Welcome And Guest Introduction

Dr Andrew Greenland 0:00

Welcome back to Voices in Health and Wellness. This is the podcast where we explore how practitioners, founders and innovators are reshaping what healthcare looks like across clinical work, business models, and the future of care. Today I'm joined by Dr. Hwaida Hannoush, a specialist in metabolic cardiology and functional medicine and founder of Preci Med Clinic. Huayder's work is focused on helping women over 35, particularly those at higher risk, prevent heart disease before it becomes a crisis. What's especially interesting about her approach is her transition from conventional cardiology into a more functional root cause-driven model, bringing a much broader lens to cardiovascular risk. So with that, Hwaida, I'd love to welcome you to the show. Thank you so much for joining us today.

Dr Hwaida Hannoush 0:41

Thank you so much for having me on your show, Dr. Greenland, and it's my pleasure.

Dr Andrew Greenland 0:46

Wonderful. So

From Cardiology To Root Cause

Dr Andrew Greenland 0:48

could you walk us through your journey from conventional cardiology into functional medicine and tell us a little bit about what triggered that shift for you?

Dr Hwaida Hannoush 0:56

Wow, it's a long journey actually. So, because I spent a lot of time training in conventional medicine, and at the same time, I always had the research mind looking for answers to my questions. So I've always, since even my medical school, tried to do research, and then I went through the classic steps into uh cardiology. Um along that I had uh also published uh many uh research articles, and I've always had question why in my mind when I did my research, and um along the way uh I had personal exposure with the medical situations where I got no answers. Um so still didn't know about functional medicine. I dedicated myself to pure research uh work uh environment. Instead of working um with in a in a hospital or private practice, I dedicated myself uh to um pure academia um at the NIH and um more so in imaging and uh trying to be um uh specialized in advanced imaging to try to detect heart disease before it becomes um overt, and especially in patients, you know, NIH is more of a they have a lot of cancer patients, and um so you know uh my um aim was always to look for things before um disease uh becomes in its worst stages. Um with that said, uh along that way, I had other, as I mentioned, I had personal family illnesses where no answers were given at all levels, at all ages in my family. And so that is when I was looking for answers, more answers, and I came to know about functional medicine, uh, which is root-called medicine, and that satisfied my um what you call uh or relieved my soul in finding, oh, I found it. Eureka, that's it. Um and then uh I said, since I have a background in cardiology, why don't I focus on cardiology prevention? And then I uh found that women are very disregarded, very uh their symptoms are invalidated, they are under treated. So I said, okay, let me uh focus on women uh and empower them to recognize uh that heart disease is the number one killer. Unfortunately, nowadays, only 56% of women know this information. Uh they think it's cancer more than heart disease. Um, and unfortunately, as well, around 60 million in the US are struggling with one form of heart disease or another. Um and it's not only that um that I read statistics and guidelines, uh I uh you can say I uh experienced it firsthand when I talk to my cardiology colleagues, but my my male cardiology colleagues who uh still stick to the conventional risk stratification and uh discuss uh things differently with women uh in terms of risk stratification, um uh ignore the reproductive risk history uh in women as well. And that is when I was more adamant in pursuing uh my niche uh to empower women, and actually, not only I do a lot of education and webinars, but also I created a community um for empowered women hearts because this is like this is my goal in life.

Why Women’s Heart Disease Gets Missed

Dr Andrew Greenland 5:28

Amazing, thank you so much for that really helpful background and context. So, just digging into that a little bit, do you have any sense of why there is this differential between men and women? You said that women were underrepresented in all sorts of ways. Why why specifically in heart disease is there an issue in your in your opinion?

Dr Hwaida Hannoush 5:45

I want to say women to start with are more complicated probably than men with their physiology. They have a lot of hormonal differences. Uh they have on top um, including their reproductive physiology. Um that's that's a s that's um that's a statement I want to also uh add to it is that um women's symptoms are different from men's symptoms, and that's what makes the whole story different. Uh and misleads the um the health uh attention or uh planning or journey. Women may just complain of fatigue while they're having a heart attack, they may just complain of um stomach upset uh or or discomfort, they may have some kind of pressure in their chest, which themselves unfortunately, and there is a recent uh actual publication on this, women on they're becoming more and more disregarding themselves, their symptoms themselves. It's not only the doctors who disregard it because they think, okay, I'm tired, maybe I didn't sleep well, maybe I didn't uh you know um rest well, I maybe I over-exerted myself, and so they ignore themselves. And then coming into the medical, real medical physiology, besides what I've mentioned, women have more add-ons in their uh disease uh pathologies. Uh they don't have only uh big artery, coronary artery diseases or atherosclerosis, they're very prone to microvascular disease, and thus comes another phenomena, uh, which is HEFPEF, heart failure preserved injection fraction, which is up to the moment being studied. Uh they have uh, you know, they have also their pulmonary hypertension. Um they have extra risks besides what I've mentioned as far as hormone and uh reproductive uh risk factors. They have the side of autoimmune risk factors. Every time we studied in the in medical school autoimmune diseases, they said, Oh, it's prevalent more in women than men. So these are risk factors also that contribute to cardiovascular risk factors. Um, so in other words, I want to say woman physiology is very complicated, uh, whether it's symptom-wise, whether it's disease-wise, whether it's risk factor-wise. I want to add also, even the classic risk factors make a woman more prone for cardiovascular disease than a man, like simple one, diabetes. We all know diabetes is a risk factor for heart disease. If a woman and man, a woman and man have the same diabetic um numbers, risk factors uh are doubled in woman more than this more than men having the same numbers, having same um, if you want to say, uh, treatment. Uh so yeah, it is it is it is a it is a very complicated situation in a woman.

Dr Andrew Greenland 9:18

Really interesting. So you've come from a conventional background, and looking back now, do you feel that traditional cardiology is evolving fast enough or are they still missing the trick here?

Dr Hwaida Hannoush 9:29

I believe, and please, for every all my colleagues, they're still missing the trick. Uh, when I see that they're just ordering the classic cholesterol, HDL, NDL, and then focus on statins, we are still missing the trick. That's that's that's my uh conclusion.

Subtle Symptoms And Reproductive Risks

Dr Andrew Greenland 9:54

Interesting. So let's bring this down to the sort of the patient level. And what would you say are some of the early warning signs that women should be paying more attention to before disease develops? You know, we'd be people listening on this school that won't be as enlightened as you in this world. What what should they be looking out for?

Dr Hwaida Hannoush 10:12

First of all, before we so is talk about the um symptom, we should uh inform the woman about her body uh and her risk factors. Starting at a young age, whether when it's uh during when she starts having menses, uh any uh abnormal symptoms and menses. We were told this morning is normal, this is not normal. Then um during reproductive age, when they have complications, they are lost to follow with cardiologists, like pre-eclimpsia, gestational diabetes, even intra uterine growth retardation is a risk factor, placental abruptions, because after all, whatever uh vascular physiology is happening between the mother and the baby is also a risk factor for future cardiovascular disease. Unfortunately, uh these complicated uh cases they are not referred to a cardiologist after uh delivery. So I want the woman to know her risk factors before she starts experiencing symptoms. Um, the other thing, now we come to the symptoms, as I mentioned earlier. Symptoms are very atypical. If she feels a pattern with even an awkward symptom like pressure or a shortness of breath, that is repeating uh not till we're uh I mean, not uh till it's become very bad, but I mean a slight pattern, a subtle pattern that's repeating itself with her. Um she should pay attention and does not shouldn't ignore herself uh and should seek medical attention right away. Uh, she should be also when she seeks medical attention, if disregarded, she should know what she needs to check for. And she needs to enlighten the physician also that I had this and this this risk and uh including reproductive uh risks uh in the past, uh, so I need please to be checked. She should be a partner with the doctor in her health journey.

Dr Andrew Greenland 12:46

Thank you. So are patients becoming more proactive and educated about prevention, or are most people still reacting to a situation when it arises from what you're seeing at the moment?

Dr Hwaida Hannoush 13:00

Unfortunately, from what I've seen, they're still reactive and uh try to have false reassurance. I've spoken with women who are severely symptomatic and they're still agreeing that they're gonna be okay no matter what, even though the plan is unchanged and nothing is changed about uh digging deeper into their story, health story. Um, so yeah, it is it's still reactive from both sides, women and the doctors. We're very good in healthcare system at uh addressing uh uh acute situations like acute MI, opening arteries, acutely, emergency, um, though there is a bit of delay when it comes to women as well. Uh what we call in confidential cardiology door to cath lab timing is still longer in women. But uh yeah, the the techniques are still are are excellent. We manage very well acute situations, but that it's all reactive and uh yeah, there's no proactive environment.

Reactive Care Versus Prevention

Dr Andrew Greenland 14:21

You're in a fast-moving space. What trends are you seeing in functional medicine or metabolic cardiology that are really exciting you right now? What are you looking to the future for in terms of your the space that you're in?

Dr Hwaida Hannoush 14:34

Uh first of all, um not only because it's root-core medicine that I'm excited about, I'm excited about functional medicine because it links all body systems together. And that's a huge uh excitement to me as well. I don't look at the heart alone, I look at all other organs. Um, I look at the milieu, the environment, the inflammation, the cardiometabolic, and uh yeah, going back to inflammation, the gut health, um uh hormonal situation. Um not only that, I'm trying my best to advance. Uh I mean, no, it's not advanced, it's I mean moving earlier, the prevention uh knowledge uh and not waiting for menopause when it when the whole problem starts uh to uh start uh addressing cardiovascular health in women. So I'm moving every every time I'm moving uh earlier and um as you heard me, I say okay, teenage, honestly, atherosclerosis can start a neutral, but let's wait, let's let's start educating the um teenage, the um and afterwards, um, and uh we'll get there hopefully. Yeah.

Whole Body Metabolic Cardiology Lens

Dr Andrew Greenland 16:18

So really good insights into your philosophy and your approach to functional medics, the value of functional medicine, root cause medicine. But could you talk us a little bit about what your clinic is uh what's the setup is for your clinic? So Pressimed, what it looks like today.

Dr Hwaida Hannoush 16:33

Presimed is a virtual clinic, only virtual clinic, so that I can have access to as much as I can of uh women. Um and it's um uh not only that, I've made it since it's a virtual clinic, it's it is um it's it has all the technical uh capabilities, uh whether starting from uh RPMs, uh ordering tests, functional medicine tests, or even blood work. Um, everything can happen from a distance. Ummunication. What is so special about Presimet is that I have patients have access to me 24-7. They chat with me through the AHR and they don't have for to wait for long waits for to contact the doctor and they access me directly. So uh this is this is one thing about Presimed Clinic. Uh, and I'm very happy that I'm doing it this way. Because I hear like sometimes um, and I know it for a fact, patients wait for six months to be with a specialist, and things can't wait. Uh otherwise they will end up in the emergency room and waiting the long hours in the emergency room. Uh, so yeah, uh this is this is one thing about Presimed Clinic.

Inside A Virtual Prevention Clinic

Dr Andrew Greenland 18:12

So, what does a typical day look like look like for you running a solo telemedicine practice? And I know no two days are going to be the same, but just give us some sense of how this kind of maps out.

Dr Hwaida Hannoush 18:23

So um it's split into sections. First part of the day is attending to the messages, as I mentioned, uh, or emails from the patients. Um the second part is um seeing patients, and then uh the third, this is this is a general because there is one day where I dedicate um a community uh QA weekly. Um so yeah, but the general is patients as a start, messages, emails, then the seeing the patients or clients, and then there's the education part, and whether it's my education or others' education, attending uh webinars, conferences, or uh and uh writing, whether I write in social media or I write for newsletters. I'm a member of many newsletters. Um and yeah, later on we can uh I can share these. And then let's not forget uh the um the uh marketing part, technology part, um, AI part. Uh so yeah, this is this is how it goes.

Dr Andrew Greenland 19:56

Yeah. So it sounds like you really crack the model. What are you most proud of in what you've set up? What's working especially well for you in the business?

Dr Hwaida Hannoush 20:06

Um I'm so proud that I discovered this route, and I am able to help as much as I can. I know one hand we have a saying, one hand cannot clap. Um but um I wish I did the the only thing I regret, I do I wish I did that earlier. But I mean, I think everything comes in its own timing. Uh I'm so proud of um also with the feedback from my patients, their um their comfort, uh, even though you know having a mindset of remote uh or telemedicine is not uh strong enough up to the moment. Many patients still feel they need to see the doctor in person. Uh so uh yeah, I'm so proud of what I've done so far as far as the patients and myself.

Day To Day Operations And Automation

Dr Andrew Greenland 21:13

That's a remarkable achievement what you've just been going through. But um I guess there must be some frustrations or challenges in doing this kind of model. What are those?

Dr Hwaida Hannoush 21:24

Yes, of course. Um I have I to be honest, I have uh a lot of frustrations. Um I mentioned part of it when I told you about the mindset. Uh the mindset of the healthcare system and uh the patients themselves. Um it needs a lot of work. Um even collaborating with other physicians like other uh GPs and Trying to, or specialists and trying to introduce the concept of functional medicine, they completely dismiss it and try to cut short the conversation with me. This is a big this is a big frustration. And this is one thing. The other thing, of course, is coverage of the functional test, the financial part, because some patients they're so eager to be attended to by functional doctors, but the cost of the tests is not reimbursed by insurances. And so they have to pay out of pocket. And this is another point I want to just interrupt. When I was in conventional medicine, I used to try my best not to test. But when I went into functional medicine, I I became a believer, strong believer in test, don't guess. So yeah, these are the two main: the mindset, the uh uh and the communication with conventional uh doctors and uh the financial aspect.

Barriers: Mindset And Test Costs

Dr Andrew Greenland 23:36

Thank you. Really, really good insights. What about the sort of operational business challenges in running a platform like this? You've talked about the mindset and the communication stuff. That's a people thing. But what about the day-to-day nitty-gritty of running the operations of the platform that you have?

Dr Hwaida Hannoush 23:51

Um I have a lot of automations that help me with this day-to-day as well. Uh, if that's what you mean. Um, and uh of course, yeah, as that's why I told you technology is very important. Um and uh yeah, it's it's uh technology is my best friend in this. Um in smoothing uh the flow of work. Yeah. I hope this answered your question. Oh, it does, it does.

Dr Andrew Greenland 24:24

Um I no, absolutely. Um the whole point about the podcast is to understand some of the things that we never really hear about, you know, the day-to-day chances of running businesses and clinics, and this is really, really helpful. So I guess um if you had a sudden influx, sudden influx of new clients next week, nice problem to have, but would anything break? I mean, what would happen if you had you know 15 new clients next week?

Dr Hwaida Hannoush 24:51

Um let me feel this because I don't have 15 clients per week. They go um uh up to the moment because it's a newly launched uh uh clinic, but uh nothing will break, everything will be flow, everything is ready uh for the patient uh from day one till we go with their journey, yeah.

Dr Andrew Greenland 25:19

So you've obviously put a lot of automation into your system to support you, but what's the biggest time drain for you personally in the work that you do? Is there anything that takes you away from what you really like doing?

Dr Hwaida Hannoush 25:31

No, not at all. Because I take my laptop wherever I am. Um, I am a mother, I have a kid who is uh an athlete, I go with her all tournaments over the weekend. I was out of town. Uh I was um uh having my laptop with me and working while attending to her tournament. I coach her, sort of, if you want to say that. Uh and I have a lot, uh I have other hobbies uh besides traveling. I also um interested in uh I like cooking. I'm uh I love cooking and uh entertaining and uh people uh social events, so yeah, it's it's uh it doesn't take me away. It is just uh this online uh this uh online presence made me uh flexible with my uh schedule. Um I I have to admit that some as I mentioned, I am working over the weekend, but during the weekday, I may have three. Actually, Friday is a uh is a mostly free day. This is this is not the norm. You said you asked me about my regular days. I have Friday is uh mostly um dedicated for um contemplating not cont I don't want to say the word contemplating um thinking thinking time uh of new ideas uh and uh new um uh event. Just it's my my my own inner my own time with myself to just think uh and uh maybe do some collaborations as well uh with other functional uh doctors and bring up some ideas. Um yeah, that's and yeah, you you don't want to know that I have a lot of ideas on the go on the to come.

Dr Andrew Greenland 27:46

Love it. No, I I totally get it, and um I think you know thinking time should be scheduled. I think it's very important. It often gets squeezed in the way that practitioners work. We're all kind of working really, really hard, trying to see as many patients as possible, and forget we need that kind of contemplative think of time. So I I totally get that. Um so are there any challenges around you know the balance between being a practitioner and a business owner? I mean, it sounds like you've nailed this, but I'm just curious to know if there's anything which upsets the balance.

Dr Hwaida Hannoush 28:20

Yes, of course, especially that's as a startup, um, because um you have to learn other things that are not related to your specialty. You know, I had to be mentored and spend time as if I'm in school, in a business school again. I have to do some work that I wasn't used to doing. Um, yes, of course, this is very challenging. And uh, you would probably say, Oh, why would I do that? Let me hire somebody and that's it, and spend this time doing something else for my uh specialty or clinic, or um not only that, um, even for my family as well. But going back to it uh and looking at my journey uh learning business, I think it gave me a lot of information also about the pain points of the clients when I called them, when I discussed things for them, when I had this uh discovery calls, uh, and trying to see um I mean to do it from the business point. Uh you know, you have to do discovery call before you they enroll in a program. That's like a journey, that's a stepwise uh journey. So I think I learned a lot. Um, and plus the business part I learned a lot about. Uh yeah, it is challenging, as I mentioned, time-wise, effort-wise, uh, but it's worth it to know. Okay, and plus, sorry to to keep uh to say one more thing, and plus in the future, when I want to enroll uh or employ uh an assistant, I know what's happening. It's not that uh so that I can teach my assistant to um what uh how to address issues. If I didn't know all of these things and immediately hired someone, I don't think it would have worked. I would have uh a turnover of assistance. So learning things myself and then teaching them to my assistant who I hope hopefully I will hire, um, yeah, that that makes a lot of a difference.

Dr Andrew Greenland 30:58

Great

Advocacy Messages And The Next Decade

Dr Andrew Greenland 30:59

advice, I like it. Um now you've talked a lot about social media, and you also mentioned earlier on about the sort of the awareness problem. What are you what kind of messages are you trying to get out there for people to read to try and change that mindset of reactivity rather than being proactive?

Dr Hwaida Hannoush 31:18

Uh lots of things in their mindset. Uh, first of all, uh it's not only about the scary, uh the uh the alertness that cardiovascular disease is number one killer, it's about knowing what are the risks, what are their symptoms, how they are different, and what they should do, and how they should interact with their physicians and ask questions, and they should be their own best advocates. That's the bottom line. There are lots of lots of myths ongoing, it's not only the cholesterol myth, there are lots of them, lots of others. So I'm not gonna dig into these now, but having what I mentioned as awareness of um how to handle the situation, uh, and ask questions and ask the why. This is also another important why do I have high cholesterol, for example? Why uh I am still short of breath while my tests are normal. Uh there is always a why. And that's how I actually, you know, Dr. Greenland, everything I do with the patients, I am doing it as if I'm dealing with myself and my family. And I went through this in every simple simple situation, clinical situation in my family. I always asked why to find the answer. So this is uh number one uh recommendation in the mindset ask the why, know your body, know your risks, and don't also accept uh we don't know also for an answer because I got this uh this uh statement myself and my family. We don't know, or we don't have a treatment.

Dr Andrew Greenland 33:32

Thank you. So next 12 months, where what do you like what would you like to achieve in the next 12 months with the clinic? Where is it where's everything going for you?

Dr Hwaida Hannoush 33:43

Wow, this Friday off is uh bringing a lot of ideas. Um you started saying I help 35 plus, I'm going younger uh in uh in uh raising awareness. And I actually starting I'm starting with my daughter who's 14. Um not only going younger uh and addressing um special uh populations as well, because there are populations who are at more risk of heart disease. Uh I'm talking about from women as mostly right now. In the next 12 months, I'm sticking with the women's uh with the women's uh niche. Um and so uh yeah, going younger, special populations, um just off uh the burner, if you want to say uh you say say it this way. Um athletes, this is very important. Uh they have they are a special population who needs special attention as well. Um yeah, and so yeah, um this is for the time being, I see myself.

Dr Andrew Greenland 35:12

Okay, I'm gonna give you a crystal ball to look in. How do you think preventative medicine is gonna evolve over the next decade from your standpoint of what you're seeing?

Dr Hwaida Hannoush 35:24

If we don't change the way we look at medicine, ill for the pill, and wait for the disease to happen, preventive medicine is gonna be staying stagnant. I want to say something, uh just as an uh transition statement. Functional medicine is not provide, is not a magic or something out of the norm. We when I everything I learned, I say I tell myself, I've learned this in medical school the first two years. All the biochemistry, the physiology, everything was learned. But then in the second half of the training, we were shifted in a way to get a diagnosis and give a medicine. Even it's funny because the first thing when I graduated, I was worried that I will forget the name of the medications to give for a diagnosis. Uh so this is this is this is uh we have to go to the basics, to the medical school, what we learned, and try to build on that to prevent disease. Otherwise, if we're still practicing the same we are doing right now, uh I think we're gonna be having the same, uh, you know, as stagnant. And actually, there was um an article about the 2050 uh project projections for women's heart health, and interestingly, they said there is gonna be increase in cardiovascular disease, there is gonna be increase in um metabolic disorders, and then the interesting part, but there is gonna be increase in statin use and uh um and more uh compliance with statin use. So you have this discrepancy, you're having more compliance with statin use and treatment of cholesterol high elevated cholesterol while you're having higher cardiovascular incidence and higher metabolic. So there is a gap here we're talking about. Something is wrong.

Dr Andrew Greenland 37:50

Yeah. With that, Waido, I'd love to thank you so much for joining us today. It's been a really interesting conversation. Thank you for your insights. Thank you for sharing your philosophy on functional medicine and your preventative approach, but also telling us a little bit about the behind the scenes of running a successful telehealth platform that you have. It's been really, really interesting. Thank you so much for joining me.

Dr Hwaida Hannoush 38:11

So much, Dr. Greenland. I'm very appreciative, and it's my honor. Thank you so much.