Reinventing Respiratory Care

What do we save in the ER? And they're like, lives. And I'm like, no, we save minutes. Each minute is a milestone, is a step. That is actually what we can sell. Create a device that is simple, a fraction of the cost, and it turns an analog device into a smart coaching digital device. Really made my life, like, have a purpose. This is what I'm going to go now, full-fledged.

We're pleased to welcome Dr. Alex Farahmand to the Deal Table. Dr. Farahmand is the co-founder and president of Tidal Medical Technologies, a company at the forefront of transforming respiratory care. His innovative product, NC, is a connected spirometer designed to improve patient compliance and outcomes both in hospitals and at home. With a background in emergency medicine and a passion for healthcare innovation, Dr. Farahmand is leading the charge to modernize pulmonary recovery. His leadership has driven clinical trials and FDA submissions, setting the stage for a new era in respiratory monitoring. We hope you enjoy. So I'm really excited to talk to you mainly because like we were talking off camera a second ago about how so many people like in the doctor world, medical profession, you know, because they do so well, they kind of stay in that lane and don't really think about entrepreneurship and don't think about beyond. And what you were talking about is you had calculated you had a ceiling. So I'd like to stop or start right off the bat of talking about that ceiling.

Sure.

And what made you look to go beyond that?

My kind of epiphany moment was around 2015 where I had pretty much finished everything. I had done residency, fellowship, and I was ready to go. Started my first job on my own, making that real money, if you will. And at that point, I was just working nonstop. I had gone pretty much 15, 16 months, and I was just working head down, just making money, trying to pay for all the kind of loans, etc. And I went and I bought some stuff, and I didn't fall into the normal traps that people do, and I didn't buy super expensive car or anything crazy, but I kept it within reason. Well, somewhere along the line, after about 16 months, I realized that I had no next step. I didn't have that milestone that I was going to hit next. Because since growing up, you know, you have elementary, junior high, high school, college, med school, residency, fellowship, job. This was the first time in my life I had no next step. And that kind of freaked me out because even though I didn't know where I was going to be with residency or med school, I still knew what the next step was. That was the time for me where I kind of realized that I had to do something different. I wasn't being captivated enough kind of mentally because nothing else was stimulating to the next step. And that's kind of where my story began, is once I realized I needed to create my own path, it wasn't created for me. That's when I ended up realizing that entrepreneurship was pretty much my next step. And that's where we are today.

What was that first step?

Reading books, 6 months nonstop. Just went on Amazon, found any book that I could read that had at least a 4.5-something rating.

On entrepreneurship?

On entrepreneurship, business, anything from, you know, learning the background of the budget to how to pick employees to how to be a leader to Atomic Habits. Every buzzword book that you know, I kind of picked up and I read. What I did realize was that there's a lot of people out there that tell you these books are great, but they may not be for you. And I think one of the best things that I learned about myself is I'm not everyone else. Maybe I don't have to like that book. Maybe I don't have to finish that book. Maybe I like this book better because this fits my personality and my life better. So I learned I don't have to follow everyone else's paths and suggestions. The best thing you could do for yourself is to create your own. And I think that's really one of the best kind of highlights that I learned because I was always busy trying to learn from other people. Everyone always said, oh, do this, do this, do this, do this. And I just felt sometimes it works, sometimes it doesn't. And it's okay if you trust yourself rather than somebody else's path.

Yeah, I like that a lot because like even right now in my business, I try to— SMU, Goldman Sachs, 10,000 Small Business, Lane, yourself, just even this podcast, learning from people. It's realizing that you may get 100% of something, but maybe only 17% is relevant to you. And ultimately, it's your path, it's your journey. Because at the end of the day, when we all die, maybe there's a week worth of mourning. But after that, maybe, but after that, people go on. So, you have your own journey, you're on your own. So, why spend that time, you know, trying to worry about what other people think you should be doing. So I do think listening to that advice, listening to that knowledge, but I think you're absolutely right. Pick and choose which one is relevant to you at that time.

And everyone's journey is different. Like, for example, when I created— when, to go back to your question, that 6 months of reading, I asked myself, I said, okay, what am I good at? And what do— what are my skills? And one of the biggest things I came to the conclusion with was I'm I'm pretty good at leading and maybe not necessarily finding the right person, but finding the right position for that person. And so that was something that I felt like I was rather good at because a lot of times we kind of say, oh, let me create the perfect team. That's kind of hard. The best thing you could do is find the best skills that that individual has and then build on top of that. And I think that's kind of where I started. And that was when I first started. And that was when I started opening up urgent cares because I knew a lot of people that were in the business, that were in marketing, that were in X, Y, and Z. And so creating that team of individuals and my partner that, that I'm with right now, he's the one that kind of brought the idea to me. I was like, this is a really good idea, let's expand this. And that was one of our first entrepreneurships, and that kind of was the aha moment, if you will, of business and medicine, uh, combining for me.

What's the process of scaling that? Because I know you have more than one.

Yeah. So there's different— so the, the, the best question that I ask myself is, do I want quality or quantity? When we first started, we had a mission. We wanted to be almost like the Walmart of urgent care. What that meant was we wanted to be well known, but we didn't want to gouge prices. We didn't want to constantly be in a position where we're, you know, increasing prices and charging all these absorbent fees. We want to be good. Great quality care in rural areas. Our destination was not in the big cities. Our destination was in the up-and-coming areas that we were seeing development, especially in Dallas-Fort Worth. Most of our clinics are in the Fort Worth area. So what we would do is we can kind of go in these areas. You look at, all right, who's building schools? Why are they building schools? They clearly know something that other people don't. How many houses are being built in that area? What's the average price of those houses? How much commercial insurance? Who's coming in. So when you do those and you can kind of see our business model was be the first urgent care in that area, expect to take a little bit of a loss, but we're expecting exponential growth in those areas. So it'll come to us. That's been our model. The first one that we did, did great. So we've been basically using the profits from those first ones and continuing and going. So now we're up to 4 and our goal is to get about 6 and then probably exit with it. But our model was very stay away from the big cities, go to areas that are up and coming, utilize the city planning and the demographics to see what they expect and roll the dice statistically with those.

Well, when you're ready to exit, I know a guy. Fantastic.

So I heard some mergers come out.

Yeah. I want to go back to the decision you made or the epiphany you had where you said, I've always had something hanging out there, the next goal, and I don't have that anymore. And you made a conscious decision that you wanted to become an entrepreneur and you went through a self-constructed reading program. So was it— was the goal of that? And were you successful in completing that reading program and saying, I now have a construct, an ideology for how to be an entrepreneur? And then the opportunity came up and you seized on it?

Is that— I wish I could say yes, but I was honestly, I was more confused. Okay. Because then you realize how much you don't know, right? Because when you come in and you realize that, oh, I'm just going to read a couple of books, I'm going to do this. This guy says that I can be a millionaire in, in 300 days, right? No problem. Well, you start realizing you don't know half of the terminology that they're talking about. So now you got to get another book to explain that terminology and then that and then it. So it almost left me in a place where I had more questions than answers, but it allowed me to know what I don't know. And that was something that I didn't know from the beginning. And that's how I allowed myself to kind of understand my flaws and my weaknesses and at least be able to recognize those before I even got started.

Yeah, we, you mentioned Vic Vescovo in our interview with him, and he was a Naval intelligence officer. And one of the things he talked about how you get in trouble investing is the unknown unknowns, right? The things you don't know that you don't know. Absolutely. That'll bite you. I'm not sure we got an answer for how to address that. Well, I was just going to say, speaking of getting in trouble, he specifically told you, my name is Victor. Oh, he did, did he not?

Yeah.

I'm sorry, Victor, if you watch this. He said my sister's name is Vic. Yeah, exactly. Yeah. So I'm sorry, Victor. Yes.. But the unknown unknowns. So you read a lot, you learned a lot, but you also learned that there was still a gap. And I assume you're still reading at some level. Absolutely. But ultimately an opportunity came across your path and now that you had an entrepreneurial mindset, you saw it as an opportunity and you executed on that. Can you describe how that came about?

So as far as the clinics went, I had a partner that I worked with in the emergency room who we always kind of bounce ideas off of each other. And he was like, hey, what are your thoughts about this? And we were trying to do this. And so I said, you know, it's perfect timing. I actually wanted to really kind of get into this world. Let me hear what we got. And so we sat down and he broke it down and he actually had a really good guy kind of formulate the business model and kind of, you know, go through numbers. And again, all things that were 100% foreign to me. I understood where he you know, the number aspect, but how he got it, right, you know, expectations, projections, and all that phenomenal projections in the sense of understanding algorithmic and addition and negative and what to look for. That was when I realized this is the business side to which I had no experience with. So when you see that, that's when it kind of really made me excited. Because I was like, this is something now I can look forward to learning. And it gave, just like I said earlier about I didn't know a lot of the terminology, well, this was an actual project that I can utilize to learn those terms. And that's when it really kind of hit me, because I was like, okay, let's do this.

And that's where it kind of— So was that project the development of these urgent care clinics? Because you also have a product, a piece of medical technology you developed that followed the urgent care clinics.

Totally different. But yes, that was originally when the urgent care kind of became self-sustaining. I was back in that spot. Yeah, you know, what do I do now? And that's when the, the, the mind just couldn't stop. And so this story started off with the incentive spirometer, the INSEE. My brother, who is a communication engineer, he's a professor up in California. One day his buddy was in the hospital, gave him an incentive spirometer. Lane, I know you've done this before. Familiar. And he said the doctor came in and said, hey, have you been using this? And my buddy and my friend's, uh, my brother's friend said, yeah, I've been using all day. And he left and my brother was in the room. He's like, I've been here all day. You haven't used it at all. He's like, ah, they don't know. They don't know how to track it. And so ironically enough, my brother calls me. He's like, hey, do you know about this thing? It's called incentive spirometer. So how do people know if one.

Uses it or not?

I was like, man, it's so hard. No one's ever come up with an idea. I was like, but you know what? You should make something that tracks it. He's like, okay. So literally over the weekend, he hot glued some stuff together. Made a little sensor, tracked the piston to go up and down, and had a little screen on the bottom of it. And within like 5 days, he had a prototype. And I was like, this is the coolest thing I've ever seen. We should do something with this. And ironically enough, his friend actually went back to the hospital 2 weeks later with pneumonia. Unfortunately, he's fine, but because he didn't use it. And that's where the whole concept of this, uh, device came in is create a device that is simple, a fraction of the cost, and it turns an analog device into a smart coaching digital device. And that really made my life, like, have a purpose. And I was like, this is what I'm going to go now full-fledged. And that's where we are with this.

So from a business standpoint, like, clearly there's an opportunity. There was a problem. Here's a solution. But like, And this is me being more naive than anything. So the, in a hospital, how many of those are there? So like if, if you have a limited number of ho— I guess it's not that limited. I guess there's tons of hospitals everywhere and each hospital needs at least 20 to 500 of these things.

Well, they're disposable, right? They, so these are disposable. Yeah. So just to give you a number on a yearly basis, somewhere between 15 and 20 million of these are dispersed.

Ah, well then that completely negates my.

Question though, or thought process. You have to— so the biggest factor of this is where, why is it important? And the number one terminology is because of CMS. I don't know if you guys are familiar with CMS, but CMS is the Centers for Medicare and Medicaid Services. This is what determines how much a hospital gets reimbursed for its services. Why is this important? Because CMS has a series of guidelines that say you have to keep this above or below this percentage, this below this percentage. So for example, you have to have your 30-day readmission for pneumonia below 18%. You have to have your catheter-induced urinary tract infection below 15%. I know this might be medical jargon, but the bottom line is these are goals that CMS makes each hospital follow. If a hospital has above these guidelines, they get dinged when they get reimbursement, especially for Medicare patients. So now if you're having X amount of money coming in for Medicare reimbursement and you are above the milestone goal and percentage on 4 of these things, well, you're not going to get 100% reimbursement. You're going to get maybe 80, 85, 90, but you're not going to get that 100%. So that's the number one factor that these hospitals have to continuously monitor is keeping up with the CMS guidelines. And hospital readmission for pneumonia is one of the biggest ones that they— that costs them money.

So I mentioned to you that I had hip replacement surgery recently and I got my bill. Thankfully, you and Ryan and the rest of the people in the room paid for my hip replacement surgery because I'm on Medicare. It was an honor. Yes, thank you. Thank you very much. Having said that, I won't quote the specific amount, but let's just say that it was tens of thousands of dollars for everything that went into an overnight stay in the hospital for a hip replacement surgery. And the actual payment by Medicare to the physician, the hospital, was a very small percentage of the billable amount. But I was able to see on a granular level, probably the spirometer that they had, and this was the bill for that, right? And it was fairly remarkable. I'm guessing it's a game, um, you know, where, where you bill at a certain rate knowing that you're only going to collect. So it's crazy. Who is your customer? Is your customer Medicare? Is your customer the hospital?

How does that process work? So the twofold question, but I'll start with the customer aspect of things. So number one, when we go and we want to go into the sales aspect of things, the first question that we anticipate— and again, we haven't officially sold the share because it has to wait for the FDA clearance, but we've already marketed this and gone— but the number question is how much do we get reimbursed? What does that mean? That means when, just like you were saying, everything has a bill, has a CPT code. Well, if we want to get this thing paid for by reimbursement, we have to go through a plethora of tests and clinical trials and all this stuff. So then we can give that to Medicare. Then Medicare looks at it and says this is worth X amount of dollars, so We're going to give you a code that says if they use the INSEE, they can bill this and we'll give them X amount for reimbursement. Well, that, my friend, takes about 5 years.

Not really worth it right now to get reimbursed, to have it qualify for reimbursement.

The whole process, because again, no one has— this is a brand new device, it's patented, it's never existed. So we have to start from scratch and we have to prove by clinical trials that it does this, it prevents this and it saves this. And then they look at it, they approve it, and that whole plethora takes years. What we do instead is we go up to them and say, look, every time you have a readmission for pneumonia, that's costing the hospital about $30,000 to $40,000 a patient. If they get even sicker, that's causing them ICU. So we're looking at $50,000, $60,000.

And that's because the reimbursement rate has declined as a result of that readmission.

No, that's because, again, if they left and they didn't have pneumonia and they come back within 30 days, that's considered hospital-acquired pneumonia, which is different than community-acquired pneumonia. So now that is a whole different world. That's when CMS can look back and say, well, look here that you had this guy come in and he just got discharged 2 weeks ago. Well, now he has pneumonia, so we don't know if we're gonna pay for this bill. Well, the hospital has to eat that bill, whatever it is. So our second, rather than reimbursement, is we will save you by preventing your hospital-acquired pneumonia readmissions, and we will show you that decreasing them will save you significantly more than you getting reimbursed $50, $60, $100 for just using this device. Because now we are able to track— this is the first time that you are able to track this incentive spirometer usage and exactly be able to identify the high-risk patients. So if you got 10 patients out there and you know these 2 are the high risks, you now focus on them to prevent them from coming back in 30 days. So you don't get hit with a $30,000, $40,000 bill that you're going to have to eat.

Does that make sense? Your charge, ideally what you'd want is a piece of that $30,000 to $40,000 as opposed to a small reimbursement on the, on the, can you construct a mechanism to charge them based on that?

So you could, but the realisticness is that it's in our business model, it's better to just create either, this is where it comes back to the actual model. So Again, we're still working on this, but we have two aspects. So we have a SaaS model, subscription as a service. This way, because all of our devices are ready for Wi-Fi, they're ready for data collection, they're ready for analytics. Once we create a database full of analytics, now you can actually use this to identify what the risk rate is for a patient that meets 60% of their goal over 2 days, and you plug it into an algorithm and it says this guy has a 66% chance of readmission. And so that is actually what we can sell is our analytics and our data that we can give to them. The second option is just to straight up do one-time use and just basically make it to a point where it follows them. Now, to answer your question back to the consumer, hospitals are going to be the best ones for right now because they're the easiest ones to kind of attack and you can utilize them and prove to them that this will help the patients. But now the patient gets sent to a nursing home or rehab or a skilled nursing facility. Well, this now goes with him. Then they go home. Well, then now this now goes with them. So now you've created two separate markets that really no one had before, is that they go from the hospital to the rehab center to home, back to their primary care. And this whole ecosystem now is all one. Whereas before there was no ecosystem because no one knew how to track it. Are you going to ask a 67-year-old dementia patient, write down, use this?

Yeah, right. And so this SaaS model is great, uh, certainly from an M&A standpoint. The multiples, you know, they start paying multiples of revenue instead of multiples of earnings when you get into SaaS. They love that recurring. They being the private equity world, family office world. Um, so who is your— who's subscribing? It would be the inpatient or the hospital?

So The hospital as a whole, and the way— this is where the SaaS model gets very difficult because you— now I'm going to split this up into twofold. You can either integrate it into their EMR, which is their electronic medical records, which is what the entire hospital uses. So again, ours, it's already ready for Wi-Fi, Bluetooth, and all that. We just have to turn it on. But you can incorporate the readings directly into the patient's chart. And doing that, however, that makes the hospital the consumer. The problem with that is that you are now looking at hundreds of thousands of dollars in cybersecurity now because you now open up that aspect of malware. I mean, I don't even know all the terminologies, but you open up that system. The second way is you essentially create your own system. You say, here, this is our system., and they use that. But ideally, interpret it or incorporating into the EMR is the best route. The hospital pays for it, they get this, but the amount of expenditure is way higher than just having a normal database. So that's to answer that question on that. The number one person is going to be the inpatient of the hospital or the actual hospital administration to prevent pneumonia.

Can we pause and back all the way up? Because, because I have— I think everyone is in the history of ever, not even ever, has used one of those devices. Yeah. Is it strictly there just to show you that, hey, my lungs are functioning?

Like, what is the purpose of that device? Imagine push-ups for your lungs. Okay. The high-risk patients, the hip surgeries. Why are they the high-risk?

The white.

Hairs. You're high-risk patients. The, the bedbound patients. Is probably the number one risk of pneumonia. Why? Because just think about this for a second. When you're sitting there, how much are you really breathing? You're breathing, but you're not expanding. When you don't expand your lungs, you don't get the proper flow of oxygen. You don't get the proper flow of blood. That's the way that your lungs fight infection, especially by taking deep breaths. You open up the bases of your lungs, whereas just kind of sitting there and doing this, you don't really open up a whole lot at the bottom. Well, once you build up that fluid, if you're not taking those deep breaths, that's called atelectasis. Which is basically just a kind of a fluopy of the sacs down in your lungs. That then turns into pneumonia. Atelectasis is a precursor for pneumonia, basically. When that happens, that usually takes a couple weeks, which goes back to the— they leave and they come back 2 weeks later with pneumonia. So what this incentive spirometer does is it bases it off of your volume of air, and it's a specific chart Bases off your age, height— no, I mean, um, age and height. And it basically says, okay, you're this age or this height, you need to be breathing at least 1,500 milliliters every, you know, 4 to 5 times an hour, um, for the remainder of your stay. This allows you to clean your lungs. So to answer your question, the goal is push-ups for your lungs to expand them, to strengthen them, because your having hip surgery, knee surgery, you got pneumonia, you're too weak to get up and walk to the kitchen because you're in the hospital bed. So you are now allowing your lungs to fight infection while you're in bed.

Is it a testing mechanism or is.

It simply an exercise mechanism? It's more of a therapeutic for sure, but it can be used for diagnostic given the fact that we are now utilizing data and seeing what happens with it. It's just that it's never been done before. So now that goes back to what we were saying about creating the database filled with successes and attempts, how many times somebody used it, how many times they got to their goal. Because just because you use it doesn't mean you're doing a good job, right? If you don't reach your goal, then.

You'Re just using it, but it's not doing anything. You were talking about how like the high-risk patients are your biggest target market, but it feels like if you can really knock down that, that gamification aspect of it, like you've got all the hypochondriacs, you have all the people that have the Apple Watches, the people that track steps, people that track their heartbeat, track their weight, track everything. This is just another thing that they can track. Like, hey, I was at 100% of my breathwork every day because I do— I mean, there's got to be a.

Market for people that do breathwork.

Fitbit for the lungs, right? Well, not necessarily Fitbit, but just Fitbit adjacent, where this plugs into the Fitbit. Because you're never going to be able to— I don't want to say never, but compete with an Apple Watch or a Fitbit. But if you can If you can feed the, the information to it, I.

Think you have a much larger market. There are so many people that would benefit from this that you may not even realize. People that have COPD that are on oxygen, they're already limited on how much they can expand. They're one of the highest risks for getting pneumonia. People with asthma, people that have, uh, you know, emphysema or any other lung disease. This now has actually— you can go into cystic fibrosis in children, you can go into sickle cell anemia, you can go into trauma patients that have rib fractures. I mean, it's limitless in a sense of how many populations there are, but it all goes back to lung infections. So to answer your question, yes, it's really about the lung infection. But to pull back, how many people are constantly getting these infections for whatever reason?. And again, I just named off 5, 6, 7 of them, but I mean, it's just, it's so many. So the endpoint is prevention, but the patient population can be any, almost any.

Population that you can think of. So going back to the business perspectives, obviously you have, because you wear multiple hats right now, you've got your doctor perspective, you own urgent cares, so you, you can actually put in the eyes of the hospital, but then you're also the business side of, of having a device. Yeah. Like when you're looking at this, are you trying— where's the intersection? Or do you like, hey, doctor hat, urgent care hat, and business hat.

Like, how does all that weave together? I think the biggest thing is understanding what overlaps and what doesn't. And that is a very difficult thing to realize sometimes because you try to do so much at once, but you can only chase one shiny toy at a time. Something is going to suffer when you put all your attention one way or else. I mean, it's impossible to give. It's like children, right? The more children you have, no matter how great of a parent you want to be, somebody is going to get some time when others aren't. The best thing that I can do, again, it all comes back to, in my mind, how do I place the team to find the best position for them? And that is one thing that I think we've done a really good job at is creating a team that understands the high-level things and high-level discussions. And that's where I come in, in a sense of being able to manage my time the best. So when it comes time to overlap and there are like when in the urgent care world you have employees, absolutely. In the medical device, we have no employees, but we know that that's a whole separate topic. The, the urgent care world and the medical device, we still go into understanding what patients do, how they think. So now we can incorporate the NC and say, hey, We see some patients in the urgent care. Hey, why don't we try this? Why don't we do this? And now you can utilize them as kind of your feedback for this.

So finding those opportunities of overlap. So you mentioned earlier that you want to— you have 4 urgent cares now, you want to get to 6, then most likely exit. One, this is a multi-part question. Like, I would be curious what we think the multiples on that would be. And then when you look at the.

Medical device, what's the roadmap for exit there? So the urgent care, as far as the multiples, I think if we get our EBITDA calculated, I think we can get at least 6 to 7x our EBITDA, assuming that all of the urgent cares are reasonable in a sense of census and patient-wise. So I think if 6 or 7x EBITDA would be reasonable for our urgent cares. This is much more difficult because We have no revenue right now because we can't technically until we get our FDA, but we have letters of intent. We know what our TAM, SAM, and SOM are. We know how many beds there are in the United States with hospitals. We know what the average cost of readmission is. We know how many home health centers, rehab centers, all of these things we know. And we understand that if we even have 5% of the market, We're looking at a pretty significant revenue, maybe even 9 figures. We got picked up by Fogarty Innovations. I don't know if you guys know what Fogarty Innovations is. So Fogarty Innovations, really fascinating. It's actually a gentleman by Dr. Fogarty who invented a catheter, a heart catheter. Back then he patented it, made bookoo's of money, opened up a medical incubator in California. This Fogarty now allows medical devices and startups to basically apply, and if they like you,, and we graciously got picked by them. We now have a little office in Mountain View with Fogarty that we utilize their expertise in all different avenues. And Gail, the CFO, and Zach, the CMO of Fogarty, they have been amazing mentors in helping us guide how to get to that exit strategy. And it was interesting, just to answer your question full circle, they said one of the reasons we picked you guys is not because you're going to be a billion-dollar company. But because you guys are going to have a very quick exit relatively. Because if I come in with a medical device and it's invasive or a pill or something like that, you're looking at 10 years exiting. By the amount of clinical research and all this type of stuff, I think we can do it in the next 2, 2 and a half. We already have the FDA stuff. We have 4 clinical trials right now. We got clinical trials at Mayo Clinic right now.. And so far, University of Colorado just finished theirs and we just saw the pre-data that they're about to publish. And the bottom line is there is a significant clinical significance in patients that use this versus don't use this and increase in compliance.

So that alone is great for us. So earlier you talked about how y'all had an idea And then seemingly within a day or two, you'll have a, you know, a mockup, a test case. That's all my brother.

Yeah.

So clearly the cost to do that is just time and creativity. What's the cost to go from that to then actually have like real devices and then go through the research process? Like, because you hear, you see things like when, to your point about like anything that's injectable or in your mouth. They spend 10 years and there were, they, you know, billions of dollars on research or whatever.

What is that in this world? So this device is technically what's called a Class 2. Class 1 is, imagine a Band-Aid, no invasiveness, a little adhesive, already been kind of proven, no big deal. Class 2 is, it's a little bit more of a Band-Aid, but it's still not anything that's inserted into your body. And then Class 3 is like a straight-up pacemaker or something like that, right? Long-term stuff. Ours is a Class 2. We got very fortunate because, again, I think we found the right people for the position. When we first started this back in 2020, we— this is pre-COVID. COVID came around March of 2020, and everybody was getting incentive spirometers as a form of helping with their lungs with COVID That was the number one thing that was preventing worsening lungs and pneumonia and things like that. We saw this and we were like, oh man, we should totally be able to use this. So we then learned what an EUA was. And you guys remember EUA? It was an emergency, uh, use authorization, meaning that you didn't have to go through the official FDA path. You just prove that this thing's not going to kill someone and we'll give you an EUA. Well, we said, all right, how can we get this? And we called a couple companies and one of them said You guys, there's no way you can do this on your own. Give us $300,000, we'll give you an EUA. And keep in mind, we're 4 guys in a garage. Like, give you $300,000? That seemed a little outrageous to us at that time. I'm sure it was a reasonable number, but we didn't have it. We had it. We didn't want to give it to them. We said, how hard can this be? We did it for under $10,000. Number one thing. Why? Because we said there's got to be a way. There can't be. We found a couple of people. One of our guys is from Johnson Johnson. And he actually— we found him on Upwork. I kid you not. He said he loves this product. He's like, he wants to work with us. And he was like, I want to, I want to help you guys. He helped get the vaccines FDA approved. So he knew the whole process. So he got us to EUA within like 4 months on Upwork. That's how we found him. And then he's followed us since, and he's actually been our main guy to do FDA stuff. My brother, who's, thank God, a communication engineer, he saved us a ton of work because he literally is the one doing all the, um, connections and the boards and designing and all that kind of stuff. Of course, we had multiple help from other people, VPI especially, to design it. But these are the places that we save so much money. Clinical trials— we found an individual that helped us get connections into Mayo Clinic, Robert Wood Johnson, Advanta, all these places, um, El Camino, and, and with Fogarty, fractions of costs. And that's the most important thing. If you want to do this yourself, you have to be in a position where you have to learn everything from scratch. And that's what our team did. We just learned everything from scratch and we found people to help guide us to get to those places. We have done everything so far. That includes FDA, getting a product, getting development, perfecting it as much as we can, doing clinical trials for under $1.5 million, which every person that we tell to is like, this is at least $5 million worth of stuff. So we got very fortunate with the team that we, uh, that we had, and a lot of people believed in us. And so we just kind of give.

Them sweat equity, if anything. And at what point do you, do.

You think you'll be revenue generating? As soon as we get that FDA. We already have a couple letters of intent, and so as soon as we get that FDA, we can actually start selling. Our model is not to go wide. It's just to go narrow and deep. We want to prove the concept. We want to go to a couple facilities and say, use this. We want to follow you. We want to see you guys use it. We want you guys to be our feedback directly with the patients, because now in clinical trials, we don't really get to see any of this. We're not allowed to be involved in it because we don't want this to be published. And then they'll be like, oh, well, you were there every day. You were biased. So we're never actually seeing this. This is— we want to be in a place where we can find a couple of places and really get that direct feedback. What about manufacturing? Manufacturing? There's a whole other world of price and margins. And what I mean by that is right now we are using a mold that we can only really make 3,000 of these before the mold is no good. And that mold cost us about $30,000. But you have to use this mold because you can't 3D print these, because if there's even a couple, 1 or 2 millimeters of variance, it doesn't fit good. So you have to make these molds, uh, very, very precise. A true mold that can make tens of thousands costs $250,000, but you make one of those you got a lot of revenue coming. So it all comes down to what we have, what we can spend. And right now we don't need that $250,000 mold because we don't have tens of thousands of orders. We just have to make enough to kind of get out there. So the manufacturing, that mold stuff, that's the one cost. The actual components, maybe $15 worth of stuff. So I'm sure we can get that even cheaper than that. I think we can basically make this.

Device for probably less than $10 if we really wanted to. And is that— are y'all going to have manufacturing in-house?

You're not going to outsource that out? So the short answer is there's certain things we have to outsource. So for example, the circuit boards, getting the batteries, all that kind of stuff, the molding, those things we have to. The actual assembly we do, we, uh, in the United States. A lot of it we want to go to the VA as well. And so that's one of our strategies. And so being, uh, going into the VA, you have to have X amount considered made in America. And so we want to make it in America anyway, although it's getting harder and harder right now. But that is the goal, to do.

It into the United States. Well, the reason I was, I was going down this line of questioning is, is because the made in America, because one thing, you know, COVID, I think, showed a lot of people was, oh, wow, we're too heavily reliant on so many other countries. And national security is at risk when you can't provide medical care to your own population.

So hearing that, that's, you know, an American-made product. Yeah. Is— and I was wearing trash bags in America. I was during the— I don't know if you all remember that time in 2020 where we were wearing trash bags as ponchos and N95s that were— had pizza sauce on it. You know, you're using it for about 3 months, the same N95 mask. While you're in the ER? Yeah.

Really?

They were out of masks. They were out of— they were out of gowns. We were out of everything. We were using N95 masks. I'm exaggerating with the 3 months, but I mean, it was multiple use. N95s are one time. You walk in there, yeah, and then you throw it away.

We were using it days, weeks at a time. How about sales? Is that something you'll do internally or.

You use an external sales force? So we have to start internally right now. We're still calling it seed round and we are going for that amount of money to which 20% of our seed round is going to be going towards marketing and sales. We're not worried too much about this massive, you know, hitting up a Merck or, I mean, I forgot all these companies' names, the manufacturer people. But ultimately, you know, you can go to these places and say, hey, will you sell my product? But in reality, it's very dependent. And they're like, well, how much am I going to make on this? I'd rather put my focus on selling this. So we're going to probably do founder-driven sales. And so the founders, such as myself, We can go into these hospitals. I work in multiple ERs, so I know a lot of these CEOs already. Go to the C-suite, talk to the CFO, the CNO, show them what we have, show them what our thought process is on prevention, and we can kind of utilize our founder-driven connections and going into sales in that aspect. That's what I think we're going to do first. All we got to do is create 3 main things: commercial trials, which we're already done or doing. FDA and commercial traction. These three things, we get these milestones, we'll start being able to give ourselves.

Evaluation for exit, and that's our goal. Excellent. And so this will be a single product company basically, although the single product.

That could have a nine-digit— well, you have to know, uh, we can't— so technically our parent company is Title Medical Technologies. NC is under— so we own Title Medical Technologies, and then we own majority of Incy and the people that have already invested, they own a percentage of this. So our goal is to create multiple.

Products and we already have a couple other in the lineup. Right. And where did you learn to do.

A holding company in this before? Is this in one of those books? So, yes. So actually, this is what we started off by asking ourselves, how do we do this? When I was reading this, again, this was terminology I was seeing, but I wasn't understanding it. This is the first time that actually allowed me to use application and understand, okay, I remember reading about this. Now this makes more sense. And that's where we all came when we went and we talked to a couple of lawyers and I said, this is what we want. Originally it was all under title, but they said you should do this, especially if you guys are going to have multiple devices. Each one of these should have its own LLC, to which now we learned that LLC nobody wants to invest in. So we're actually transitioning into a C corp. Because apparently that's what venture capitalists all like.

Um, and so that's what we're doing now, transitioning that. Yeah, dress up to be appealing to.

Your ultimate upstream buyer. And I didn't know how big of a deal that was. Yeah, C-Corp versus LLC. But again, stuff that we learned and very, uh, you know, tax-friendly, I guess, the VC world, and that's what they like to see. So that's it. But that's our goal, is to be a medical device company. And, uh, we have a motto microfix. We're not looking to create this massive, you know, brand new innovative thing right now. What are the biggest problems that are just so neglected? And how can you just tweak a little something, fix it? That's it. Do a little microfix and you can fix it. I didn't coin that term, by the way, although I really like that. I heard it and I was like.

This is really good. I'm going to use it. I like that as well. Being small and nimble has its advantages. I was a founding shareholder of a company that we were an orphan pharmaceutical company. And what I learned was that the big boys of Bristol-Myers and, you know, the Merck's, that if a drug gets at or below $100 million of annual revenue, they don't want it. There's not enough— there's not enough economics in that to justify them taking their time and effort. So they'll sell off those drugs. So we became a company that would buy, you know, drugs that had fallen below that $100 million that they were no longer giving any, any energy and attention to. And we would then pay a lot of attention to it because it was very meaningful to us. Right. And we would maybe move the manufacturing. We then used Cardinal Health and leveraged their sales force. We were not going to, you know, we had to get into hospitals and doctors' offices. We didn't have founders that could go knock on doors. So we use Cardinal to go as a distributor and take our product in there. So like you, it was an interesting education for me. I had the business background but not the medical background. Ultimately, we were not successful as an orphan pharmaceutical company, but we had a right of first refusal at a major university for anything that came out of their medical research.. And one of the things that came out of that was intravenous ibuprofen. Wow. And ibuprofen was a well-established drug, but not for intravenous application. So if you had patients that were unconscious in ERs that had high fever, now, you know, so we were fast-tracked by the FDA. So we got a much compressed— because there'd been so much research on ibuprofen, we were able to piggyback on that. So like you, our cost to get.

It approved, this other application of ibuprofen. That's fantastic. I didn't even know there was an IV ibuprofen. I know the IV acetaminophen, which is amazing. Yeah. IV ibuprofen is very expensive, I'm sure.

That's why. But the utilization of it is fantastic. Yeah. So it was an interesting education for me to realize that $100 million drugs aren't worth the time and energy of the large drug manufacturers. But for you, they were? But for us they were, that you could leverage somebody else's sales team. We basically were virtual. We had the property, which was this product, intravenous ibuprofen, but we didn't manufacture it, we didn't sell it.

All of those were leveraged through strategic relationships. And that's exactly kind of what we're very trying to mirror is We don't have to go through— everyone else has done all the heavy work. You've done this, you're monitoring this, you're doing this, you're getting pinned for this. We're just trying to find that connection of how can we just fix this a little bit, right? And here's the best part, to kind of come back full circle on the CMS stuff. If you take money from CMS, meaning Medicare, Medicaid, hospital, you are by law required to publish all of your milestones of CMS online for the public to see. So what does that mean? Now granted, it is hidden upon link after link after link. I mean, they do a really good job burying that stuff, but there are companies out there that their main job is to get this data to find out. So once we're ready to sell, guess who we're going to hit up? Who in the United States has the worst hospital readmission rate? We're going to go there and be.

Like, buddy, Yeah, you're dead last, right? What do you got to lose?

How many $30,000 to $40,000 readmissions? Exactly. Yeah, are you experiencing?

Start at that bottom list and just go, hey, I got this thing that cost me $10 to manufacture that can solve your problem. I'll sell it to you for $1,000. But, you know, so you spoke about earlier about micro fixes and, and looking to find these small problems and fix them. Are you focused primarily on this product right now, or do you leave room for innovating and solving other problems? And then is the goal to have multiple at any given time, or hey, let's focus on this one, get through.

FDA, get it selling, then move on to the next one? So this is the first time in my life I have taken money from other people, and I'll be totally blunt with you, this is all new to me. So I am not comfortable putting my sights on other medical devices until I can make sure that The people that entrusted their money with me and us are going to get a result. Now, with that said, absolutely, at any given time, my mind is like, I'm going to write this down. I'm going to come back to this because this is a great idea. But I— we do not have the time or energy to give to this while this still is not a living, breathing thing. It's growing. It's doing good. It's almost ready. But until we at least know that we are in a very good state with this, I cannot consciously give effort to anything else full-time, at least. So once this is done, we have the other ideas. We've already created a pathway for them, just kind of on our spare time, but nothing more as far as money or anything like that has been given to those.

But our goal is multiple. Yes. So this is a question to both of you guys, just maybe because I also don't really come from the raising capital world ever before. Like, if you've done— I'm assuming you've done fairly well in the medical world as a doctor, as an ER doctor. Like, why not just self-fund the whole thing? Like, at what point do you go, oh, I, I don't necessarily want to shoulder this whole thing. Let me bring in outside capital.

Like, what does that decision tree look like for you? Forget about self-funding. Why don't I just take a loan? Right? Why include others at that time? Our biggest thing was we need help. Who can we get help from? Not necessarily financial, but knowledge, experience, expertise. So we brought on lawyers, other doctors, specialists, people that can actually get our name through certain avenues and connect us with people. Those were the types of people that, again, it all comes back to creating an ecosystem, ecosystem of individuals that can help grow within as well. If I were— if we were to do this on our own, yes, we would have taken a risk. We could have done it, but it would have been a pretty substantial climb on our own. Now you bring in 6, 7, 8 people, you give them percentages, you're like, hey, help me get this, help me connect with this, help me do this. Now you've created a team. And that team is always going to help elevate. And when they need someone, you need.

Something, they can help that. So, so it's less about the money.

And more about the skill set that that person has with the money. Yeah, I think that was— and that was our number one because again, and everyone knows this, when I was very transparent with them, I was like, this is our first time doing this and we are learning as we go and we would like as much help as we can get. And I send newsletters as much as I can, just kind of updating all the investors and We'll be very honest with them. We're like, listen, guys, we are having some difficulty with the FDA. If anybody knows anybody or we're looking for this, this and this, and then somebody will reach out and see if.

They can connect us to somebody. Yeah, because I've heard multiple times, I think even people on this program, which was not all good money is good money.

Not all money is good money. No. So, yeah, there's two factors when you take money from individuals. They're a silent investor or somebody that's going to be able to help you. And when you're dealing with negotiations on how much equity or sweat equity or what the convertible note is and how much percentage you want to give, it all depends on what they have to offer as well. And you can negotiate that with these individuals.

And that's something that we learned slowly. Yeah, the majority of M&A transactions I've been involved in the last few years have not been full sales of the business. One we just completed, 40-year-old founder, owner-operator, got to the point where he'd grown a sizable company, you know, 8-digit value, wasn't getting to see his wife and kids, was consumed by the business, felt like that the next level of growth would be even more consuming. And he didn't want to sell all the business. He wanted to reorient what he worked on in the business day to day. He wanted to get out of certain functions and focus on others. And he wanted to have a partial monetization to take chips off the table and, and free up some of his time. I talked to a couple of young SaaS business owners the other day and I said, why are you interested in selling? They said, oh, we don't want to sell. You misunderstood it. Yeah, yeah. We're looking for a strategic partner. We have started this business, grown it. We sort of— we don't know what we don't know anymore, right? So we've gone as far as we can go with our knowledge set. And, you know, we'd like to continue growing. We feel like we need somebody that's been there, done that, that can open doors for us. So a lot of what I work on are strategic deals as opposed to full sales. Full sales, usually somebody my age that says, I don't want to do this anymore, I'm ready to sell the business and retire. A lot of what's happening right now, a lot of what private equity firms are looking for is partners that want to stay on in an altered role.

Absolutely. With a partial monetization, which is very common. And that's where I think this is where is a completely, you know, land that we're still learning as well is, for example, creating that market to commercialization and the strategicness behind it in a medical device world with so much red tape. I don't know. I mean, hospitals, you can't just go to a CEO or CFO and be like, buy this. They got to go through their committee. They got to go through their finances. They got to go then go through a board meeting. I mean, almost everything has to get checked off. So there's so much red tape. These are the factors of how can you get to those shortcuts. So then the question is, stop going to these massive Kaiser Permanentes and HCAs and Baylor Scott White. Let's go hit the middle, more private hospitals. And that's where I shine. I know these CEOs, they're, they're not affiliated with any chain, but the downside is they only have 1 or 2 hospitals. They don't have a massive thing. They're not going to make a massive order. Or they don't have the exact funds because a lot of these other places are kind of— so it's finding that sweet spot. It's like, do you spend 9 months hoping to get a sale at Baylor Scott White, to which you may not, or do you go and hit 5 or 6 of these smaller hospitals, get some commercial traction, get your name out there? Hopefully they tell their buddies in the smaller hospitals and so on and so forth. So what is that sweet spot? I don't know, but why not hit.

Both of them at the same time and see which one gets best? Results. When does that sales process start?

Are you already making those conversations? The— or do you wait until FDA approved? So the conversations have already slowly started. The actual commitment and stuff, that again, it all comes down to fundraising because we have to make sure that we're not, uh, promising what we can't deliver in a sense of numbers. But we're also— we, we have to get this FDA Marketing is very similar to— imagine I come out with a fundraiser thing and I got a Kickstarter and I got this really cool thing and I send this and I'm like, everyone loves it. Well, in my mind, I'm going to be able to sell this in a month and a half. And I'm like, you know, just making sure everyone knows. Well, somehow it gets postponed in 7, 8, 9 months and nobody even remembers what they signed up for anymore. So it's almost like you want to introduce it, but you don't want to go too deep into it because you don't want the fire to die. And so that's kind of where we are with it, is perfectly placing the seed, watering a little bit, showing them it, going through and giving it to a couple of patients and for the employees to play with. And then hopefully in the next 60 days, really going in there and starting.

That sales market and getting letters of intent and getting some revenue. Do you foresee a future where you're.

Not practicing medicine, you're practicing entrepreneurship? Solely, exclusively? No. My life I've incorporated into the ER. And this is what I used to teach the residents. I was like, when a patient comes in, every question that you ask the patient should be either towards or away from a diagnosis. And it's all a bunch of yeses and nos for the most part. 90% is yes and nos. How long have you had this? Does it hurt when you do this? No. What about this? No. Yes. No. Have you had this? Yes. No. Yes. No. Essentially, it's an algorithm of binary code. 1, 0, 0, 1.

Right.

I've come to the conclusion that's all life is. Life is just a series of binary yes or nos. Do I take this job? Do I take that job? Do I marry this girl? Do I have a kid? Do I live here? Do I move there? Yes, no, yes, no, yes, no. To me, the emergency room is what gives me the algorithm of life. And honestly, I can't see myself not working in there. I'm not saying I'm going to work. 20 shifts a month or anything like that, but keeping that patient engagement, I don't think I could ever— even if it's a couple shifts a month, just.

Having that connection with medicine, I, I could never give that up anytime soon. That's great. Lucky, lucky patients, um, uh, to, to.

Have you with that level of commitment.

Um, well, oh, don't go look at my Google reviews. I'm not sure. Well, you know, you're only as good as your worst review, right? Um, and, uh, If you watch enough medical dramas on television, the ERs are all overrun. I know that I'm from Memphis originally, and I was involved with the mayor's committee at the Regional Medical Center, and it became basically a primary care physician for the uninsured in Memphis. Oh, yeah. And it was just a nightmare. And the ER was just overrun. Constantly. Yeah, there's so many systemic challenges in healthcare. I'm glad I'm not in charge of.

Trying to fix those things because I'm not even sure where to start. Well, that's why we started the urgent cares. We saw that there was a failing issue with the ERs. We saw that all these freestandings were kind of falling and we're like, we're fairly confident in the next 5 years with all these high deductibles and insurance, we're going to go straight to a cash system.

Them.

Yeah, for a lot of Middle America, they're there, they can't afford these deductibles. Yeah, so we're like, what's the best route to go when this happens? Let's start making urgent cares in these rural areas where no one has tapped.

That's what we're doing. Hopefully that pans out. But I want to go back to the beginning. We're talking about ceilings versus possibilities, but before that, I do want to give you an opportunity to show off your, your toy. Sure. Your device.

Yeah.

You know, I'd love for you to bring it up and show it to us and, and tell us why, why.

This is going to make you trillions.

And trillions of dollars.

I wouldn't say trillions, but I hope he'll settle for a billion. Yeah, just one. So this is basically your average incentive spirometer. And what it does is, again, push-ups for the lungs. And so as you take it, you know, you have the numbers. I don't know which camera, but long story short, this is a volume of air. So this all looks familiar to you, and each one of these is written. So based off of someone's age and height, let's say their goal is to get to right around 1,000. Well, you have to basically take this— so that to me is expanding the lung. That 1,000 milliliters of air entered my lungs, and that, based on an already created chart, says that that did a great job of opening up my lungs. Well, no way to track this, as we discussed. So what the Insee is, is this is basically just a little device that is able to clip onto the bottom of the Viair. And once it does this, it snaps on right here. And basically, once this is done, you just hear that click, and this is easily removable. And so once it's done, you basically turn this on at the bottom. And a bunch of lights start coming on. And that red one is the alarm as well. So while it's sitting there, you can now take whatever you need. And let's say you have a goal of 1,000. See the green light? It— I made my goal. Good job. That's it. Now our next prototypes are going to have all of this stuff is all red. It's all green. The whole thing lights up. So positive reinforcement. Once this thing goes and you set it for 10 minutes or 30 minutes and it's an alarm, if they haven't used this for 30 minutes or whatever it is, a giant red light comes on and it starts blinking. We have a beep that says beep beep, so it reminds you of using it. So you now allow the nurse and the respiratory therapist that usually goes in and shows them how to use this and watches them, you know, they don't need to utilize their time anymore. And they can only go in, and when they go in, they see the bottom of it and they can read the screen on how many times they used it and how many successes they had. You can't really see it on camera.

Here, but it's all kind of written right there. That's the key. And you're— and you're not having to— you're just adding on to something that's already existing. Exactly. So like This will work with the.

Industry standard of the— I'm not even going to attempt to— the breath thingy.

Yes. Yeah, we call it the IS, incentive spirometer. But so like, but yours just snaps in place on all of them.

You don't have to go and reinvent the IS. So this right here is a very specific brand called the AirLife. So here's the beauty of it. This specific one fits this, and this is basically the market. This has about 65 to 70% of the market.

It.

So there's about 3 or 4 other ones, but we just did the industry one. Our patent and our design covers any medical, any type of incentive spirometer that we— basically all we got to do is change the molding. The actual— this is open right now because we have to reprogram it— the actual technology right here, this is what our patent is, because this measures what we call the time of flight. So as the length of the piston goes up, that's the time of flight to which the sensor recognizes, and it can tell which one hit. It's almost like a radar gun, basically. But this technology, you can put it under any of the incentive spirometers and just change the mold, and it clips onto whatever you like. Eventually, we know this— this company has.

Actually already reached out to us because I they want to. That's what— that's where I was going to go to.

Prevents them from doing it themselves, correct? Yeah. And honestly, any other way is just not cost-effective. So, um, I mean, short of putting—.

Opening this up and putting a device inside it— well, because, because the, the—.

Your device is reusable. Their device is a, is a one, one patient, correct? And now what we can do is if we utilize this, we actually, you know, We've taken this to so many levels. We've gamified this. In fact, we have a game where it's a little wolf, not a little wolf, but a wolf and the three piggies. And on the screen, it has a goal on the line. And if you're doing this, you can actually look on the screen and do this. And there's a little wolf that's huffing and puffing. And if you get to your goal, he goes. And he blows the house away. That's great. It's just a game, right? You can make any game you want, but creating that gamification— again, it all goes back to skilled nursing homes, rehab centers, children's hospitals, children's hospitals for cystic fibrosis, you know, sickle cell anemia, and all these type of stuff. Absolutely, the limitless options. But that's where it all starts with— what can we do with this to maximize and reach that entire patient population.

That nobody really ever thought about. That's where we are. That's great. Well, it's funny because, you know, having had that recent experience of, you know, hip surgery, they're measuring everything. Yeah. And yet this is on the honor system. Exactly. They come in every hour and I'm doped up. You know, I've just had my leg. Sawed off and, and they go, did. You blow in the— Yeah, yeah, yeah. Oh wait, I get out when I— yeah, okay. Yeah, sure, I did that. Yeah, it's like, did you exercise? Yeah, right, of course.

Yeah, right.

So, you know, they're taking your temperature, they're, you know, the IVs, everything is, uh, is data that's being captured. But for that, which has a much larger repercussion than I would have thought, I just sort of thought of it as, yeah, this is just a box they have to check. But you're telling me that there's a certain amount of folks that don't use that, that get pneumonia, come back in the hospital at considerable risk to their lives and expense to the hospital.

So everybody should have an aligned incentive to fix that. Absolutely. And this is one— and again, I don't want to put it out there like if you use this, you are not going to get pneumonia. But again, it's all about risk stratification. Yeah. If you're not breathing, your chances are going to go higher. Now, you're a 32-year-old kid that had gallbladder surgery, you're not even getting up for 3 days, are you going to get pneumonia? Probably not. You're 70 years old, you had hip surgery, you already have COPD, you already have oxygen issues, you already have— you're at much higher risk. And so these are the ones that, again, it all comes back to risk.

Stratification and statistical readmissions. That's our target audience. High risk. So as we get coming to a close now, um, I wanted to circle all the way back to the ceilings versus possibilities that you would literally— hey, if I worked X hours, X days, I will make Y dollars— and that kind of freaked you out. Yeah. But in the entrepreneur world where there is no ceilings, it's just blue ocean or an endless desert, and it's sometimes from a mentality standpoint It goes back and forth even in the same day. It's all a mental game.

Absolutely.

So what do you like better? Like the open sea, the, the possibilities, or do you like that structure? And then I, I just want to go down this line, line of questioning.

For a second and see where, where you're at. It's funny. Have you ever read Blue Ocean Strategy? Yeah. Love that book. I was in the middle of the ocean with no land in sight. And I had 360 options because every degree you just had to pick one and go. Maybe you'll hit land, maybe you won't. That's where I was, and that's where I felt the calmest. Ironically, because I come from an ER world, I come from a high-stress world of not knowing what's going to walk in that door. And as much as I maybe fear inside, That's what drives me to make the best decisions in a sense of speed, efficiency, saving that person, making the, the, the minute-to-minute decisions. I have a joke in the ER where I tell the nurses, I'm like, what do we save in the ER? And they're like, lives. And I'm like, no, we save minutes because each minute is a milestone, is a step. And if you don't understand what minute comes after which, then you're not really being as efficient as you can. That's how I look at the, the business aspect when I started going into it is how can we save these minutes? How can we save errors? If you want to incorporate that into entrepreneurship, each minute that you lose is an error that you got to do something, got to fix it. And so that's when I feel the best. And I'd rather have an unknown than a calculated I'm going to make X amount if I work every day. 'cause I was getting paid hourly. I work every day, X amount of hours a day for 365 days. I can calculate exactly how much money I make a year. I didn't like that.

I'd rather make nothing than with a dream than have that. Now you have a business, you could be in the ER and FDA's approved your product and it's being sold and you're not in the weeds doing that and money is coming in to the business. I ran a wealth management firm and it was a fee-based wealth management firm. And so every day the money was under management, we earned a fee. And I remember I had 3 children. They were young at the time and didn't really understand business, but we were on vacation. They heard me on the phone with someone on a business call. And afterwards, my oldest child, my daughter said, so Dad, let me get this straight. We're on vacation. We were in Turks and Caicos and you're getting paid while you're here on vacation. And I said, yes, I am. Now, if I stay here and don't go home, you know, that'll eventually end because the business does have some level of dependence on me to be there. But at the same time, and that's one of the things in M&A world, uh, where the greatest value is created is when people build owner-independent businesses. That's one of the hardest things, uh, hardest conversations I have with business owners is what's the value of the business if you walk out the door, right? Um, yeah. And if the business is dependent upon you, if you can't take a 3-week vacation, then you don't have a business, you have a job. And you are building a business that's not dependent upon you, that can generate significant revenue and profitability that you own your piece of. And you can be on an island or you can be in the ER. Sounds like you take as much pleasure.

Being in the ER as I took.

Sitting on a beach. It's a love-hate relationship. Well, once this goes through, we'll get.

To borrow his plane and his boat. There you go. Yeah. You know, I wish I could tell you I'm going to buy one of.

Those, but I had that and I'll.

Be honest with you, It's, uh, the plane or the boat or both. I've never had a plane, but I've had the boat. And, uh, you know what they say about the boat. Yeah, first day and last day. First day and last day. You know what boat stands for? What? Break out another thousand.

Uh, every time you turn around, winterize, summerize, store, sewage tank, out of bathroom. Similar to like, uh, being, being a part of the SMU network because their whole thing is pony up. And then it's like, you know, that's their battle cry for the sports. But pony up is also like, you better pony up that money, tuition to do, or, or in alumni donations.

Alumni donations.

Well, Alex, thank you so much for being here. Really appreciate the conversation, and I look forward to seeing, um, the FDA approval. And, you know, and seeing that ticker go by and you got acquired. And I hope I'm not, um, the user, the user patient, um, that can come back and speak to it, uh, next episode.

I don't really want another hip. Exactly. So we'll just do it for lung exercises.

You have the best lungs in the house. I'll have the best lung— the lung push-ups. I like that analogy.

That helped me understand. Yeah.

Well, thanks again, sir. All right.

Thank you guys so much. Thank you, Alex. That was great. Thank you.