Ep. 53: When “You’re Fine” Isn’t a Full Story: Rethinking Longevity with Whole-Body MRI — with Dr. Pooja Singh, Physician Lead for AI, Safety and Quality at Prenuvo

You can pass a routine physical exam, hear “you’re fine,” and still have something serious going on. Dr. Pooja Singh lived that as a kid. Doctors attributed her symptoms to anxiety, and three cardiologists on three continents agreed. Then further imaging revealed the congenital heart disease she had carried since birth. In this episode, Dr. Regina Druz talks with Dr. Singh, a physician at Prenuvo who likes to chase the rare diagnoses others miss, about what a whole-body MRI can add to preventive medicine and early disease detection, why her team treats it as a supplemental screening tool, and how a color-coded scoring system sorts each finding by urgency. They also talk about women who book scans for the whole family and schedule themselves last, the heart symptoms in women that still get dismissed, and why cardiology training still centers on heart attacks in people who might have benefited from prevention 20 or 30 years earlier.

Watch on YouTube: A video version of this episode is available on the Own Your Heart Health YouTube channel. Subscribe to be notified of new episodes.

Episode Chapters

[00:00] Rethinking the Physical Exam for Longevity
[01:36] Years of Being Told It Was Anxiety
[08:25] Coarctation of the Aorta Explained
[14:05] Why She Became a Doctor Who Chases Zebras
[18:18] Why Cardiology Still Waits for Heart Attacks
[22:58] How Whole-Body MRI Becomes the New Physical Exam
[32:20] Why Women Schedule Their Own Scans Last
[34:13] Women’s Heart Symptoms That Still Get Dismissed
[39:28] How Findings Are Scored to Avoid False Alarms
[42:08] Why Technology Still Needs a Human Partner
[49:41] How to Get a Whole-Body MRI

Transcript

[00:00] Rethinking the Physical Exam for Longevity

Dr. Regina Druz (00:02): Welcome to Own Your Heart Health. I’m Dr. Regina Druz, your holistic cardiologist. This week, we will dive into common heart health concerns, uncovering root causes and unpacking scientific discoveries and controversies. The information provided does not constitute medical advice. Please contact your healthcare practitioner before making any changes that may impact your health.

Well, this is another Friday fun day. You know, I love to record my podcast on Friday because it’s such a beautiful day, you know, sort of end of the week. You can regroup, look back at what you accomplished or didn’t, and, you know, potentially make the plans for the next week.

I am today with some wonderful guest, Dr. Pooja Singh, who I’m going to give you the kind of the whole lowdown on in a moment. And Dr. Pooja and I, what we’re going to discuss is something which is somewhat controversial to a degree, but also an emerging area. And it has to do with reinvention of the physical exam and figuring out what the physical exam is supposed to be for health optimization and longevity, right? And so, Dr. Pooja, welcome to the show.

Dr. Pooja Singh (01:18): Thank you. Thank you for having me, Doctor Druz.

Dr. Regina Druz (01:21): No, you’re welcome. You’re welcome. And I’m going to ask you a question that I ask every single person who’s been here, which is, how did you grow up to be who you are today? Give us, you know, give us your, your journey, Dr. Pooja, your journey into medicine.

[01:36] Years of Being Told It Was Anxiety

Dr. Pooja Singh (01:36): Wow. I mean, I’m Indian, so I was told to become a doctor. No, just kidding. So yeah, I mean, that was part of the thing. I worked for a lot of, like, NGOs growing up, Kalahari, ActionAid, and my dad was like, “You love doing service to mankind, so you should probably want to do medicine.” And I was like, “That’s a lot of science.”

But, you know, also I was, I think growing up I was a patient. I was a very regular patient at doctor’s offices. And it was very impressive to me that, you know, they just had a lot in their head that was going on when they saw their patients. And I was like, wow, like just putting a stethoscope to my heart, he can tell exactly what’s wrong with me. So I, I was just very amazed and impressed by that idea. And I think I wanted to see if I could hear things out of people’s chests. And that was kind of intriguing. So that’s what led me here.

But I think my journey in medicine shifted quite a bit when I was a first-year medical student, so it, it was, it was a, a very enlightening experience. So I like to call myself the Trojan in the world of medicine, if you may. Definitely not like still.

Dr. Regina Druz (02:44): But why, why the Trojan? Tell us about that.

Dr. Pooja Singh (02:47): So, you know, like, like I mentioned before, I’ve, as a kid, I had quite a few doctor visits, and I come from a family of physicians. My mom’s a family medicine doctor, my grandfather was a physician. And growing up, I had like, you know, I’m not as tall as my siblings, and I had a lot of leg pains that would wake me up in the middle of the night. And my parents would take me to the doctor, and they’re like, “It’s just growing pains, it’s just this.”

And then they were like, they kept telling me, like, “You have anxiety,” because I would pass out, but not really pass out, as a kid running cross country. And they were like, “You know, she’s just anxious.” And they would do, like, I had serial echoes from the age of twelve, I think, all the way till nineteen. And of course, you know, when I went to medical school, I sat and I compared those reports, because I had like worsening regurgitation in each one of them.

But at that point in time, I was like, they were like, “She just has anxiety. She just has like some mitral valve prolapse. She has like a chordae tendineae rupture.” It’s like, all right, okay, maybe I have that.

And then I think, when I finally went to medical school, like I lived on a separate continent than my parents and probably gained a little bit more weight than I usually was. And I didn’t do a lot of sports at that time, because there was just so much to study. So when that happened, my blood pressure shot up. And the cardiologist, and I saw three cardiologists on three different continents, kid you not, one in Asia, one in Europe, and one in America. So like, they were all like, “You’re fine, you just have anxiety.” I was like, maybe this is what anxiety feels like.

And then as a medical student, like when my blood pressure shot up, I was like in this tiny village in rural India, and they go, like, like, “Why does she have high blood pressure at 19?” And then they, they’re like, “Okay, maybe she has pheo, maybe she has this.”

And then I go back to my cardiologist, obviously, and he’s like, “Let’s do a workup for pheochromocytoma.” Sends me for an MRI. Obviously, I’m negative for that. And then the MRI doctor comes out and she’s like, “So, you know, we didn’t really find anything. So what’s your symptom?”

And I started telling her this entire story from like, from the time when I was a younger kid to then. And I was like, you know, in class of anatomy, when they were teaching us pulses, I couldn’t find my dorsalis pedis or my posterior tibial. Like, I couldn’t find any of the pulses in my leg. And she goes, like, “That’s so interesting. Let’s take you for a vascular ultrasound.”

So she takes me. She’s like, “You don’t really have any blood flow. You, your blood vessels are very small in that area.” So now she puts me back in the scanner, and this time she goes, like, head to toe. And of course I light up like a Christmas tree, because I have this congenital heart disease called coarctation that I was born with, apparently. And I was very lucky to be one of the nine survivors back in the 90s for this. But they didn’t necessarily, they, what they told me was I was very lucky to have made it to the age without having any problems. So I was like, I think I had a fair share of doctor’s visits for somebody who’s nineteen. So I think if you were…

Dr. Regina Druz (05:37): You were lucky to be alive. Even though you had all these doctor visits, you were not really diagnosed up until so much later.

Dr. Pooja Singh (05:44): No, no. And even when I think it was finally picked up, I think it was my twentieth birthday when I was holding my MRI report. It was like literally three days, and the day of my birthday was when I got the report. And I went to the cardiologist. I think he was just very embarrassed, because he was like, “Okay. Well, I guess you have this, and I guess it’s real.” I guess it’s…

Dr. Regina Druz (06:05): It’s not anxiety, right? How easy it is to, to blow off women with symptoms, right? Whether they’re young or old. All the time. All the time.

Dr. Pooja Singh (06:16): And I was, and, you know, you’re so right, because now, retrospectively looking at it, it, it makes so much sense, because, you know, when I was being trained also, like, that was the thing, right? It’s like, like, you know, just women. So like it, I think it just made me…

And of course, at that point in time, he was like, “Well, we don’t really have a surgery for somebody your age. We don’t know really what to do for you. So we’re gonna have to be creative here and figure it out.” And I was like, “You’re gonna be creative with my heart? That doesn’t sound very good.”

Dr. Regina Druz (06:48): Not, not optimistic.

Dr. Pooja Singh (06:50): No, not at all. And I think at that point my dad was like, “I thought you said she had anxiety.” Like, he’s not a doctor. So he was just like, “What the hell is happening here? Like, you said she had anxiety, and now, like, she has this birth defect she’s had for 19 years, and you’re telling me she’s lucky to be alive?”

Like, and then I think he met, like, we met a bunch of surgeons, and nobody really wanted to touch me at that point, because they were like, you know, like, “She’s, she’s not, we don’t know what she’s gonna do.” Like, you know, “There’s, the risk is much higher for the surgery. You might as well just let her live it through.”

But I was actually going into heart failure at that point. Right. Because I had a significant amount of regurgitation. And I find this part of the story very funny, but it’s not. And because all my blood supply was in the upper part of my body, so, you know how in like heart failure your legs swell up? Like, my body from the top puffed up. So like my hair, scalp, like my hairline started here, and my face was this big. And my, my siblings used to find it very funny. It’s not funny, but it was at that point in time, because they were just like, “Wow, like, you look really weird.” And I was like, “Thanks, but no thanks.”

And then I was lucky. I think I found, like, there was this one cardiologist who had come from London. Angioplasty had just become a thing, and he was like willing to do an experiment. And he’s like, “You know, if she, if it, if it takes, it takes. And if it doesn’t, like, then, you know, we’ll do it. We’ll send her for open heart.” And I was like, “All right, well, I guess that’s it.” And then I had that surgery.

But at that point, I think I was given the option, like, “Do you wanna stay in medical school, because it’s very stressful? Or do you wanna, like, come out?” And I was like, “Are you kidding me? I am so staying here, and I’m gonna change how medicine gets practiced.”

[08:25] Coarctation of the Aorta Explained

Dr. Regina Druz (08:25): Amazing. Amazing. So, so let’s just give our listeners a little bit of a clue, because even for cardiologists, you know, maybe for cardiac surgeons not so much, but even for cardiologists, congenital heart disease, and you know, which is heart disease people are born with, unless you specialize in it, you may not know much of it. But one of the congenital heart diseases is called coarctation of the aorta. And I had one patient to date, and I’ll tell you that little story. It was sort of like also the aha moment.

And the coarctation of the aorta is literally the narrowing of the aorta. As it, you know, the aorta starts from our heart, it’s sort of like a hook, like a candy cane, it dives down, right? A very large vessel, because we have to branch off different, different vessels to supply the rest of our body, of course. And you know, from the top, from the arch of the aorta, the vessels take off as well. So, you know, so beyond those takeoffs, the aorta gets narrowed. And it’s usually congenital, because this is, you know, an area where the muscular structure of the aorta is disrupted. So there is a narrowing, and there’s pressure buildup. And of course, the blood is not getting downstream, and it, it overloads the heart.

And you know, so first of all, it’s amazing that you actually got found, right? You got found in time, and there was a physician who was willing to work with you, even though the risk was, was on a higher side, to address this. Because, you know, here you are today, a doctor, a wife, a mom, and, you know, having a full life that you probably would not have had, right? If, if there wasn’t an opportunity to diagnose and to fix this. You know, so, so I think that’s, that’s amazing.

And my only patient with coarctation was actually in her 50s and who came for a completely different reason. I think I told you that story. She came for, I just opened my practice, that was years ago. And this gastroenterology doctor in our area, he was driving by my practice, and he saw it, and he liked the name. And the name at the time was Integrative Cardiology. So he liked that name, Integrative Cardiology. And he’s like, “Okay, I’m gonna send some patients to her.”

So he sent this lady to me. She was a sweet lady. She lived in our neighborhood. It was a basic thing. She was expecting a gastrointestinal procedure, and because she was very hypertensive, he wanted medication adjustment prior to the procedure.

And so as I was seeing her, I could not get over the fact that this patient was super compliant with all of her medications. She was on five medications for blood pressure, I kid you not. She was taking them routinely, religiously. She had seen multiple cardiologists, she had cardiac studies done, all of the routine studies done, and nothing was ever found. The exact same story, right? Maybe a little bit of mitral regurgitation.

And I put a stethoscope on her chest, and I sort of heard a murmur. But then I listened to her lungs, and there, there was this machinery-style, like, murmur that was absolutely blowing my eardrums. And I said, “Have you been told that you have this finding?” And she said, “No, I have not.”

And I sent her to a local hospital for, again, a repeat of a routine procedure. They didn’t find anything. I finally sent her to a cardiac MRI, which is what we’re going to talk about. And sure enough, she had coarctation of the aorta. She actually had to get an open repair. But, you know, an open repair was a profound change, because she essentially went from refractory hypertension to basically stage one hypertension, much improved quality of life, and of course, you know, improved, you know, health span and lifespan. So…

So how do you then, you know, now that you’re a survivor of such a difficult and life-threatening and emotionally, you know, charged diagnosis, right? Something that stays with you for the rest of your life. How did that shape your medical journey? How did you evolve as a physician?

Dr. Pooja Singh (12:29): I think it definitely had an impact of, like, being a much better listener. And…

Dr. Regina Druz (12:39): Well, that’s, it’s okay, it’s good. You know, I hope our listeners appreciate what it takes for Dr. Pooja to share her story, because, you know, and so many of you are living with chronic conditions or conditions that are life-threatening, you know. I tell about my breast cancer story, I cry almost all the time. So it’s, it’s totally normal, you know.

People who we don’t know will be watching this or listening to this. But you know what? Maybe it will help a person. Maybe just one person, maybe just a few people. Maybe it will help those people to advocate for themselves, because you and I are both insiders in the medical domain, right?

And, and you came from a family of insiders. Like, right, even as a child, you may not have advocated for yourself, but your mom was a physician, so, you know, so she was on the sort of inside track, right? So, you know, and we as insiders failed to really make a difference for ourselves sometimes. So where does it actually leave a regular individual who doesn’t necessarily have these points of access? Right. This, this is something to, to think about. You know, how challenging it is for people actually to get good answers, and to get appropriate medical care, and, you know, to get the right partners. So, so pick it up anywhere where you feel comfortable.

[14:05] Why She Became a Doctor Who Chases Zebras

Dr. Pooja Singh (14:05): Yeah, no, I, I feel like it definitely made me a, a better clinician, because it made me realize that textbook medicine is textbook medicine, and people are people, and sometimes they don’t fit together. And our job as a physician is to be able to connect the dots and not just, like, take anything for granted.

Like, yes, we can run down the possibility of, like, common things are common, but sometimes uncommon things are common too. They’re just undiscovered. And that’s one of the reasons why I call myself a physician who likes to chase zebras, right? Like, in medicine, we’re taught to look for the horses over the zebras. And I like to say I’m a doctor who chases zebras.

And like, I was fortunate enough to practice in places where I could get patients that I thought were the zebras for all these years the right amount of care. And then I was super happy when NYU opened their congenital heart disease thing for adults diagnosed with congenital heart disease, because that happened in 2020. But before that, there wasn’t a place for people to, like, collect and talk about their experience, which was also really nice.

Dr. Regina Druz (15:14): Exactly. Exactly. So, so what is a forward physician? Tell us about that.

Dr. Pooja Singh (15:20): Yeah, so I like to identify as a forward physician. I mean, apart from the fact that I worked at Forward. I think for me, that was like an eye-opening time, because the one thing that I did realize after working in, like, private, private medicine in the hospital, as well as, like, public hospital systems, was that, you know, there was a break in the system. Like, people would keep coming back, and it was like a revolving door.

And the way it was explained to us is, like, like, the outside world isn’t well connected. Like, their pharmacy isn’t reaching them, their, you know, like, their home care isn’t reaching them, and blah blah. So obviously, as a, as a hospital physician, it was very frustrating to, like, see these patients come back, and teach your residents, like, teach them everything, you know?

And I, I think my patients have been such good teachers. Like, I remember one of my heart failure patients telling me, like, “Doc, you went to school for 10, I don’t know how many years, to learn all these medicines. Don’t expect me to learn them in three days while I’m…” And I thought that was like such an aha moment, because it’s like, it’s so true, right? Like, we give them all these fancy names, and we’re like, “Here, take this. This is your water pill, and this is your heart pill, and this is…” So, you know, educating the patient became, like, a major priority for me.

And I was very happy about it, but it was still not satisfying. Like, it didn’t feel like I was serving the purpose I was trying to serve, because I wasn’t really diagnosing any zebras. I didn’t, you know, hospital medicine is very different.

And then I came to Forward, which was a startup, and we had this amazing thing called 60-minute visits. And I was like… And in those, I found a ton of zebras. And I found a lot of patients with things that, you know, they were never diagnosed with. They were told, “You’re fine, your blood looks fine, you’re normal, this is normal.”

And I think them and me alike, I think we were very appreciative of that time that we got to spend together and, like, come down to, like, “These are the tests that we’re gonna run.” And, and it felt like teamwork instead of, like, me talking at them. And I just, I think the collaboration worked really well. And I think that’s where it changed how I thought about medicine, but also how I wanted to practice medicine for the rest of my life.

And it was going to be a very futuristic way of doing it. Like, I wasn’t going to sit there and look at, like, there’s so many people dying with heart disease. It’s the highest mortality. Cancer is the highest mortality. I’m like, no, I’m going to do something about that highest mortality. Like, that is going to be a different story 10 years from now.

And, you know, like, I think as physicians, if we all work towards that, which I know that you’re doing, and a lot of other physicians who are willing to, like, step away from that academic, traditional medicine world and spend time with their patients, we will see that number change. It might not be in the next 10 years. Maybe it’ll be in the next 20, 30 years. But that is the goal. It’s to change that reality. Right. So…

[18:18] Why Cardiology Still Waits for Heart Attacks

Dr. Regina Druz (18:18): A hundred percent. And I have to tell you, that’s the reason why this podcast is actually called Own Your Heart Health. Because I want to bring forward this idea that we’re the owners of our health, right? It’s our ownership responsibility to really own the health the way that makes sense to us, not the way that is defined by insurance companies and, you know, the way that sort of like… And it, and it’s hurtful that so much of conventional medicine, which still does great things, is kind of positioned towards this, you know, acute emergency rescue intervention.

Like, I’ve been prepping for my annual cardiology board research. You know, cardiology boards, you can now just do, like, one section once a year and, you know, research one topic, right? Actually, congenital heart disease was like two years ago. So this year it’s, it’s bread and butter. It’s coronary artery disease.

And, you know, as I’m sitting there, you know, I’m like, you know, as a cardiologist, if you don’t know coronary artery disease, then, then, like, you’re really in trouble, right? Like, you know, like, go do something else. So I was like, you know, happy to see that on my, you know, on these practice questions I score highly. I’m like, “Great, I’m going to ace this exam.”

And then something occurred to me as I was reading each question. I was like, why is everybody on the board exam questions in their 50s and 60s, and they have two to three chronic disease risk factors? They’re almost always high blood pressure, high cholesterol, diabetes, or high blood pressure, high cholesterol, obesity, and/or smoking or physical inactivity. And they’re having heart attacks, they’re having angina, you know, they’re having all these things.

And, you know, the boards are focused on, how do you take care of these patients? You know, which medication you wanna give them, which procedures you wanna do, when should you fix them when they have an acute MI. Which is great, because if we don’t fix the acute MI in that 120 minutes that a patient rolls through the door, we’re not really saving their heart as well as we could.

But then I wanted to, you know, almost scream at those board questions and say, these individuals should have been looked at 30 years prior, 20 years prior, when these, you know, coronary plaques were just in their early stages, when these risk factors were just popping up. Because, you know, they were a 30-some-year-old office worker whose life was mostly sedentary, whose diet is ultra-processed foods, who, you know, sort of lives in this obesogenic environment. And they, and 20 and 30 years later, these are patients, right? These, these who we’re seeing. Like…

So when will cardiology shift, not just in terms of paying lip service to it and, you know, doing some preventive things and putting out guidelines? When will cardiology training fundamentally shift from intervention to prevention? Like, you know, I don’t think I’m going to see it in my lifetime. I’ve sort of, I resolved to the fact that there’ll be, you know, some people like you and I, and, you know, who are pushing this envelope, who are trying to provide this to patients. But that fundamental conceptual shift has not happened yet. And it’s been overdue for decades. It’s not new science. It’s, it’s, it’s something that we’ve known for a very, very long time.

And, you know, you’re seeing this, a study published in the New England Journal of Medicine. They just published a wonderful study, I think it’s called REACT. It was on the prevalence of silent atherosclerosis in really young people and, you know, in general. By the time most people are 30, we have about, you know, 10-plus percent chance of finding some atherosclerosis in some vascular bed, right? So this is not really a disease of the aged. It’s a disease of us, you know.

And it’s just absolutely kind of, you know, anguishes me to, I can’t even describe it, like, you know, to whatever degree, that, you know, I, I will be, you know, as always, found to be a competent cardiologist based on my board. But the board has very limited, you know, value placed on finding these patients, you know, decades before they come into the emergency room having a heart attack.

But I know you practice differently. So tell us about, you know, you are reinventing the approach to medicine using modern technology. So, you know, you started at Forward, but you’re doing something very interesting right now. Why don’t you talk about that?

[22:58] How Whole-Body MRI Becomes the New Physical Exam

Dr. Pooja Singh (22:58): Yeah. So of course, unfortunately, Forward shut down in 2024. So after that I worked at, I work currently at Prenuvo, and we do whole-body MRIs here, and it’s a screening tool. And I am all for it, because, clearly, as a patient, right? I, I can tell you that there are so many times that I went to the doctor and had, like, an echo done, and somebody listened to my heart, and somebody… And it was 12 years in the making, plus.

And, you know, retrospectively, everything, you know, hindsight, when you look at reports, you’re like, now I can connect the dots, right? Like, now I can go back and connect all the dots. But I think, if you don’t even have that basic information, how do you even begin to connect dots? Right.

And I truly believe that the future of medicine is technology. And it’s a combination of the wearables that people have, these whole-body MRI screens that they do, because when you connect them, you literally give the doctor a superpower. Because you’re, I think of them as super tools, right? So, like, if your wearable, your HRV is different, right? And it’s moving. It’s an alert to your doctor, like, something’s not fitting. But it’s also an alert to you. Like, your Apple Watch says your resting heart rate has gone up in the last so-and-so. Or, like, so between that and the MRI, I think…

I think that the future of medicine is a lot of technology, which is actually going to be a part of, and become, the physical exam, over the physical exam that we currently do in our clinics. Which is, I’m not denying that it has benefits to it, but it’s not the only thing that’s gonna work. Not in today’s world.

Dr. Regina Druz (24:45): There are so many things you put in there, but let’s start from the top. So, first of all, what is a whole-body MRI? You know, what, what exactly does it do? And potentially, who may benefit from whole-body MRI? If people are considering it, because I know patients have been asking me, you know, “I want to get a whole-body MRI.” I’m like, well, I know just the person who can educate us on whole-body MRI. So, so what is it? What is it? And who should get it?

Dr. Pooja Singh (25:11): Yeah, and a whole… So I’m, I’m gonna speak from Prenuvo’s perspective. I, Ezra is another company, but I don’t know the details of their quality and everything.

Dr. Regina Druz: Sure, sure, sure.

Dr. Pooja Singh: [Unclear] quality at Prenuvo, so I can tell you about that. So Prenuvo is a whole-body MRI company, and they basically go from head to toe in 60 minutes. And they, there are certain softwares, because it’s a non-contrast study. There are certain windows that are designed to specifically look at sections of the brain, the cartilage, the muscle, the bone. Like, it’s designed to look at the body.

And all these windows are actually written and printed in black and white on the report for the patient. So if they were to take the report to, like, an orthopedist or to anybody, that person would be able to see, like, these are the windows they used to see what they saw in the report.

And then there is, like, because it’s a screening tool, we don’t consider Prenuvo diagnostic whatsoever. We call it a supplemental screening tool. So we do tell folks, like, you know, it doesn’t replace your mammograms, doesn’t replace your colonoscopy, doesn’t replace your Pap smears. You still have to do all of those on a regular basis. We’re just adding to that information.

And it basic, it’s, I personally think everybody should get it from the age of nineteen. I, it’s only allowed after the age of nineteen, because I’ve had the privilege, as somebody who practices at Prenuvo, to see younger and younger people find things that they could actually take care of, which otherwise, you know, they would have probably passed away. And there, I’m gonna say one that’s really ominous, like pancreatic cancer, stage zero. There’s no, like, you, you don’t hear “stage zero cancer,” period. But at Prenuvo, we do get to find those, right?

And to me, like, if you can give somebody the, the privilege of living a life, then you’ve done your job right.

Dr. Regina Druz: Exactly.

Dr. Pooja Singh: So, like, we’ve had people who are twenty-two, twenty-three years old and get diagnosed with that. And when they go to the oncologist, or they get additional testing, and they’re confirmed to have that, they’re like, “You know, this changed my life.” Right. And then the, the lymphomas. But also, we have simple things. Like, we have the tech neck, the younger people who just hang their neck all the time.

Dr. Regina Druz (27:31): Tech neck. I like that. The word, the work-from-home neck, right? Like, like, like this.

Dr. Pooja Singh (27:37): So it’s like, yeah, maybe you don’t want to hang your head over your phone all day and look at Instagram, you know? Like, maybe you do wanna stand up and maybe put your phone at your eye level.

So, like, it, I personally think it, it has so much impact on every single person that can get it. I mean, I understand price point is definitely something. So, you know, as a company, I think Prenuvo’s always working towards betterment, and they have different programs that they run at this point, where there’s, like, a NeuroQuant, which is for the brain, the heart, and there’s body comp. But you can do them as standalones as well. So I appreciate that they are trying to make it better, but that’s where they stand. But I really think it’s, it’s beneficial for everybody. Yeah. As well as physicians.

Dr. Regina Druz (28:22): It, it’s such a great point, because I think, again, you know, that reframing is required, right, in our minds. Because conventional medicine is always the sort of acute care, rescue type of medicine. And most of our tests have been validated in that acute rescue model, right?

You know, like, cardiology bread-and-butter testing, for example, is still stress testing. And that’s probably one of the most common tests that we do. Which is an excellent test, because we can figure out what is the person’s exercise capacity. We can even measure VO2 max. We can figure out, do they have a hypertensive response to exercise? You know, we can write an exercise prescription. But unfortunately, for many patients who are in the early stages of heart disease, these tests will turn out to be just fine, right? So we need to find an opportunity to find disease so much sooner.

That’s why, typically, when we see patients on our side, at Holistic Heart Centers, our entire cardiovascular longevity assessment is essentially a very in-depth vascular and cardiac ultrasound. Because we scan carotids, we scan the heart, we scan the abdominal aorta. Pretty soon we’ll be scanning renal arteries and the leg arteries. Because, you know, your vascular tree is continuous.

And, you know, you may be in your thirties, walking around with high cholesterol. And maybe with interventions, whether it’s medication, supplements, lifestyle, all of the above, in about twelve weeks or so this cholesterol will begin to look so much better. But the main impact has to be in that vascular tree. If we’re not getting the impact there, then it means something is off.

So, you know, so whole-body MRI to me is very intriguing, because as a cardiac imager, and, you know, in my, I guess in my career as a conventional cardiologist, I was focused on cardiac imaging. I actually did a lot of nuclear stress tests. I ran a nuclear lab. And then, you know, a little bit of echo, a little bit of cardiac CT, you know, some familiarity with cardiac MRI, although certainly not in any way, shape, or form an expert in that.

But, you know, but the cardiac MRI would always, or MRI in general, what I always found so impressive about it is its ability to give us this tissue characterization, right? This sort of, like, that deep, you know, ability to visualize small things in tissues, especially in, in areas that don’t have easy screening-type tests. Like you mentioned, pancreatic cancer, right? You mentioned NeuroQuant. None of the tests that we have outside of this are good enough, you know, to kind of give us that early window of opportunity. So, you know, so it’s, so it’s, it’s fascinating that we actually are coming into this technology.

And I feel like, you know, it’s shifting the focus. Because when you go to a doctor for an annual physical, and you get your basic blood work, and you get your chest listened to, and you get a blood pressure check, which may or may not be true to what your blood pressure actually is, right? Because it’s done in a doctor’s office. And, you know, you get a basic, you know, heart-lung exam. Maybe they’ll touch your abdomen, and, you know, you’ll move your arms. Maybe they’ll ask a bunch of questions. That’s sort of like just a very basic screening, right? That’s, that’s the floor.

I’m not saying people shouldn’t be getting it. I think it’s really important. But I think the recognition needs to be that this is only the very basic foundation, like the first step. You know, there are so many other steps on, on top of it.

So what would you say, Pooja, is, you know, kind of your typical patients? Kind of give us a flavor. Who is coming in for whole-body MRI? Kind of, you know, men, women, age groups, what are they concerned about? You know, what, you know, who, who is, who is taking an additional step, you know, beyond that first, you know, the basic, the basic, basic, low-hanging fruit? Who’s taking an additional step to, to get this screening?

[32:20] Why Women Schedule Their Own Scans Last

Dr. Pooja Singh (32:20): So a lot of the patients that we get are folks who are, like, proactive seekers of health. Like, they truly believe in preventive medicine. Some of them are true biohackers, if you may. Not, not the Bryan Johnson-level ones, but, like, you know, like, they, they care about their health, and they care where it’s heading. And so we have a lot of those.

We also have a few who are just anxious, right? And I think counseling prior to the imaging, and then doing the consult after the imaging, is a major aspect for this particular kind of patient, which happens as well. Right. So we have those.

And then I will say that women often buy it for their entire family and then schedule themselves last.

Dr. Regina Druz (33:09): Always the last.

Dr. Pooja Singh (33:11): And my favorite story is this one lady who, like, had her husband, all her grown kids, their spouses, everybody go through the scan. And she put herself last, and it was during the holiday season, and obviously it showed something. And she came back to, to thank us. It was in one of our meetings where she was telling us, like, how grateful she was. But one of the things she said was, like, “I’ve never imagined myself as the one who would be sick. I always thought of myself as the one who would take care of the other folks that were sick.”

I’m like, that is so true for most women. Like, they will always put themselves second, because they think they can, they’re just superheroes. I mean, they are superheroes, but, like, you know, they’re truly just superheroes. So they should… So she was, like, very taken aback that hers was the abnormal one. But she was very happy that it was diagnosed in a place and time that she could be healed and protected, and, like, you know, she felt really good about that. But that, that, that story left an impression, because it made me realize women always put themselves last.

[34:13] Women’s Heart Symptoms That Still Get Dismissed

Dr. Regina Druz (34:13): Yeah, that, that is, that is a very common, unfortunately, thing in, in women. And I actually, you know, it’s funny that you mentioned that, because I recently spoke with a patient, and this patient became a little upset. And the reason why she became upset during our conversation is that she had symptoms that were looked at by cardiologists, non-cardiologists. By themselves, the symptoms didn’t really sound life-threatening, but sounded like mostly perhaps related to menopause, perhaps related to some supplements that she was taking, or the environment.

And I mentioned that it is important, even though the symptoms are not classic. But in women, symptoms tend to be quite atypical when it comes to coronary artery disease. And even a healthy person that is otherwise really healthy and on the younger side may have coronary artery disease. Maybe not the conventional coronary artery disease, because women sometimes get microvascular angina, or, you know, something called INOCA, which stands for ischemia with non-obstructive coronary arteries. Sometimes much weirder stuff, like sudden coronary artery dissections, that could even be undiagnosed in some women. It really depends.

And I said, it is important, since you hadn’t really had an evaluation since three years ago, and it’s been three years, and these symptoms didn’t really go away. If anything, they’re becoming worse. It is important at least to think, could this be coronary artery disease?

And she became very upset at that point. And she sort of started saying, “Well, you know, like, you know, don’t put these ideas in my head, because, you know, why should it be coronary artery disease?”

And I said, “Look,” I said, “it is so important for me to say this, because I’m a cardiologist who’s been speaking about heart disease in women for a long time.” And what I had seen is that despite all of our educational efforts, women continue to be under-evaluated and, in many times, undertreated, right? Because, just as your story shows, some things have changed, but not that many things, right? You know, we still get a lot of that pushback.

And, you know, my personal health story, which, you know, was the impetus for my book coming out in December, Longevity Switches, has, you know, taught me that lesson, you know, right? And, and Pooja, I’m gonna take you up on, on writing, you know, some, some praise for that book, because both you and I are calling ourselves medical zebras, and, you know, we definitely are. You know, you’ll definitely find a medical zebra in that book.

But the point is, is that I was always surprised that despite all of our education, all of our outreach, all of our sort of social media presence, we, it’s still the norm for a woman to be sort of blown off if she has symptoms, right?

You know, and, and I even told this patient, I said, “Look,” I said, “if the symptoms that you’re reporting, identical symptoms, and you were exact same age, exact same risk factor profile, but you were a man, not a woman, right? Everything the same except your gender. You would have been a man and not a woman. You would have already had this type of cardiology evaluation, and you would have known that it either is or it isn’t. But because you’re a woman, you’re being told that, you know, you, it’s probably not, not that, right? Nothing, nothing.”

So, so this is, you know, this is a message, I think, to all people, but to women in particular, is that you’re not invincible. And, and maybe your superhero power comes from being proactive and making your family members proactive. That’s the true superhero power, in my opinion. Really making other people take steps toward their health. You know, that’s, you know, that’s, that’s extraordinary.

So, question for you. Because, you know, so whole-body MRI, it’s a non-contrast exam, which means nothing gets injected in, in your arteries. You know, you guys don’t use gadolinium, which is typically something that we’ll need for a dedicated MRI. And of course, because of that, you know, certain things are, you, you’re not able to see, so it’s not necessarily diagnostic.

But some of the criticisms, I think, leveraged at whole-body MRI as a technology or as, you know, a new frontier in physical exam, was that, because MRI is such a sensitive technique, and so many things you could see in tissues, but you’re not using contrast, a lot of these patients, let’s say 90-some percent, there is some finding, right? But most of these findings are not of any concern. But it becomes about one in three have something that may require them to go on and follow up with, right?

So, so how do you sort of reconcile this, that this is a very sensitive technique that does give a lot of false positives? You know, which means something is found, but it’s not really a disease-generating thing. You know, it’s sort of just, it is what it is. And about a third of these patients have to go and get additional investigations. You know, sort of, what’s, what’s the, what, what’s the reconciliation to that, if, if any?

[39:28] How Findings Are Scored to Avoid False Alarms

Dr. Pooja Singh (39:28): Yeah, so I definitely want to give credit to the radiology team here, because in our reports we have the classification called ONCO-RADS. And ONCO-RADS is basically the whole-body MRI classification for clinically significant diagnoses and oncologically related significant diagnoses. And they classify every single finding into a one, two, three, four, five category.

And usually one is, like, “Fun fact finding, this is how you were born.” Two is, like, “You might have a deviated septum. It’s worth having a conversation. You don’t really, you know, you don’t need to go have a surgery for it, but, like, if you’re having difficulty breathing or you’re snoring more.” Three is more of, like, “You have a pancreatic cyst that’s so-and-so size. It looks like an, it’s an IPMN, and you want to follow up with it with a repeat pancreatic imaging or a Prenuvo scan in one year.”

And four and five, so five are usually the, the carotid dissections, the aortic dissections that we pick up. Those are the ones that our radiologists are gonna pick up the phone and call the patient and be like, “Hey, how are you doing? You need to go to the ER.” And four is usually like, “We found a mass. We wanna communicate this to you. We wanna tell you.”

We, we have something called the Prenuvo Referral Network, where we’re plugged in with certain health systems, and we are able to refer patients into that, especially if they don’t have a primary care physician.

So the, the findings are very much classified into what their relevance is clinically and oncologically, which I do think… And they’re classified, like, with ONCO-RADS, but they’re also color-coded. So I find, like, if you don’t want to even read the ONCO-RADS scoring, you can just look at the color, and it’s a good… Yeah, red is, like, really urgent, and, like, purple, like, the pink is like, “Okay, this is concerning.” And then three is, like, brown, and blue is, like, calmness, like nothing.

So I like that they’ve made the effort to make the report very legible and make it, make it very user-friendly. But they’ve also, the, the instructions are very clean on it. Like, it’s like, “This is a thyroid nodule. According to the guidelines, this doesn’t need to be followed up because it’s less than a centimeter.” Or, “This is a pancreatic cyst. It needs a follow-up in one year from now.” Like, the instructions are very clear-cut.

So I don’t necessarily find that people would end up going through unnecessary investigation or anxiety. But also, like, if they feel that way, there’s also the consultation that the preventive medicine team does there. So I, I do think that helps as well. I don’t know if this helps answer the question that you were looking for, but…

[42:08] Why Technology Still Needs a Human Partner

Dr. Regina Druz (42:08): A hundred percent. And I think, you know, you sort of brought up something which is really important, is that we are obviously living in the era where technology is expanding so rapidly, faster than we could even imagine, right? Especially right now with artificial intelligence and agentic AI, all these capabilities are just extraordinary.

And so many patients have taken to going to these large language models, which are essentially publicly facing models, and just uploading their results and asking for information. And I believe that, you know, unless that changed recently, healthcare or health issues type of queries are usually either number one or number two across all of these platforms. So I think we are rapidly sort of accelerating toward an easier opportunity for data interpretation.

But at the same time, you know, medical care is more than just data collection and data interpretation. Medical care, especially if, if the goal is health optimization, is about partnership. And this partnership with physicians, with your care team, is what I think makes a huge difference. Because it’s really having people on your side who are able to guide you.

Because, you know, we, it, and sometimes it’s just difficult to explain why we’re guiding you a certain way versus the other. Because, you know, the data is sort of dry, but it’s really understanding you as a person and helping you make appropriate lifestyle choices. So I think, you know, technology will never, in my mind, replace doctors or nurses. Not only because it would be very difficult to do it in an acute setting, an emergency setting, but because this is just, it’s more than just being human. It’s, it’s, you know, it’s being your partner.

Yeah, and I think it’s fantastic that these new technology tools are actually used in that framework, right? Because I’m sure, I wonder if you ever asked your patients, what’s the most valuable part? You know, is it really the MRI itself? Or is it, you know, the fact that you get a chance to speak with a doctor who wants to know more about you and to give you that comprehensive advice? Like, you know, what, what, what is more valuable?

Dr. Pooja Singh (44:27): No, that, that’s a perfect question, because usually the consult comes after the reports, and we sit down and explain everything. And that’s when I think the patients feel very supported. They have clarity on the next steps, and they know exactly what to do. And you’re, you’re a hundred percent right on that.

Like, technology is like a doctor having nine arms. But it’s still the mind of the doctor that has to communicate and coordinate the nine arms of information. So I think at Prenuvo, like, we’ve understood that. But also, like, coming from my experience at Forward, like, the, if the doctor, the doctor, provider, nurse practitioner, whoever it is that’s holding the hand of the patient, the care navigation, like, that’s, that explanation is best done from human to human. And nobody can ever replace that. The technology is only there to help you just do it better, do it more efficiently, not have loopholes.

Because again, right, like, I feel like doctors always get the short end of the stick. Like, I, I make this joke, but it’s not funny. Like, our stethoscope, our blood pressure cuff, otoscope, ophthalmoscope, these were all from the 1800s, right? And they haven’t changed. And then it’s like, “Here, take this. And you’re really intelligent, so now go save the world.”

And it’s like, thanks, but no thanks. Like, you know, can I have something more? Like, I will go save the world. I know that. But, like, can I have something more? And I think it’s an unfair push, like an unfair responsibility on the shoulders of a doctor alone to, like, “Here, save all these thousand people, but we’ll give you no tools.” So yeah, these are excellent tools, but in the absence of the right provider, they mean nothing. So you’re a hundred percent right on that. Yeah.

Dr. Regina Druz (46:16): Exactly. And, you know, like, yes, you know, like, my stethoscope right now has AI capabilities and electronic recording. So it’s sort of fun. I’ll put it on the chest, and it records the heart rhythm. And if I think I hear a murmur that, you know, I want to get further sort of reading on, I could go into my little app, and, you know, my little app would, would give me some sort of interpretation, right? But, but that hadn’t really changed in a, in a very, very, very long time. It’s still the same idea. It’s just giving me a little bit more accuracy, right?

But it’s still the same idea. With, you know, things such as whole-body MRI or vascular ultrasound, you know, carotid ultrasound, sort of, like, the whole vascular tree ultrasound, this is really, in my mind, the new physical exam normal. Because, you know, it opens that window of opportunity to really tell a person, “Look, you know, your labs may look good, and your physical exam is good, and your electrocardiogram is good. And, but you, there is early plaque buildup in your arteries. And if we don’t take care of it…” You know, or there is some sort of a finding, let’s say, as you said, a category four finding on one of your internal organs, and if we don’t take care of it, that could seriously impact your, your longevity, you know, your health span, your lifespan.

So, you know, so there are these opportunities. And I think the current environment, because it’s so saturated with technology, could also be very confusing to patients. So, you know, so I want, I want people to understand that, you know, this is not sort of like a pro-technology, anti-technology discussion, right? We, we are in the technological domain that has tremendous applications. They’re evolving, data is building, we’re learning from it. But the most impactful part is still that human connection.

And if you don’t have a human connection, if you don’t trust the doctors you’re working with, your medical care team, then you need to find, you need, you need to even tell them that, right? And then you need to find someone else.

Like, I always get, you know, a little bit sad when patients come and they consult with our team, and I’m sort of redirecting them back to their medical group or their physician. Because there are basic questions, important questions, that they need to ask that physician, to advocate for themselves and to understand why there is a certain recommendation and why they may not want to follow this recommendation. But the patients almost invariably say, “Well, you know, the doctor didn’t really have time. They didn’t want to listen to my questions. They were not open to it. They were not open to this discussion.”

And this is sort of, you know, it is always very sad for me to see this, that, you know, here’s this person who is really worried and upset, and has a good reason to do this, and may actually be not taking the next appropriate step in their care because no one had a chance to have a conversation with them. Right.

You know, it’s like, it’s, it’s, it’s always, you know, I, I like how you say it, forward physician. I think, you know, we are, we all need to be forward physicians. And, you know, because we have so many forward-looking patients now, that we need to be these forward physicians.

So, Dr. Pooja, how can a person who is interested in whole-body MRI get one? What are the steps?

[49:41] How to Get a Whole-Body MRI

Dr. Pooja Singh (49:41): So you can either go to the Prenuvo website, or you can go to Dr. Druz.

Dr. Regina Druz (49:46): You can… There are other doctors like Doctor Druz.

Dr. Pooja Singh (49:49): Right. Yes. And we do have, like, a physician referral partnership as well. So when patients come through physicians, they, the, if their physician wants to do the consult, we provide them all the material that we were trained on, and they can do the consult. We do the consult with them. We partner with the physician and do the consult together.

So I do find that very helpful a lot of times, because patients are like, “So here’s a doctor I trust, and then here’s a doctor I’ve never met before, and they’re gonna sit together on my consult, and I’m getting two for the price of one.” Which I think is, like, really nice.

Because a lot of times, like, my, my favorite story is the one where the patient’s like, “Yeah, I drink five to seven days a week, but my blood test is great.” But, you know, now I have a fatty liver on the MRI, and they’re like, “But that doesn’t make any sense. My blood test is great.” And I’m like, “Yeah, but we, we see that.” And this is the perfect opportunity for their primary doctor to be like, “Yeah, this is why we’ve been talking about your alcohol consumption.” And, you know, like, “I agree.”

So, like, I feel like then doctors don’t feel like they’re a broken record. They don’t feel like they’re repeating the same information. They just have proof, and they’re like, “Here, if you keep doing what you’re doing, this is what’s gonna happen. And I don’t get to control that. It’s in your control. My job is to be your guide.” So I feel like it’s very helpful in those conversations as well.

So yeah, the website is a great way. Going through physicians, partner relationships, that, that’s a great way. But either, however you do it, as long as, I think, if you can get it, it’s just a more deeper version, deeper look, of your entire physical exam. So…

Dr. Regina Druz (51:28): Absolutely. And I think what you mentioned is that, I’ve done it now probably close to ten times, you know, sort of a joint consult for a patient of mine with either their primary care doctor, because they refer them to me, or another integrative specialist. You know, as an integrative cardiologist, you know, I speak often to integrative rheumatologists, integrative gastroenterologists, right?

And sometimes their expertise is very valuable, because, you know, I have my skill set, but obviously it’s, it’s, you know, I’m not going to be the same-level specialist in every single specialty vertical, right? It’s, it’s not possible, you know. And even, you know, I love speaking to radiologists, because sometimes when I send patients for various studies, you know, their reading is a little bit different from mine. So I’d like to correlate that. But this is such an extraordinary opportunity for a patient to be able to, you know, literally tap into the team.

And I always tell patients, look, this is like car racing. Like, I, first of all, I’ve never been to, to, you know, car racing. I’ve never raced a car. I have one patient who loves car racing. But, you know, like, like, like from the films, right? When this driver pulls up in their vehicle, and the whole team descends upon him, you know, and they’re changing stuff, and they’re making sure he’s okay, and they’re, like, rotating tires and whatnot. And, like, boom, this car then drives off, you know, at the speed of a bullet.

And, you know, it’s like, it always stuck in my mind, because I’m like, honestly, this is sort of that team approach. You know, we’re all focused on the patient. That is the patient-centered care, that cross-collaboration, that communication. Because, you know, we are not, individualized medicine, personalized medicine, is different from population-level medicine, right? It’s focused on the person in front of you, because that person in front of you, you know, is a mother, father, uncle, you know, sister, you know, a person, and they deserve our attention. And so, and so this is what we’re trying to, to bring out there.

Well, Dr. Pooja, it’s been a delight. Any closing thoughts? Any parting wisdom for our listeners? Anything you want them to know, to remember? Anything you want them to do on Monday? Because, so, today is Friday. So anything you want them to do on Monday?

Dr. Pooja Singh (53:41): I mean, I think as long as they take this lecture to heart and understand that medicine is changing and evolving, and there are physicians who are willing to be a part of that change, and they have access to those physicians on podcasts like this. I think that’s the most greater message. And that they should reach out to those physicians, because they didn’t, I mean, it wasn’t easy to leave the academic world, but they’re doing it for a reason and a purpose. So that’s right. Yeah.

Dr. Regina Druz (54:12): Right. And let me second that, because, you know, it wasn’t easy to leave the world of traditional cardiology, you know. So I can tell you that from personal experience. And there’s still, you know, a certain sadness that I experience when I see some of my colleagues, you know, at those big meetings and in that traditional cardiology world.

But, you know, but my feeling that I get from the patients that we serve, you know, when they get the results that they want, when they feel, you know, when they come into a meeting, like a virtual session like this, and say, “I feel great,” you know, like, unprompted, they say that. And I feel so, you know, just elevated by this. And at the same time, I feel so honored that they trusted me with the most precious asset that they have, which is their health.

And I think that’s, that’s really sort of a way to think about it. Your health is your most precious asset. And it’s not something to be taken for granted. It’s not something that you can get a discount on. It’s something that you either own or you don’t.

And with that thought, I’m going to thank you, Pooja. That has been tremendous. And you’re welcome. And I’m looking forward to seeing you in person when my, my MRI is read, you know, like, hopefully, hopefully, yes, hopefully nothing, nothing in the red. And if there is, I will let the listeners know what, you know, what, what transpired.

Dr. Pooja Singh (55:37): Okay. You keep me posted. Thank you, Doctor Druz.

Dr. Regina Druz (55:40): Got it. You got it. Thank you.

Thank you for tuning in to Own Your Heart Health with Dr. Regina Druz. This podcast is powered by Holistic Heart Centers. If you enjoy the show, please rate and review us on your favorite podcast platform. To learn more about our services, visit HolisticHeartCenters.com and subscribe to our YouTube channel. The link is in the show notes. See you next week.

If you want to know where your own cardiovascular risk sits before that conversation, the HeartWell Quiz is a starting point.

Frequently Asked Questions

What is a whole-body MRI?

As Dr. Pooja Singh describes Prenuvo’s scan in this episode, it images the body from head to toe in about 60 minutes without contrast. Specific imaging windows are designed to look at sections of the brain, cartilage, muscle and bone, and those windows are printed on the patient’s report so another specialist can see how each finding was obtained. Dr. Druz adds that because nothing is injected — no gadolinium, which a dedicated MRI would typically use — certain things cannot be seen, so the scan is not necessarily diagnostic.

Does a whole-body MRI replace mammograms, colonoscopies or Pap smears?

No. Dr. Singh is explicit that Prenuvo does not consider the scan diagnostic and calls it a supplemental screening tool. It does not replace mammograms, colonoscopy or Pap smears, which still need to be done on a regular basis; the scan adds information to them.

Who gets a whole-body MRI?

Dr. Singh describes three groups: proactive health seekers who believe in preventive medicine, including some biohackers; a smaller group of people who are anxious, for whom counseling before the scan and a consult after it matter most; and women who buy scans for their entire family and then schedule themselves last. Her personal view is that everyone could benefit from the age of nineteen, the youngest age at which it is offered, and she acknowledges that price is a real consideration.

Doesn’t a whole-body MRI find a lot of false alarms?

Dr. Druz puts the criticism directly: because MRI is so sensitive, most people have some finding, most of those findings are of no concern, and about one in three people are sent for follow-up. Dr. Singh’s answer is the reporting system. Every finding is graded with ONCO-RADS on a scale of one to five and color-coded, with plain follow-up instructions — for example, that a thyroid nodule under a centimeter does not need follow-up under the guidelines, or that a pancreatic cyst needs a repeat scan in a year. The most urgent category, such as a carotid or aortic dissection, prompts a radiologist to call the patient directly. A consultation with the preventive medicine team follows the report.

What is coarctation of the aorta?

It is a narrowing of the aorta, the body’s main artery, and the congenital condition Dr. Singh was born with. Dr. Druz explains it in the episode: beyond the vessels that branch off the arch of the aorta, the vessel narrows, pressure builds up, blood does not get downstream well, and the heart is overloaded. The clue in Dr. Singh’s own case was that she could not find the pulses in her legs. Dr. Druz describes her only patient with the condition, a woman in her 50s on five blood pressure medications, whose coarctation was found on cardiac MRI after years of routine testing had found nothing.

Why are women’s heart symptoms still dismissed?

Dr. Druz says that in women, symptoms of coronary artery disease tend to be atypical, and that women can have forms of it beyond the conventional kind — microvascular angina, INOCA (ischemia with non-obstructive coronary arteries), and coronary artery dissections. Despite years of education, she says, women continue to be under-evaluated and often undertreated. Her test for patients: if a man of the same age, with identical symptoms and the same risk factor profile, would already have had a cardiology evaluation, the same question deserves an answer for a woman.

Why does Dr. Druz say cardiology still waits for heart attacks?

While preparing for her cardiology board exam, she noticed that almost every question described a patient in their 50s or 60s with two or three risk factors who was already having a heart attack or angina. Treating an acute heart attack quickly matters, she says, but those patients should have been looked at 20 or 30 years earlier, when plaque and risk factors were just beginning. She does not expect cardiology training to shift fundamentally from intervention to prevention in her lifetime.

Can technology replace the doctor?

Both physicians say no. Dr. Singh compares technology to a doctor having nine arms, while the mind of the doctor still has to coordinate them, and says the explanation is best done human to human. Dr. Druz says medical care, especially when the goal is health optimization, is about partnership with your care team, and that if you do not trust the clinicians you are working with, you should tell them, and then find someone else.

How can someone get a whole-body MRI?

Dr. Singh names two routes: directly through Prenuvo’s website, or through a physician. Under the physician referral partnership she describes, a referring doctor can join the post-scan consult so the patient hears the results with a doctor they already trust. The episode’s own advice is to talk with your own healthcare provider before you book a scan.

Show Notes & Resources

Guest: Dr. Pooja Singh, Physician Lead for AI, Safety and Quality at Prenuvo

Dr. Pooja Singh is a board-certified internal medicine physician and the Physician Lead for AI, Safety and Quality at Prenuvo, where she also supports the preventive primary care program by translating whole-body imaging and advanced diagnostics into longevity-focused care plans.

For over six years, she was Clinical Lead Primary Care Physician at Forward, an AI-based concierge medicine company, where she led multidisciplinary teams and helped design the Forward Health CarePod.

Her work there shaped protocols for the safe, effective clinical use of AI-powered diagnostic and engagement tools.

Earlier, she was Assistant Professor of Medicine at Columbia University Medical Center, held faculty appointments at Weill Cornell and St. George’s University, and served as Chief Medical Resident at Lincoln Medical Center, earning multiple teaching and quality awards.

Her career is united by a commitment to using precision diagnostics, technology, and evidence-based care to help people live longer and better.

Topics & Resources Mentioned in This Episode

Whole-body MRI as a supplemental screening tool — what it can and cannot see without contrast
Coarctation of the aorta — Dr. Singh’s own diagnosis, and Dr. Druz’s patient found on cardiac MRI
ONCO-RADS — grading and color-coding findings, and the follow-up each category triggers
Women’s heart symptoms — microvascular angina, INOCA and coronary artery dissection
Cardiology board exams and the shift from intervention to prevention
Vascular and cardiac ultrasound in Holistic Heart Centers’ cardiovascular longevity assessment
Technology as a tool, and the physician partnership around it
Prenuvo — the whole-body MRI company where Dr. Singh practices
Forward — the startup with 60-minute visits where Dr. Singh worked before Prenuvo
Longevity Switches — Dr. Druz’s book, coming out in December

Take the Next Step

Take the HeartWell Quiz
Speak With a Human
Access Courses and Events
Get HeartWell Toolkits

Holistic Heart Centers

holisticheartcenters.com
HeartWell.ai — AI-powered cardiovascular risk assessment
Address: 55 Bryant Avenue, Suite #6, Roslyn, NY 11576
Phone: 877-511-5166
YouTube: @reginadruzmd
Instagram: @dr.reginadruz
Podcast: Own Your Heart Health — available on Apple Podcasts, Spotify, and all major platforms

Listen & Subscribe

If you enjoyed this episode, please rate and review us on your favorite platform — it helps more people find the show.

Apple Podcasts Spotify YouTube