The Science of Stem Cells, Exosomes, and Healthy Aging with Dr. Mari Mitrani

After years in emergency medicine, Dr. Vassily Eliopoulos (Dr. Vass) coded a man in a rural Wyoming ER who was his age, had no other risk factors, and looked exactly like him. That night pushed him from the ER toward longevity medicine and cardiovascular prevention. In this episode of HuMed, pediatric ER physician Dr. David Spiro talks with Dr. Vass about why doctors neglect their own health, the "golden handcuffs" that kept him stuck, how therapy and CBT-I helped him heal from years of night shifts, and why he believes disease care and true health care are two different systems. He also walks through his longevity pyramid, built on community, purpose and sleep, not supplements and saunas. CHAPTERS 0:00 He coded a man who looked exactly like him 0:28 Meet Dr. Vass: ER doctor turned longevity physician 2:05 The code in Rock Springs, Wyoming 4:48 Why doctors neglect their own health 8:13 The lost art of healing 11:03 "We're training technicians, not physicians" 15:07 Trapped in a broken system 18:18 The golden handcuffs 20:44 Healing from decades of night shifts 28:30 Disease care vs. true health care 35:37 Why no one told Dr. James Wittig he was sick 39:04 Advice to his younger self: don't let fear decide 42:32 Dr. Vass's longevity pyramid 44:55 What dying patients talk about 47:51 Purpose: the old dog and the rabbit 51:21 A quarterly "board meeting" with his kids 53:16 Fasting, thermal springs and community 57:54 Closing thoughts

"I did healing for myself first, so I could become a better healer." Before Dr. Melissa Mondala treated patients with lifestyle medicine, she needed it herself. She lived with IBS and reflux from her teens, and during her training at Loma Linda she was diagnosed with an atypical breast cancer. Changing how she ate, moved, slept and handled stress changed her health, and her husband's, and it reshaped how she practices medicine. On this episode of HuMed, Dr. David Spiro talks with Dr. Mondala, a double-boarded family and lifestyle medicine physician, fellowship-trained in integrative psychiatry and integrative medicine, about the patients who shaped her: a young single mother of three with pancreatic cancer who kept running for her kids, and a fashion designer with an autoimmune disease who got her life back layer by layer. They also discuss: Lifestyle medicine vs. integrative medicine, and where they overlap Why ferritin matters even when hemoglobin looks normal Her approach to adult behavior change: one habit, SMART goals and habit stacking What medical training leaves out about nutrition and sleep Advice for frustrated, burned-out physicians who feel stuck practicing reactive medicine Dr. Mondala earned her MD at Chicago Medical School at Rosalind Franklin University. She is co-founder of the Doctor Lifestyle Clinic, a direct care practice, and author of Embody Lifestyle Medicine: How to Build a Successful Direct Care Startup. HuMed unveils the human side of medicine through honest conversations with physicians. Follow the show so you never miss an episode. Chapters 00:00 Cold open 00:22 Introducing Dr. Melissa Mondala 02:25 Her own health story: IBS, reflux and food as poison 04:21 Loma Linda and the Blue Zones 05:30 A breast cancer diagnosis during training 07:00 The pillars of lifestyle medicine and her husband's autoimmune disease 08:49 The young mother with pancreatic cancer 13:53 Lifestyle medicine vs. integrative medicine 18:50 A patient with autoimmune disease and a difficult cycle 27:36 Why ferritin matters 31:45 What standard medical training leaves out 36:48 Night shifts, sleep and processed food 40:09 How to change adult behavior 44:12 Accountability, SMART goals and habit stacking 47:05 Lifestyle medicine and autism spectrum disorder 50:54 Advice for frustrated, burned-out physicians 53:31 Closing

Dr. Rick Pescatore was driving to Pittsburgh with a woman he had met on Hinge, describing a kind of patient he sees every ER shift: pain, nausea, vomiting, and tests that all come back normal. She said the person he was describing "sounds exactly like my mom." A few weeks later her mother was dying in an ICU, and nobody could solve her mystery illness. The missing piece turned out to be vitamin B1 (thiamine). The woman from that drive is now his wife, Katie. Dr. Pescatore is a board-certified emergency physician. He went through the U.S. Naval Academy, studied aerospace engineering, and served in the Navy's submarine force before medical school. He trained at Cooper University Hospital, served as Delaware's chief physician during the COVID-19 pandemic, is editor-in-chief of Emergency Medicine News, still works shifts in a community ER, and co-founded Belly MD. In this conversation with Dr. David Spiro, he talks about helping diagnose his future mother-in-law, why so many ER patients are told they are normal when their lives are not, and how that pattern helped burn him out of full-time emergency medicine. They also get into what night shifts cost physicians, his Navy call sign, his time leading Delaware's pandemic response, and why an ER doctor who used to roll his eyes at supplements now sells them. In this episode: – The drive to Pittsburgh: "sounds exactly like my mom" – An ICU stay nobody could explain, and the vitamin B1 answer – "We tell them that they're normal, but their lives aren't" – Disorders of gut-brain interaction and the ER – Why he calls GLP-1 drugs some of the most revolutionary in history – Burning out of emergency medicine, and the night-shift toll at every age – F-18s, submarines, and the call sign "Aquaman" – Chief physician for Delaware during COVID-19 – An ER doctor selling supplements: his answer to the eye-rolls Chapters (00:00) Cold Open: "Met a Girl on Hinge" (01:05) Welcome & Meet Dr. Rick Pescatore (03:16) The Drive to Pittsburgh: "Sounds Exactly Like My Mom" (04:30) Decades of Symptoms, Then the ICU (06:19) Vitamin B1 and Gastrointestinal Beriberi (07:03) "We Tell Them That They're Normal" (08:12) Saving Her Mom's Life With a Vitamin (10:03) Belly Pain: What the ER Can't Fix (11:27) Disorders of Gut-Brain Interaction (13:09) Should Emergency Medicine Change? (14:21) Diet and the American Food System (16:47) Sulfite Preservatives and Vitamin B1 (19:31) GLP-1s, Falls, and the Toenail Question (22:50) The Naval Academy, F-18s, and the Call Sign "Aquaman" (27:24) "I Burned Out of Emergency Medicine" (29:26) The 3 a.m. Problem: Night Shifts and Physician Health (30:40) Dr. Spiro on Night-Shift Anxiety (33:04) Chief Physician for Delaware During COVID-19 (35:57) Building Belly MD (40:33) Supplements: "I Used to Be That Guy" (44:12) An ER Doctor Selling Supplements? (45:43) Testing for Vitamin Deficiencies (47:47) Closing

A Monday morning, 6:45. Dr. Kim Blankshain is changing her infant son when she hears a crash in the next room. Her husband is sitting on the edge of the bed, bleeding from a gash in his forehead. She expects a few stitches. Hours later an ER physician says the CT scan came back and he is being sent downtown to see neurosurgery right away. "What is happening?" Dr. Blankshain is a neuro-ophthalmologist in the Chicago suburbs, a specialist in vision problems that begin in the brain and nervous system. She was in fellowship, trained to read MRIs and CTs, when the scan on the screen was her husband's: an epidermoid cyst pressing on his brainstem, and brain surgery set for the next morning. She joins Dr. David Spiro to talk about being the doctor in the waiting room, and how it changed the way she delivers bad news to her own patients. In this episode: - Why knowing the medicine made it harder, and the moment the neurosurgeon asked, "What do you do for a living?" - The waiting-room buzzer three hours into a four-to-six-hour surgery: "That can't be good" - Receiving bad news as a physician: "I wasn't really hearing what he was saying" - How she gives hard news now: slow down, say it more than once, and sit in the silence - Going back to work the day after her husband came home, with her time off for the year already used on six weeks of maternity leave - Parental leave in medical training, and why she calls the culture "cruel" - Working-mom guilt and the "have it all" lie: "Something has to give on any given day" - Marriage after a baby: feeling like roommates, a year of couples therapy, and TV-free Thursdays - What she tells pre-med students: "It's still just a job" Dr. Spiro also shares how he gives bad news to families in the pediatric ER. Chapters 00:00:00 "What is happening?" 00:00:20 Meet Dr. Kim Blankshain 00:01:50 What a neuro-ophthalmologist does 00:02:22 A crash in the next room 00:04:10 The ER and the CT scan 00:06:08 Rush University: the MRI and the neurosurgeon 00:07:27 "What do you do for a living?" 00:08:14 Brain surgery, tomorrow 00:08:53 The waiting room: "That can't be good" 00:09:43 Six weeks of recovery 00:10:13 How it changed the way she sees patients 00:11:45 On the other side of bad news 00:13:04 Slow down, repeat it, sit in silence 00:14:17 Dr. Spiro: bad news in the pediatric ER 00:15:25 "You are so lucky that you came to me" 00:16:36 Back to work the next day 00:19:41 Parental leave in medical training 00:22:43 Balance with a five-year-old 00:23:58 The "have it all" lie 00:24:39 On call on the Fourth of July 00:26:37 "It's still just a job" 00:27:50 Marriage after a baby 00:29:23 Couples therapy and TV-free Thursdays 00:32:33 Why she believes in therapy for physicians 00:33:44 "Nobody says that to a mechanic" 00:34:08 Why she reached out to HuMed 00:35:31 Closing Check out the Inside HuMed Newsletter: https://www.humedpod.com/inside-humed This episode is one physician's personal story and is not medical advice. If this episode meant something to you, follow HuMed on Apple Podcasts and send it to one colleague who needs to hear it.

A resident on night call writes one word in a chart to describe his patient's husband, a man in his 90s: "senile." He thinks it means "very old." The note gets corrected, but the word stays in the edit trail, and a few days later the record shows the patient has read it. Every instinct tells him to leave it alone. He calls the family to apologize anyway. Dr. Aditya Pawar is a transplant nephrologist at Beth Israel Deaconess Medical Center and Harvard Medical School. That phone call became "Safe Space," his essay in The New England Journal of Medicine. He joins Dr. David Spiro to talk about what the couple said to him on that call, why it took him years to understand it, and who a clinician's "safe space" really protects. In this episode: - The apology he almost didn't make, and why he says it would be just as hard tomorrow - Why "safe space" in medicine often protects the doctor, and what a "brave space" with patients looks like - Telling a patient you don't yet know the best approach - Practicing in India versus the U.S.: five-minute visits that never really end, and seeing your patients at the grocery store - Why he calls paternalism "a protective mechanism" - What he says to kidney patients who won't let their own child donate - What he tells first-year medical students about the 20-minute visit that needs an hour and twenty - His uncle's lesson from Sunday evenings seeing patients in a village in India: "As a physician, we've always lost" - Six hugs from a grieving family after one of his first codes Dr. Spiro also shares what it was like to lead his team's debrief after a child died in his pediatric ER. Read the essay: "Safe Space," N Engl J Med 2026;395:840-843. https://doi.org/10.1056/NEJMp2518528 Chapters 00:00:00 "As a physician, we've always lost" 00:00:20 Meet Dr. Aditya Pawar 00:02:03 "It started from a mistake" 00:02:33 Night call, a couple in their 90s, and one word 00:04:27 The phone call he almost didn't make 00:05:11 What the couple meant by "safe space" 00:06:37 Parents in the room during a resuscitation 00:08:20 Who is the safe space for? 00:10:03 From safe spaces to brave spaces 00:12:55 Medicine in India versus the U.S. 00:15:11 Sharp boundaries, and crossing the line 00:17:43 "Every single cell of my body is telling me don't do it" 00:21:14 What safe space meant as a child in India 00:23:10 Family, elder care, and what gets lost 00:28:16 Organ donation: "Do not take away that decision from me" 00:30:00 Teaching first-year medical students 00:34:26 Dr. Spiro: the debrief after a child dies 00:38:06 His uncle, Dr. S.S. Jamwal 00:39:49 One of his first codes as a resident 00:41:11 "This concept of death, you have to get comfortable with it" 00:42:11 Six hugs from a grieving family 00:42:44 Closing If this episode meant something to you, follow HuMed on Apple Podcasts and send it to one colleague who needs to hear it.