Confessions of a Fat Cardiologist

John P Erwin III, MD, FACC, FAHA, FACP

As I was visiting with a patient the other day, he told me, “You know, when my doctor referred me to you, she said you are the absolute best with complex patients and worth waiting for to see in consultation.  She was right.  She also told me that I would like you because you {ahem} struggle with some of the same things that I do (while pointing at his current weight on the electronic health record).” As a blush rushed over my face from the compliment as well as the reference to my waistline, I realized that it was time for me, as a cardiologist, to provide my personal obesity story to others as this is an issue that is sweeping the land in epidemic proportions and is still quite poorly managed.  I hope to share with you some of my background and brief insights into my personal struggle with maintaining a healthy weight – one that as a cardiologist, I’m a bit ashamed to admit.

As I write this, I am in the 2 week countdown period to my own plans for undergoing gastric sleeve surgery to help to battle this chronic thorn in my side.  For many years, I have been a believer in the science and outcomes of this procedure and I have referred many patients who have had dramatic improvements in their health and in their quality of life. “So why aren’t you having it?” has been a frequent question that my patients whom I’ve referred have asked me.  Great question! I’ll walk you through my story to hopefully provide some insights into that answer and to also point out why I am answering it differently now.


I have not always been obese.

I was recruited to play Division I NCAA football as an undersized defensive lineman.  When I arrived at freshman camp, I was the strongest, fastest…and smallest lineman on the team.  I realized very quickly that despite my assets of strength and speed, without an “anchor” of some weight, the other talented players around me, once physically engaged, held the “ mass times velocity “ advantage over me quite easily.  I also played in the years where anabolic steroid use was rampant in college football.  Quickly, those with whom I had a strength advantage over caught up with me by “living better through chemicals”.  It dawned on me early that despite my dreams, I would likely never take a snap in the NFL on Sundays, so the consideration of steroid use was never a suitable option for me.  With these things in mind, and with coaches who demanded on-field dominance, I went to “work” to gain the needed weight to do my job. I could always lose the weight after I quit playing, right?!  Between this, a couple of major injuries, and a position change that called for an even more supersized-me, I finished my college career at a playing weight of 287 pounds on my 6’2” frame.


Then came medical school… 

Hours upon hours of classroom time, lab time, and study time did not lend itself well to an active physical lifestyle. At least in college I was burning thousands of calories a day on the field and in the gym.  In medical school, I didn’t eat more, but I didn’t eat less despite this “intake versus burn” equation shifting drastically.  I had gotten into the habit of eating quickly in college to get the calories in before I was full.  Now, in medical school, I was eating fast to get it in while I could during my limited non-academic pursuit hours.  I have never been a “ stress-eater ”, but I have been a “ tired-eater ”, and this became a part of the spiral that has plagued me since that time.


I have been successful with lifestyle weight loss, but…

On multiple occasions, I have lost 50-100 pounds over the course of the “med school and beyond phase” of my life.  I have done this essentially with caloric restriction (Weight Watchers ) and “ exercise bulimia ”.  The issue has been maintenance of the lower weights.  It is well-known that there are metabolic changes that occur in people after intentional weight loss efforts that undermine the ability to maintain the lower weight. A study published in the New England Journal of Medicine showed that one year after initial weight reduction, levels of circulating mediators of appetite that encourage weight regain after diet-induced weight loss do not revert to the levels recorded before weight loss.  I have always been a healthy eater, despite my humorous assertions on twitter , but I continue to struggle with portion control, eating too fast, and the “tired and on-the-run eating” phenomenon described earlier that tends to come with a physician’s lifestyle.  In addition, my weight roller coaster over the years has typically been punctuated by injuries related to over-zealous exercise… so the cycle goes something like this: Get in great shape.  Become hyper-competitive.  Have an injury/surgery leading to long periods where I can’t exercise. Re-gain the weight. 


After these cyclic weight fluctuations, I’m now at an all-time high weight of 320 pounds!  

Now, if the Dallas Cowboys call tomorrow and say that they need a nose-guard for one play, this may be fortuitous! For most every other aspect of my life, it is clearly not.  Most of my close friends are surprised when I tell them this weight and say, “You carry it well.  I’d have never guessed”.  Until the last year or two, I have been “fat and fit”, but a back injury sustained in an automobile accident and later exacerbated by a boot camp training injury has greatly curtailed the exercise that I like to do ( High Intensity Interval Training ) and has relegated me to the elliptical trainer and simple resistance training exercises.  The catch-22 is that my back prevents me from doing a lot of activities and my own experience shows me that my back pain is considerably better when my weight is below a certain level.  Over the past 2 years, I’ve simply not been able to break the threshold to get my weight below that level where back pain is not a daily distraction.


The dreaded risk factors creep onto the scene…

Two years ago, I was diagnosed with obstructive sleep apneaand Stage I Hypertension that have been well-managed, but thankfully do not have dyslipidemia or diabetes.  It’s great peace of mind to know that my cardiac calcium score is zero, but beyond cardiac risks I know the other long-term complications of obesity and wish to do anything in my power to avoid them.  As a Dad to two young men, I have a goal not only to live to see my grandkids, but to be able to run and play with them!


“Surgery is the failure of medicine”

As an internist and a cardiologist, I have been taught that mantra since my third year of medical school.  That mantra is also many non-surgeons’ cognitive bias even though the evidence clearly now points in favor to bariatric surgery for the management of significant obesity. While we should always look for the least invasive way to treat a problem, modern surgical tools to assist in weight loss are most certainly a Godsend.  Unfortunately, cognitive biases frequently cloud physicians’ judgement and there is a stigma associated with this problem even amongst those with whom obese patients turn to and trust to help them and most who meet the criteria are not referred for evaluation.  Admittedly, in my own case, I recently confided in a trusted colleague that my decision to finally follow evidence-based medicine and make the decision for surgical assistance leaves me feeling “as if I’m cheating to lose the weight”. With very sage and compassionate words, she simply asked me, “Is it cheating to treat blood pressure with anti-hypertensives or to treat other medical conditions with medications or surgery?”.  No- it is not after lifestyle management has been tried and failed.


Confession and Absolution.  

Knowing what a lifestyle change that this upcoming surgery will bring, my thin wife who has walked this path with me for 34 years wanted to be sure that I was certain that surgery was the direction that I wanted to take, and this led to several months of pondering.  I must confess that my normally decisive mentality has taken pause along the way as many people that I have spoken to about their experiences post-procedure have unveiled some of the intangible things that they did not anticipate such as some loss in the social ties around a dinner table, the verboten occasional cold beer on a hot day with friends, or the issue of perplexed wait-staff when one leaves most of one’s food untouched at a restaurant.  These things do cause me some mild concern, but I am also a man of strong Faith. In the Sermon on the Mount, Jesus tells His followers that “If your right eye causes you to sin, tear it out and throw it away.”  This merely means that we should be prepared to make exceptional sacrifices to get to where we need to be. The word sin in the Bible derives from the Greek word ἁμαρτάνειν (hamartánein) and means “missing the mark”.  My scale has been missing the mark for far too long and my current job description does not call upon me to physically move 300 plus pound men in directions that they don’t want to go.  It does call for me to be a witness to many men and women who struggle with their weight and to help guide them down the path to a better life. I intend to do that.

Dallas Cowboys, if you want me for that one snap, please call soon!

101 thoughts on “Confessions of a Fat Cardiologist”

  1. Excellent read about a journey in battling obesity that is common for most people in America – just in varying severities. Kudos to this physician and cardiologist for providing a window into his experience so that others can benefit.

  2. Dr. Erwin! I’m so happy to see your new blog, and you’re off to a good start with such an important, timely and personally vulnerable topic. Thank you for taking the time to talk openly about this.

    Those of us who have in the same boat (I’ve basically been on one diet or another since I was 13) will be eagerly following your progress!

    Best of luck to you and welcome to the wonderful world of blogging.
    regards,
    C.

    1. Thank you, Carolyn. The dipping of my toe into the ‘blogosphere is slightly nerve-wrecking, but the response has been overwhelming. I wish you continued success on your path and would appreciate any tips from your writing experience that you’d like to share! Happy New Year!

  3. Please do not do an operation until you have explored the carnivore diet/ketosis/LCHF. Please review Michaela Peterson and Shawn Baker. Please, do not have an operation until you have explored dietary options.

    1. It is good advice to say “do not do an operation” to someone who has not done the research, tried other options, and who does not know that the surgical route is not an “easy” one, either. The diets you mention have no long-term data, however. Bariatric surgery, however, does.

  4. Thank you for this blog post, John. I see myself in much of what you have described. I wish you all the best and have no doubt that you will be successful.

  5. What a great share. To that point I have experinced many many of the same struggles and do so today. Good luck with the surgery and ongoing effort!!

  6. John, Thanks for sharing your journey and I know you will inspire many. You are a true healer and you will meet this challenge with the same mix of determination and humility that has made you a leader in our community!
    Wishing you all the best.

    1. Thank you so much, Mike. Means a lot to me coming from a respected colleague and friend. Praying blessings on your New Year!

  7. Man, (Doc) I have always admired you on Twitter. You’re the kind of guy this 50 & fat guy would be proud to have as a Father, an attending, or a mentor of some sort. I’m 250 right now, have OSA and have a knee injury that limits my exercise. I get it!! Got for it man! Keep the writings coming and best of luck with your surgery. I’ll be praying, as I follow along.
    PS: My emergency medicine rotation is at BSW in Dallas in May. You’ll have to recommend a place I can grab a cold beer.

  8. Wish you the best Dr.Erwin, it is not easy what you are going through. I am sure many people share the same challenge including me.

    You are brave enough to share this with everyone. I am sure you will do excellent with the surgery and I wish you the best of health, wealth and happiness.

  9. Wow! This is brutal honesty that most of us in medicine lack. You are modelling positive behavior for yourself and your patient’s. Truly inspiring!

  10. Good for you. Thanks for tour frankness. I see a lit of what you have said in my self and my pts but really never consided it before until you have put it down. Good luck in your journey.

  11. Sir thank you for sharing. I, too am a believer. I can relate to your story. I balloned up & down with my weight all my life. It started in high school. I’ve been athletic all my life. I love sports. I played basketball, softball, shot-put, & was in band. I lose 65 pounds in 5 months with Slim Fast. I started back “regular eating” & it all and more came back. I was 350 pounds after college. I had had enough. I started gastric bypass surgery plans to get rid of the weight for good, as I thought. I started by cutting fried foods, walking, & no sugary drinks. I actually lose 40 pounds BEFORE surgery. My roommate asked if I was going through with it. I said, “yes.” Surgery day I was 310. After surgery, I lost 130 pounds easy. I was considered “skinny fat” with no muscle tone. That was 2003. Fast forward to July 2016, nursing school graduation. I was 20 pounds after from my pre-surgery weight and devastated. I was about to start the paperwork for gastric bypass surgery revision. My nursing instructor asked if anyone wanted to know how she had effortlessly lost weight to contact her. I reached out. She introduced me to “Keto.” That saved my life!!! I’ve moved to Carnivore and Extended fasting. I love it!!! I will list my changes….

    1. Excellent illustration that surgery is just a tool in weight loss and weight maintenance. Takes a full program/plan to make it work and stick. Best of luck on your path.

  12. Tiana Continued….

    Keto -> Carnivore way of eating.

    My benefits:
    -less dandruff
    -better sleep
    -decreased eye floaters
    -decreased eye jitters
    -MORE energy
    -less PMS symptoms
    -clear skin
    -softer skin
    -weight/fat loss
    -decreased appetite
    -lost inches
    -no constipation
    -better bloodwork
    -better/stable mood
    -better digestion
    -better satiety (low cravings)

  13. Dr. Erwin, great post! As an overweight physical therapist, I really appreciate your candor, and, more importantly, the messages implicit in your writing. Which, to me, include:

    This is not a simple problem.
    Obesity is not a character flaw.
    There is no “sure fire cure”.

    Best wishes.

  14. Great post doc. Ex military, EMT, then lab school. After 30 years in high pressure corporate jobs and start ups I ended up at 400lbs. Did a bypass since the sleeve wasn’t an option. Second life for me. You’ll do great.

  15. What an insight into an inspirational Cardiologist and equally inspirational human being! Wishing you a speedy recovery and a happy and healthy future

  16. We all miss the mark in many ways. Being overweight is one of the most public taboos. Shame on us. I wish you success. And good health. But most I wish you acceptance of yourself. You deserve to feel the love and respect many of us have for you on Twitter. Fat be damned. Lots of healthy productive fat in my family. Genetic St Bernard’s. Not Greyhounds. Whatever, be true to yourself. Those who love and respect you do not care what you weigh. Whatever you do, do it for you.

    1. Thank you for your well-wishes. I most certainly accept myself and am blessed to have a supporting, loving family and social support system. I pray for those who do not…and try to partner with them. While I accept myself, I do not accept the physical limitations of my weight and thankfully, this can be changed! All my best to you!

  17. I think it’s the right thing to do. You’ve tried every other way and it didn’t result in a continuous healthy weight.
    I wish you all the best Dr. John!

  18. Great first blog post! I’m interested to know what you, as a cardiologist, think of Paleo/primal/keto. For me, I was at my peak doing Crossfit and paleo. Now I do sedintary work and have a 3yo, which is reflected in my waistline. Due to household allergies my diet is nowhere near what it was, but even with injuries, the low carb high (good) fat/protein diets work.
    Have you looked into Robb Wolf and Loren Corsain.

  19. Dear friend John,

    I admire your determination in this fight against the scales. As a surgeon, I have to disagree with your old “mantra” that ‘surgery is the failure of Medicine’ : I think it is a complement in the therapeutic arsenal for the best possible result in each case!

    I wish you absolute success with your procedure and can achieve personal satisfaction allied to health, always!

    Best regards and an incredible New Year!!

    1. Dr. Alex- please don’t misunderstand, I think that modern surgical approaches are a Godsend. I must say that even in my general surgical training, when discussing surgeons would pimp about the indications for surgery, one of them listed was “the failure of medical therapy”. Unfortunately, this concept is taken too far by some non-surgeons. I appreciate the God given gifts that all of my surgeons bring to the table for the benefit of both my patients…and me! I am the veteran of multiple orthopedic surgeries that have gotten me back on the playing field of life.

      Thank you for your well wishes, friend!
      Happy New Year!

  20. Brother John – praying earnestly and fervently over you right now and through this surgical procedure time. A lot of your story resonates very much with my personal weight roller coaster. Remember, Ben Franklin and Winston Churchill were also “fat” and lived full lives to 84 and 95 years young respectively, What made them the exceptions that proves the rule that skinny isn’t always healthy?

    We’ll discuss this further in the coming months, please and thank you 🙂

  21. I’m sorrry to hear that you have had a hard time with weight issue’s and need to resort to surgery. I would suggest at this eleventh hour to look at the low carb diets to find your healthy and natural alternative. Please research doctors such as Dr Ken Berry, Dr Shawn Baker and Dr Ted Naiman to name a few. I know your story too well as have many that have struggled with weight and chronic illness all their lives only to realise we’ve been misled and given the wrong information. Now that he have the knowledge, we don’t have any problems with weight and or chronic illness. Please, research before you make this irreversible decision, you won’t regret it.

    1. It’s presumptuous to assume that other options have not been research and/or tried. The “resorting to surgery” mind-set you described is the exact one I tried to address. It’s science- pure and simply. It’s been studied and validated for long-term success in my demographic. I do thank you for your concern.

  22. Dr Irwin your story will certainly benefit many who look up to you and who struggle to understand the dilemma of obesity. We must all be willing to do that which we prescribe for our patients. You are preparing to walk the walk you have set for others. Thank you for your honest and courageous story. I would love a post surgical follow up story in the weeks and months to come. You are in my prayers!
    Warm Regards
    Nancy Lundy, ANP-BC, ASCC

  23. Your openness and honesty that we as physicians are first and foremost people like everyone else. As I tell my patients “ I have a house too”. I struggle with chocolate and get minimal physical activity despite advising others to do so. We are all here helping each other along , encouraging each other.
    I am attaching a 2 minute link to kim Williams, immediate past President ACC and chairman at Rush cardiology. He opens his story of moving away from ( high calorie) animal fats . ( oils have the same 9 kcal / gm calorie hit ) . After that I recommend all Americans see Forks Over Knives ( on Netflix) and sign up for weekly emails. If you are willing to give this a 21 day test then the Physician Committee for Responsible Medicine has a 21 day app to transition your diet over to Plant Based . (PCRM.ORG) . / another video great for a rainy Sunday is What The Health”. You will need to learn new lifestyle changes if you go through surgery to “ make it stick “. Im not telling you anything you dont already know – just making it real for “ the man in the mirror”.
    Surgery requires time and money invested. If you were my family , I would take the same time and money and invest in 3 week immersive lifestyle program . That is the most dramatic proven transformation for those with the time and means to do so. Theres a link to the American College of Lifestyle Medicine on my website sralphmd.com for all the supporting evidence. Im here at any step along the way as I know you would be for me.
    In His Name…

    https://youtu.be/nyNy2mSnNRo

    1. Thanks, Dr. Ralph. I have immense respect for Dr. Williams, but frankly- he’s never been fat. I’ve not only tried many of these other approaches, but have studied the outcomes extensively. For a person in my demographic, there is certainly nothing else out there with the impact and long-term benefits seen with Bariatric surgery done in a true multi-disciplinary program with a team around life-long for coaching and support. These 3 week intensives don’t have any peer-reviewed evidence so is not truly proven and validated.

      I thank you for your concern. Please know that I do not do anything in haste and without deliberation of the options.

  24. Hello, I have pondered whether to get gastric bypass but am afraid I won’t be able to stuck with the restrictions. A high school friend who has always been obese has has it and done wonderful. I really think that if I was given a diet pill, that would help me as I am immobile and cannot exercise. Ive had cauda equina syndrome twice and currently suffer from complex regional pain syndrome exercise is not an option for me. And caloric intake has not helped because my metabolism is slow. Good luck in having surgery.

    1. Certainly partner with a doc who can help you. One must be careful of which Bariatric surgical team they use. I do endorse the team at Baylor Scott & White- Temple, TX. I’ve studied all of the pharmaceutical approaches, too. There is not good evidence in the long-term and frankly, the meds out there now scare me.

  25. Inspiring and admirable! Best of luck! Love, prayers and support of everyone who knows, and hence admires you, will be with you in this journey! 💪🙏❤️

  26. Hey doc, I’ve been following you for a while and live here in the Dallas area with you. (Actually in Arlington about 10 minutes from the stadium.) I was about 400 lbs a few years ago at 40 and stopped eating sugar and grains. I was shocked at how fast the weight came off and how I’ve been able to maintain it. I’m at about 240 right now. Have you considered doing that? I don’t track anything out worry about calories. I eat when I’m hungry and dive eat when I’m not. I was shocked at how easy it turned out to be. Let me know if you’d like more info about it or a few book recommendations.

    1. I’ve literally tried everything. As mentioned in the writing, I’ve always been a healthy eater. Post 50, weight loss doesn’t come as easily as it did in my 20’s, 30’s, and 40’s. Best of luck on your path!

  27. Well written
    Agree with you and bariatric surgery decision.
    Hope everything went well
    So go ahead and good luck..
    Mario

  28. It will be interesting to follow your progress. We have some severely obese people on staff here, as well as some, like myself who are overweight. Obesity is a challenge for many doctors.

  29. John, as my brother from another mother, we have walked parallel paths. I too have 3 times in 30 years lost 70 to 100 lbs (currently down 98 lbs in 2018). I too have been unable to sustain these nadirs. I too have seriously considered bariatric surgery, but my major concern is the late (5 yr) failure rate presumably due to not solving the underlying eating disorder that causes our cycles. I’ve discovered that a daily 16 hr fast (after dinner to lunch the next day) has really helped to enhance my metabolic rate. I plan to continue the heathly food (knives over forks) daily fasting to see if this will allow me to maintain this loss. Time will tell. Good luck to you on your journey..

    1. Thank you, Christopher. I most definitely appreciate you sharing your experiences. Central Texas and your part of Louisiana makes it tough on those of us trying to maintain a healthy weight. I’m confident in the program that our Bariatric Team uses here at Baylor Scott & White- Temple. It’s a truly team approach where the patient signs a contract of agreement that longitudinal follow-up with the multi-disciplinary team continues indefinitely. There are too many “fly by night” “programs” out there who essentially do the cutting, make their dollar, and send the patient out to fend for themselves. Our program has had an outstanding track record not only of weight loss but of weight maintenance, so that gives me confidence.

      I wish you the best on your journey. I respect you so much for your model as a great cardiologist with high integrity. Happy New Year!

  30. Best wishes John. We are here in Tipperary, Ireland, rooting for you and wishing you all the best. (Yes, we are John’s parents). Delighted you are taking it on with gusto. You will succeed.

    1. Thank you! You raised a fine man who happens to be an outstanding physician. I am very honored to call him friend! Praying for you to experience the happiest of New Years!

  31. Awesome Doc! I need to do the same but don’t have the time saved up on my new job yet. I have the same issues. I’ve tried lifestyle mod and workout but injury sidelines me and the pounds pack back on. I have a Significant family hx of early cardiac death and early onset CAD. My grandpa died at 48 from a MI. Mom passed in December of 2016 due to complications from DM, CAD, and CHF. My calcium angio score was zero in 2017, I’m not diabetic or hypertensive yet but I am over 35 on my BMI with a waist circumference > 35. As a nurse, I’m always encouraging my patients but can’t seem to take the same advice. So I’m glad you’re following your own RX!

  32. I think this is a wonderful first blog post! 👏👏👏 I love how you lay it all out on the table from how it started to where you are now.
    It’s always a heavy weight to ponder such a surgery or any surgery for that matter but you’ve thought it through and I wish you much success for your new journey in life.
    I hope you get that call from the Dallas Cowboys 😉

  33. I’ve been living on the verge of obesity for as long as I can remember, coming closer with each of my three pregnancies. I am going to try and give the lifestyle changing programme another go for 2019. So wish me luck as I do you for your upcoming surgery.
    I enjoyed reading your article and appreciate the fine balance you achieved between writing as a medical professional and writing for the layperson. I also liked your personal approach and dabs of humour.
    By the way, I saw your tweet publicizing your blog by accident. I have just started blogging myself. Topics life lessons/experiences embedded in creative writing (poetry and prose)

  34. This required courage. To accept what one has become, and to continue to find a way out of it. I am sure you will run with your grandchildren. Sincerely

  35. No one else can decide what is the best strategy to gain a healthier weight range , for you, than you
    As for heart health, I have been off statins for two decades due to compromised kidney function and now hope that low inflammation markers such as C-reactive protein will indicate that cholesterol is less likely to build up. I hope this is still valid.

  36. Dear Dr.Erwin,
    Thank you for your candid account of your travails! I admire your courage and transparency and wish you very well!
    As a caring elderly Internist, despite all the yo- yo weight fluctuations, I would advise you to choose the lesser evil of non- invasive approach. It has worked for you time and again. You have identified what has nullified it – you seem to be a strong man with adequate motivation.
    Effective Bariatric surgery- no doubts about its wonderful health benefits- is irreversible and but it’s good outcome can be defeated by diet habits.
    You will be well guided by your Bariatric team.
    Don’t know if you ever thought about how healthy and trim the good Lord Jesus Christ looked ! And why?
    May the good Lord show you the right way!

    1. Thanks for your concern. If we were all just perfect like Christ there would be no need for any medical intervention, yes? The metabolic changes and mechanical back limitations will prevent success in other approaches, the literature bears this out. We must all realize that the surgery is only an assistive tool and not a cure. My bariatric team and I plan to bring all tools to use. My deliberations have been both scientific and spiritual in nature. The answers have been made clear before my announcement via this blog entry. All the best to you!

  37. Dr. Erwin its great to see your blog and will be good to follow. I’m glad you are willing to share the battle we all try to win and that is staying healthy, whatever our challenges are. Best wishes as you pursue this goal.

  38. John, what a witness, thank you for you bravery & honesty!
    I am a 250lb UK primary care physician with a special interest in diabetes & a 40 year yo-yo dieting history.
    I am in the contemplation stage of bariatric surgery & will follow you with great interest. Good luck & God bless!

  39. What a refreshing and informative blog post! Best wishes as you undertake this route to deal with your health issues. It is a great thing to acknowledge to your patients that you understand their struggles and relate to their successes and failures to obtain better health.

  40. That was a wonderful and inspiring post! It takes real guts to admit one’s deficiencies and to publicly share it. In your case I think it will help a lot of people who are struggling with this issue by providing a window into your struggle and how you came to the decision of Bariatric surgery after giving it much thought.
    My cousin had the same apprehension about surgery and was avoiding it for many years to the point of getting DM, HTN and OSA. On my visit to India few years ago I convinced her to get the surgery and now she has lost all of those diagnoses and looks fit and great.
    I wish you success in your endeavor and luck on that Cowboys call!!

    1. Nidhi- thanks so much for sharing that about your cousin. The Cowboys didn’t call, but life is good anyway!
      Happy New Year!

  41. John, your candor is admirable, as is your genuine concern for others. You have always very kind and considerate, especially so when we consider your devotion to patients.
    Great to hear you have a solid plan.
    Best of luck with everything.
    Rooting for you!

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