Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs. Hi, this is Daniel Lobell with the Doctorpedia podcast. And today I’m on the line with Dr. Nassir Azimi. How are you, Dr. Nassir?

Dr. Nassir Azimi: (00:35)
As good as you are. I’m here having a beautiful afternoon in San Diego. Just finished my cases and looking forward to a weekend where I don’t have to work.

Daniel Lobell: (00:45)
That’s great. And should I call you Dr. Nassir or would you rather I call you Dr. Azimi?

Dr. Nassir Azimi: (00:51)
Whatever! Whatever is more fluid for you is good enough for me. You can call me Nassir. You can call me Dr. Azimi. You can call me Nassir Azimi. You can call me anything.

Daniel Lobell: (01:03)
This is an easygoing doctor! I mean, that’s pretty cool. You never know, you deal with all kinds and you are one of the top doctors in the world. So to have such an easy going attitude about things, I will say is quite impressive. But before we get into how you became one of the best doctors in the world, I’d like to start at the beginning. You have such a fascinating story. And I got the opportunity to read a little bit about you before the interview. I’ll lead into it, but you were born in Afghanistan, is that correct?

Dr. Nassir Azimi: (01:32)
Yes. 1970 Afghanistan.

Daniel Lobell: (01:35)
That’s vintage. That’s vintage Afghanistan. [Laughs]

Dr. Nassir Azimi: (01:38)
Yeah, “the good old days”, as they call it. The days before terrorism and the days before war and all of the things that evolved. I mean, when I was a kid, I didn’t even know what a gun was until I grew up to be nine years old. And then I saw them on the streets.

Daniel Lobell: (01:55)
Oh, I thought you were going to say, “and then I joined a militia.” It’s better that way – that you just saw them on the street.

Dr. Nassir Azimi: (02:00)
Well, I was too young. Believe it or not, they were recruiting us! My parents left – for a few reasons – but one of them was that they were already recruiting our cousins – one side for the military (although the military was a little bit more organized) but the other side, the Mujahideen or the rebel forces, they just looked at you and if you were tall enough, they gave you a gun and took you.

Daniel Lobell: (02:26)
That’s like, “there goes the neighborhood.” You know, “they’re giving kids guns, time to go.” Huh?

Dr. Nassir Azimi: (02:32)
[Laughs] Yeah. It’s a lot like some parts of Los Angeles, where they get guns as part of a certain ritual.

Daniel Lobell: (02:41)
Right. So that seems like as good a reason to move as there ever has been one. And you guys moved to Pakistan, right?

Dr. Nassir Azimi: (02:48)
Yeah. When you say “I moved”, it sounds a lot like you take a plane ticket or you book a bus and then you pack up and go. We were kept in secret. My mom and dad one day basically said, “we’re leaving.” And we said, “where are we going?” And they had some packages and said, “we’re going to grandma’s house.” We went to grandma’s house. Then all of a sudden, the next morning we were at a bus station, took a bus to the outskirts. Then there were four nights (because during the days they would bomb people leaving the country) so we would take nighttime travel; sometimes on camels, sometimes walking and sometimes renting jeeps that were basically smugglers that were taking people away across the border into Pakistan. So we actually had a journey like that. It was four nights in total. During the days we kind of slept in the villages or wherever there were places to kind of rest.

Daniel Lobell: (03:47)
None of that sounds very fun except the off-roading in Jeeps.

Dr. Nassir Azimi: (03:52)
Yeah. [Laughs] Actually, riding camels and things like that were also kind of part of the picture.

Daniel Lobell: (04:00)
Be honest. That sounds fun too. Yeah.

Dr. Nassir Azimi: (04:04)
It’s more fun in Cancun when you’re on a beach, though.

Daniel Lobell: (04:07)
I rode camels in Essaouira, in Morocco with my wife recently.

Dr. Nassir Azimi: (04:11)
Nice.

Daniel Lobell: (04:11)
And it was the first time to my memory that I ever wrote a camel and I was terrified. I mean, you’re so high up – it’s not what you think.

Dr. Nassir Azimi: (04:20)
I was just about to say it doesn’t sound like you’re afraid of heights, because that is a height up there.

Daniel Lobell: (04:26)
Yeah. We were also on the edge of a cliff overlooking the city. So it was a double height. Yeah.

Dr. Nassir Azimi: (04:33)
That is scary. I can only imagine the view right now.

Daniel Lobell: (04:36)
It was beautiful, but you had to tell yourself, “okay, I’m sure this camel knows what he’s doing.”

Dr. Nassir Azimi: (04:43)
[Laughs] He’s been fed well.

Daniel Lobell: (04:46)
[Laughs] I mean, this is not a typical childhood of the people that I get to speak to usually, but it’s certainly an exciting one. I think your life started off like an Indiana Jones movie.

Dr. Nassir Azimi: (04:59)
You know, honestly – I know when you say it, it kind of sounds a little bit cliche, but in reality, whenever I look back and I think about my life, I think I watched a movie. I can’t imagine that being my life. I mean, look at me today and where I am in beautiful San Diego practicing interventional cardiology, having 12 years in the Ivy League, constantly getting awarded honors and living a life that I could never have dreamt even during peace time Afghanistan, but especially after the war, being a refugee in Pakistan, spending two years there, where my mom and dad worked in the refugee camps and then ultimately coming to America and not being able to speak English, but learning it over a few months and then excelling at school. When I sit here everyday, people always ask me, “why do you always look happy?” Because when I look back, the only choice I have is to be happy and be grateful for what I’ve been given.

Daniel Lobell: (06:03)
Yeah. Wow. How old were you when you moved? Or escaped?

Dr. Nassir Azimi: (06:08)
When the Russians invaded, it was 1979. I was nine. When we fled, it was 1981. So I was 11. And when we got to the United States in August of 1983, I was 13.

Daniel Lobell: (06:24)
Wow. And that’s when you learned how to speak English?

Dr. Nassir Azimi: (06:30)
In Afghanistan in the seventh grade, you started learning the ABCs and they educate you. As you can imagine, most countries have English as a second language. And so for us, it would have been that route, but I wasn’t there in school long enough to learn any English. Then when we were in Pakistan, I was born speaking Farsi, but in Pakistan I had to speak Pashto and Urdu, so I had to learn those languages–

Daniel Lobell: (07:00)
–But isn’t Pashto also the language of Afghanistan, isn’t it? And Dari?

Dr. Nassir Azimi: (07:04)
Yes, it’s half. Dari is the language I was born with. Half of the people (approximately) speak Dari or Farsi and the other half speak Pashto. And I did learn Pashto there, but I became more fluent in Pashto when I was in Pakistan in actual organized school.

Daniel Lobell: (07:22)
They taught very little Pashto when I was a kid in school in New York. Very little Pashto. [Laughs]

Dr. Nassir Azimi: (07:28)
Yeah. Well, they’re teaching more now. [Laughs] You have to go to Bronx Science or Stuyvesant or one of those schools, you know?

Daniel Lobell: (07:39)
[Laughs] Farsi is a helpful language to have in California, certainly. Especially if you want to get some nice gourmet Sabzis or something.

Dr. Nassir Azimi: (07:48)
Oh yeah. Especially in LA, because there’s basically a rich culture of Persians and a lot of Iranian immigrants and a lot of great, great food and culture. In San Diego as well, w have a lot of Persians here in San Diego. The dialect is a little bit different, but there are actual Dari-speaking Afghans also in LA and San Diego.

Daniel Lobell: (08:12)
Yeah. That was one of the shocks for me moving from New York to LA, I thought I was preparing for a culture of Hollywood, but when I got here, it was a culture of Iran.

Dr. Nassir Azimi: (08:22)
Yeah, exactly. You know, the nickname for Los Angeles – Tehrangeles. Right? I don’t know if you’ve heard that but that’s what a lot of people call it.

Daniel Lobell: (08:34)
[Laughs] Tehrangeles. Tehrangeles sounds like a kind of spider.

Dr. Nassir Azimi: (08:39)
[Laughs] Yeah, could be.

Daniel Lobell: (08:39)
“Watch out there’s a Tehrangeles over there!” So we’re laughing a little bit, which is a good lead in to talk about the fact that I am a comedian and when I was reading up on you, it said that that was a dream of yours, that you wanted to be a comedian. By the way, I think you went the right way with this.

Dr. Nassir Azimi: (08:56)
I know!

Daniel Lobell: (08:56)
But I’m curious how a kid growing up in Afghanistan and Pakistan developed an interest in comedy.

Dr. Nassir Azimi: (09:08)
Well, when you live life and you especially go through some difficult times, you either find sadness to run to, or you turn to laughter. I tend to like laughter as a better alternative. For me, it was always reading jokes and telling jokes. My favorite section of the Reader’s Digest was “Laughter is the best medicine.” I don’t know if you ever remember reading that, but that section always had the good jokes. During my high school years, I would stay up until late at night watching Saturday Night Live. When I went to New York, I wanted to see if I had any chance of being on that show, which I didn’t, because I didn’t have any idea of how to approach it. But in my first year, I was on the board of managers at Columbia University. And as part of that, I basically organized a lot of activities. I was also selected to be a manager of the Student Activities Center. So I had a dual role and I got to hire comedians like A. Whitney Brown and Rob Schneider and Adam Sandler. And then of course, when Adam Sandler was giving his presentation, I got a little five minute chance to do a little intro and “open for him”, if you will. And obviously I blew it. I really blew it. The audience, most of them were people I had invited, because they were my classmates and schoolmates. I got booed. And when you get booed at any level, it’s bad, but when you get booed at an introductory level, you learn to start studying your chemistry better because your hopes of being a successful comedian are kind of demolished. I actually ended up studying hard and being a doctor. But to be honest with you, that ambition still is a part of me. I still make a lot of jokes and I still use humor to disarm patients. I was just teaching my students yesterday – when a patient is very irritable and angry and I can’t break through and I can’t have any connection, I actually stick a piece of paper that’s blank. And I write the letter I and the letter Y and the letter Q and I ask them to read it. And they say, “I Y Q” and then I say, “I like you too.” And then that kind of creates a little bit of a breakthrough.

Daniel Lobell: (11:32)
[Laughs] It’s so silly but it’s good.

Dr. Nassir Azimi: (11:36)
And then we go and restart. But because actually the way I write, they usually read “I X O” and I go, “no, please let me rewrite it.” But you get where I’m going with that.

Daniel Lobell: (11:50)
Hey, you could have brought an easel up on stage and done some stuff like that. It might’ve been kind of an interesting act.

Dr. Nassir Azimi: (11:59)
Yeah. I have some good jokes that have come along over the years, but I don’t want you to steal them for your routine. So I’m not going to tell you.

Daniel Lobell: (12:07)
Right. Never trust anyone.

Dr. Nassir Azimi: (12:07)
[Laughs] No I’m just teasing you.

Daniel Lobell: (12:07)
[Laughs] Good advice from a doctor.

Dr. Nassir Azimi: (12:14)
Actually do you know Extra Normal? Have you ever seen Extra Normal?

Daniel Lobell: (12:21)
No.

Dr. Nassir Azimi: (12:21)
Okay. There used to be a website called extranormal.com and you could take characters and feed them lines and then change camera angles, and then create little cartoons. I created a few of them based on my own original jokes. One day I’ll just send you a few of them so you can see them. They might not be funny to you, but they are, to me. For example, I have one that says (Maura and Noah are my kids), so it says, “Hi, Maura.” “Hi Noah.” And then it says, “I went to the store the other day and I ordered a Dr. Pepper.” It says “What happened?” And then the waitress came back and said, “we have a shortage of Dr. Pepper.” And so what did she bring to you? And then she brought me a PA Pepper. So obviously the way I say it right now is not as funny as if you watch the little cartoon that I’ve made because as the Dr. Pepper showed us, there’s a lot more PA peppers.

Daniel Lobell: (13:18)
[Laughs] Yeah. Pepper. I like it. I like it. And I would love to see the cartoons, please do send them to me.

Dr. Nassir Azimi: (13:25)
I’ll send them to you.

Daniel Lobell: (13:25)
You know, the difference between people who become comedians and people who don’t is a very deep seated delusion. I, myself, and many of my friends bombed probably just as hard as you did opening for Adam Sandler. And the only thing that kept us going was probably a need for love and attention and some deep seated delusion. But eventually you get your footing for it.

Dr. Nassir Azimi: (13:50)
Well, Danny, I like to call it courage. Let me tell you a story you won’t believe, but it’s a true story. Okay?

Daniel Lobell: (13:58)
Am I still allowed to try to believe it?

Dr. Nassir Azimi: (14:02)
Well, I’m going to convince you to believe it once I finish, okay? It’s going to take a few minutes and you can delete it if you don’t like it, but it talks about courage. Have you ever heard of Matt Iseman, Dr. Matt Iseman?

Daniel Lobell: (14:16)
No.

Dr. Nassir Azimi: (14:16)
He’s the host of the American Ninja Warrior. About two years ago, when Schwarzenegger was the host, he won The Celebrity Apprentice. The reason I’m telling you about him is that he went to Princeton, undergrad, and from Princeton, he went to Columbia University Medical School, which is a prestigious medical school. And then when he finished those, after eight years of his track as an aspiring doctor, he was my intern at the University of Colorado. We both did internal medicine for a year. And he was obviously during that time also doing his standup and going to the Comedy Store, et cetera. But at the end of that year, he invited all of us to his father’s house and he made an announcement. His announcement was that “I’m leaving medicine.” After – the way I look at it is – 200,000 minimum hours of Princeton education, maybe 300,000 minimum hours of Columbia education, a year of his life given up to internship – he left medicine for comedy. We all thought that was the punchline because we thought that was a joke, but he actually did it. What it took for him is a lot of courage. The ability to basically be able to say, I’m going to erase all of these years when I contributed and I struggled to become a doctor to go on and pursue the dream that I always wanted. And to be honest with you, I think now he’s laughing at us because he’s enjoying life. He’s not getting paged every 30 minutes. He’s not waking up in the middle of the night and he’s going around doing what he loves. So the difference between him and me, and the way I see it maybe you and me, is that you have the courage to pursue that dream. When obviously I was too afraid to leave medicine because that’s the only thing I knew and that was my only channel to a life of success. And I’m very happy. So I’m not trying to sit here and say, “Oh, I wish I had done that.” That’s just a small part of me that wishes that I had done that because the things that I get is that I get to help people. I get to potentially keep a person living longer for years to come and that in itself is rewarding.

Daniel Lobell: (16:32)
I would imagine so, and I’ll tell you this: it’s never too late to throw away a life of medicine. [Laughs]

Dr. Nassir Azimi: (16:42)
[Laughs] Well, if you convince me, that’s probably where I’m going to go,

Daniel Lobell: (16:46)
Oh boy, I think too many people’s lives depend on you not doing that. But I think you can always also do comedy. Why not? I like to think that if I could do what you do, I would do it because I would love to be able to save lives.

Dr. Nassir Azimi: (17:06)
Yeah. I’ll be honest with you. Laughter is a good way. I really feel like when you make people laugh, there are actually studies that show you release endorphins and chemicals that actually help to benefit, not just the mind, but also the body in terms of the cardiovascular health and the relaxation of blood vessels and other benefits. So I really believe that when you make people laugh, you make a big difference.

Daniel Lobell: (17:33)
So you’re saying I’m costing you work. [Laughs]

Dr. Nassir Azimi: (17:36)
Actually, yes. I think if there was less laughter, there would be more business for me. But to be honest with you, I don’t want to have more business. I’ve actually been complimented – and I take it as a compliment – because one of the nurses who works with me and he’s been experienced for over 20 years, he said to me, “you’re different because you’re always hoping that your patients are normal, that they don’t have disease. Where the others are interested…” And I’m not actually indicting my colleagues in any way. I just feel like all of us, this is what we do. We want to help. But I actually wish that they’d be normal, that they don’t have disease so that I don’t have to be needed.

Daniel Lobell: (18:18)
Is it just out of laziness? You get there and you go, “Oh man, I hope this guy’s not sick. I hope I don’t have to do anything.” And you’re like, “Oh man, that’s an hour of work right there.”

Dr. Nassir Azimi: (18:27)
Well, I don’t want to call it laziness because if you look and I think I’ve probably told you, I did four years at Columbia University. I went four years to Dartmouth Medical School. I spent three years at the University of Colorado, internal medicine, three years of general cardiology at Yale overlapping with a year of nuclear at Yale and then a year of interventional cardiology at Yale. And so that’s a lot of sleepless nights and effort. And I definitely didn’t do all that to try to stay out of doing work.

Daniel Lobell: (18:56)
I don’t know, if I’ve ever heard a description of lazy it’s that. [Laughs]

Dr. Nassir Azimi: (19:04)
[Laughs] Then I can’t win you over, my friend.

Daniel Lobell: (19:06)
I was kidding when I made the laziness joke, but I think it’s also a good lead-in to talk about: I think it’s pretty impressive that you hold four board certifications and you’re certified in internal medicine, cardiovascular medicine, nuclear cardiology, which I’m not even sure what it involves – I guess people who have almost had a heart attack from bombs – and interventional cardiology. What is interventional? I guess you just intervene? How’s that any different than any cardiology, aren’t they always intervening

Dr. Nassir Azimi: (19:35)
The truth is that most doctors that practice medicine are doing some intervention to help. I mean, even when a psychologist takes somebody and confronts them about their issues it’s actually called an intervention. So you could argue everything that we do is some form of intervention and trying to get somebody on the right track. But in the context of interventional cardiology, it means that when somebody is having a heart attack, G-d forbid a clot forms in an artery. Then my pager goes off, right? The patient will start calling 9-1-1 at the same time as 9-1-1 is activated, I get a page that 9-1-1 may get an EKG before the patient even gets to the ER and that EKG gets sent over the internet or over the wireless network to me. I look at that EKG and I go, “this guy’s in trouble” and I leave the house. By the time I get there, I might get there at the same time as that ambulance. And then the first thing we do is we take that patient to a procedural unit called the catheterization lab, where we take catheters and we enter their body and take pictures of their heart arteries, looking for blockages. If they have blockages and we can fix it, then we push a wire through the blockage, put a balloon to dilate it and then leave a stent, which is a wire mesh to keep that artery open. That’s the intervention. That’s the most common intervention that an interventional cardiologist does, but there are other interventions. It used to be if you had a valve problem in your heart, then you would actually have open-heart surgery and somebody put a new valve. Then you would spend a couple of days in the ICU and a few days on the floor. Assuming you had a normal progress within a week or two, you’d be discharged home, and then you’d have a month of recovery just healing your wounds. Now we actually put valves through the groin, from a transcatheter approach. Most of our patients leave the hospital by 24 to 48 hours. We’ve sent more than half of our patients – even if they were in their nineties – home 24 hours later, without any observable sign that we were inside the body. So that’s an intervention and we’re keeping people around. You could probably… I could find you patients that you could interview that we’ve done a valve, let’s say in 2014, who are now walking around. Some of them – one of my patients was 93. And at that point, some people were wondering, “what did you do?” “How long is this person going to live?” If you see that patient right now at age 98, about to be 99, you would say, “wow, she looks good now, but imagine what does six years mean to somebody?”

Daniel Lobell: (22:15)
Right.

Dr. Nassir Azimi: (22:15)
In the old days, we’d say, “you’re 93, you have a bad valve, no surgeon wants to touch you, then get ready and go get your life organized and arrange for your death so that you could have a dignified death.” But what we’re doing now is actually prolonging that life, but not just adding years, adding quality to those years. Valve replacements, these Watchman procedures, we are actually now embarking on mitral valve interventions. We’re doing a closure of holes. It used to be that if you had what we call a PFO or a septal defect in your ventricle or in your atrium, you’d have to go for a open-heart surgery. Now we do those procedures through the vein and the patient could be home the next morning. I would say 95% of my patients that had a hole closed in their heart went home the next day. That’s pretty impressive in itself. I think we’re really pushing it. Our field is really coming along in terms of interventional cardiology. But I like to start with a joke about that if you don’t mind. A few years ago I ordered white coats. One of the reasons that they criticize us is our penmanship in medicine, right? They say doctors have bad handwriting. I sent my coat with my name and my field – interventional cardiology. And what came back in the mail after I paid $30 was a quote that said “Nassir Azimi, MD.” And then at the bottom international cardiologist, because they didn’t realize it was not interventional. They read it as international.

Daniel Lobell: (23:56)
That’s also accurate.

Dr. Nassir Azimi: (23:56)
I look at this thing and I’m thinking, “do I throw this thing away? Is this a good idea?” Because it’s not really reflective of what I do, but then I said, “no, I spent $35. I’m just going to wear it.” Nobody challenged me, so I actually decided to order a bunch of them because now I can claim to be an international cardiologist.

Daniel Lobell: (24:19)
[Laughs] I love it. And you are one! You’ve certainly moved around the globe.

Dr. Nassir Azimi: (24:24)
[Laughs] That’s true.

Daniel Lobell: (24:24)
Your parents were both doctors. You kind of touched on this when you were talking about how in Pakistan, they were treating people. Was that with the Red Cross or what was the capacity that they were working in?

Dr. Nassir Azimi: (24:35)
It was a refugee aid group called Inter-AID. They were international group that were going around and in the refugee camps, bringing rations and supplies and providing medical care. My mom was an obstetrician gynecologist, but they didn’t need that. They needed a primary doctor. So she actually worked as a primary care provider for them in the camps.

Daniel Lobell: (25:04)
That’s amazing. And I imagine that you watching your parents do this kind of work is what probably inspired you to go into the field, right?

Dr. Nassir Azimi: (25:15)
Oh yeah. So I came here, I didn’t speak English. I was trying to learn English and people would ask me when I could answer them: “what do you want to do?” With a very thick accent, I would tell them “I want to be a doctor.” Some of them would obviously (probably) grin and maybe wonder, “how is this guy going to make it?” But I had a strong will and my mom who basically encouraged me and said that I could do it. She always pushed me. My mother was a doctor in Afghanistan and worked at the Pakistan refugee camps but when she came to the U.S., she couldn’t pass her US MLEs – the medical licensing exams that required her to have a license.

Daniel Lobell: (26:02)
Can I guess? She went into stand up comedy. [Laughs]

Dr. Nassir Azimi: (26:05)
No, I wish. I wish. Actually she was a very serious person, but I love her and I miss her. She became a nurse’s aid. A nurse is a demotion for a doctor, but a nurse’s aid is a demotion for anybody because it’s tough work. It’s basically cleaning up the patients and doing other things. She did that mainly because she wanted to be independent and not be dependent on welfare and things like that. But also because she felt like she had to prove to us that that hard work pays dividends. Whenever something would happen, she would say something to the effect of, “I go there and I clean these people and, and you should at least do your part of studying.” It was her encouragement and her dedication to the field that actually encouraged me to become, to become a doctor. Even in those days, I would tell people I want to be a doctor and some of them would probably go, “there’s no chance.” Even my guidance counselor in high school – I had a very good GPA, I was the third graduating in my class in high school – and my guidance counselor was telling me that I should go into a vocational school. I didn’t listen because I wanted to be a doctor. I went to Columbia, I studied chemistry, I was pre-med and I shined there. Then I got myself to Dartmouth medical school. But if it wasn’t for the mother that I had, I don’t think I’d be where I am and so I’m really grateful.

Daniel Lobell: (27:44)
Sounds like she was an incredible woman.

Dr. Nassir Azimi: (27:47)
She was. She really was. Over the years she got herself – she went from being a nurse’s aid to becoming a nurse and becoming the nursing director of a nursing home. I was really proud of her building herself up again – not to the same level as she was – but to a level where she was proud of herself.

Daniel Lobell: (28:10)
That’s really a remarkable story in every way. You can’t argue – if you have that kind of inspiration and your mom tells you, “look at what I’m going through, go be a doctor” – there’s not much argument you can put up.

Dr. Nassir Azimi: (28:26)
Oh, no, I I’m pretty sure she was very proud of me because I just think that she lived her life through me because she couldn’t do the things that I ended up doing. But she was proud because somebody was doing it and it didn’t have to be her.

Daniel Lobell: (28:44)
I would imagine she was very proud of you. I can’t imagine how she couldn’t have been. I was going to ask you which dorm you were in in Columbia?

Dr. Nassir Azimi: (28:54)
Oh, well, I moved around. I was originally – my first year was in John J. Hall. You probably know exactly where that is in the corner, right next to the Butler library. And then my second year I ended up in East campus. My third year I ended up in John Jay again. My fourth year I ended up in Shapiro.

Daniel Lobell: (29:19)
Yeah. Do you know where the Morningside dorms are?

Dr. Nassir Azimi: (29:23)
Yeah. Yeah. I know exactly what those are. Yeah.

Daniel Lobell: (29:26)
I ran a business out of them. My business partner went to Columbia and together we started a comedy magazine and we used his dorm as our base of operations. So even though I never went to Columbia officially, I lived on the Columbia campus a few years and went to all the Columbia parties and had a business running out of the Columbia dorm. So I feel like on some level, a kinship with the Columbia students.

Dr. Nassir Azimi: (29:52)
You’re my classmate! [Laughs] For the majority of the students, that was the life. And yet you actually making money while the rest of us were paying tuition.

Daniel Lobell: (30:00)
Well, I’m not sure it was making money, but we were eventually breaking even. [Laughs]

Dr. Nassir Azimi: (30:06)
I would have been your number one customer, a comedy magazine would have been just the right thing for me during those days.

Daniel Lobell: (30:11)
Yeah. It was free. It was free. We were making the money off advertising, but the cost of printing and distribution and everything – I was 19, 20 years old and I decided to jump into the world of print media just as it was dying. So it wasn’t exactly the most lucrative decision I’ve ever made, but it was certainly a fun time at that age.

Dr. Nassir Azimi: (30:33)
It is an experience and experience is what you need as you get older, you know?

Daniel Lobell: (30:38)
Yeah. Well, speaking of magazines, you’ve won several awards. You’ve been recognized as a top interventional cardiologist by your peers in San Diego Magazine, which is pretty cool.

Dr. Nassir Azimi: (30:49)
Yes.

Daniel Lobell: (30:49)
And Castle Connolly, among others. So let me ask you: what do you think makes you a top doctor?

Dr. Nassir Azimi: (30:57)
I really believe that I treat patients like they’re my family. I make decisions. The question that we get when it’s voting – and the whole community of doctors in San Diego vote, and that’s the San Diego magazine one – the question that we get asked when we vote – and I vote for others too – the question is asked is: “who would you like or feel comfortable taking your family to?” So we doctors have our own preferences for who we think is a good doctor based on the criteria is that we find a value to us. And to me, a good doctor is somebody who treats patients like family. American medicine has somehow been polluted with business interests and sometimes people do things that are not necessarily congruent with the patient’s best interest. I think of those people as being the minority, but they ruined the name for the rest of us. But the way I look at it is when I see a patient, I look at them and then I go, “if this were my brother, if this were my father, this was my mother – what would I want to do and what would be the best way to get that done?” First and foremost, I think decision-making makes you good or bad or better or average, et cetera. But more important than that: dedication. I won the Best Heart Attack Care in the Nation. That to me is basically not just a grade of my year as an interventionist, but it’s a grade of my life: how available I am when I’m on call, how fast I get there, where I live, and then when I get there, what skills I have that I can actually make that person better and not hurt them and do it in such a way that that’s done within the window that is required by me by national statistics. To me, it’s a lot of factors, I think: paying attention during school, developing good skills and habits, but more importantly, I think making good judgment is why I feel like I’m being picked.

Daniel Lobell: (33:10)
Yeah. I love that answer. I think that’s basically the philosophy of what could make somebody the best doctor or if they don’t like their family the worst. [Laughs]

Dr. Nassir Azimi: (33:21)
[Laughs] Yeah, that’s exactly true. This is a good point because my patients are very smart. This patient came to me and said, “what would you do?” And I said, “if you were my mother, this is what I would do.” And the first question she asked me is, “do you like your mother?” [Laughs]

Daniel Lobell: (33:42)
[Laughs] Yeah.

Dr. Nassir Azimi: (33:43)
Because obviously it would affect her decision which way to go.

Daniel Lobell: (33:48)
Absolutely. Yeah. [Laughs] That’s an important piece of the puzzle to find out. I saw a quote from you that I really liked about why you maintain your board certification in internal medicine. And it said, it’s because you don’t need it, but you like the idea that you can treat the entire body. I was wondering if you could expand on that idea because it sounded good anyway, but as more than a sound bite, what do you mean by it?

Dr. Nassir Azimi: (34:16)
Okay. I’ll go back to medical school. In medical school, I had a hard time picking what I was going to be, but one of the things that affected my decision-making after pediatrics – which was my original interest in joining medicine – was ruled out because I was put on the cancer ward and I watched children with cancer die. I just felt like that could not watch that in my life, so I decided to do something different. But the buzz in the medical community is that the internist is the doctor’s doctor. So when doctors get sick, they don’t go to a naturopath. They don’t go to a surgeon – obviously if they need specific surgery, they would pick a surgeon over an internist – but internal medicine is a very cognitive oriented field and internal medicine is where you learn kind of diseases of all types. When you’re an internist, you can sub-specialize and be a cardiologist and even further sub specialize and be an interventional cardiologist. You could be a endocrinologist and just deal with endocrine issues, such as thyroid and diabetes, et cetera. You could do gastroenterology. You could do rheumatology, you could do nephrology, you could go into policy. But internal medicine, to me, is where it all starts in the medical field, because when you’re graduating, you either have to choose a surgical field an obstetric field, a psychiatric field, or a medical field, or family medicine. To me, internal medicine made the most sense. So I took that. All subspecialists have to do their three years of internal medicine. So I did those three years and I did it in a rigorous program that was considered top three in the West at the University of Colorado. I put a lot of time and effort in that. Then obviously I started to sub-specialize and I did my cardiology years. And then you asked what’s nuclear cardiology? Some people put the ‘u’ in front of the ‘n’ and call it unclear cardiology, but nuclear cardiologists use nuclear radioisotopes, injecting them into the body, hoping that they’re taken up by the heart muscle, and then scanning that part, looking to see how much of that tracer ended up where, and then making clinical decisions based on that.

Daniel Lobell: (36:41)
That was going to be my second guess, by the way. [Laughs]

Dr. Nassir Azimi: (36:44)
Yeah. I know because most people don’t survive nuclear bombs very well, so that was not going to be a good one.

Daniel Lobell: (36:56)
That was going to be my second guess. [Laughs].

Dr. Nassir Azimi: (36:56)
They end up with a pathologist more than the cardiologist. Then there’s interventional cardiology. So I love my specialties. I thrive on it. But when you look back, when a patient comes to you, some patients that have chest pain actually don’t have a heart problem and if you’re focused only on one organ, and you start to think only of the heart problems and that person doesn’t have a heart problem, you miss everything else. When a fisherman goes fishing and throws a net out, they put a big net and then they pull it out and then they see what they got. I like that about internal medicine, because it gives you an approach to a patient where you start broadly looking at the whole person. I have diagnosed more people with chest pain as having depression than probably most of my colleagues. And the reason is because I look at that person – I look at the approach and I approach it more from a broad perspective of the internist and then I narrow down. The fact that I have these different boards allows me to look at that person a little bit better. When I was young, my father would always tell me about the four blind men and the elephant. If you take four blind men and ask them to describe an elephant, each one would give you a perspective and it would be a very detailed perspective, but it would be of the part in the stance where they were. So one would give you a great description of the trunk, another one of the tail and another one of the fore leg and another one on the hind leg. But the real truth is that elephant is a formed entity. So I feel like the more different fields that you have with you, the better, you’re going to have a sense of what’s wrong with that patient. That’s why I keep up my boards.

Daniel Lobell: (38:47)
That’s sounds like a good reason to me. It seems like it gives you – as you put it – so much more available jurisdiction, I suppose. You didn’t put it that way, but I think that’s what you were the sentiment of what you were saying, right?

Dr. Nassir Azimi: (39:04)
Yeah. I think so. Jurisdiction is probably the right word. I don’t overstep – a lot of my patients will have their own internal medicine specialist and I don’t overstep. I don’t try to take over their care, but I actually do share the decision. I call that person. I say, “hey, this is something that came up in our discussion, maybe needs further pursuit.” Sometimes the patient will say, “just start the workup and send the report to my doctor.” And I do that for them. But I feel like it’s really helped me a lot to stay active and involved in internal medicine

Daniel Lobell: (39:40)
It makes sense. As you were saying it, too, I’m trying to figure out how to pronounce my next question for you. Which is to say I’m not in the medical world, but I have a little note here that you are a world expert on anticoagulants. Did I say that right? And antiplatelets?

Dr. Nassir Azimi: (39:56)
Yes.

Daniel Lobell: (39:57)
I don’t even know what those are, so I’m kind of curious to find out.

Dr. Nassir Azimi: (40:01)
Okay. Let’s just think of ourselves as just blood flowing through arteries, right?

Daniel Lobell: (40:08)
That’s how I always think of myself.

Dr. Nassir Azimi: (40:11)
A lot of blood is flowing through your arteries and they go into your brain and your kidney and your liver, then your heart arteries and all that blood is circulating, but none of it’s leaking out and none of it’s clotting. Because you have a fine balance between clotting and bleeding in your body, so that the net effect is neutral. In your body, you have molecules that actually promote clot. So if you cut yourself, you start bleeding, you start clotting. That’s where you form a clot. As the blood leaks out of your body, it all clumps together in a tube or if you’re bleeding in your shirt or under the bandage, you just find a clump of blood because it’s clots. That’s the clotting mechanism, that’s called coagulation or clotting.

Daniel Lobell: (41:00)
Okay.

Dr. Nassir Azimi: (41:01)
What leads to coagulation or clotting is platelets. Obviously platelets stick together. One of the most common antiplatelet is aspirin, that keeps them from sticking together. That’s why we say be careful when excess aspirin, because it might make you bleed because it inhibits your platelets so you don’t clot very well.

Daniel Lobell: (41:22)
That’s why they tell you to take aspirin before you get on a plane, right? So you don’t form a clot in your leg or something?

Dr. Nassir Azimi: (41:28)
True, for that and an aspirin when you call the medics and you feel like you’re having a stroke or if you think you’re having a heart attack, we recommend that you take aspirin as soon as possible. So that if you were to call, we’d say, “take four chewables.” Or when you show up in the ER, the emergency physician quickly gives you four chewable aspirins because aspirin is going to inhibit your platelets from sticking together and we suspect that a heart attack and stroke is by and large a clot that happens, so inhibiting a clot. That’s anti-platelets. I’ve been going around and involved with research and giving speeches on anti-platelets over the years. But also anticoagulants is that besides platelets, what causes a clot or different factors – there are proteins that are made in the liver that basically are inactive, but as soon as something triggers it, the factors start activating and then they together with the platelets form that clot that we talk about. Anticoagulants are drugs that prevent coagulation. For example, Coumadin, Warfarin was one of the original anticoagulants. Heparin is an IV medication that we give that’s an anticoagulant. And then of course, the newer agents that you probably have heard of since Pradaxa, Xarelto, Eliquis, Savaysa – these agents are all anticoagulants. Our science in terms of the study of coagulation and platelets has really advanced immensely over the last 15 to 20 years.

Daniel Lobell: (43:06)
It’s fascinating stuff. It got me thinking – I have a friend, I think he’s in his late fifties. He’s a runner. He runs marathons, he runs Ironman – all this stuff. This past year he needed a quadruple bypass surgery. And I think to myself, “how did it happen?” He seems like the healthiest man on the planet. He’s vegan, he keeps his weight down, he runs every morning. What kind of thing could cause that? I’m thinking, when you’re talking about the clotting, is that what they talk about when you have a blood clot? Is it a blood clot in your heart? The arteries clotted? Is it fat? is it blood?

Dr. Nassir Azimi: (43:55)
This is actually a great question because our old understanding – atherosclerosis (hardening of the arteries) basically Greek: athero meaning plaque, sclerosis meaning hardening. That’s basically a lifelong problem and when soldiers were shot in Korea, they did autopsy, and request permission from their families to look at their hearts for science. What they found is their hearts had some plaque in the arteries – and all of us have different rates of plaque deposition in our arteries – but those soldiers that were shot in Korea demonstrated that in a Western society, in America, because of how we eat because of what we eat, not necessarily because of what our body looks like, or how much exercise we get (exercise is really important and I’m glad that he exercised, I would still recommend that he continue that) but because of a lot of factors. The factors that we think of, the most common factors are age – the older you get, the more likely you’re going to have buildup of plaque. Diabetes – having uncontrolled sugars will lead to more plaque, uncontrolled cholesterol will lead to more plaque, uncontrolled blood pressure will lead to increased plaque. Obviously smoking is a bad thing and that in itself triggers atherosclerosis and accelerates it, and so smoking is bad. Genetics: there are people that are very lean. Actually in Southeast Asia, in India, there are people in villages that have relatively lean people, and they’re all getting heart disease in their forties. That’s somewhat genetics, but it also could be an addition of the environment. While they’re exercising, they’re still eating a lot of fats and the type of fats, whether it’s trans and saturated, et cetera – all of these things make a difference in terms of the diet as well. But the biggest risk for heart disease that I think nobody talks about is stress and adrenaline. Some of us are more stressed than others. Some of us deal with stress better than others. Some people get stressed and they start smoking. Some people get stressed and they start eating donuts. Other people get stressed and they go for a walk. Other people laugh, other people joke. There are a lot of ways to deal with stress that are healthy and some that are not so healthy. I had a patient who was 35, I was doing an angiogram and he had limited risk factors, although he was diabetic, and next door, my colleague was with a 90 year old smoker with high blood pressure, high cholesterol. Guess which one of the two – and this is the same day – which one of the two went to surgery? My 35 year old. It’s hard to predict. That 90 year old with the smoking and high blood pressure and high cholesterol had a much higher chance of having disease, but he did not have much disease. So that’s not saying to smoke and not take care of yourself. It’s that heart disease happens because of multiple factors. A lot of patients will go, “I exercise so I can eat whatever I want.” Some people say, “I eat very healthy, so I don’t need to exercise.” But the way to approach heart disease is basically to take care of all the risk factors. If you smoke, quit smoking. If you don’t exercise, start exercising. If you don’t eat healthy, start eating healthy. Obviously some risk factors are not modifiable – bad genetics, I’m not going to be able to change, but if you have a family history of bad cholesterol, you could just start taking cholesterol medicine at an earlier age. We have a lot of agents available now that addresses that.

Daniel Lobell: (47:35)
It’s interesting. It actually backs up your statement earlier that laughter is really the best medicine in a way, because if you’re able to laugh and reduce stress, you could actually prevent heart disease, it sounds like.

Dr. Nassir Azimi: (47:48)
I feel like that definitely is a very important aspect, but I wouldn’t go and tickle all of my patients trying to get them to be healthier because I think that’s just one component, like I said.

Daniel Lobell: (48:01)
I figured out how you can make it in comedy, by the way.

Dr. Nassir Azimi: (48:05)
How?

Daniel Lobell: (48:05)
What you’ve got to do is you got to get all the comedians, the top comedians to come in to your practice, and then you close up all the holes in their heart. Then they won’t need to do it anymore and you can take over the whole field. [Laughs]

Dr. Nassir Azimi: (48:18)
This is the way to do it. I like that. I’ll start with you first. [Laughs] Daniel Lobell is my first patient.

Daniel Lobell: (48:22)
We are almost out of time but I wanted to talk to you a little bit about the online health space. Obviously we are very excited to have you with Doctorpedia and you are the Chief Medical Officer at the Heart Health channel. What do you hope to provide with that channel?

Dr. Nassir Azimi: (48:49)
One of the biggest things lacking, especially in today’s medicine, is good education. I feel like an informed patient is really a healthier patient because if a patient understands what they have, what to do about it, how to go about it, they’re going to do better than the person who gets a diagnosis that they can’t pronounce and have no idea how to approach it. Yes, we doctors do spend some time in the office trying to educate, because I actually feel like doctor comes from Latin doceo, which is ‘I teach’ or docere – ‘to teach.’ I feel like it’s my role to teach the patient. I put the effort out to teach the patient, but when a patient hears, let’s say, a valve problem – their mind gets stuck on that. They haven’t had any channels open to hear the rest of the story. They look like they’re listening, but they go home and the only thing they remember is that I have a valve problem. Then they Google it and on Google, there’s so much misinformation. Google is rich with information, but a good amount of that information is misinformation. Then they get extremely confused and then if, for example, let’s say they had a stroke and they needed to be on Xarelto, which is a blood thinner to reduce the risk of stroke or Eliquis, which is another blood thinner or whatever agent their doctor prescribed (so that it doesn’t sound like your podcast is endorsing one over another, right?) They need to be on a blood thinner. They look up that blood center and they find wrong facts are facts that are not relevant to them. And then they stop that medicine. They have a stroke again. You won’t believe it but numerous times I’ve seen people have complications because they found wrong information, applied it to themselves and intervene based on a Google answer rather than their doctor’s recommendation. What I like about a channel like Doctorpedia – and particularly the Heart Health Channel – is to be able to offer patients education. Hopefully a lot of information on prevention. The best way to deal with any problem is not to have it in the first place. But if they do get the problem, to give them education about what that problem is, how to deal with that problem, where is the best place to get help for that problem, and then what are the consequences of taking the treatments and not taking the treatment. That’s what I would like to do with Doctorpedia, particularly as it applies to the Heart Health section.

Daniel Lobell: (51:28)
It sounds fascinating to me and it’s something that I definitely want to look into more and I hope that people listening to this will go and check it out because the best thing you can do for misinformation is give Mister Information? [Laughs]

Dr. Nassir Azimi: (51:44)
Oh no, actually you’re right about Miss and Mister information, but a lot of people are Mrs. [Laughs]

Daniel Lobell: (51:50)
I think sometimes you see them traveling together on the information highway.

Dr. Nassir Azimi: (51:55)
But I really believe that the best thing in medicine is an educated patient. A patient that understands. You could have the most difficult problem if you have a good doctor and you know what to do with that, you can do much better than having a simple problem and not getting the proper education and ending up with the wrong treatment or the wrong diagnosis and then dealing with all the consequences that come after.

Daniel Lobell: (52:22)
Absolutely true. One of the things I’ve been doing for the past five years as a comedian is I’ve worked in adolescent drug rehabilitation facilities. I run groups and I try to use humor to help teens talk about what’s going on and they’re there for various reasons – substance abuse or suicidal ideation, or they’ve been abused physically or sexually or whatever it is – and they wind up either taking drugs or cutting themselves or trying to kill themselves, to reiterate my point. One thing I’ve said to them – over and over I’ve said, “look, you’re not bad people, you’re bad doctors.” I said, “think of it like this: you’re in a lot of pain. It’s emotional pain. You don’t know what to do, so you’ve just prescribed yourself whatever you could get your hands on. You’re like, ‘well, maybe this will work or maybe that’ll work. Or maybe if I cut myself, that’ll work.'” I said, “if you went to a doctor and they prescribed you, they said, ‘here cut yourself a few times a day.'” And then the kids always laugh at that. I said, “well, you wouldn’t think that’s of a doctor. Right?” I said, “well, you were that doctor to yourself, as a patient.” I said, “you come to a rehab to learn what would be actually helpful to me. I always make that point to try and open their mind up to accepting the treatment. But it’s been a fairly effective argument. I think in a way you’re making that same argument in general about health. Becoming educated – whether it’s an emotional illness or physical illness – makes you a better caretaker for yourself and not totally reliant on somebody who could be wrong or misadvising you.

Dr. Nassir Azimi: (54:05)
Daniel, during the break, when you were working on the sound, I actually YouTubed you and I found out about your credit card that called you Dr. Lobell.

Daniel Lobell: (54:17)
[Laughs]

Dr. Nassir Azimi: (54:18)
I really believe – and I started out by saying that laughter is the best medicine. You basically give people one of the best medicines out there because as a comedian, you make them laugh. But I actually found that what you just said a lot more impactful. What you’re doing with those adolescents and the way you approach it is just like a good doctor would. Because a good doctor would tell them exactly what you have said to them or continue to say to them is that, is that when people are in pain, when people suffer, they reach out and then when their doctors aren’t understanding or aren’t offering them some form of therapy, they start self-medicating and some of that self-medication ends up being self harm. Because if you use any medicine without properly understanding the risks and benefits and the alternatives, you could get unexpected consequences. I really love what you just said. And I think you deserve that credit card.

Daniel Lobell: (55:18)
[Laughs] Thank you. They took it back. If you get to the end of the bit, I abused that credit card. [Laughs]

Dr. Nassir Azimi: (55:24)
[Laughs] I didn’t have time, you called me!

Daniel Lobell: (55:26)
It’s a long piece, I know. I wasn’t able to hold on to that one.

Dr. Nassir Azimi: (55:34)
But you lived the life of a doctor.

Daniel Lobell: (55:34)
I lived the doctor life for a little while, but I was young and irresponsible and I didn’t pay the bills and eventually they shut my office down. It’s been an absolute pleasure. Last question: how do you feel that Doctorpedia in general – and I think you kind of answered it with your last answer – but more generally speaking, Doctorpedia itself – what do you think they can offer to assist the online health space?

Dr. Nassir Azimi: (56:00)
The most important thing we can do is educate. Doctorpedia is going to be a very, very, very important resource for patients to go to, to get more information. When they go to Google – and Google is a good place to get information, don’t get me wrong. I Google things every day. But when you Google things, you get a lot of answers. Some of them are by quacks. Some of them are going to people that don’t have any understanding of medicine. Some of them are by attorneys that are suing a particular company. And then patients get scared. But when you want to go to a trusted place, a place where you know that this site has been organized and dedicated to having information reviewed by board certified physicians. Like for example, you heard about my credentials, I’m going to be personally reviewing the content that shows up on the Heart Health Channel. I’m going to be contributing to information that is applied to certain cardiac procedures and cardiac interventions and cardiac medications. You could at least say, “well, this information was reviewed by a board certified physician,” rather than just randomly picking something that was written and later finding out that the person who wrote that wasn’t even a scientist.

Daniel Lobell: (57:20)
Right. I think you’re right. I think Doctorpedia is offering at least that – we’ve got the credentials and it offers you some meaningful and hopefully informative advice that you can go to for such a wide variety of different – I don’t want to say ailments, but things that you may be facing medically. How about that?

Dr. Nassir Azimi: (57:45)
So the ambition – when I talked to them, the ambition is really just great in the sense that there are going to be thousands of sites dedicated to almost every health issue that one could have and over time is going to be comprehensive with articles and videos and physicians that one could reach out to and get advice from. But the most important thing that I think Doctorpedia would want the audience of your podcast to know is that this is intended to be a supplement to good medical care. This is not going to replace good medical care. You still have to go see your physician. You still have to go get your prescriptions from your physician. You still have to listen to what the doctor says, but this will be a place to go get supplemental information. If you didn’t understand what the doctor was saying, in terms of the nuclear stress test that you’re going to undergo, you could not Google it, you could actually enter it in Doctorpedia and find relevant information from Doctorpedia directly.

Daniel Lobell: (58:49)
Dr. Nassir Azimi, it’s been an absolute pleasure and a delight getting to talk to you. I learned so much and I look forward to checking out your channel on Doctorpedia and learning even more. Thank you for doing the interview.

Dr. Nassir Azimi: (59:02)
Thank you so much for your time and I wish you the best. Keep on making people laugh. And I really appreciate what you do for those adolescents.

Daniel Lobell: (59:10)
And I appreciate what you do, keeping people’s hearts going. [Laughs]

Dr. Nassir Azimi: (59:15)
Hopefully you’ll never need me. That’s all I can say to you. I tell patients that I’m like King Solomon – it’s better to have me and not need me, than to need me and not have me.

Daniel Lobell: (59:27)
Well, G-d willing, I’ll never need you. I guess for me, it’s the opposite. It’s better to… not… it’s better to need me than to have – no, I guess it doesn’t work that way. [Laughs].

Dr. Nassir Azimi: (59:36)
[Laughs] You were… no I’m joking. Thanks so much!

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