This isn’t typically what you’d expect on my Forbes column, but given the recent healthcare reforms underway with the new administration, I’d like to share my story.
It’s a tale involving a series of undiagnosed conditions, a highly respected doctor, and an alternative form of medical healthcare funding that may or may not gain traction as we continue into the 21st century. I had issues with weight gain 3 years ago, issues with fatigue, issues with insomnia, and I had been working out and watching what I was eating, but I was still getting heavier and I couldn’t understand it.
I deduced that the inexplicable weight gain could only be attributed to a medical condition. I had gone to see several other doctors that were consistently adding it up to old age, or to a changing metabolism—things I had no control over directly—and my weight continued to get worse. I decided that those responses were reflective of what I was actually feeling and so I needed to investigate it further.
I continued to balance my workout schedule with a high-power role running a startup business, though I began factoring in research to my daily routine. Several more doctors, a referral, and an appointment later, I met Dr. Lionel Bissoon.
In lieu of navigating the constraints of traditional health insurance policies, he practices concierge medicine, also known as “retainer medicine,” “direct care,” or “the MDVIP model of personalized preventive care.”
We have witnessed an increase in health care costs across the board, particularly the spike following Obamacare’s implementation in 2010. The American Journal of Managed Care found that hospital care represented the largest component of national healthcare expenditures in 2012 at a little over 31%. The study that concluded that the MDVIP model of personalized preventative care effectively mitigated hospital discharges, and allowed for increased physician interaction, which directly correlates to lower hospital utilization and ultimately, lower healthcare costs.
I had a conversation with Dr. Bissoon in January of this year to discuss concierge medicine through my own personal medical history.
The most important thing for me to do is listen to the patient.
Christopher P. Skroupa: I want to cover this idea of concierge medicine, and how you have an ability to understand multidisciplinary, multi-specialization medicine and get to the root causes of things. Our first appointment was almost two hours, where you did this extensive fact finding and discovery interview with me, and then we went into a set of evaluations. So let’s start with that—it would be great if you could characterize or express how you approach some of the complexities that your patient’s face and your process and how you go about it.
Dr. Lionel Bissoon: The most important thing for me to do is listen to the patient. When people come in, I sit behind the computer and they tell me a story and I guide the discussion to figure out the facts, then figure out how this whole human body—this whole person—is interrelated. So I listened to your symptoms about the growth hormone and the testosterone replacement and asthma, and then the story was, “Well, the doctor changed my medicine.”
I asked what was the name of the medicine, and the medicine you were given was in a class of drugs called beta blockers. As far as I was concerned, that actually made you worse, but in a traditional interview, I wouldn’t really be concerned about that. I was just listening to all of the complaints and trying to put together and synthesize them so I could look at you as a human being as opposed to just a few symptoms here and there, but also listen to what worked for you in the past.
Skroupa: Remember when we were sitting in the office, you were taking notes and I remember telling you I was on Atenolol, and you said, “For what?” and I said, “For migraines.” You said, “Well there’s 10 pounds right there.”
Bissoon: I really was in shock when you said you were taking it for migraines. I thought you said you were going to say, “ I have blood pressure issues.”
Some people take Atenolol for panic attacks or when they’re speaking on stage—it’s a drug that slows your heart down. But the side effects include weight gain, lethargy, fatigue, decreased focus and decreased concentration. I’ve seen people that can’t even get out of bed after taking that drug. So the first thing we did was take that particular drug away.
Skroupa: And it was interesting, because once the drug was taken away I could feel my energy spiking up and a greater sense of attentiveness. What was funny was literally waking up in the morning, day after day after day, and seeing 8 to 10 pounds come off of me.
Bissoon: I saw you about two weeks later. Your focus was better, your concentration was better, your weight went down. We hadn’t really instituted a full treatment program at that time, and the beta blocker had a really profound effect on you. Because you were on a beta blocker to be safe, we decided to do a coronary calcium score to make sure your heart was healthy before we took away this medicine.
Before you came in my office, I actually called those doctors and said, “I need you to see this guy as soon as possible”…To me, preventive health should be urgent.
Skroupa: And just to pick up on that, I think what was impressive that after the first appointment was that you referred me to an endocrinologist, a pulmonologist, and a cardiovascular specialist. I thought what was fascinating and helpful was your ability to pull all the diagnostic tests from those three groups and put them together and see where they align or contradict one another.
Bissoon: Before you came in my office, I actually called those doctors and said, “I need you to see this guy as soon as possible.”
Even though it wasn’t a life threatening emergency, part of what I do is pick the phone up and get you an appointment as opposed to making you talk to a secretary and have her say, “Well the next appointment isn’t available for like 3 months.” So I call in and said, “Hey, I need you to see this guy right away,” even though it wasn’t urgent.
To me, preventive health should be urgent. If someone has a stroke or a heart attack we should approach this with some urgency, but with prevention with urgency we don’t have to worry about a true emergency.
Skroupa: Let’s carry that conversation forward. There are some really interesting threads to this, one of which you mentioned was the stim test. Tell me about the stim test.
Bissoon: According to federal law, we can’t really give growth hormone because of all the wonderful benefits—there are over 100 benefits—to avoid people abusing growth hormone. Growth hormone has its own law because athletes were using HGH to enhance performance. Because of that, you have to prove a deficiency prior to prescribing HGH, so we did what’s called a growth hormone stimulation test.
The test involves administering a shot of a medicine called glucagon, though there are a couple other agents you can use. We then draw blood every 30 minutes, and look at growth hormone levels and determine if you have the ability to make or not. During the test, your blood sugar will goes up and then the blood sugar comes down slowly over time down, and when the blood sugar declines, the growth hormone level should go up, and in your case, you failed to respond. Failing to respond was an indication for me to give you growth hormone, which you clearly you needed based on the test.
Skroupa: And that resulted in a specific diagnosis. What was that diagnosis?
Bissoon: Adult Growth Hormone Deficiency or hypopituitarism secondary to head trauma from skiing.
We see football players and the harm they’ve inflicted on themselves and their family members, and some even resulting in suicide, which is sadly a thing, and an easy thing to prevent.
Skroup: What what was interesting with the stim test was that it demonstrated that my pituitary gland, or my hormonal master switch, was not fully operational.
Bissoon: That is correct. So, in response, the HGH therapy replaces the growth hormone your pituitary gland failed to make.
When I’ve talked to you in the past about your head injuries, you kind of blew it off, but I had to pull this out of you because you were a skier, and you still ski, and you had several head injuries from skiing which you never really attributed to part of your long-term well being. But there’s a whole science on traumatic brain injury, and now, that movie Concussion (2015) talks about CTE, or Chronic Traumatic Encephalopathy, so people don’t realize the impact of brain injury or head injury in the long term.
We see football players and the harm they’ve inflicted on themselves and their family members, and some even resulting in suicide, which is sadly a thing, and an easy thing to prevent.
So if you’re skiing and you have a collision or playing football or a car accident the brain basically has an acceleration-deceleration injury where the brain is vibrating back and forth. Treating this damage to the brain, which is essentially a ball of jelly inside a hard shell, means considering it hitting that hard shell. In the middle of the brain is the pituitary gland which is being yanked upon, and the gland is damaged so it affects the function though it may not happen early, it may happen later on in life.
So it’s interesting that after the injury, you had some lightheadedness and dizziness, which you didn’t think was significant. When there is an injury, most people tend to be in denial about their injury, and it’s fascinating because nobody wants to admit that they had an injury so they blow it off and I have to kind of pull it out of them because it’s really, really important when you’re treating HGH: Why did you have the deficiency in HGH? Why did you fail to respond? Because of that, the history of multiple injuries was important because you didn’t think it was going to affect you later, but cumulative head injuries—even one injury—is enough to hurt that pituitary gland.
The whole idea here is that this was never done before so well where there was more than one thing going on in me.
Skroupa: That wasn’t the only thing we learned about me though, was it? Talk a little bit about the parasite. I want to bring this forward because the whole idea here is that this was never done before so well where there was more than one thing going on in me. And I think we sometimes think we create a diagnosis and we fix it and therefore think everything is ok, but there were other things.
Bissoon: Well let’s talk about the parasite. Most people who live in New York, businessmen and businesswomen, travel frequently for work. They travel outside the country, they travel in the country in different time zones, and all of those things affect your immune system. We eat in restaurants, but we don’t think of the people making our food in restaurants. Even in the United States, they come from India, they come from Asia, they come from South America, Mexico, and I have nothing against Mexico by the way, but these people evolve with parasites and they’ve gotten accustomed to it, but our bodies have not been exposed to it. We don’t think we can go to restaurants in Manhattan and contract a parasite.
Also, when you travel internationally for business or pleasure, one can be infected with a parasite from food and you may have an episode of diarrhea or maybe a little anxiousness or belly pain and think nothing of it.
Skroupa: And what I think was really fascinating was once you were diagnosing it, I went to the doctor whose expertise was…
Bissoon: Tropical medicine. The world’s expert. He’s written textbooks on it. Dr. Kevin Cahill.
My version of treating people is looking at the whole problem.
Skroupa: Right. And after going through a round of antibiotics, I think I went down another belt loop at least because I think the parasite was bloating me and affecting my sense of energy and my digestion, and all kinds of uncomfortable things that we don’t think about. Until I actually went through that experience, I didn’t know how badly I really felt.
Bissoon: Which is interesting, because we don’t think about how bad we feel until we feel better. You may have had it for years. You’ve been walking around probably with this parasite and we did a special test to look at your immune health. When you came to see me, you didn’t have that many gastrointestinal symptoms, but intuitively, something didn’t sound right to me because the whole picture wasn’t making sense. The traumatic brain injury made sense, the asthma made sense, but still there was something missing. So I decided to look at your GI health. I did some immunologic testing and the response you had was indicative of a parasite and asthma. We knew you had asthma, so the next step was to send you to Dr. Cahill who diagnosed the parasite.
My version of treating people is looking at the whole problem. And some people come here and say, “Look, I just want you to treat my testosterone.” And it kills me to say, “I’m sorry but that’s not what I do, I do the whole person, and if you really want that you may want to go someplace else.”
Skroupa: I think that’s a great point, because I’m now 56 years old, and what I really appreciate is the idea that we can stay energetic and vibrant and youthful and beautiful and sexual and all those things we really want to be by the time a lot of people my age have really given up on any of it.
It’s all made possible by conducting these diagnostic tests and bringing in these other individuals. For instance, you brought in a great cardiologist who did a full assessment and evaluation on my heart health. I recall that you sent me to him because my internist put me on the wrong amount of theophylline and my blood pressure was at frighteningly high levels without me even knowing it.
Bissoon: I checked your blood pressure and it was so elevated, I had to get you to see Dr. Jeffrey Kohn-an amazing open-minded cardiologist. Theophylline is a really good drug—it was used for weight loss back in the 1940s and 50s, but they stopped using it for weight loss because we live in a country where one is good, but maybe two or three are better and would cause you to lose weight faster. Theophylline has a lot of toxicities associated with it, so you have to be really, really careful.
So whoever raised the drug did not monitor your blood pressure for side effects, so overall, you weren’t feeling so hot anyway after the drug was raised. That really does have an impact on the quality of life.
Skroupa: Tell me all about the genius gene and things I can’t eat and can’t drink and why and what happens to me under stress.
Bissoon: Part of our work effort is we do a custom nutrition program that involves genetic testing, and one of the genes we look at is called the COMT, which translates into Catechol-O-Methyltransferase, and this gene breaks down something called dopamine, a neurotransmitter in your brain.
People who have the normal gene have normal levels of dopamine, and people who have a certain mutation tend to be smarter because they have excessive dopamine in their brain. So, for instance, your partner had an AG mutation, and you had the AA mutation, where AA has the highest levels of dopamine in your brain so it does make you smarter. It makes you more driven because the dopamine is stimulating the frontal cortex of the brain and it gives you that level of super intelligence, and it also make you driven, makes you work harder, makes you creative, but the downside of the gene is that when you’re under a lot of stress you produce so much dopamine that you can’t break it down, so in stressful situations it becomes harder to do the same things you would normally do effortlessly—it’s harder to handle stress with your combination. Interestingly, every executive I see has one of the two combinations we mentioned.
So many people look at their health, wellness and wellbeing as a financial transaction and its not.
Skroupa: Now that test you do for all of your patients, is that typically an approach that you take to all diagnostics, or was it something you applied only to Chris’ patient plan?
Bissoon: My goal is to do this for every patient. Now some patients will come in here and say, “Well doctor, I don’t want to to do this. I just want you to do this.” And I basically tell them, “Well, would you rather feel 70% better or 100% better? You have a choice.”
They’re not concerned about my costs as a fixed cost but when it comes to laboratory testing, they are concerned about the cost. I explain to them that if they have health insurance, the labs will bill the health insurance for laboratory testing, and if your insurance doesn’t pay, the lab offers a significant discount up to 70% off the bills, and most of the labs in the United States do offer a discount if you ask, so they can get their healthcare. This should not be the issue keeping an executive from being well. And when you explain that to people they say, “Ok yeah, that makes sense now.”
It’s interesting how people look at health as not well being but as a financial transaction, and you can’t define your health as a financial transaction, and so many people look at their health, wellness and wellbeing as a financial transaction and its not. This was an eye-opening thing because it dawned upon me that most people look at their health as a financial transaction.
In today’s world where these executives have to do so much more work, they’re traveling more, they’re exposed to the light in their computer, their iPhone, all these things have an impact on their overall wellbeing. So being normal is not enough. Being optimal is what I’m interested in.
Skroupa: And to pick up on that, I think what’s fascinating is that most people don’t want to fix the problem—they want to eliminate a symptom or treat a condition, and I think what you do, Dr. Bisson, is you want people to achieve maximum wellness, maximum potential in a sustainable manner. And what requires a different level of patient commitment, don’t you think?
Bissoon: It requires a different level of patient commitment, but the doctor also has to be wanting to do that. He has to have the passion about doing that. I tell people that if they want to be normal, just go find somebody else because I’d rather you be optimal. In today’s world where these executives have to do so much more work, they’re traveling more, they’re exposed to the light in their computer, their iPhone, all these things have an impact on their overall wellbeing. So being normal is not enough. Being optimal is what I’m interested in. So we’re making people optimal—I try to do as much as possible as they will allow me to do.
Most people in New York love to eat sushi. Well, sushi carries the risk of parasites. You’re eating raw fish, so it’s important to look at people’s whole bodies, and look at their parasites. We also do something called a test for small intestinal bacterial overgrowth (SIBO). It’s estimated that 1 in every 3 persons have this. This means there are over 100 million-plus people walking around with something called SIBO, and SIBO can screw up your immune system, it can make you tired, it can make you run down, it can cause heart disease, diabetes, back pain, arthritis. So if you look at the whole person, people come in asking for testosterone and I end up looking at their gut health and at their heart health, I look at their brain health. They talk to me about their back pain. Well where is it coming from? So you have to approach it as a whole. And also not just make it about getting a bunch of tests but the tests have to mean something so you can make an intervention so you can actually fix the problem.
Chris, with your health it’s interesting—we can’t undo the genes but we know the gene has a certain function so we can loop around it. For instance, with your smart gene, green tea or black tea or chocolate, will slow down the COMT gene even more you will become overstimulated. Thus, in a stressful situation, the worst thing to do is to drink a cup of green tea or eat some chocolate. The best time for you to do those things is on the weekends when you are relaxing, not when under a lot of stress. Also, there’s nutritional bypass to make the genes work better, and it’s really fascinating how it changes people’s lives.
I think this is why executives who carry an enormous amount of weight emotionally and psychologically with their businesses, really need to put themselves first.
Skroupa: And that’s where I think this kind of medicine really has an impact—moving you from functioning effectively to optimization. I think this is why executives who carry an enormous amount of weight emotionally and psychologically with their businesses, really need to put themselves first. It ends up really helping the people they work with, the people around them, the people they serve and their families because it makes them fully integrated into their performance expectations. It’s really frustrating when you want to be the best you can be, but your body can’t carry you.
Bissoon: That is so true. And interestingly the COMT gene makes you smarter when it’s slow, but outside of the brain, it increases estrogen and adrenaline in your body , and the two things together makes you put on weight.
Skroupa: Am I correct if my memory serves me correctly, when you did the diagnosis you said my estrogen was quite high, is that true? Which is really not all that unusual for people my age who are under a lot of stress.
Bissoon: Yeah, there’s a condition called estrogen dominance, there is a computation where we look at testosterone versus estrogen and you had more estrogen than testosterone. So most guys I look at that have some belly fat, that’s usually when the estrogen starts increasing. As we get older we convert testosterone to estrogen, and the more we convert, the fatter we get around the belly. And that COMT gene that’s making you smarter is also increasing your estrogen production outside the brain.
It’s not a one sized fits all, it doesn’t work that way. So every body, every human being is unique.
Skroupa: Let’s talk about the nutritional side. I believe in nutrients and supplements, and years ago, I used to just experiment with them on my own—I was probably the Vitamin Shoppe’s favorite customer at one point—and I think what you did differently was to really pull from diagnostics and identify what are the right nutritional supplements, how to take them, and what you think the impact would be of them.
Bissoon: We approach nutrition with a program called the Integrated Genetic Solution, which is what we talked about earlier—it involves a very comprehensive set including genetic testing, nutrition, cancer markers and hormones . With that testing, we will see all your nutrition deficiencies and can custom-make the nutritional supplements/vitamins for you. It’s actually made in a pharmacy made specifically for you by prescription. So someone is weighing out the B6, the B12, the Vitamin A, the Vitamin C, the Vitamin D, and they put all these in capsules specifically to meet your nutritional needs.
Now, there are some things we can’t put in the capsules, specifically CoQ10, fish oil, those things we can’t mix with the other vitamins, so we treat those separately. If there’s a risk of heart disease, fish oil and CoQ10 can be preventative.
We know you had a couple genetic deficiencies so we had to give you specific nutrients to bypass those genetic mutations. When we see a genetic mutation, we can’t undo a gene—we can’t snip it out and and replace it—but we know the function of the gene, and we can think of it as a roadmap. And if there’s a block in the roadmap, we bypass it.
We recommend nutrition based on extensive lab testing—we treat deficiency to optimize one’s health. It’s not a one sized fits all, it doesn’t work that way. So every body, every human being is unique. You have deficiencies that are unique. And even if we look at the genetics they are unique, different mutations for everybody, and you put the whole comprehensive thing together then we can do a better job treating the person.
Dr. Bissoon allowed me to get to the root of the matter—to bring about a better performance, healthwise.
I walked into the Hudson Hotel a month ago and saw a concierge I’ve known for years. “Hi Jade,” I called out, and she said, “Oh my God, look at you! You look 15 years younger! How much weight did you lose?” She came around the counter and marveled at my decidedly slimmer form. “A brand new person,” she marveled. “What a transformation!”
Those who really want to take control of their wellness, and take control of passion and their ability to really drive the world in the direction they want, it takes this kind of performance and this kind of doctor to help. As the CEO of a startup, I can say firsthand that concierge medicine can be a solution for executives to manage through the many, many things they have to do.
So you may very well have asthma, and that could be fine, but you may not know that other things are affecting you metabolically that are affecting your asthma that if treated, you may experience a different outcome. The idea of concierge medicine is to really be an advocate and pull together.
Traditional or specialized medicine that focuses on general intern practice or specialized practices tend to not look at other things that could be affecting a particular experience.
It’s important to look holistically at your body, and how it functions in context to its own unique restraints and challenges.