Heartfelt, #74

Dr. Lowell Gerber:

So we always have to keep in mind that we want to do something for our patients and that to our patients there's a lot of drive to do things to people for a lot of different reasons.

Steve Shaffer:

I like Maine because of the values that people have on the east coast, especially in Maine. The weather determines your values because as fishermen know, if you're in trouble, it doesn't make any difference if you like somebody or not. You go help them. The rules are based upon nature. Normally you can surround yourself with yourself and not have to challenge yourself in this way.

Kate Shaffer:

Chocolate is definitely one of those ingredients that you have to learn from rather than learn to master. I have learned a lot from working with it about pretty much everything.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast show number 74, Heartfelt, airing for the first time on February 10, 20, 2013. This week is a very important week in my life. This is the week that my daughter turns 12. It's interesting, my Sophie calls Valentine's Day Sophie's birthday, because that's exactly what it is in her mind and it's appropriate. She's my third child. She is the child of my heart. She was the unexpected blessing behind her other brother and her sister, and she served to remind me that you can be a doctor and live in your head. You can spend as much time as you want focusing on the thoughts and the ideas, but there's always going to be a part of you that's connected back to this very loving energy that's around us in the world. So happy birthday to my daughter Sophie, and I'm very privileged to have on the show with us today other people who have Heartfelt ways of living in the world and bringing their message to people just as I am. Our guests today include cardiologists Dr. Lowell Gerber, Steve and Kate Schaefer of Black Dinah Chocolatiers on Isla Ho and Frances Howell of Hiking to build hope. Dr. Lowell Gerber is a cardiologist that spent many years with rooting around in the arteries of people's hearts, trying to fix problems that had started years before. Over time, he came to understand that the type of medicine he was practicing was too far downstream. He wanted to go upstream and help people's hearts to be healthy. From earlier on, Steve and Kate Schaefer of Black Dinah Chocolatiers are offering their own version of living in a heartfelt manner in their Chocolate Tear Studio in Ilaho. As we've come to understand recently from the medical research, dark chocolate is actually good for us, as is the love that's put into creating a product that people enjoy. We know that you'll enjoy their interview in Frances Howell of Hiking to Build Hope is one of the most enthusiastic proponents of hiking we have ever run across. He reminds us that it's important to live our lives with passion, get out there, connect with nature, and really do what brings your heart joy. So from my heart to yours, Happy Valentine's Day. I'm sending lots of love in your direction and I hope that you are able to bring love into your own life and send it back out again. Thank you for joining us today and hearing our interviews with Dr. Lowell Gerber, Steve and Kate Schaefer and Frances Howell. As you might imagine, given that I'm a radio show host, I really enjoy spending time talking to people about their health. Many of the things that I speak with my patients about or talk about on the air are things that I've learned in my own life and not necessarily through my training as a doctor. Recently we've started a series at the Body Architect of Information that combines the best of all worlds, and our next topic is on February 27th, and it will be about revving up your metabolism. For more information on the talk that we're giving on February 27th at the Body Architect in Portland, or to sign up, please call 207-774-2196. We look forward to seeing you there. When we think of Valentine's Day, obviously we think about hearts, and we're thinking more about hearts as they relate to love. But we also think about hearts as they relate to our blood and physiology. And of course, I think about it this way because I'm a doctor. So I've invited one of my fellow doctors, Dr. Lowell Gerber, a cardiologist who practices in, to come in and talk to us about this wonderful organ that helps us pump blood throughout our bodies and really keeps us alive. Thanks for coming in.

Dr. Lowell Gerber:

Well, thank you for such a nice introduction because I too feel that the heart is the source of love and relationship in life. However, what we were just talking about earlier in medical school and the medical profession, I sometimes have arguments with my colleagues that say that the heart only exists to hold the two lungs together, or the heart only exists to provide a source of blood supply to the brain, or the heart only exists to circulate blood to the gastrointestinal tract or the ovaries or uterus or whatever their organ of interest is. And so I'm very pleased to be part of a discussion where we can talk more about the holistic effects of the heart and what it represents.

Dr. Lisa Belisle:

You and I spoke on the phone yesterday and it was interesting to me because you were an interventional cardiologist for 30 years. Thirty years. And I think you described an early sense that really the body was just a box around the heart when you were, you know, this is the heart, this is your focus. You're going to go in there, you're going to do what you need to to the heart, and the body just becomes this box.

Dr. Lowell Gerber:

Well, and actually when I step back and have this out of body experience and look back on what I was doing, so actually the body was lying on a table and I had my means and mechanisms for getting into the body, but the heart actually was located in a box suspended over the body. So in your cath lab, for many of the newer physicians, I think it's unfortunate, but they take this as a video game. So truly, for 30 years, I was focused on a very small portion. In fact, when I was putting in a stent in a coronary artery, I was interested in about a segment of the artery that was maybe 1 to 2 centimeters long and maybe 3 millimeters in diameter. And beyond that, it was somebody else's territory. Now, I had an interest in cardiac rehabilitation and I have a master's degree in exercise physiology. And I never gave that up. But as I went into medical school, I became like all the other doctors and basically put aside everything that I'd been learned in the science of anatomy, physiology, pathology, biochemistry, and began to follow the guideline based medicine that we're all now accustomed to.

Dr. Lisa Belisle:

Well, I want to step back and explain for people who have never been in a cardiac cath lab and maybe people who have been, but don't really realize what you're saying, that when you're. And I was part of this, when I was a medical resident A medical student, you go in there, the person's on the table, there's stuff that's happening to the person. But what you're looking up at is basically a. A screen, a television screen. So it really does feel like you're kind of monkeying your fingers around in a very highly skilled way to get an achieved result up on a screen.

Dr. Lowell Gerber:

Exactly.

Dr. Lisa Belisle:

That must have been a very kind of, let's just say, disembodied experience.

Dr. Lowell Gerber:

Well, and that's why I call it reflecting back on my 30 years in the cath lab as an out of body experience, because we got very accustomed to knowing a patient by the disease that they had and our exposure to the patient very often. Many of the physicians that I know really didn't examine a patient very much. The interventionalists, when they met the patient, there was a small opening in the gown over the groin area and now over the wrist. And for many of them, that was really the introduction. We try to avoid that now and get to know our patients better. But still, it is a very impersonal way of taking care of patients. This is the surgical approach. There are many people who have bonded with their surgeons or with their obstetricians. I don't know as many that bonded with their interventional cardiologists because typically the relationship is quite short. What used to be an experience where somebody would have a heart attack and come in, they'd be in the hospital for two weeks. So now they come into the emergency room, they're met with a very skilled team who makes their assessments very quickly. There's a stopwatch that starts ticking. There's a time frame to get them into the cardiac catheterization laboratory to get the procedure completed. And it used to be called the door to balloon time, and now it's the call to balloon time. So from the time the patient calls for help, the stopwatch starts and the balloon is. The balloon is the device that's put into the artery to deploy, usually to deploy a little piece of metal that's called a stent. So when the artery is blocked, we open it with a balloon and then put a stent in there to keep it open. So that's all on the clock right now. And now there are case managers who are meeting with the family when the patients come into the emergency room with their heart attack to begin the discharge planning. So a patient may come in with a heart attack and be out of the hospital within 24 hours. So the whole time that we had to bond with the patient, develop A physician patient relationship to take advantage of that teachable moment when the patient and their family are suffering a medical crisis and they're more open to listen to things that's really been diminished. And so for many patients, they're in and out so quickly. For many of them, it quite literally is difficult for them to believe that anything bad really happened because it goes so quick. They're sedated, they're treated very humanely, but the teachable moment is gone. And so one of my interests is to make lifestyle changes for people. And usually that teachable moment is when a patient and their family are very much open to a lifestyle change. But that's gone for many, well, after

Dr. Lisa Belisle:

30 years being an interventional cardiologist. And for people who are listening, an interventional cardiologist, just define that a little bit.

Dr. Lowell Gerber:

So there are different types of cardiologists. So back when I started training, there was no such thing as an interventional cardiologist. There were clinical cardiologists who were physicians that often worked in their office, and there were invasive cardiologists who often did most of their work or some of their work in the hospital, doing those procedures where you actually do something to the patient to make a diagnosis. And that something was usually putting a small tube into an artery, a peripheral artery, usually in the groin, and then advancing a tube up into the arteries of the heart and taking a picture of the heart, and often putting a tube into the chambers of the heart, measuring the pressures. And that was called catheterization. So the invasive cardiologist did cardiac catheterization, measuring the pressures of the structure or function of the heart in coronary angiography. So it was cardiac catheterization and coronary angiography. And then in the late 70s and early 80s, for the first time, we were able to actually do something to the artery besides take a picture of it or measure its function. And the first things that were done were using a balloon to stretch the artery open. And at the same time, we learned how to stretch the arteries and the legs open the arteries and the kidneys, the arteries actually leading to the brain, were done very early, but the problem was they kept coming back. And so then in the mid-80s and early 90s, we introduced putting little pieces of metal around that balloon, called a stent. And that's probably one of the most frequent procedures done in the United States today, opening an artery. So the cardiac catheterization, measuring the pressures and function, and the coronary angiography, taking the pictures, are a preliminary step. And then the next step is actually to do something to the patient to change them, and that's putting the balloon and stent in. Now, that's gone well beyond that now, because now we put artificial valves in without surgery. We put stents in the carotid arteries that. To hopefully to prevent stroke, into the renal arteries to prevent kidney failure and the arteries of the legs to relieve symptoms. So it has really expanded. And now we do this not only in neonates to avoid recurrent congenital heart surgeries, but there are procedures done in utero in the fetus. They can do this.

Dr. Lisa Belisle:

So we're talking neonates, babies.

Dr. Lowell Gerber:

We're talking about babies before they're born,

Dr. Lisa Belisle:

just before they're born.

Dr. Lowell Gerber:

So this whole idea of interventions in cardiology and radiology, I've got to give a lot of recognition and respect to the interventional radiologists who've helped this field develop. It's not just cardiologists, not just radiologists, but neurologists. It's been nephrologists. It's really been a blossoming of physicians who want to do something for their patients more proactive than surgery.

Dr. Lisa Belisle:

Well, this is a good place for me to jump in because what you've just spent this time describing, and I think it's really helpful because we hear these terms and people who are listening, they hear these terms, but we don't always get them defined as clearly as that. But it sounds very technical. I mean, it sounds like a very technical field where you have to be very skilled with your. Well, you have to be intelligent. You have to be able to use your fingers in a way to manipulate the things that need to go into very small spaces. And it's. What we've been able to offer patients is truly amazing. And we've been able to prolong lives. We've been able to do really wonderful things with the technology. But after 30 years of doing this technical stuff, you've really shifted the way that you now practice medicine, and you're in the process of shifting this.

Dr. Lowell Gerber:

Well, one of my interests became what's called now multivascular disease. And that's why I tried to bring in all those other disciplines. Because the same disease process not only affects the coronary arteries, but affects arteries throughout the body. So we reach a point, as people age and develop other medical problems that promote this atherosclerosis, do we get to a point where we're going to put stents in? 2 carotid arteries, 2 renal arteries, 3 coronary arteries and arteries and legs? Where does it end? And Maybe we're approaching this a little too late now. My father was a dentist, and he got interested in dental prevention very early and was at odds with the Chicago Dental Society because prevention really wasn't something people were really interested in then. And so maybe some of that's rubbed off on me as I've maintained my interest in interventions, but also in cardiac rehab and prevention. And a lot of what we've heard about prevention has been pretty much held as blasphemy that it doesn't work, it can't work, and that anybody who tries to reverse these things is a quack. And I believed that. And I had a fair number of patients who were getting chelation therapy in Florida, where I practiced for a long time that had failed chelation therapy. The disease progressed despite it. And so, of course, we just said, this is just more proof that you can't change it. And what we do as interventional cardiologists, putting in a balloon in a stent is the answer. And then as we got better at putting in balloons and stents, the technology got better, the devices got safer. We, I'm speaking generically amongst interventional cardiologists and radiologists, started to feel, well, if most heart attacks occur with a plaque, that's less than a 50% blockage, I don't think most people know that. Most people think that if you have a severe blockage, that's when you have a heart attack. Well, if it happens acutely, if a plaque ruptures and it blocks an artery, then people have a heart attack. But most of those heart attacks occur from plaques that are less than 50%, obstruction of the lumen. In fact, most of them are 30%. And we call this now a vulnerable plaque because we know more about the pathophysiology. So many of my colleagues felt that, well, if stenting a 70 to 90% stenosis is a good thing, then maybe we should be stenting the 30 to 50% stenoses to prevent them from ever having a heart attack. And that was called plaque ceiling. S E A L I N G not C E I We hear a lot now about ceilings, fiscal capital debt ceilings, but we're talking about a different type of ceiling. And so physicians thinking that they were doing a good thing for their patients by sealing these vulnerable plaques in vulnerable patients, we began to create a new disease category of stent, thrombosis, stent dissections. So we always have to keep in mind that we want to do something for our patients and that to our patients, there's a lot of drive to do things to people for a lot of different reasons.

Dr. Lisa Belisle:

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Dr. Lisa Belisle:

Well, and you're right that this is and again, it's very important, if you have a patient who comes in with a lesion, you certainly don't want them to have a heart attack or a stroke. So it's not that this doesn't have its place, but you've been working more upstream than that, literally and figuratively. I think you've been working more with metabolic disease, with obesity, with dietary changes, and you've been trying to get people to a place where you're trying to impact things before they get to the place where they need to have a stent. So talk to me about that.

Dr. Lowell Gerber:

So this is where I start the conversation with my patients. And I start out my life doing exercise physiology. A master's degree, was working on a PhD in that. And in medical school, I was doing research on endothelium, injecting very minute amounts of what's called endotoxin. It's an inflammatory component of bacterial cell walls. And studying the interaction between the blood and the vessel wall. I've been looking at that for 30 years. As I got into interventional cardiology, my life was taking care of the other end of that experimental model, and that is the effects of chronic disease on the endothelium, the plaque buildup. So I've been trying to put that together, but it's always been at a distance. It's been a research interest, it's been a clinical interest. And then what happens at age 50, I think I mentioned this to you. At age 50, I realized that I had been doing triathlons. I've been cross country team, been an athlete all my life. I was doing triathlons. And then at age 50, I started to slow down, I started to gain weight, had done nothing different about my exercise regimen or my diet, but I was slowing down and gaining weight. And my running partner, who was 73 years old, was starting to pull ahead of me. And we would run one day, swim one day, cycle one day, do resistance training one day. Then often we would go and look at the course and do the course because you had to be competitive. You really had to know the course. Had to know where to leave your bike, where to leave your shoes, where to leave your pick up your goggles. And so we would do that one day and just do a light workout. Then we would compete and take a day off. And we did that almost every in Florida. You could do a triathlon more than once a week if you really wanted to. And so my own doctor told me that I should give up the Mediterranean diet that it was on because there was too much fat in it. And I should go on a very low fat diet, get the fat out of my diet, and I should start doing what I told my patients. They should work out three to five days a week at 30 to 45 minutes of moderate intensity because I was eating too much fat. And I was over training. And so I did that and I gained more weight. My cholesterol wasn't bad, but it never got where we wanted it. And he wanted to start Me on statins, my blood pressure was never really high at rest, but on the treadmill test, it went up a little bit too much. And so he wanted me to take an ACE inhibitor. Both my mom and dad had coronary artery disease, but both at very late age. But he wanted to be preventive and started me on aspirin. So now I'm on aspirin, beta blocker, statin, an ACE inhibitor, and I'm following the advice I give my patients. And I'm gaining weight. My cholesterol's not getting the target. My blood sugar, my fasting blood sugar is still at the. It was normal, but it was the upper range. It was in the 90s. And he's telling me that. I realized, Dr. Gerber, that you're very, very busy. You make rounds, you do all these procedures, but you need to start taking care of yourself. You need to follow this diet and do this exercise. And then I just kind of got very flushed and had this, I call it an aha moment where I said to myself, oh, my God, he's accusing me of not. I'm doing exactly what I should be doing. In fact, I'm doing less than what I used to be doing. And I'm gaining weight, my blood pressure is going up, my blood sugar and my cholesterol is not a target. I said, oh, my God. My patients weren't lying to me. I was so arrogant that I would get up at 3 o' clock in the morning with a patient having a heart attack, put a balloon in the stent, in the widowmaker, that's the proximal part of the artery where if it closes off completely, they die. We'd get them into the lab, open it up, I'd pat him on the back, saved your life. Pat myself on the back. I saved his life. And I'd give him this regimen to follow and ask him to see me back in six weeks to three months. And if they weren't at target, if they hadn't made the goals I set for them, I would have them see my dietitian about a very low fat diet. I'd have them go to the gym that I selected because they were a very medically oriented type of gym, and have them follow the American College of Sports Medicine guidelines that were recommended, and I'd have them come back and they still hadn't made their progress. And again, I was so arrogant, I would say, you better really get with the guidelines here because you're going to have another heart attack and nobody may be able to get to you quick enough to save your life. And they'd say, doc, look at me. Here's my journal. I go to your dietitian. Here's my exercise log. I go to your gym. I breathe air. I drink water, I eat granola. And look at me. And then when I did it to myself, when I had gained 50 pounds, had metabolic syndrome with pre diabetes, pre hypertension, my cholesterol was a little bit too high, and then found I had a plaque in my carotid, I said, oh, my God, I am doing it to myself, following the guidelines. And that's when my life shifted 180 degrees. I said, you know what? Something's wrong here. And I had to find out what was wrong.

Dr. Lisa Belisle:

So what are you doing differently now? What do you now offer your patients and now practice yourself?

Dr. Lowell Gerber:

So what I had to do for myself is find out why wasn't I following those guidelines. They're supposed to work for everybody. And what I did is just had to go back in my memory to where was I when I was working on my PhD in exercise physiology, when I was studying body composition and nutrition. And so I went back and looked at what we knew 40, 50 years ago and looked at where we are now, and then looked for a type of physician that had a more of a holistic approach to treating a human body than the guidelines. In other words, what is it about Lowell Gerber that his diet isn't the same for him as other people that exercise or what are the metabolic hormonal factors are there? And so I found a physician that would do that, that would have a very personalized approach to find out from. Detailed history, physical family history, biochemistry, hormonal patterns. You know, where am I today? And as most of us in medicine have had to learn, some of us the hard way, is that patients have wants and needs. And I knew where I wanted to go, but he knew where I needed to go. And they weren't the same because he was thinking about individualized, personalized care. And I wanted to follow the guidelines because that's what I had been taught. And so it took me a little bit while to wipe my slate clean and follow what they had told me to do. And that as a former researcher, physician, PhD candidate, to go back and look at it for myself and make up my own mind.

Dr. Lisa Belisle:

You and I could spend hours and hours on so many different aspects of this, because I know this is something you've dedicated your entire life to. It's so hard to encapsulate this down into an hour long show. How can people find out more about the work that you're doing in the community and where can they hear you speak and connect with you, you personally? What's the best way to reach you?

Dr. Lowell Gerber:

Okay, well, at this moment I'm actually in a metamorphosis. Professionally. I've done cardiology now for 30 years, finished my cardiology training. I hate to see this in 1980 and transitioning more to a full time practice of a combination of preventive aging, preventive cardiology and weight management. And I've been actually questioned by some of my patients about why would a physician who's interested in preventive aging include children and families? I'm developing a medical retreat for. My fantasy would be to have baby boomers with their parents and their kids. Because when I see a middle aged woman who comes in who wants to lose weight and she's got kids at home and her own parents to care for and she's working because of the economy, she doesn't have time to fix six different meals. So part of the challenge is to figure out the dynamics of the family as well as the dynamics. So it has to be a lifestyle that they'll stick with. So it may not be perfect, but it's better than what they're doing. So I see children who are and you probably see them as well, they're infants. They're most recently took care of a nine year old who had obesity, hypertension, pre diabetes and hyperlipidemia. And the answer by his pediatrician was to make him work out more and put him on antihypertensives, glucose lowering and statin drugs.

Dr. Lisa Belisle:

But when people come to see you, you don't do that for them. And I know your practice is in transition, but how do people contact?

Dr. Lowell Gerber:

So I have a webpage and you can go to www.leanerme l e a n e r me.com or the new complete practice. So leaner me is the weight management aspect. I have an age management practice which was live younger, love longer, be strong. And those two are being combined into a single program called Younger Leaner Me. And so all those will lead to me, I didn't bring a business card today because those are being I've got consultants, my goodness, telling me you know, how to design the card, how many letters to have, you know, and that's the part of this I don't like. But in order to get the word out, as you're doing for me now, people need to know how to get ahold of me. So www.leanerme.com is probably the easiest and I hope to have the new practice up and running full probably by Valentine's Day. That's kind of my target right now.

Dr. Lisa Belisle:

Perfect. Well, as I said, there's just so you're just a wealth of information and I know that there are many, many more shows that we could do on various aspects of what you're doing. And I congratulate you for spending all this time and really trying to understand things so that you can create personalized plans for people, preventive cardiology plans and other weight loss plans. So I appreciate your coming in and speaking with us today. We've been talking with Dr. Lowell Gerber, whose cardiology practice is in Freeport.

Dr. Lowell Gerber:

Thank you so much for helping me get the message out, particularly for women on Valentine's Day. And I will be giving this talk on Preventive Cardiology in Freeport in Portland, and it'll be in the newspaper and on my website.

Dr. Lisa Belisle:

One of our good friends, Beth Schisler, the co founder of Seabags, when she heard that we were putting together our Valentine's Day show, said, you know, I have this group of people that you definitely need to meet or these two individuals you definitely need to meet. And this would be Steve and Kate Schaefer, who are the co founders of Black Dinah Chocolatiers all the way up the coast or off the coast at the Isle of Ho. Isle of Ho, which I thought was kind of exciting. And the fact that you agreed to come down off the island and talk to us about what you're doing at Black Dinah Chocolatiers makes me really happy. It's a good way to start my day. Thanks for coming In.

Dr. Lowell Gerber:

Yeah.

Steve Shaffer:

Glad to be here.

Kate Shaffer:

Thanks for having us.

Dr. Lisa Belisle:

And I know that actually you came up from New York City, so. Or New York.

Steve Shaffer:

Yes.

Dr. Lisa Belisle:

You're not having to come down off the island today, but what's that like, to live on an island?

Kate Shaffer:

Well, it's a lot. It's a lot of scheduling. This time of year. There's only two boats a day, which is pretty good for a remote main island. But it's still. You really have to plan your life around the boat schedule.

Steve Shaffer:

Yeah, the nickname of it is Luggahoe, because you're always lugging something on or something off.

Dr. Lisa Belisle:

How long's the ferry ride out there?

Steve Shaffer:

About 40 minutes.

Dr. Lisa Belisle:

So how does that feel? Does that give you kind of a Zen time frame in which to just kind of hang out, or are you doing business stuff? What's that like? I've always wondered, to actually live on an island, not just visit.

Steve Shaffer:

I'd say it's a hurry up and rush. So, you know, you get used to having to rush to get ready either the night before, preparing everything. So when you get up in the morning, you're ready to go that morning to catch the boat. And once you're on the boat, that's that moment of Zen where there's nothing else she can do but sit.

Dr. Lisa Belisle:

And do you bring this sort of sense of what sounds like just mindfulness and rolling with it and being kind of peaceful in the way that you approach your lives? Do you bring this into the work that you do with creating chocolate?

Kate Shaffer:

Sure. I mean, I came out to the island as a cook for the inn. Out there was the keeper's house, actually. It's going to reopen again this summer,

Dr. Lisa Belisle:

but

Kate Shaffer:

it is definitely, I won't say fly by the seat of your pants, but it's definitely work with what you have and the resources that you have. And that was a huge factor in creating our business model. We wanted to make fine chocolate, but we really wanted to use our local resources. And since chocolate is so not local, everything else we use really, we felt, had to be. So, you know, we took a look. We started right there in our front yard and started looking around at what we could use from the island, from Maine to create a really high quality confection that would resonate not only with gourmet chocolate lovers, but with Maine itself. So, yeah, definitely.

Dr. Lisa Belisle:

So what did you find when you were taking a look? I'm fascinated by the fact that you look in your front yard and find something that might go into a chocolate.

Kate Shaffer:

Sure.

Dr. Lisa Belisle:

Tell me about that.

Kate Shaffer:

So I Mean, Maine is very known for, for instance, Kate's butter. We use butter in our truffles and, you know, local cream and milk. We use local herbs, fruits, and flowers. So apples, right from the island, pumpkins from our neighbors across the water, Blueberries, of course, raspberries, strawberries.

Steve Shaffer:

Well, when we first moved out here, Kate grew up in California. And so when she first moved out here, her thought was, what about the food? Because California has such great food and it's abundant. And within, I think, the first couple of years when she was working in the lighthouse, having to source food, she found out that the food here was much better than what she was being able to find in California. And she was very surprised.

Kate Shaffer:

Right. Well, it was more accessible. And I really developed a lot of personal relationships with the farmers. So, for instance, I was living on the island when I was a cook at the lighthouse. I was living on the island five days a week. So I would do all my farm runs on my way to the boat for my week out. And so I developed a lot of personal relationships with this very dynamic network of farmers and home gardeners. And when we decided to start our own business, it was a natural sort of organic movement to use the resources that we had already developed with them. So it was fun. It was really fun.

Steve Shaffer:

I think of it as an organic process. You know, we have it. We built the business with an idea in mind and then just let it develop with a reflection back from the community and so forth. So it's been a very interesting process.

Dr. Lisa Belisle:

That is very interesting because not everybody lives in a place that they would consider a community. I mean, you can call something a community because you live there and there's other houses around you, but there isn't necessarily always the back and forth on an island. You kind of have the people who are on the island with you and even the people who are on the mainland. I mean, if it's a small town in Maine, there's only so many of them. You kind of have to learn to get along and to rely on one another. What's that been like?

Steve Shaffer:

Well, I think one of the things that has been really interesting for us as we've hired people from the community, is targeting people that we go, okay, who has a skill set that we think will fit in here, and then offering them an opportunity that they wouldn't have had, so that they may be doing something that they can is what they can do, but it may not be tapping into a skill or something that they. An interest that they have. And I think that we've been able to offer up a different way of being out there, and they've been able to actually fulfill a sort of like, oh, wow, I'm good at this. I can do this. So it's been really fun to see that kind of interaction happening.

Dr. Lisa Belisle:

Right.

Kate Shaffer:

So one of the questions a lot of people ask is, I mean, there's 40 people that live on Ilaho, and when you start a business, especially a growing business out there, people say, well, you know, what about the workforce? You know, where do you hire from? Do you hire from off island? And we have not, because it's sort of amazing. We've found our perfect co workers right there on Ilaho. I mean, we couldn't have asked for better people to work with with more perfect skill sets.

Francis Howell:

Right.

Steve Shaffer:

And I guess, you know, for me, what was the crux was at the beginning was we sat there and said, we want to be here, so what are we going to do to be here? And we didn't sit there and come in with an idea, well, we're going to move here and do this. We sat down and said, okay, what can we do here that is feasible given the community and the materials that we have at hand? And so that's the thing. It was very organic in that whole process on both ends, in the design of the business and also in the production of the chocolate. How, you know, creating things.

Kate Shaffer:

Yeah, it's definitely a different way to create something is being in a place that you want to be and taking bits and pieces from it and creating a model from your surroundings.

Steve Shaffer:

And so often it's like, you know, the look at how businesses are created. People sit there and say, oh, I want to move up to Maine and do this. And we came to Maine because we wanted to be in Maine. And then we said, what is it we're going to do here in order to survive? Because we are on a remote island, so you kind of have to sit down. And we spent a full winter working out the details of what we could do and what was possible there. So we really thought about it.

Kate Shaffer:

Yeah. So it makes perfect sense that we started making chocolate.

Dr. Lowell Gerber:

Right.

Dr. Lisa Belisle:

Well, it is a very different way of approaching things because I think people do often come in with sort of a top down. I am this and I'm gonna fit. I'm gonna sort of put myself in this place and expect things to kind of morph around me. And what you're doing is saying, we want to be in this place, and let's see what is already in Existence. And how can we create this collaborative group to actually create a product? And that's something that I find really very touching, because in Chinese medicine, when they talk about food having an essence, and they talk about specifically live foods, they talk about different plants and growing different fruits and vegetables, and they have different essences. But you're creating something from food sources that are already. I mean, maybe those foods still have their essences, but you're actually contributing personal essences and the essence of the community and into the chocolate that you're making, which is a very loving process.

Kate Shaffer:

I think so. And also, chocolate itself is an extremely magical substance. I mean, I was never crazy about chocolate before we started it. I mean, I wasn't, you know, gaga about it, but as an ingredient, I was always fascinated by it and how it behaves. And it is. Especially combining it with other things, including energy and all that stuff, it's. It's magical.

Steve Shaffer:

And that's one thing, too, is when Kate was working at the lighthouse and she was having shoulder issues, I think it was. And she went to see somebody who did some body work. They said, you need to stop putting stress into what you're doing. And so she, you know, really took it to heart and started coming in saying, okay, I'm gonna put my love into this. This is what I love. And at the same time, she started working with chocolate, which is very frustrating because it doesn't behave like any other product. So she had to change her attitude towards it. And I think that was. It was an interaction. I mean, chocolate has, you know, you can make it beautiful. It's also chemistry and it's food. And so it combined a number of things that touched on what Kate liked to do. And she. I think she said, I don't want to put the stress because I'm frustrated with this product. I'm going to learn to love it and work with it. So it totally changed how she did what she did.

Kate Shaffer:

Chocolate is definitely one of those ingredients that you have to learn from rather than learn to master. And at least that's the way I approach it. Maybe other chocolatiers do it differently, but I have learned a lot from working with it about pretty much everything. You know, I think it definitely relates to life and how we live our life on the island.

Steve Shaffer:

You know, Kate's been able to laugh at a lot of the mistakes she's made. She has on her homepage, I think it is, for Facebook, a photo of the chocolate that she spilled onto the floor. And it was really beautiful because the floor Is kind of orange and pink, and there's this chocolate Jackson Pollock type design. And it looks. It's great, you know, so it's sort of seeing the mess and being like, well, that is still kind of beautiful. It's not what I wanted, but.

Kate Shaffer:

Right. It ruined every project I was planning that day. We got a really good photograph out of it. Yeah.

Dr. Lisa Belisle:

Steve, are you from Maine?

Steve Shaffer:

I'm not. I grew up in Pennsylvania. I moved to Maine, graduated from UMO, and then moved to California and then realized I really liked Maine. I like the community, how small it is and so forth. So I wanted. I introduced Kate to it, and we moved. She decided, yeah, I'll move back here. I'll try living here.

Dr. Lisa Belisle:

What is it about Maine that attracted the two of you? Why. Why Maine? Why the Isle of.

Steve Shaffer:

When I lived in Maine previously, I really liked the island. So I was always attracted to the smallness of them in the community. And when I moved to California, I was kind of intimidated by California because it's always this, you know, magical big place and stuff like that. And I felt like I was living in Maine because I was kind of avoiding people. And so when I moved to California, I was like, okay, I was living in, you know, in different places and so forth. And I realized I really was there because I liked Maine because of the values that people have. And one of the things that I think about is how people came to America initially to design, to set up communities. And on the east coast, especially in Maine, the weather determines your values, because as fishermen know, if you're in trouble, it doesn't make any difference if you like somebody or not. You go help them. And so the rules are based upon nature. And on the west coast, it feels to me like people made a gold rush. They went over there for wealth, and the whole system was set up on society. So the rules, when you base them on society, are changeable. You know, one minute it can be this rule, and the next minute it can be this. So it wasn't as stable. People weren't as community oriented, even though living was easier. And I realized that I really liked this about Maine. I really liked the community. And one of the things I really appreciate on the island is I've developed friendships with people that I would never have developed. And so the opportunity has been that because we live so closely with people, that I feel so enriched by that, where normally you can surround yourself with yourself and not have to challenge yourself in this way.

Kate Shaffer:

Can you tell he studied philosophy?

Dr. Lisa Belisle:

Yes, I can tell that you're a very well rounded individual. I don't know about that, but why is it called Black Dinah?

Kate Shaffer:

Black Dina is the name of the mountain, which is actually really just a. A rock right outside our back door. So on all the old maps of Idaho, they have it on the old maps, but not on the new maps. And it's a rock. It takes about 10 minutes to hike up to the top of it and you get a great view of Penobscot Bay and the Camden Hills.

Dr. Lisa Belisle:

What are your favorite products that you. I mean, we've talked a lot about life and living and coming back to the chocolate idea. What are some of the favorite, your

Kate Shaffer:

favorite creations that we make? Well, I mean, I love our truffles, and that's our, our biggest product. And I mostly love them because of the process of making them. I mean, they're fabulous to eat and all that, but it's just, it is so rewarding to start from scratch. You know, your cream, your chocolate, your butter, and make the best ganache you could make and then coat it in the best chocolate you can find and make it look beautiful. So I love that process. But as far as products go, I think my favorite ones are the ones that have sort of sprung up

Dr. Lisa Belisle:

from

Kate Shaffer:

by accident or just by innovation because we're trying to figure out how to use, you know, the bits of caramel that we cut off that would normally, you know, be composted. You know, it's a great thing. You know, we hate to get rid of it. So Steve, you know, Steve and I will sit there, we'll be in the kitchen looking at it, and Steve will stick a chocolate frog on a, on a piece of caramel and be like, hey, we could do this. This could be our frog on a log. Which is definitely one of our best selling products now.

Steve Shaffer:

So, yeah, we do, like, you know, that was one thing too, is having to bring, like, with our chocolates, we would always take back what hasn't sold because they're fresh and they'll mold and so forth. So we didn't want them in the stores beyond a certain date. So we'd bring them back. And so then we were like, what are we gonna do with these? Because it was, you know, heartbreaking to have to compost them. So we started making ice cream, you know, so it's always this thing of what do we do to reduce our waste stream? You know, I have to say one of my favorite, I mean, not only for the taste is the varietal, which is. I like it. Because what it is, is in South America, this is a Peruvian chocolate. And what happened was down there they were growing cocaine because that was the only source of income that these communities had. And the war on drugs, the government would come down and decimate the communities. And so they started having to go into the rainforest, creating new fields, destroying the rainforest, setting up again. And then the government would find them and make them move. So you were ruining the community, you were ruining the rainforest. So this organization came in and said, okay, we're going to offer them chocolate, we're going to teach them how to grow chocolate, we're going to buy it from them, we're going to make this high quality chocolate and we're going to sell it. And so the varietal is actually.

Kate Shaffer:

That's a truffle.

Steve Shaffer:

It's a truffle and it comes from. It's one source. So you really get the flavor of the chocolate. It's our most requested truffle. And it's also supporting another community that is trying to, you know, make themselves viable, you know, so I feel like that is, you know, because I'm philosopher, I don't have a great palette like Kate does, you know, so I think about the whole process of how we're setting up things and how. What is the stream from beginning to end. And so that's one of my favorite products.

Dr. Lisa Belisle:

How do people find out about Black Dinah Chocolatiers, the chocolates that you're making out of?

Kate Shaffer:

Sure. Well, we've been very lucky to have had a lot of media coverage since 2007 when we started. So regionally we've been covered in a lot of the magazines around here. We don't really do any paid advertising nationally. We've been in Martha Stewart and Gourmet and the Boston Globe, but also we do wholesale to certain outlets along the coast of Maine. Our biggest part of our business is our website, so we do 75% of our business online. So we ship all over the world. However, we really wanted to make our product affordable and accessible to people in Maine. So we are pretty well covered from north to south along the coast of Maine where People can find our chocolates in stores in their local communities and take them home and then hopefully order them online.

Steve Shaffer:

So. Www.blackdinachocolatiers.com or you can Google Black Dinah Chocolatiers or Black Dinah. You may get some odd things when you do just Black Dinah, but we'll show up pretty much near the top.

Dr. Lisa Belisle:

Well, it has been a great pleasure and a very sweet pleasure to spend time with you both. We've been talking with Steve and Kate Schaefer, who are founders of Black Dinah Chocolatiers up on Idaho. Thank you for again, bringing sweetness into the world and for bringing sweetness into my morning.

Steve Shaffer:

Thank you.

Kate Shaffer:

Thank you.

Steve Shaffer:

This has been great.

Dr. Lisa Belisle:

Not too long ago, the Dr. Lisa Radio Hour was contacted by an individual whose Facebook page was called Hiking to Build Hope. We were fascinated, and we wanted this individual to come on our show and talk about hiking, but he happened to be out on the Appalachian Trail, of course, hiking. So when he contacted us again recently and said, I'm back in town and I'd like to talk about hiking and hope, we said, great, come on in. And we're so thrilled to have the chance to talk with Frances Howell of Hiking to Build Hope at long last. Thanks for coming in, Frances.

Francis Howell:

Thank you for bringing me in. Hiking to Build Hope is really excited that you brought us in last time. We were trying to reach out to you when you answered our call through email. I was on the Appalachian Trail at that point, and I just really, you know, I want to start this with a positive impact on people. And this is what it's about. It's about healing, you know.

Dr. Lisa Belisle:

Well, tell me about that. Why did you start hiking and how does it bring healing into people's lives?

Francis Howell:

It started as a dream. Just came to me. So our church was doing a campaign to raise $5 million. It's a pretty big church, and this just came to me. So I wanted to do a walk through New Hampshire, try to raise funds. But our church takes care of itself when I pray for it. So. But it became Hiking to Build Hope and it's going there. Maybe someday we can do something. I don't know. So Hiking to Build Hope started out as a dream. I don't know what hope looks like. I'm trying to find out.

Dr. Lisa Belisle:

So that you're going to share your message by using the technology and communicating with people all over the world, Right?

Francis Howell:

I'm not bringing technology on trail, and I kind of want to speak to this for Outdoor magazine. They wrote up an article that three days in the LPAC can increase your brain power by 25%, and it's real. So I'm going to try not to bring technology on the trail. I got a good team behind me. They're supportive, and that's what I need, because you can't make it alone.

Dr. Lisa Belisle:

So if people get in touch with you through Facebook, is that the best way?

Francis Howell:

Yeah. You can message me, put a post on the site, or if you want to keep your identity out, I don't blame you, just send an email, call. Those are two good ways.

Dr. Lisa Belisle:

Okay. And I know that you are very good at getting back to people because you and I have been communicating back and forth. So people who are interested in hearing more about Hiking to Build Hope, they can be in touch with you.

[Unidentified voice]:

Right.

Francis Howell:

And I built a PayPal account. We're going to try to push that forward. That was recommended from, again, a person who's very, very connected to the Appalachian Trail community.

Dr. Lisa Belisle:

Very good. Well, we've been speaking with Frances Howell of Hiking to Build Hope. And we so appreciate your being persistent and coming on the show and sharing your message, which is a very important one, that people should get out and connect with the environment, increase their brain power, connect with their communities, and really, wherever they're coming from, they should do what they can to make other people's lives better. And I think that you're one of those people, Frances. And we're very pleased that you came in to speak with us today.

Francis Howell:

Thank you.

Dr. Lisa Belisle:

You have been listening to the Dr. Lisa Radio Hour and podcast show number 74, Heartfelt. Our guests have included cardiologist Dr. Lowell Gerber, Steve and Kate Schaefer of Black Dinah Chocolatiers on Idaho, and Frances Howell of Hiking to Build Hope. For a preview of each week's shows, sign up for our e newsletter and like our Dr. Lisa Facebook PA page. You can also follow me on Twitter and Pinterest doctorlisa and read my take on wellness on The Bountiful Blog, bountifulpath.com For more information on my medical practice at the body architect, call 207-774-2196, and they can also give you information there on our February 27th rev up your metabolism talk. We love to hear from you, so please let us know what you think of the Dr. Lisa Radio Hour. One of our sponsors, Apothecary by Design, has let us know that there is an upcoming event that they're encouraging you to go to. Sounds pretty great. It's called Women's Looking and Feeling youg Best with Dr. Messina Wright and Katie Donahue of RX Skin Therapy. This will be taking place on February 26, 2013 at 6:30pm for more information on this event, visit the Apothecary By Design website or their Facebook page. This is Dr. Lisa Belisle, hoping you've enjoyed our heartfelt show. Thank you for allowing me to be part of your day. May you have a bountiful life and Happy Valentine's Day.