The KIND Revolution

Kyle Hartfield had already watched other people go through TMS. He knew it was not supposed to hurt. And he still sat down for his first session braced to start seizing.

That confusion between TMS and ECT is one of two beliefs that do real damage. The first keeps people out of the chair entirely. The second sets up the people who make it in.

Dr. Nanos sits down with Kyle Hartfield, founder of iTalk TMS, a patient advocacy platform he built because he could not sit through five seconds of the content that already existed. He is not a clinician and says so repeatedly. He came to this as a patient, after his best friend died by suicide sent an addiction he had carried since childhood out of control. He is four and a half years sober, and careful to say he did not do TMS in order to get sober.

So here is the honest version of both halves.

On the fear: ECT deliberately induces a seizure under general anesthesia. TMS does neither. You sit in a chair, you are awake, you drive yourself home. Across more than 586,000 sessions, the seizure rate was about 0.31 per 10,000 sessions, and within published guidelines in people without risk factors it appears to be fewer than one in 60,000.

On the expectation: it does not work for everyone. In real-world treatment-resistant depression, roughly six in ten respond and about three in ten reach remission. Kyle says it plainly, and his metaphor is the best thing in the episode. TMS is a crane that lifts you out of the hole and sets you on solid ground. You can turn around and fall back in, or you can start climbing. The climbing is still yours.

This is The Kind Revolution — where we bridge science, compassion, and courage.

If you are struggling, call or text 988 in the US to reach the Suicide and Crisis Lifeline.

Hosted by Dr. Georgine Nanos, MD, MPH | Kind Health Group, Encinitas, CA

Guest: Kyle Hartfield | iTalk TMS

For education, not medical advice. Kyle Hartfield is a patient advocate, not a clinician.

Sixteen percent of Americans who have heard the term "palliative care" believe it means giving up. Thirty-eight percent think it is the same thing as hospice. Neither is true.

Dr. Nanos sits down with Dr. James Ross, founder of the Brain and Body Institute in Tulsa. He is a board-certified family physician who is also board certified in hospice and palliative medicine, and across nearly 25 years he has delivered thousands of babies and later sat with those same families at a grandmother's bedside.

He offers the sentence that clears up most of the confusion: all hospice is palliative care, but not all palliative care is hospice. Palliative care is about quality of life at any stage of serious illness, given alongside treatment meant to cure. As he puts it, while medicine works on helping you live longer, palliative care comes behind and asks what would help you live better.

And the research is not soft on this. In a landmark 2010 trial, patients with metastatic lung cancer who received early palliative care alongside standard care had better quality of life, better mood, less aggressive treatment at the end of life, and longer survival. Less aggressive care, and they lived longer.

Then the part that should move people. Half of hospice patients die within 17 days of enrolling. About one in four signs up in the final week of life. One documented reason for that delay is families resisting what feels like giving up. The misconception is not harmless.

Also: the question he asks patients that reframes everything, which is who do you want to be when you die, and what you do with the answer.

This is The Kind Revolution — where we bridge science, compassion, and courage.

Hosted by Dr. Georgine Nanos, MD, MPH | Kind Health Group, Encinitas, CA

Guest: Dr. James Ross, MD | Brain and Body Institute, Tulsa, OK

For education, not medical advice.

Sixteen percent of Americans who have heard the term "palliative care" believe it means giving up. Thirty-eight percent think it is the same thing as hospice. Neither is true.

Dr. Nanos sits down with Dr. James Ross, founder of the Brain and Body Institute in Tulsa. He is a board-certified family physician who is also board certified in hospice and palliative medicine, and across nearly 25 years he has delivered thousands of babies and later sat with those same families at a grandmother's bedside.

He offers the sentence that clears up most of the confusion: all hospice is palliative care, but not all palliative care is hospice. Palliative care is about quality of life at any stage of serious illness, given alongside treatment meant to cure. As he puts it, while medicine works on helping you live longer, palliative care comes behind and asks what would help you live better.

And the research is not soft on this. In a landmark 2010 trial, patients with metastatic lung cancer who received early palliative care alongside standard care had better quality of life, better mood, less aggressive treatment at the end of life, and longer survival. Less aggressive care, and they lived longer.

Then the part that should move people. Half of hospice patients die within 17 days of enrolling. About one in four signs up in the final week of life. One documented reason for that delay is families resisting what feels like giving up. The misconception is not harmless.

Also: the question he asks patients that reframes everything, which is who do you want to be when you die, and what you do with the answer.

This is The Kind Revolution — where we bridge science, compassion, and courage.

Hosted by Dr. Georgine Nanos, MD, MPH | Kind Health Group, Encinitas, CA

Guest: Dr. James Ross, MD | Brain and Body Institute, Tulsa, OK

For education, not medical advice.

Colorectal cancer used to be an older person's disease. It is not anymore.

Dr. Nanos sits down with Sonia Ramamoorthy, MD, FACS, FASCRS, Chief of the Division of Colon and Rectal Surgery at UC San Diego and the 2024-2025 president of the American Society of Colon and Rectal Surgeons, where she is the fourth woman and the first Asian woman to hold the office in 125 years.

Here is the shift, in her own practice. 24 years ago, nearly every colorectal cancer patient she operated on was in their 60s, 70s, or 80s. Today they are in their 30s and 40s. Incidence is now climbing about 3% a year in adults aged 20 to 49, and about 14% of new US cases are in people under 50.

They get into why it keeps getting caught late, and the answer is uncomfortable. The early symptoms are rectal bleeding and a change in bowel habits, which are also the symptoms of hemorrhoids and of nothing at all. So the patient waits. The majority of young patients later diagnosed with this waited three to twelve months before seeing anyone, and most of them delayed because they did not recognize the symptoms as serious. Then, sometimes, the clinician waits too.

Dr. Ramamoorthy's answer is not a scary campaign. It is one instruction, pointed in both directions: if the treatment does not fix it, circle back with your doctor, and doctors, circle back with your patient.

Also: why screening now starts at 45, why this is one of the few genuinely preventable cancers, what the exercise and microbiome research actually supports, and the colonoscopy discussed honestly by two physicians who have each had one.

This is The Kind Revolution — where we bridge science, compassion, and courage.

Hosted by Dr. Georgine Nanos, MD, MPH | Kind Health Group, Encinitas, CA

Guest: Sonia Ramamoorthy, MD, FACS, FASCRS | UC San Diego Health

For education, not medical advice.

You have had the scans. You have had the labs. Everything came back normal, and you still cannot roll over in bed without the room moving.

Dr. Nanos sits down with Dr. Kim Bell, PT, DPT, a vestibular physical therapist who has spent more than 20 years on one problem: the dizziness nobody else could solve. Her patients call her The Vertigo Detective, and they fly in from around the world.

Her very first vertigo patient had been dizzy for 20 years. She was in her mid-70s, she had broken almost every bone you can imagine from falling, and the only time she left her house was in an ambulance. Three sessions later the vertigo was gone. That patient looked her in the eye and said, do you understand, you gave me my life back.

They get into what a real vertigo evaluation includes, why a normal MRI does not rule out a brain cause, and the single mechanical fact underneath most missed diagnoses: in a lit room your own eyes suppress the sign a clinician needs to see, by as much as 66%. Which means the exam that finds the answer has to happen in the dark, with equipment most clinics do not own.

And they get into the part Dr. Nanos keeps coming back to. When every test comes back normal, patients hear a dismissal. It is not one. It means the dangerous causes are ruled out and the real one is somewhere nobody has looked yet.

This is The Kind Revolution — where we bridge science, compassion, and courage.

Hosted by Dr. Georgine Nanos, MD, MPH | Kind Health Group, Encinitas, CA

Guest: Dr. Kim Bell, PT, DPT | betterbalanceinlife.com

For education, not medical advice.

Fertility has always been framed as a woman's problem, and meanwhile half the equation is standing quietly in the background with nobody asking about him.

Dr. Nanos sits down with Dr. Kian Asanad, a fellowship-trained reproductive urologist and microsurgeon who directs the USC Fertility and Men's Sexual Health Center at Keck Medicine of USC.

The number that reframes everything: male factor is involved in about 50% of infertile couples, and it's the sole cause in roughly 20%. Half. And the male workup is now genuinely easy, which makes it strange that it's so often the last thing anyone does instead of the first.

They get into what happens when a test comes back with no sperm at all, which is about 10% of men evaluated, and the microsurgery that can still find sperm about half the time. They get into how he tells a couple the odds without taking their hope, and what he sees in those same couples on the other side.

And then the part every man in his thirties needs to hear: testosterone therapy is, functionally, a contraceptive. It shuts down the signal that tells the testicles to make sperm, and about 65% of men go to zero within four months. It's usually reversible, but it takes months to years. Dr. Asanad points to a secret-shopper study in JAMA Internal Medicine in which 6 of 7 online platforms offered testosterone to a man with normal levels who had said he wanted children.

This is The Kind Revolution — where we bridge science, compassion, and courage.

Hosted by Dr. Georgine Nanos, MD, MPH | Kind Health Group, Encinitas, CA

kindhealthgroup.com

Guest: Dr. Kian Asanad, MD | USC Fertility and Men's Sexual Health Center

asanadmd.com

For education, not medical advice.

You looked in the mirror and something had changed. And someone told you it was just aging.

Dr. Nanos sits down with Dr. William Umansky — a board-certified plastic surgeon with over 30 years in practice in La Jolla, Stanford-trained, named by his peers one of San Diego's Physicians of Exceptional Excellence — for the plain-language conversation most women never get.

They get into what estrogen actually does to skin, and why up to 30% of dermal collagen goes in the first five years after menopause, which is why the change can genuinely feel like it happened overnight. They get into rapid weight loss and the face, and Dr. Nanos makes the point that it was never really about the medication — the same thing happens after any large, fast weight loss. They get into where fillers stop working and what that conversation should sound like.

And then the part that should make you sit up: there is no medical board preventing a physician from another specialty from performing your facelift or your liposuction. "Cosmetic surgeon" is not a recognized board. Dr. Umansky explains exactly what to check, in about five minutes, before anyone operates on you.

Plus breast implants start to finish, saline vs. silicone, how long they last, when to scan them, the rare lymphoma, and whether mammograms are safe, and a rapid-fire round on sunscreen, side-sleeping, and "preventive" facelifts.

This is The Kind Revolution where we bridge science, compassion, and courage.

Hosted by Dr. Georgine Nanos, MD, MPH | Kind Health Group, Encinitas, CA

Guest: Dr. William Umansky, MD | drumansky.com

For education, not medical advice.

You hit the goal, and the peace you were promised didn't arrive. So you set a bigger goal. If that loop sounds familiar, this one's for you.

Andrew Poles has coached more than 10,000 leaders — across NASA, Netflix, Dell, Schwab, and Epic Games — and he left the corporate world to build a practice that hit six figures in six weeks. He's also an ultra-endurance athlete, and his forthcoming memoir Over the Gate is about what a 100-mile mountain-bike race taught him about identity and worth.

He and Dr. Nanos get into the thing so many high-achieving people quietly struggle with: burnout that no amount of time management seems to fix. Andrew's argument is that burnout isn't a scheduling problem — it's a nervous-system and identity problem. We're trained to believe our value as human beings is something we earn through production, and so we run down "tunnels with no cheese," working harder and harder toward a fulfillment that achievement was never going to deliver.

They also talk about fear — why, neurologically, "fear happens to you" and the only real choice is what you do next — and the very personal story of the race Andrew took on specifically because he was certain he couldn't.

This is The Kind Revolution — where science meets courage and medicine meets humanity.

Hosted by Dr. Georgine Nanos, MD, MPH | Kind Health Group, Encinitas, CA

Guest: Andrew Poles | Executive & Founder Coach | andrewpoles.com

He learned to stay calm defusing bombs. Now he uses the same steady hands and the same nervous system to take on medical misinformation online.

Dr. Zachary Meade took the least conventional route into medicine imaginable. A childhood in and out of foster care. Years as an explosive ordnance disposal technician in the military. A detour through electrical engineering. Then med school, and now a career as a military anesthesiologist in San Diego.

He and Dr. Nanos get into the whole thing: how he researches a viral health claim (start with the nugget of truth, then go to the actual evidence), why "big wellness" has quietly become bigger and in some ways worse than big pharma, and the simple rules he gives patients for spotting a fake — like the 60-second credential test and watching what someone's actually selling at the end of the video.

They also talk about the human side: informed consent in the OR, how he talks a terrified patient through the minutes before anesthesia, what a hard childhood and the bomb squad taught him about handling relentless online hate, and a closing message to anyone who's ever felt unloved or alone that is, honestly, the best part of the episode.

This is The Kind Revolution — where science meets courage and medicine meets humanity.

If this episode brings up a hard time for you, you're not alone. In the U.S. you can call or text 988 for the Suicide & Crisis Lifeline, any time.

A psychiatrist missed her own perimenopause. She thought her antidepressant was causing the night sweats.

Dr. Carlene MacMillan is a child and adolescent psychiatrist, the Chief Medical Officer at Radial, and spent years chairing the Clinical TMS Society's insurance committee — which means she is one of the few people in the country doing the tedious, unglamorous work of getting brain treatments actually covered. She is also a woman in midlife who walked into a routine OB-GYN appointment, got asked whether she still gets her periods, said yes, and watched the conversation end there.

"It's not a bad doctor," she tells Dr. Nanos. "The standard is just so low."

What follows is a conversation about where women's symptoms go to get misfiled. Dr. MacMillan describes patients whose depression she successfully treated — who then said I'm not depressed anymore, but I still feel awful — and who turned out to have PCOS, endometriosis, or autoimmune disease that had been dismissed for years as being in their heads.

They also get into high-THC cannabis and the adolescent brain, why TMS is covered after roughly two failed medications rather than four, what accelerated protocols mean for access, and why she'd like the field to stop calling itself psychiatry and start calling itself brain medicine.

This is The Kind Revolution — where science meets courage and medicine meets humanity.

🎙 Hosted by Dr. Georgine Nanos, MD, MPH | Kind Health Group, Encinitas, CA

👤 Guest: Dr. Carlene MacMillan, MD | Chief Medical Officer, Radial | https://www.meetradial.com/carlene-macmillan