setting was, where you hear all these bells and sirens going off, the radio constantly going off because rescue is bringing in a patient, or you're back in the room with a Baker Act patient and there's six security guards in there trying to hold this one patient down and you cannot. We've given him everything we possibly can. He is throwing poop on the walls. Very different setting.

Judith Abbey, APRN, DNP: 10:26

I had instances where a patient literally would throw their cup of water at me because it took me a long time to bring them water, knowing that in trauma room 37, we just had to resuscitate a patient. And so it was very different going into these people's homes and they appreciated that I was there and actually felt like I was healing, like I was doing something, and that feeling or that fulfillment for which I went into healthcare it was there again.

Dr. Michael Koren: 10:55

So by starting your own business, you had a sense that you were making a difference in people's lives.

Judith Abbey, APRN, DNP: 11:00

That's correct.

Dr. Michael Koren: 11:01

And did not get that sense when you were in the institutional setting

Judith Abbey, APRN, DNP: 11:04

that is correct.

Dr. Michael Koren: 11:04

So that was a big motivator for you.

Judith Abbey, APRN, DNP: 11:06

That was a big motivator.

Dr. Michael Koren: 11:07

And so starting a business is hard. There's a lot of things you have to do. Who helped you with that?

Judith Abbey, APRN, DNP: 11:12

God.

Judith Abbey, APRN, DNP: 11:13

God and also the right people really.

Dr. Michael Koren: 11:16

I can use God's help, I think, for my business.

Judith Abbey, APRN, DNP: 11:20

I highly recommend it. I highly recommend it.

Dr. Michael Koren: 11:23

Okay, well, I know God can do accounting and legal work and everything else.

Judith Abbey, APRN, DNP: 11:29

He works through people and he sends the right people, and I think that has been what's been driving me forward, because I can speak specifically to my training. There was not a single iota of entrepreneurship or business in there. I knew how to take care of a person.

Dr. Michael Koren: 11:46

You were not driven at all by the financial side. Nothing like that you were just on the personal side and the connectivity with the patients, and you figured out the financial side.

Judith Abbey, APRN, DNP: 11:54

This is for learning on the fly.

Dr. Michael Koren: 11:55

Got it but.

Judith Abbey, APRN, DNP: 11:55

God has sent the right people to me every single time to help make it work.

Dr. Michael Koren: 12:00

Well, that is important because the wrong people can create huge problems.

Judith Abbey, APRN, DNP: 12:03

Oh my gosh, Lots of problems, lots of problems.

Dr. Michael Koren: 12:06

Okay, so tell us a little bit about your business model and then we'll get into some of the type of patients that you help. Okay, so I want to get you to become part of my medical team. So how do I go about that? To become part of my medical team? So how do I go about that? How do I pay you? How does this all work?

Judith Abbey, APRN, DNP: 12:19

So this is strictly cash pay Insurance does not cover this yet, and how this works is I will pick a case of food poisoning. So if there is somebody who ate something bad and they're having food poisoning or they got the stomach flu in certain instances, you go to the emergency room or you go to urgent care because it's coming up out from up here and down there. You're both sides and and you're absolutely horrible feeling, miserable,

Dr. Michael Koren: 12:50

like norovirus.

Judith Abbey, APRN, DNP: 12:51

Terrible. We've been seeing lots of those cases the past couple of weeks.

Dr. Michael Koren: 12:54

Yeah.

Dr. Michael Koren: 12:55

And we're trying to prevent that with vaccine studies. By the way, here we are.

Judith Abbey, APRN, DNP: 12:59

And that would encourage people to definitely pursue that route, and so they go to the emergency room for these conditions. One, there's that whole wait time, and this is something I saw a lot practiced in the emergency room, because already we have like 50 people in the waiting room, everybody feels that they're there for an emergency, sure, but for somebody who is puking and having diarrhea at the same time, they do not want to be there, right?

Dr. Michael Koren: 13:22

And so let's mention the fact the triage nurse calls you and says Mr Jones, can you come out? And Mr Jones is in the bathroom. So he misses his turn.

Judith Abbey, APRN, DNP: 13:33

Exactly, and Mr Jones comes out not too happy at all. And so what we do for Mr Jones is Mr Jones, instead of you going to the emergency room, you reach out to us, you stay home, because it's easier for you to go to the bathroom. While you're home, right, and you're right in your own environment, it's comfortable for you. We will come to you, we'll take all that hassle out. You're going to get the same medical care you would at the ER or the urgent care, and this is in the comfort of your home. So, really, that is what a model is. It's very patient-centric.

Dr. Michael Koren: 14:02

That's beautiful. Yeah, and again, what are they going to do for you in the emergency room? There's no magic cure for a norovirus.

Dr. Michael Koren: 14:08

You're going to get hydrated, get your electrolytes.

Dr. Michael Koren: 14:11

and it's going to run its course over a few days, right?

Judith Abbey, APRN, DNP: 14:14

So, we're going to hydrate you and we're going to give you some Pepcid if it's necessary. Sometimes we do an anti-emetic. Depending on how bad it is, we call in prescriptions for you.

Judith Abbey, APRN, DNP: 14:27

So it is a whole medical process

Dr. Michael Koren: 14:28

and how much would that cost somebody? So that's always important for people is the economics of it.

Judith Abbey, APRN, DNP: 14:32

So on average, it's going to cost you about $300. If we're going to do additions to it, then the prices could fluctuate.

Dr. Michael Koren: 14:39

Right, and a lot of insurance companies have co-pays of $250 or $300 or more when you go to the emergency room Right.

Judith Abbey, APRN, DNP: 14:44

Right. So if you would consider that time of you having to get in your car and the drive time, go sit in the waiting room, wait for hours on end before you're pulled back and then you're there forever before the physician comes to see you and yeah,

Dr. Michael Koren: 14:56

and is it just you at this point, or do you have people that help you?

Judith Abbey, APRN, DNP: 14:59

We're a small team, so I have a small team of three plus me, so we're growing.

Dr. Michael Koren: 15:04

Okay, and how do you get the word out other?

Dr. Michael Koren: 15:08

than this podcast.

Judith Abbey, APRN, DNP: 15:08

Word of mouth has been very essential. Google reviews have been phenomenal too. We're also doing some ads here and there on social media and also Google.

Dr. Michael Koren: 15:17

So you mentioned acute diarrheal illnesses. How about other things that you do for people? What other services do you provide?

Judith Abbey, APRN, DNP: 15:22

So I often like to categorize this into we have the sick care. So we know, with the food poisoning or somebody who's really hangover, they have all kinds of symptoms from it. We see patients for migraine.

Dr. Michael Koren: 15:34

Hangover cures. I think that might be a big business.

Judith Abbey, APRN, DNP: 15:42

It is. I really the the the hangover part is what has popularized what IV therapy is over the last couple years, because people like going to all these, like parties, and they get drunk and you know they get hung over and like, oh, I need a banana bag, you know. So that has definitely popularized IV therapy is, and so

Dr. Michael Koren: 15:57

the other cure for hangovers was to give more alcohol.

Judith Abbey, APRN, DNP: 16:01

I didn't know about that.

Dr. Michael Koren: 16:03

Is that part of your protocol?

Judith Abbey, APRN, DNP: 16:04

No, unfortunately not.

Dr. Michael Koren: 16:06

Okay, well, I don't think that's evidence-based.

Judith Abbey, APRN, DNP: 16:08

It's not.

Dr. Michael Koren: 16:09

Okay.

Judith Abbey, APRN, DNP: 16:11

And so the sick component part of it, we deal with those minor, acute things. And there's the other part, for wellness, where we have individuals who they're not sick, you would say. However, they understand the importance of nutrients or nutrition in their lifestyle. So we have some patients we work with who have chronic conditions, especially those who have like gastrointestinal things, either malabsorption, crohn's, where they're not necessarily getting all the nutrients they need. This becomes a way for them to supplement that. So a big part of it is doing lab work to identify what the gap is, what their ranges are, and then that helps us to tailor a treatment plan for them. So those are the two categories and I always want to educate that there is a maintenance therapy and then there's a replacement therapy. So in instances where we're doing maintenance therapy, it's okay. We know there are like maybe somewhat of abnormalities or we're not within range where our body needs to be, and so we do maintenance therapy to get our body maintenance really what it means. If we're do maintenance therapy to get our body maintenance really what it means If we're doing replacement therapy.

Judith Abbey, APRN, DNP: 17:22

I'll illustrate this with a patient that I worked with. So she had a complete thyroidectomy. Her thyroid's gone. It's been months trying to regulate her calcium levels and she's tried everything. Her team had her on everything she reached out to us. We rechecked those levels Of Tried everything. Her team had her on everything she reached out to us. We rechecked those levels. Of course she was hypocalcemic. So we came up with a plan, did a couple of treatments specifically replacing her calcium.

Dr. Michael Koren: 17:46

Intravenous calcium

Judith Abbey, APRN, DNP: 17:47

Intravenous calcium, and then after that we rechecked labs, Boom, she's back within range. So then that becomes replacement therapy. So for some people after we've done replacement therapy then we cycle back to maintenance therapy. But then there's always that lab work component, trying to make it evidence-based and direct care.

Dr. Michael Koren: 18:05

Right. So I think those are important points and I think it's fair to say that not everybody in this quote less regulated space of bringing healthcare to patients' homes is as evidence-based as you're describing. So you and I were just talking, before we got started, about vitamin C therapy, which is a little bit controversial. So we know, for example, that if you are vitamin C deficient, that vitamin C replacement can help, just like we learned about scurvy, for example. But giving very high doses of vitamin C has never really been proven to do a lot of good, although some people advocate that without evidence, and we'll post what's called a forest plot of a lot of studies that we're doing specifically to see if high doses of vitamin C prevent cold symptoms, and the truth is is that they really don't, even though some people will take the data and try to say, oh well, that one study, it was trending in the right direction.

Dr. Michael Koren: 19:02

And this gets into some of the technical elements of analyzing the evidence which we'll show in the show notes, but I love the fact that you're very evidence-based and you're helping people resolve their symptoms and you're lab-directed, and these are very important distinction factors to show that you're doing a really nice job with evidence.

Judith Abbey, APRN, DNP: 19:21

Absolutely, you hit the nail right on the head and usually when it comes to vitamin therapy you hear that, oh, this is expensive pee or you hear all these kinds of labels for it. And often in our medical world or when it comes to research, sometimes it's hard to quantify or really lend much credibility to anecdotal evidence. So we hear all these patient stories, success stories, but it can be quite hard to really say I'm going to do a randomized control study specifically for vitamins. Now I have seen some studies where they are talking about high-dose IV vitamin C for cancer care, not as their primary, and we always want patients to understand that you should be working with your medical team and going with what they recommend and making sure that the evidence supports that.

Dr. Michael Koren: 20:12

Or doing a clinical trial.

Judith Abbey, APRN, DNP: 20:13

Or doing a clinical trial Absolutely

Dr. Michael Koren: 20:14

A clinical trial where you're systematically setting up an experiment where you'll learn the truth,

Judith Abbey, APRN, DNP: 20:17

absolutely, absolutely.

Judith Abbey, APRN, DNP: 20:21

Right, and so you did talk about colds and vitamin C. And yes, taking vitamin C during a cold is not going to cure it. We do know that vitamin C may make your symptoms lower or reduce how long you have the cold for, or even zinc.

Dr. Michael Koren: 20:38

And, in fairness, that's debatable. That's debatable and we can show the actual evidence. So again, with things like that, there's no harm in taking vitamin C, no, no but what concerns me is when people try to oversell it, and the fact is that the studies that have looked at it have not been consistent and meta-analyses have shown that it's probably a wash quite frankly, and a lot of other stuff.

Dr. Michael Koren: 21:03

Looking at vitamins in general, show that using vitamins when you're deficient is great.

Judith Abbey, APRN, DNP: 21:09

It's helpful Right, it's helpful

Dr. Michael Koren: 21:10

, but using vitamins when you're not deficient probably doesn't do a whole lot Right. So, again. I think that's a general sense, and other things should be done, in my opinion, in clinical trial settings.

Judith Abbey, APRN, DNP: 21:19

Right, right. And also it's interesting to know that the majority of what the American diet is, most people are deficient in certain things and they have no idea. So magnesium is a very common one that most people tend to be deficient and not knowing that they're deficient in magnesium. So I think that's key for us doing that blood work, to know where do you fall at and then that really helps guide care.

Dr. Michael Koren: 21:43

Yeah, I love that. So I'm a cardiologist and you're absolutely right, a lot of people are on diuretics. That waste magnesium.

Dr. Michael Koren: 21:49

And a lot of people don't know that magnesium is hard for a lot of people to absorb. Unless you test it, you don't know if people are deficient, and for magnesium in particular, you have the blood test, which is not the perfect way of knowing if you're full body deficient, and so you have to do a cellular test to determine that, and sometimes that's expensive and we don't do that. Except in rare circumstances. So sometimes you have to have a little index of suspicion.

Dr. Michael Koren: 22:21

And again, we know that people that are deficient in magnesium will have more palpitations, for example.

Dr. Michael Koren: 22:23

They may have other complications that are very, very subtle that you don't really get to until you replace the magnesium. And what's interesting is, if your kidneys work, that you don't really get to until you replace the magnesium. And what's interesting is, if your kidneys work, you can't really overdose the magnesium.

Dr. Michael Koren: 22:37

So you always have to look at the safety elements of it.

Judith Abbey, APRN, DNP: 22:38

That's very true because when we work with individuals who have core morbidities and they have a whole list of other conditions they're dealing with, then we're very particular wanting to know what their kidney function is conditions they're dealing with then we're very particular wanting to know what their kidney function is and that lab work really really becomes important because, yes, it could be benign for a healthy individual who just needs to replace their magnesium, but then for somebody who's in kidney failure or they have other things going on, it's very critical to know how you're treating them.

Dr. Michael Koren: 23:08

That's right. So any solution that works for one person may not work for somebody else.

Judith Abbey, APRN, DNP: 23:12

You have to individualize it 100%, and I think that's one thing we try to really push is going back to. Oftentimes people see what IV therapy is and they're like, oh, I can just pick this or I can pick that, or I can pick that. No, it really should be personalized to you and there has to be a conversation with you and your provider, or even before the nurse or the paramedic, whoever actually does that infusion for you. You, as the patient, need to have a conversation with either a nurse practitioner, a physician assistant or a physician in some sort, so they know if they get a thorough history of really who Mr Jones is, and then that should guide what the treatment is going to look like, because at the end of the day, it is still a medical process.

Dr. Michael Koren: 23:58

Right, it's interesting. I happen to have an interest in magnesium. It's one of the first investigator-initiated studies that I did when I first got into practice over 30 years ago got into practice over 30 years ago, and magnesium is a particularly fascinating area for you because we actually use high doses of IV magnesium to treat arrhythmias. So in an arrhythmia called torsades we use very high doses of IV magnesium.

Judith Abbey, APRN, DNP: 24:23

Obviously, you shouldn't be dealing with torsades in somebody's home, which is a life-threatening problem.

Dr. Michael Koren: 24:28

But the concept of getting the magnesium level up quickly and having an effect on the heart is well-known, but you have to again individualize it. So there may be some cases where taking the pills is going to be okay, but the truth is you can get your levels back to normal much quicker by using IV magnesium, compared with pills which some people just can't absorb very well,

Judith Abbey, APRN, DNP: 24:49

no, and we always want to advocate for food.

Judith Abbey, APRN, DNP: 24:51

Food should always be the go-to where we're getting all these nutrients from, but for whatever reason, sometimes food does not meet those requirements, so this is a good way for you to supplement that. But then, going back to the magnesium conversation, you do a basic Google search and you find different kinds of magnesium for different things. So sometimes patients find it hard to figure out. Okay, find different kinds of magnesium for different things. So sometimes patients find it hard to figure out. Okay, what is the right magnesium for me? And so people understanding that, yes, magnesium, but then that second part of the magnesium is really going to tell you what that magnesium is going to do for you and how beneficial it is going to be for your baby.

Judith Abbey, APRN, DNP: 25:28

We can circle back to that

Dr. Michael Koren: 25:29

and sometimes it's a little bit of trial and error. Some people absorb one magnesium salt better than another. They do better with magnesium oxide versus chloride versus something else Right. All right. Well, that's really helpful information. So what other patient types have you been able to help? Just for the audience to understand where they might want to call your service.

Judith Abbey, APRN, DNP: 25:51

There is a particular direction that I feel like the functional space, or buzzword anti-aging longevity, is going towards, and there's this molecule called NAD, or nicotinamide adenine dinucleotide.

Dr. Michael Koren: 26:05

Antioxidant.

Judith Abbey, APRN, DNP: 26:06

So NAD is a coenzyme or cofactor, and NAD is found in every cell in our body. And so we are beginning to have some sort of evidence that is given as a causal link between low levels of NAD and certain conditions or certain diseases. And for which reason? It's because, like, NAD is implicated in all of these metabolic processes. The theory is, as our NAD levels decrease, if we're able to replenish that NAD, maybe we could reverse some of these conditions, maybe we could live a bit healthier, maybe we could live a bit longer.

Judith Abbey, APRN, DNP: 26:43

And so what we're using NAD therapy for? And again, you know, NAD is mostly concentrated in those mitochondrial cells, where, or I should say organ systems, where there's a high concentration of mitochondrial tissue, so your heart, your brain, reproductive tissue, and so NAD tends to be quite pronounced. Or, for the patients we work NAD, tends to be very beneficial for them in those regards. Over time I say to people all the time you can't just take one thing, you can do one time. And that's not how you know research. You try for a while so we can collect some information and see what the improvement is. Has anything changed? Has it not changed?

Dr. Michael Koren: 27:24

Yeah, and this, in fairness, is a little bit more controversial than some of the other things you brought up.

Dr. Michael Koren: 27:28

So you know, the whole antioxidant hypothesis is something that has been out there for quite a number of years. I actually worked in a lab when I was in college that was working on some of these things and unfortunately, for whatever reasons, supplements haven't had the effects that we had hoped. That doesn't mean that the future won't be different, and it doesn't mean that there isn won't be different, and it doesn't mean that there isn't a glimmer of truth in the hypothesis, but we don't really know exactly how to deal with it at this moment. So one of my first actually my first scientific publication was showing the antioxidant effects of free radicals that were generated when you use the, chemotherapeutic drug called Adriamycin, and the simplest way of getting rid of the free radicals is just introducing oxygen to the system.

Dr. Michael Koren: 28:21

So no one really thinks that that is going to solve the problem but, it does change the free radicals, so it gets very complicated in terms of this whole concept of what to do with these free electrons that can cause tissue damage, and how do you manage that, which is really what the whole NAD hypothesis is looking at Right. Are you familiar with the work of Dr. McCord from Duke? No, I'm not. Yeah, he was one of the original pioneers of this. I don't know if he's still around. I haven't checked his work recently. How pioneers of this?

Dr. Michael Koren: 28:50

I don't know if he's still around. I haven't checked his work recently.

Judith Abbey, APRN, DNP: 28:52

How long ago is that?

Dr. Michael Koren: 28:53

This is when I was in college.

Judith Abbey, APRN, DNP: 28:54

Oh boy,

Dr. Michael Koren: 28:54

It's probably more fingers and toes than I have to count that far back, but anyhow, it's some interesting stuff, but I would put that more in the unproven category, more hypothesis generating. So why don't you tell people how we get your service, how you get in touch with you and your team?

Judith Abbey, APRN, DNP: 29:12

Wonderful. So we have a wonderful website On the Go Drip. I feel like On the Go it just rolls right off your tongue. I like it. So you go to www. OnTheGoDrip. com On the Go Drip. That was a mouthful OnTheGoDripcom.

Dr. Michael Koren: 29:27

One word?

Judith Abbey, APRN, DNP: 29:28

All one word yes.

Dr. Michael Koren: 29:29

On the go drip.

Judith Abbey, APRN, DNP: 29:29

Yes, onthegodrip. com.

Judith Abbey, APRN, DNP: 29:33

And we have all the information you need on there

Dr. Michael Koren: 29:35

so you can just work online and then

Judith Abbey, APRN, DNP: 29:36

you can work online.

Judith Abbey, APRN, DNP: 29:37

You can give us a phone call, you can send us a text message whatever is convenient for you.

Dr. Michael Koren: 29:40

Why don't you tell everybody what your phone number is?

Judith Abbey, APRN, DNP: 29:42

904-544-5010. Excellent.

Dr. Michael Koren: 29:46

Excellent.

Judith Abbey, APRN, DNP: 29:47

That's our phone number.

Dr. Michael Koren: 29:48

And what's your typical response time if somebody calls?

Judith Abbey, APRN, DNP: 29:51

About 30 minutes.

Dr. Michael Koren: 29:52

Wow, okay, well, that's better the ER

Judith Abbey, APRN, DNP: 29:53

In 30 minutes. Way better Between 30 minutes to one hour. We would have somebody at our location, .

Dr. Michael Koren: 29:59

That's amazing. Yeah, well, thank you for now that I know that I might send some patients your way.

Judith Abbey, APRN, DNP: 30:03

Absolutely .

Dr. Michael Koren: 30:06

Any last words for the MedEvidence audience?

Judith Abbey, APRN, DNP: 30:09

I have a question for you. Sure, because, staring like sitting right across from you, there is this book behind you. That's just like staring right at me.

Dr. Michael Koren: 30:17

Yes, and I wonder, or I just want to know, what the story behind that book is. Well, let me see which book you're talking about.

Judith Abbey, APRN, DNP: 30:23

It's very prominent. This one, that one, that one, okay, wow, this, that one, that one.

Dr. Michael Koren: 30:28

Okay, wow, this was not a setup, by the way, no, you just happened to ask about this book. So when.

Dr. Michael Koren: 30:40

I was in medical school, I took courses at the Harvard School of Public Health and Dr. Weinstein and Dr. Feinberg led this course on decision analysis and this is a book that they wrote together with some other authors. Back in the 1980s, when I went to medical school, Dr. Feinberg was my medical school advisor. He became the dean of the Harvard School of Public Health while I was there and obviously it was nice to have a mentor that became the dean, but he actually also became the head of the Institute of Medicine some years later.

Dr. Michael Koren: 31:10

So he was one of my teachers and mentors and tremendous. I learned so much from him. Dr. Weinstein was the primary guy. He was a physician, he was a non-physician. He was the primary guy that ran the course teaching about how to use quantitative analysis to make medical decisions. So my claim to fame is that I took their course and it was probably the fourth year or so that they did the course you did, I did I took the course and this was the book from the course.

Dr. Michael Koren: 31:34

I was the first student to get a perfect score on the final exam, including the extra credit question. That's my biggest claim to fame, so thank you for bringing that up.

Judith Abbey, APRN, DNP: 31:43

No way, that is unbelievable.

Dr. Michael Koren: 31:48

Anyhow, it's a great book that helps you analyze how to make. That is unbelievable, but anyhow, it's a great book that helps you analyze how to make medical decisions, and my medical school thesis was about whether or not to neutralize the acid content of pregnant women before they deliver to prevent the acid aspiration syndrome, and that was my first major medical presentation on that.

Judith Abbey, APRN, DNP: 32:08

What were your findings on that? That sounds.

Dr. Michael Koren: 32:11

Well, I have my thesis in my office, if you want to read it.

Judith Abbey, APRN, DNP: 32:13

I would love to read it.

Dr. Michael Koren: 32:15

It's only 150 pages of light reading, and you're probably the first one to ask to read it. Yeah.

Judith Abbey, APRN, DNP: 32:22

I would love to.

Dr. Michael Koren: 32:23

Other than my mom who read the introduction and liked that didn't read any of the paper, but anyhow, we basically found that it was important to neutralize the acid content of pregnant women and that if you had the ability to predict when the delivery was going to occur, you should use a histamine blocker like Tagamet in those days or Zantac more recently, and that was actually helpful to neutralize the pH of the stomach content. So, god forbid, the pregnant woman vomits and aspirates. They're much less likely to get severe lung damage. So that was the finding and we actually looked at how much it costs. So back then Tagamet was a drug you had to pay for. It wasn't a cheap generic, it wasn't that much, but it wasn't a cheap generic. And wasn't that much, but it wasn't a cheap generic. And do you spend, does the system spend a million dollars to protect a certain number of women? So we actually brought it down to the financial parts, which is why I'm always interested in business and how people in the medical field develop their business models.

Judith Abbey, APRN, DNP: 33:23

Right, wow.

Judith Abbey, APRN, DNP: 33:23

So if you could predict or you knew exactly when the mother was going to deliver, Then you would give the histamine blocker how far out before delivery.

Dr. Michael Koren: 33:36

Typically you would want to do it within a few hours, so you know, two to 12 hours before.

Judith Abbey, APRN, DNP: 33:41

Right, that is pretty cool.

Dr. Michael Koren: 33:44

So that's what we discovered, but thank you for the question.

Judith Abbey, APRN, DNP: 33:46

Absolutely. It was just there, like it's quite, and it's placed differently from the rest of the books in your collections. I was like it must really mean something to you. There's a story behind it.

Dr. Michael Koren: 33:58

There is a story behind it and, again, it's the way we should be thinking about medicine in terms of quantitative decision analysis. That is definitely one of the points we make on MedE vidence, and people should find physicians or nurse practitioners or other medical providers that think in those terms.

Dr. Michael Koren: 34:14

We think in terms of analytics.

Dr. Michael Koren: 34:16

We think in terms of what's proven and we're not just trying to make up stuff as we go along. We don't know everything and sometimes we have to make decisions based on uncertainty, but for the things that we do know, we need to leverage those things and it's an important part of what we do.

Judith Abbey, APRN, DNP: 34:29

Wow, that's phenomenal.

Dr. Michael Koren: 34:33

So, Judith, you've been a delight.

Dr. Michael Koren: 34:35

Thank you for joining us on MedEvidence and we'll have you back again. and good luck on your business.

Judith Abbey, APRN, DNP: 34:39

Thank you. Thank you very much.

Dr. Michael Koren: 34:41

Thanks for joining the MedEvidence podcast To.