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Scot: Hey, Troy. What was one of the things that everybody said about being a new dad, and you're like, "Eh, really?" and it turns out it's true? What was the one thing? Do you have something?

Troy: I think the anxiety that comes with it, that's probably the one thing. I heard people say, "You will lie there at night, and you will just listen to her breathe. And you will just make sure you are hearing her breathe." And I was like, "No way. I would never even do that." I have absolutely done that. So, yeah, that's definitely true.

Scot: Oh, man. Transitioning into fatherhood, like any chapter, can be really, really challenging and it can have an impact on your health. I mean, how many times have you heard guys say they stopped exercising or eating right after they've had kids, or their sleep is just constantly impacted after that? Or just even emotional health issues. It's a big change in your life. And we have a guy that has just become a new daddy, Dr. Troy Dadsen.

Troy: Dadsen, with a D.

Mitch: Dr. Troy Dadsen.

Scot: With a D.

Troy: There we go.

Scot: And this is a Sideshow episode of "Who Cares About Men's Health," where we're going to get a new daddy update, where Troy is going to tell us some of his experience as it relates to his life, and back to the Core Four that might be able to help other new dads.

"Who Cares About Men's Health" provides information, inspiration, and a different interpretation of men's health. My job, I bring the BS. I'm Scot Singpiel, and I chose not to have kids because I was afraid I'd screw them up. So that's why I don't have kids.

Troy: Scot, I was deathly afraid I would screw them up too. But I have a kid now, and hopefully I don't screw her up.

Scot: Now that is the MD to my BS, new daddy, Troy Madsen.

Troy: Yeah, that's me, bringing the baby to the show.

Scot: And nieces and nephews are enough for now, says Mitch Sears. He's on the show as well.

Mitch: Yeah. I'm good for a bit. Yeah, I'm good.

Scot: Okay. Because I just made that up to be clever in the intro, and then I asked myself, "I wonder if that's true. I wonder if he actually wants to have kids at this point."

Mitch: I don't know. No.

Scot: No?

Mitch: No. We'll see. I mean, we'll figure it out at one point or another.

Scot: Okay. All right. Troy, it's great to have you back on the show for a new daddy update. So I've got one question for this episode of the podcast. Tell us all about being a new dad.

Troy: So I'm just going to go into a 20-minute monologue now.

Scot: Actually, just give us an update to start off with. How's it going so far? How long's it been and how's it going?

Troy: So things are going incredibly well. It's been two months. She just turned 2 months old. Her name is Adeline. We call her Addie. That's her nickname. So she goes by Addie. She was born just over two months ago.

And I will say the delivery experience itself went incredibly smoothly. It was funny. It was just about . . . Well, it was one week before she was due. And Laura, my wife, was at the vet with one of our foster dogs, Arthur, who, Scot, you know well. You saw pictures of him at least. Very cute little guy. And Laura calls me and says, "Well, Arthur is doing well, and I think my water just broke."

Mitch: She buried the lede? Ugh.

Troy: Yeah, she totally buried the lede. She started with, "Well, Arthur is doing well. Everything is good. And I think my water just broke."

Scot: Well, from a comedic standpoint, that is the delivery. So good for her.

Troy: Yeah, exactly. From a comedic standpoint, yeah. So she came home. We went in to the hospital. So we got in there about noon. Addie was born about 2 in the morning. Came out with her eyes wide open and just the most beautiful little girl I've ever seen. Obviously, I'm very biased.

Scot: Of course you are.

Troy: And then I had about an hour with her alone because they just had to watch her over just in the pediatric . . . just the neonatal care unit. So I had about an hour in there with her alone, just sitting there with her, and just looking at her and just thought, "Wow, this is absolutely remarkable."

And every day since then, I've felt the same way. Every day it is just . . . Just to see her grow, and develop, and her mental development as she's become more attentive and more focused on our faces. Just in the last two weeks, she'll smile. I'll look at her and she'll see me and she'll smile, and look at Laura and smile and laugh. We'll laugh and she'll laugh, and it's just the cutest thing in the world.

And she's just my little best buddy. We walk around during the day. She loves to ride around in this pack. I've got this little pack that sits on my chest, and she's facing me and she just loves that. She'll ride around all day.

Some days, after a long run, my legs are tired and I'm like, "I don't know if I can be on my feet for another three hours carrying this kid around." But she loves it, and she'll fall asleep. And she'll look around, look outside at the squirrels and birds and whatever else.

It's like I've got this new little best friend at home now. And quite honestly, just really enjoying it.

And I think probably the biggest surprise in all this has just been how smoothly everything has gone. Again, me being kind of the pessimist, where I see so many things that go wrong in pregnancy just throughout my medical career, and just being aware of those things. And so I think just every day I'm so grateful that everything has gone as well as it has, and everything continues to go well, and just really enjoying the time I have with her.

Scot: You know what? As you were talking and as we're having this conversation, Troy, it just dawned on me talking about the new baby and going into depth about details about the new baby is something that we tend to think that women do, right? That's my perception.

Mitch: Yeah.

Scot: But then as you're talking about this, and I'm sitting here and I'm listening, I'm like, "I don't know if guys talk about . . ." Do you get asked by other guys about how it's going, and are they expecting an in-depth update? Are they just expecting, "Eh, it's great"? What's your experience with that?

Troy: Yeah, I think it is definitely less of a guy thing. I have had one friend in particular who has seemed genuinely interested, who has texted me. And we really haven't talked. It's been more just text. But he's always like, "Oh, send me pictures." I don't know if he's just being nice. I think most guys it's kind of like, "Hey, how are things going?" And you're like, "Oh, things are good. She's great." But he has seemed a little more interested.

But I think it is not a conversation I would say I've had a lot beyond having the same sort of conversation with my parents or siblings. Kind of telling them about things. And even then, when I say siblings, I'm talking about my sisters.

So, yeah, I don't know that guys have that sort of conversation a lot, but we'll see.

Scot: Yeah. I want to jump in and ask, this friend of yours that has shown some interest, does that make you feel different? Do you like that? Do you like talking about her? I guess what I'm trying to get at here is maybe we should do this more often for our friends that have become new dads, because they would enjoy talking about it. It would make them happy.

Troy: I think it would make them happy. But I also kind of feel like I don't want to be the guy who is always saying everything about his cute little girl and showing everyone pictures because I'm kind of like, "Do they really care? Am I over-sharing? Is this too much? Do they really want to know all this?" So there is that sort of guy thing in me too, where it's kind of like, "Do they really want to hear me say all this stuff?"

Scot: If the shoe was on another foot, if it was not you with the new baby, but a friend of yours that you would consider a close friend, would you want to hear about it?

Troy: That's a good question. Probably at this point I would a lot more than I would have a year ago. I think as you're going through it, and you're having those experiences, and then others share that with you . . .

I think six months down the road, if I have a friend who has a new baby and they're sharing their experiences with me, I think then there's a certain amount of nostalgia and reminiscing that you would experience as you hear their experiences.

But let's say a year ago, I don't know that I would've been that interested. And that's just simple reality, just because it wasn't really part of my life. I didn't really have a lot to relate to there.

So that's kind of where I'm sometimes hesitant to say too much and feel like I'm over-sharing, or being that kind of irritating person who's showing them 100 pictures of my new baby and they just don't care.

Scot: I mean, I am actually genuinely interested. Even though we're doing this for a podcast episode, I'm genuinely interested in hearing about your experience and hearing about it in depth. Although there are other people in my life that I would not be, but I consider you a much closer friend.

So I think I want to flag this as a little takeaway. At least my observation is if you have really close friends and you're not having these discussions, maybe open up because it's really going to make that other person feel really good. They want to talk about it, I would imagine.

Troy: They do. Yeah, I think so.

Scot: You say you want to talk about it.

Troy: I do. I love talking about her. I really do.

Scot: Don't just peg this as this is something that women do. Men can do this too.

Troy: Yeah. There are so many cool experiences just on a daily basis, just little tiny things. Again, like I said, when she started to just focus on us more, and you could tell her eyesight was improving and focusing on our smile, just the laughs, and the little sound she makes. And talking to her, her looking at me and then her moving her mouth and making little noises like she's trying to talk too.

It's just silly little things like that, but it's just like, "Wow, this is so cool." Every day she entertains me. I'm not bored at all. Every moment I spend with her I find interesting and entertaining in some way.

Scot: So you said what's been surprising for you, and definitely it sounds like you've been blessed how well things have gone, because that doesn't necessarily happen in all cases. But what's been kind of challenging?

Mitch: Sure.

Scot: What do you deal with there?

Troy: Yeah, I think some of the challenges . . . Fortunately, I think I did have some preparation for them. I will say this, and I don't want to say this in a negative way at all, but leading up to this, I received more unsolicited advice than I have ever received at any point in my life.

I can only think of a couple cases where I might have asked for some advice, but the amount of advice I have received was astounding, as people found out we had a baby on the way. But that's a good thing. I think it helped me out a lot.

But I will say one of the things that has been a big adjustment is just expecting everything is going to take a whole lot longer. If we're getting ready to go out anywhere, you just expect it's going to take a lot longer to do that.

There were some unexpected medical issues very early on. Not major issues, but just some things that came up where it was, in that first week, multiple visits to the pediatrics clinic. The first couple days, we were just down there every day. It was a little stressful. No question about it.

Scot: Yeah, I didn't know about that.

Troy: Yeah. It wasn't big stuff. I mean, it was just stuff that comes up.

Scot: But at the time, it probably was, right?

Troy: It wasn't. I mean, that's the thing. Again, I knew of so many things that could possibly go wrong that I felt very grateful that that was all that we were dealing with. It wasn't big stuff. It was just like, "Okay, I've seen this in the ER. I've dealt with this. This is what we do." But it was an added level of just a little more complexity.

Scot: Yeah, it makes your life even more busy because you've got all these appointments and more traveling and stuff.

Troy: Yeah, exactly. So that's why it was a relief to just kind of get through that first week. And then at the end of the week, the pediatrician was like, "Hey, everything is good. We'll see you back here in a couple weeks." So I was like, "Great. We have two weeks where we don't have to come and see a doctor." So that was nice.

But yeah, I think in terms of just unexpected things that have come up, I think it helps having . . . Working in the medical field definitely helps to at least kind of know a lot of what you could deal with.

I will say, though, maybe one of the most unexpected things I have dealt with is how you truly as a medical professional lose all objectivity when you're talking about your own child. It's very different.

I may see a rash in the ER and be like, "Oh, that's what it is. No big deal." I see a rash on her, I'm like, "Oh, wow. It could be this, this, this, this, and this, and I'm really concerned." I'm a little different because I'm overthinking it.

But I will say, I think every parent runs that risk of turning to Dr. Google. You Google stuff and you see every awful thing that it could possibly be. And that's kind of where my mind has gone at times, like, "Oh, it could be this, this, this."

Yeah, I think we all face those anxieties as this little person who we just are so involved in, and care so much about, and don't want to mess things up on, that we might overthink certain things. So I think that happens to everyone, regardless of whether you're in the medical profession or not.

Mitch: So one of the things that I'm finding really interesting hearing about this kind of dialogue is being someone who has not really thought about kids much. When I was younger, there were some medical things going on. I was told I might not be able to have them, etc. If you were to have talked to me a couple years ago about any of this, I probably would not have been interested. I just would've been like, "Uh-huh. Babies."

Scot: Even with Troy?

Mitch: Even with Troy. I would've . . .

Troy: No offense, Mitch. I would've felt the same way.

Mitch: I would've been appreciative of his excitement. But me, myself, I'd be like, "Cool. Let's see what else we can talk about."

But in the last few years . . . We made the joke about nieces and nephews, and I have some, and I've interacted with them. I was the youngest of my family. I didn't have babies to hold, and there was no real child interaction until just recently in my life. And there's kind of an excitement about it, right? They're new. They're trying new things out.

And so it's so exciting to hear Troy, someone I've worked with, someone that I care about, my friend, having these things for his own baby, and his own experience. So it's different and I appreciate it.

Troy: Well, thanks, Mitch. I will say that, too, in terms of what other people have said . . . and I've heard it for forever. Everyone has always said, "When you have kids, it completely changes your life." I never heard anyone say it changes your life for the better. They always just said it changes your life. I feel like my life is a lot better. I love it.

Scot: Oh, that's awesome.

Troy: This has been good. I will say this has been great. It has absolutely been a huge change.

And it's so funny because that weekend she was born . . . She wasn't due for another week. We had planned out at least five different activities we were going to do that weekend. We were going to go to the symphony. There was a Gorillaz concert that Monday. We were going to go to that. We didn't buy any tickets. We were just like, "We're going to wait until an hour before." So obviously we canceled all . . . we didn't do any of those things.

We haven't gone to any concerts, no shows, nothing like that since then. It completely changes your life. There's no question. But those are minor things.

Scot: The trade-off is worth it.

Troy: It's well worth it. I'm absolutely enjoying it.

Scot: All right. Well, let's jump to the Core Four check-in, because fatherhood does change a lot of things, right? Your life is flipped, turned upside down. And sometimes it can be hard to maintain some of those things, and a lot of stuff changes. So, Troy, how are you doing with the Core Four? Let's go ahead and start with eating. Has the eating changed at all?

Troy: No, it hasn't, and I feel fortunate there. The one big change I will say early on is that I wasn't eating as much. And it's funny, I actually lost a few pounds in the first month. I think I just wasn't eating as much. Just busy. And then with kind of sleep patterns being off, for me personally, I wasn't eating at night.

So in terms of the time-restricted eating, intermittent fasting, whatever you want to call it, usually I'm doing 12 hours. So then I was actually having nights where I was going 15, 16 hours.

Scot: Without eating? Okay.

Troy: Without eating. So I think that may have been part of it. But it's been good. I have tried to focus on that, on making sure I'm not eating a lot of sweets, or stress eating, or snacking in the middle of the night if I'm up, things like that.

Scot: So you have had to make a conscientious kind of effort?

Troy: Oh, for sure. Yeah, there's no question. And I knew that was potentially going to be an issue with snacking in the middle of the night if I'm up with her, or, like I said, kind of stress eating, turning more to sweets, that kind of stuff. So I have tried to make a conscious effort to say, "Stick with what you're doing." And it's been going well, so that's good.

Scot: How about activity? I think I already know the answer to this. You've been such a dedicated runner, and you've had such a running habit that I'd imagine that it's been pretty easy. Or no?

Troy: I would not say easy, but fortunately, it has been consistent. And I'm still fortunately . . . Again, this had to be a conscious effort, and I feel like we're in a good spot now where I feel like I'm good with keeping going with this. But I really wanted to say, "I'm going to keep doing this and I don't want this to be something that I just give up."

I think it was John Smith . . . He said a couple things that stuck with me. Number one, he said, "With every child, pick one of your hobbies and forget about it. You're going to lose it." So I was like, "I don't want it to be running."

But then he also said . . . He offered to go to Buffalo Wild Wings with me or something. And he said, "You just need to do stuff just so you feel like yourself."

And so kind of tying those two things together, I just thought, "I want to keep running," because when I run, that's how I really feel like myself. I just love that time. I enjoy it. I'm out there with my dog. And so I've been able to keep that going and be consistent.

It's been something with Laura where it's like, "Hey . . ." We both say we want to support each other to do these things we enjoy. She loves going to classes, like exercise classes, fitness classes, so I'm here to help her do that. She helps me to make sure I have the time that I'm going out going running.

Scot: That's awesome.

Troy: So that's been a conscious thing to make sure we're doing that. That's been good.

Scot: Yeah, communicating with your spouse and just planning out how that is going to be possible.

Troy: Yeah, exactly. It is so much more complex when you've got a little one at home, and you're trying to balance childcare and all that. It's a whole lot different than when you're just kind of doing your thing and like, "Hey, maybe I'll go running at 6 this morning. Eh, maybe I'll go running at 7. Maybe 8." It's much different when you're making sure you . . .

So, anyway, so it's just been a matter of organization, and making sure we're communicating, and sticking with what we like to do.

Scot: It takes more work, man.

Troy: Yeah, it does.

Scot: Not only are you bringing more work home with that kid, but it just takes more work doing the things you did before the kid. How about your emotional health? How's that doing?

Troy: It's been good. There certainly has been an element of anxiety. There's no question about it. Anxiety of making sure I'm not doing anything that would ever put her in harm's way, doing anything stupid, anything that . . . I don't know. You just read so much, like, "Put the baby back to sleep. They have to lie on their back. They can't lie on their stomach. Nothing in there that could suffocate them." I can't have any blankets in there, no toys. Stuff like that. I don't want to do anything like that, and I want to know everything I need to do to make sure there's nothing that could potentially harm her.

And these are just little tiny things. I'm not talking about dropping the baby. I'm talking about making sure there's not a blanket that she could somehow bunch up in her face and suffocate. So there's definitely that element of anxiety, and I think every parent experiences that.

So, yeah, from an emotional health standpoint, I think a little more anxiety. But at the same time, I think there have been so many positive things from an emotional health standpoint too. Just the reward and joy in being able to interact with her.

You asked about running and fitness. I think this kind of thing brings so much more meaning to just health and diet and all those things, just because I want to be a healthy dad for her. I want to be healthy. I want to be here for her in the long-term. I want to stay healthy. It's not just about me running marathons or trying to qualify. I want to keep running because I want to stay healthy.

A lot of things we talked about on the podcast have had a lot more meaning as I've thought about those in terms of just healthy lifestyle, and being healthy, and doing that for her too.

Scot: So there's a lot of extra overhead you have to deal with. If you think of the mind . . . And this is just an analogy, right? It's flawed like all analogies. But if you think of the mind as a computer, everything you have to keep track of is just another processing unit, right? You've added so much more, all the things you talk about that you're just trying to pay attention to make sure that your child is safe. So that kind of fills the cup.

Are you doing anything additional to help with your mental health or help bring a little bit of relaxation from that kind of anxiety or that stress?

Troy: I've been watching a ton of sports.

Scot: That's what you do, huh?

Troy: Watch so many sports. And it's been a great time to have a baby. The month of October and November, it's just like sports heaven. There was the World Series. NBA starts up. College football and NFL are in full swing. That's kind of my release in a lot of ways, watching sports. It's distracting.

Scot: It helps turn your brain off for a little bit.

Troy: Yeah, it turns the brain off. Yeah. And it's fun too, because it's time we're kind spending together. I'm carrying her around, have the TV on, walking around with her with the little pack on, and she really enjoys that. And so, yeah, that's probably been my thing.

But you're right, I think you do need that sort of release where you just be . . . And not to go down on the dark side, but you have to be aware that some people, it just becomes so overwhelming. And the sad part is, again, as a healthcare practitioner, I've seen the cases where it's become completely overwhelming and you see the shaken babies and you see those who have been abused, and it is just absolutely horrible. And you just ask what led to that? How did people get to that point? I don't know all the dynamics there.

And then there's postpartum depression. We've talked about it in men, as well as in women. So that's something. And I worried about that going into this. I wondered, "Is Laura going to experience this? Am I going to experience this?" I've had many patients in the ER, women in particular, who have experienced postpartum depression.

So, again, I think you do have to have that release. You do have to have those other things where it's a distraction. And we've tried to have other activities, like planning activities every week with her where we're going out on walks. We're planning this week to go do this little drive-through Christmas light thing where you drive through and see Christmas lights. Just little things like that that you can look forward to, activities you can do together.

And as I'm saying this, I kind of feel like a jerk. I'm sounding like I know what I'm doing. I have absolutely no idea what I'm doing. Let me just say that up front.

Scot: Fair enough.

Troy: I have no idea what I'm doing. We're just trying to figure this out. But this seems to be working. And again, two months into it, so far, so good.

Scot: Yeah. And I think the important message is I think sometimes people feel guilty if they're not 100% with the new child all the time. But you still do have to take time for yourself, whether that's something you enjoy doing, or just even some downtime where you can just turn the brain off for a little bit.

And if you're having struggles with that, that's an important thing to talk to a professional about and get some tools to help work through that.

Troy: That's it. And I've had to tell myself that a few times. I've had to just say to myself, "If I'm not in a good place emotionally, I cannot be emotionally available to help her out." I've got to be in a good place. Laura needs to be in a good place. I think every parent needs that.

Yeah, you've got to be able to . . . whatever that means. Like you said, if you need professional help, if you're just turning to family members, whatever, friends, to get some help, being able to . . .

Scot: No shame in it.

Troy: Yeah, no shame at all. You've got to be the best parent you can, and that's how you do it. You've got to be in a good place emotionally.

Scot: All right. Core Four check-in, the last one. I think I know what the answer to this one is going to be. That's why I saved it until last. Sleep.

Troy: Sleep. Again, this whole process has been so pleasantly surprising. I dreaded the sleep piece of this just because I've struggled so much with sleep. I really just thought, "This is going to be awful. We're not going to sleep."

So what we did very early on in the first couple days is we decided we're going to split up the night shift. So Laura took the 9:30 p.m. to 3:30 a.m. shift, and I took the 3:30 a.m. to 9:30 a.m. shift. And I set my alarm. Every night at 3:30, I got up, took over for her. I was then able to bottle-feed her. Laura had dedicated sleep time. At that point, she was feeding like every hour or two. She wanted to eat, and she needed to eat. She's growing a ton. So that's how we did it.

We did that for six weeks. And then at that point, she got to a point where she's sleeping more consistently and much longer stretches. So we haven't done that since then.

And Laura . . . thank you, Laura . . . has been the one who gets up with her at night now, which some nights it may be once or twice, fortunately.

But it was interesting doing that regular sleep schedule. So I was falling asleep at like 9:30, sometimes 9:00 before Laura's shift started. Doing that consistently, it actually worked out pretty well.

And I thought a lot about what Kelly Barron talked about, about sleep hunger. If I've ever had trouble falling asleep before, I now know if I get up every morning at 3:30, I will not have trouble falling asleep because I had no trouble falling asleep.

So it actually worked out pretty well, where just having that regular sleep schedule . . . It was kind of nice in a way. It was always tough to get up that early, but . . .

Scot: But it's consistent, which is . . .

Troy: It's consistent.

Scot: . . . not a thing you've ever really had before.

Troy: Yeah. I mean, in stretches I . . .

Scot: You're taking the male paternity.

Troy: Yeah, exactly.

Scot: Do you get crap for that from the other guys?

Troy: I sure do.

Scot: Do you?

Troy: Sometimes it's very subtle, like, "Wow, they didn't have that when I had my baby."

Scot: "Well, yeah, how lucky am I?"

Troy: I'm like, "I'm so glad I have it." So I'm very fortunate. Yeah, I have been on paternity leave. That's something the university offers, and I am so grateful for that. This would've been much different trying to do crazy shifts along with this for the last two months.

Scot: And it's something that not everybody has, so it's just one of those great things.

Troy: I know. I mean, that being said, I think most people, at least you can . . . Yeah, you take FMLA time, but . . .

Scot: It's whether you get paid.

Troy: I mean, I get paid. Yeah. For me, it's like eight weeks. Well, it's really six weeks paid, and then two weeks of just leave. That's technically how it works out.

Scot: You highly recommend it if it's available to people and they can make it work.

Troy: I will say that. I will tell anyone if you have that option, take it with no shame whatsoever. Do not feel ashamed. Do not feel you have an obligation as a man, because you're a man, to say, "Well, I'm not going to take it because I'm a man. I'm going to keep showing up at work. I'm not going to take paternity leave." Absolutely take it.

And I think it's a number of reasons. Number one, I feel like it's really helped me to be available to kind of do that shift schedule and help Laura out. It's been great for just being there with Addie, with my baby, to bond with her.

But then also, we've kind of been a little bit isolated. We're not really going out. And this is something our pediatrician told us, like, "Keep your circle tight. Don't be going out and doing a lot of things out in public. There's a lot of flu. There's a lot of RSV. There's COVID."

So it's been, I think, a good thing for her health too, where her immune system is very susceptible, where we've just got kind of our tight little circle here and we're not out in public a lot.

I think, again, don't be ashamed to take that time off for a number of reasons.

Scot: All right. As we wrap up this episode, what would you like to learn from our experts? Do you have any experts you'd like to have on the show to talk about dad issues?

Troy: We need pediatricians on here. I think every episode we have going forward should be pediatricians. What do I expect three months, four months? I know that's not practical.

I would love to have Kirtly on here more. I think she's so insightful. I thought so much back to what she talked about with pregnancy, and what to expect, and how to be emotionally available. And I think that's a really important thing going forward. How do you continue to do that as a husband and a parent?

Beyond that, I think diet and exercise are always going to be a challenge, because there are going to be different challenges at every phase of her life in terms of just her needs and the time investment. So I think anything we can continue to talk about there. It's just a great reminder and motivation to keep focusing on those things.

Scot: Yeah, reminder to keep focusing on maybe ways to make it simpler, or easier, or less time consuming, which isn't always possible. I mean, you can only shave it down so far. But those are good insights.

Troy: Yeah.

Scot: Well, Troy, congratulations.

Mitch: Yeah.

Troy: Yeah, thank you.

Scot: I'm so excited and happy for you, and every time your wife posts pictures on Facebook, I love it.

Troy: So many pictures. So many.

Scot: That's all right. It's a well-documented growing up she'll have.

Troy: There's no question about that. Yeah, no doubt.

Scot: All right. Well, Troy, thanks for sharing your insights about being a new dad. I hope that that is helpful to you if you're a new dad, and maybe you can take one of the things Troy talked about and apply that when you are expecting your child, whether that's, "Listen, I've got to make a conscientious effort to make sure that I still exercise, or that I find something that I can do that gives me a little break with my brain for a few minutes a day."

What were some of the other things you talked about? Don't have those stress foods in the house if you think you're going to eat them. But on the other hand, if you need some stress food sometimes, then go for it.

Troy: Yeah, go get those Oreos.

Scot: Everything is just kind of in the middle, in balance and moderation.

Troy, congratulations on being a new dad. Thanks for sharing your experience, and thanks for caring about men's health.

Troy: Thank you, and thanks for talking to me about it. Like you said, it's fun to talk about it. And this is the most I have talked about it since she was born and it's really fun to talk about it. So I appreciate you listening to me and letting me chat about it.
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This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Mitch: Have you been feeling a little off lately or maybe sad for a prolonged amount of time without any obvious cause? I know I feel that sometimes. Could it be depression? And if it is, what are we as guys supposed to do about it?

Depression is one of the most common mental disorders in the U.S. impacting as many as six million men a year. And yet, according to research, men may be more likely to suffer from the severe consequences of depression, like substance abuse and suicide.

This is "Who Cares About Men's Health," where we aim to give you some information, inspiration, and a different interpretation of your health. And today we'll see if we can't shed some light on depression.

I'm Producer Mitch, and I bring a little more than the microphones. And as always, we have Scot, manager of The Scope Radio, and he always brings a healthy dose of BS. Hey, Scot.

Scot: That's right. I'm ready with a healthy dose of healthy BS. I don't know what happened there. My mouth stopped working. All right. Why don't you introduce Troy?

Mitch: And the man who brings the MD, Dr. Troy Madsen.

Troy: Mitch, I'm super excited to talk about depression.

Mitch: I know, right? The most exciting topic. And joining us today is Dr. Scott Langenecker, the clinical neuropsychologist and professor of psychiatry at University of Utah Health.

Dr. Langenecker: Hi.

Mitch: Now, before we get to the professional, I think one of the things that we should probably talk about first is kind of the layperson's understanding of depression, because I think we toss that term around a lot. It's like, "Oh, I'm feeling a little depressed." That seems to come up a lot and I'm not always 100% sure if that's true depression. Scot, when you hear depression, what does it mean to you?

Scot: That's a great question because it comes back to this whole notion of what does it even mean to be happy? I tend to think that my people, if you will, tend to be maybe just a little on the depressed side. Maybe we don't relish in life as much as other people. Maybe we're not as effervescent.

But what is it really? I don't know. Is it a feeling of you just can't go on? Is it a feeling of you can't breathe, like you're dragging your feet in concrete just trying to get things done? Is that depression? So yeah, I'll be curious to find out.

Mitch: Yeah. And what about you, Troy? I wonder if in your practice at the ER and stuff like that, you must have at least a little bit of an understanding of it.

Troy: We do see a lot of patients who come in who are depressed. And certainly, I think all of us have fluctuations in mood and outlook. I think depression in my experience, it's more when it's . . . You get to a point where it's just like this haze, this fog that you're in, and it affects your ability to do your work. It certainly affects your outlook, affects your relationships.

So I see it as certainly a step beyond just a lot of, I think, the fluctuations we might feel in our mood over the course of a day or a week or whatever that might be.

Scot: Or just a little sadness or feeling the blues or something like that.

Troy: Yeah. Exactly. And like you said, Mitch, you might be like, "I just feel depressed today." But yeah, I think it's certainly something beyond that kind of mood changes we might experience.

Mitch: Yeah. And personally, I actually got diagnosed with some depression this last year and have been taking a kind of professional approach to it. But I don't want to bury the lede. I don't want to steal anyone's thunder when talking about depression. So why don't we get to Scott?

Dr. Langenecker, what is depression? And I guess as a follow-up, what is causing that?

Dr. Langenecker: So I want to put it in two big categories to start out with. The first big category is that you all alluded to, that sort of feeling sad for more than just a day, maybe a couple of weeks. So that's one big bucket.

The other big bucket is, "Man, I used to really enjoy hiking or skiing or running or playing basketball, and now it's kind of like blah. It doesn't give me that jazz anymore." And it could be one of those things. It could be one of the other things.

There are another seven symptoms that can be part of it, but those are the two big ones that sort of tip people off. But if you're not looking forward to things coming up in the future, or you look at your schedule for the day and you're like, "This is objectively a good day and I still feel sad," that's probably a tip-off.

Scot: Is it really sadness, though? I mean, how do we even define what sadness is?

Dr. Langenecker: Well, that's a great question because I'm not sure men are allowed to feel sad.

Scot: Oh, okay.

Dr. Langenecker: Can I say that?

Mitch: Only anger.

Troy: Scot, you've never felt it, so you wouldn't know.

Scot: Right. The eternal optimist.

Dr. Langenecker: Sadness isn't a man thing.

Scot: I don't know. Yeah, I think about depression and I don't know that I think about sadness necessarily. Maybe something like overwhelmed with some emotion. Maybe it's overwhelmed with sadness.

Dr. Langenecker: Yeah. So let's talk about the male interpretation of sadness, which is, "I've got people counting on me and I can't cut it. I can't do what I'm supposed to do and I'm letting them down. I feel this pressure and I can't do what I'm supposed to do as a man, supporting my family, supporting my job at work." So it comes across as that. That's one way.

The other way is irritability and anger, which is like, "Ugh, that person just drives me crazy all the time." And maybe it's true. Maybe they are. Or maybe it's just that you're feeling a bit depressed and anything is going to set you off. Those are kind of the two big ones for men.

Troy: It's interesting that you frame it that way too, because I agree. I think a lot of times we think of sadness like just being really weepy and down in the dumps. But to think of it that way in terms of just feeling more irritable and angry and just a sense of inadequacy, that makes a whole lot more sense in terms of, I think, probably how that sadness manifests in us as men.

Dr. Langenecker: Yeah. I would add there's sort of this classic trope about the middle-age crisis for men and getting a new wife and getting a sports car and buying new golf equipment. There's a premise for that that's sort of rooted in depression, which is, "Man, the things that used to really interest me just don't anymore. I feel kind of flat. I feel not into it anymore." Every time you go into that sort of stereotypical midlife crisis mode for men, is that depression? No. But it is some clues, right?

Troy: And you also mentioned it's not just a day. It's not just one day, "I feel irritable today." Maybe I didn't sleep well last night. You're talking about something sustained over weeks to really diagnose depression.

Dr. Langenecker: Yeah. And I should add one more thing. I know you've all talked about the interface between the brain and the body. Sometimes depression comes out, not just in men, but in women too, it comes out in the body. So people are like, "Oh, my back is just driving me crazy. I can't get comfortable, I can't sleep," or, "Man, my knee is just bothering me lately." And it turns out that there's actually a reason for that.

So some of the neurochemical systems that interface between the body and the brain are sending some of those signals both directions. And so it comes out sometimes as pain.

Troy: Yeah, and I will absolutely second that. A very large percentage of people I see in the ER with chronic abdominal pain, back pain, even chest pain, they're clearly underlying emotional health issues, and a lot of that is depression.

So that's a good point of being aware of maybe some of the physical symptoms we're seeing. Certainly not to blow those off as just writing those off without getting those checked out, but it makes sense that a lot of that does relate to depression or mental health.

Mitch: Wow.

Dr. Langenecker: And if you take that analogy a bit further, and this goes back to my upbringing, when you had pain in the olden days, you would go see a chiropractor, like if you have back pain or leg pain or whatever. And what happens in a chiropractor's office? You get a kind, caring individual. They do some manual adjustments. They spend some time with you. It's a powerful human interaction, and it resets some of those neurochemical signals in addition to some of the psychological support that comes with it.

Mitch: So if it's causing trouble in your mood, your behavior, and also in your body, do we know what causes depression?

Dr. Langenecker: We have clues.

Mitch: But no answers. Just clues? Okay.

Dr. Langenecker: We have clues, but no answers. Yeah. So the easiest way to think about it is our brain is really, really sensitive to things that are dangerous to us. And we grew up evolutionarily in a place where it was really a bad idea to not be afraid of a tiger or of a rattlesnake. And it was really a bad idea to sort of go wandering out in the dark at night. And so our brain has adapted over time so that, for many reasons, we would sleep, but also so that we would have a healthy fear of things that could kill us.

Well, it turns out in the United States today, it's a pretty safe place. Part of the evolutionary makeup that we had, too, is that we had to form small groups to protect each other. And so social connectedness was a super huge important part of being healthy and staying alive.

And then the final thing is if we got sick, we needed a system to keep us separated from other people so that we wouldn't necessarily get them sick as well.

All of these things are great if you're running around in prehistoric times with sabretooth tigers and whatever, but it's not super helpful in our environment now. So we have these super-sensitive in-tune systems for detecting danger and stress and so on, and sometimes our system gets over reactive to these triggers in the world.

Sometimes, however, we have experiences which I would put in the broad category of not being fair. And if I had a nickel for every time I said to a patient, "Hey, what happened to you was not your fault, and it wasn't fair, and let's see what we can do about it," I would be a very wealthy man and I wouldn't be talking to you right now.

Mitch: So you're saying that everyone is maybe hardwired to have these kinds of responses? It's not like you are some sort of different. You're not some anomaly if you experience depression.

Dr. Langenecker: This is where I'm at today, after 25 years of studying this. I think that apart from maybe 3% or 4% of humans, we all have the capability of becoming depressed. And I think that's actually an inherent part of being human. I think it's a good part of being a human. And if you don't have those signals working when things go wrong, people probably won't like you very much.

Mitch: You're unlikeable if you can't get depressed? Is that what you're saying?

Dr. Langenecker: You're unlikeable if you don't care about things and don't care about other people. And it turns out if you take that capacity to care and you combine it with bad experiences, a lot of times that's going to end up being maybe not depression, but some sadness, a couple of days of sadness.

So you asked me the question, "What is the cause of depression?" And that's the segue. The segue is a couple of days of sad to more than a couple of days of sad. I use this term professionally. It's perseveration of negative mood. What the heck is that? It means that the negative mood doesn't leave, no matter how hard you try and shake it.

So it brings me back to Charlie Brown with the rain cloud over his head following him around. That is a beautiful example. And I know that Charles Schulz experienced depression because nobody else would draw that unless they experienced depression.

Mitch: And that's interesting that you said that because that was kind of my sign that something was up. In the past, I could maybe go for a jog after I learned to enjoy running, or I could watch a movie and I could pull myself out of a funk if I did these particular activities, eating food I enjoyed, etc. Suddenly, nothing seemed to pull me out of it. And it didn't matter how hard I worked or how many self-help programs I tried or how many books I read, I just could not get out of it. And that's when I knew I had to talk to someone. And eventually, I had to get some medication for it.

Dr. Langenecker: Yeah, that feedback system, right? We have a feedback system from our brain to our body. And you sort of think in depression, that system gets jammed up. It isn't working the way it's supposed to.

I don't know about any of you, I joined the conversation about running late, but I don't like to run. I hate running, but I love how running makes me feel. And if all of the sudden I didn't feel that way after running, it wouldn't take long for me to say, "You know what? I don't want to run anymore." And that's what depression does.

So we mentioned it before. Depression is this sneaky [beep] that takes away the joy from things and then convinces you that that's a good idea. Like, "Oh, no. I shouldn't seek out joy anymore. That's a great idea. I should just sit in my bed."

Troy: And how good are we at actually recognizing that in ourselves? How often do you find people like Mitch who recognize it, get help, versus how often is it others who are really pointing that out, saying, "Hey, you used to really enjoy this. You don't do it anymore. What's up?" I'm curious how that really works.

Dr. Langenecker: It's interesting. I don't mean this in a negative way, but we as humans have a lot going on, right? There's a lot of stuff going on in our heads, lots of stuff going on in our lives. And sometimes we just miss it. We miss it in ourselves. We miss it in other people. And that's not bad on anybody else. That's just the complexity of being a human being.

But sometimes it's absolutely the case that you miss it yourself. Absolutely the case that somebody else is like, "Hey, I notice that you're a bit off. What's going on?" And then of course as a man, our first response is, "Whoa. No, no, no. We're not going there."

Scot: "No, no. Everything's fine."

Dr. Langenecker: "I just rubbed some dirt on it. It's fine."

Mitch: Right. Can we say sneaky [beep], Scot, or is that what . . .

Scot: I don't know.

Mitch: All right.

Scot: Why sneaky [beep]? Why is depression a sneaky [beep]?

Mitch: That's what I was going to say.

Scot: What is the fact that has . . . What's the definition of [beep]?

Dr. Langenecker: Yeah. Unpleasant fellow. Let's use "the sneaky unpleasant fellow."

Scot: Oh, yeah.

Mitch: Okay. I love that.

Scot: I thought it meant something else, I guess. Okay.

Dr. Langenecker: So, in technical speak, we talk about cognitive distortions, like how depression changes the way you view the world. You view the world in more black and white terms, like, "Things are all good or they're all bad," or, "People are out to get me," or, "Things are never going to work out for me." And those cognitive distortions don't really work for a podcast or for actually talking to patients, like real humans. And so I've come to think of depression as this sneaky inner voice.

So you might remember back in the day, long ago in cartoons where they had the devil on your shoulder and the angel on your shoulder. This is kind of the devil on your shoulder saying, "Yeah, things are terrible. They're always going to be terrible. And that person is not going to help you, even if you ask them for help."

And so those cognitive thoughts are happening in the same exact system that does all of your problem-solving. And it doesn't take long to figure out, "Oh, so the same exact system that's doing the problem-solving is also distorting my perceptions of the world." That's the trap. That's the sneakiness of depression.

Scot: It's like a little saboteur.

Dr. Langenecker: It is absolutely a saboteur. And then to add insult to injury, in depression, I will feel ashamed that my brain is doing this to me on top of that.

Scot: Actually, it's like that game. What's that game, Mitch, that brought up the term sus? "It seems sus."

Mitch: Oh, "Among Us."

Scot: "Among Us." Yeah. It's like the little evil person in "Among Us" that pretends to be your friend, pretends to be looking out for you, but really behind the scenes, not doing cool things.

Dr. Langenecker: Yeah. So we come back to the question of "What is depression?" Depression is your own brain convincing you that things that are good for you aren't good for you.

Mitch: That resonates so much with me. I was actually talking to my therapist the other day. I've been in a bit of a depressive episode. And when I was chit-chatting, it was just like . . . He's like, "You know what you need to do to get better." And I'm like, "I know. I need to start eating better, I need to get out, I need to do the things that I enjoy more, remind myself I enjoy them. I need to be talking to people."

And he's like, "Even if you don't like doing it right now, that's just your depression telling you, 'No. Don't work out. No, don't go talk to these people because they hate you,' or whatever. Just power through it. Ignore them. It might be unpleasant, but you've got to start doing those types of things if you're going to get out of the depression cycle."

And I think that's kind of what I want to ask next. What do you do? How do you fight back against this saboteur of depression?

Dr. Langenecker: I'm glad you brought that up, Mitch, because there's another piece to this. So you take this maleness of "I don't need help," and then you take this sort of cultural belief that we're doing the Horatio Alger thing and just pulling ourselves up by our bootstraps. And then you take this idea of positive psychology, which is literally rub some dirt on it or rub the dirt off of it. I don't know what it might be. And for somebody who's experiencing depression, that's basically telling them, "You're an idiot. You can't figure it out. You should have figured it out a long time ago. Why are you such a moron?"

And I'm using really strong language here because that's the saboteur. The saboteur can take really well-meaning, "Hey, maybe you could try this," or often, "You should do this," and it comes across as, "I'm incompetent, and I'm making a big deal out of this, and I should just get over it."

So part of the work with a therapist, honestly and truly, is getting folks to realize that they deserve better and to believe that they deserve better and to do things in the world to actually experience the better. That's how we beat the saboteur.

Mitch: That's interesting, because on another episode we kind of talked a little bit about the first couple of mental health workers I worked with. I was suffering from depression and that was the very same thing I felt. When that first person was like, "Oh, yeah, have you tried gratitude journaling?" the first thing I thought was, "I've tried it. It's obviously not working for me, doc. You've got to help me here. I'm not going to open up the journal again. Things are obviously terrible."

And I think looking back on that, he was probably giving decent advice and good advice. I just was not in the mood to hear it.

Dr. Langenecker: And that's why I use the analogy of a journey with some really comfortable shoes because it's not just the what, it's the when. And there's a phenomenon in depression, the waxing and waiting of depression, where as a therapist, I wait for windows of opportunity. I don't force windows of opportunity. And that has taken years to hone that skill, because if I force it at the wrong time, I'm going to be breaching some of that trust that I worked so hard to build with my client.

Mitch: So to kind of wrap up this discussion on depression, Scott, it sounds like depression is when you are feeling out of sorts or sad for more than one day, things that you used to enjoy aren't giving you that spark of joy that they used to. At what point should someone . . . what is a sign, a red flag that they should probably go talk to someone or they should probably seek some sort of treatment in one way or another? And what can they expect on those first steps of their mental health journey?

Dr. Langenecker: So to come back to that point, having the sadness or lack of joy for . . . Technically, we use the term two weeks or more as sort of the breakpoint. That is not a magical number. That is just a number that we've come up with over time. It could be more than five days, it could be more than three weeks, but just sort of this idea that something is off.

And then if it starts to mess with your sense of who you are as a person and what you deserve in the world, that's the point at which you say, "You know what? I don't have to fight alone. There are really talented people who are out there ready to help me."

Mitch: I love it. And what can they kind of expect on their first couple of steps into getting help?

Dr. Langenecker: I think the main thing is don't rush it, like we were talking about before. Don't feel like you have to rush this thing. We get into this mindset of, "Oh, I can take my car in for a tune-up." A brain tune-up is much more complicated than a car tune-up. It might take a couple of months. It might take longer. Be comfortable with the idea that you are investing in you. You are investing in you deserving a better life.

Mitch: Scott, thank you so much for joining us, and thank you for caring about men's health.

Dr. Langenecker: Thank you.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Mitch: Now, mental health is something more people than ever are struggling with according to a bunch of different articles. And I can tell you from personal experience that it's just as important as your physical health. And that's why we made it one of our Core Fore.

But as guys, as people who may not have been raised with the most positive approach to mental health, it can seem a bit overwhelming to get started. And finding the right mental health specialists can be everything.

Today, let's see if we can't learn how to find the right mental health specialist for you. This is "Who Cares about Men's Health," where we aim to give you some motivation, inspiration, and maybe a different interpretation of health.

I'm Producer Mitch, and I bring a little bit more than the mics, I'd like to think. And as always, we have Scot Singpiel, manager of The Scope Radio and one of the best BSers that I know.

Scot: I can't wait to start shoving some feelings down. I'm really excited for that.

Mitch: Perfect, I'm excited for that. And bringing the MD and maybe a touch of validity to the show, it's ER physician Dr. Troy Madsen.

Troy: I don't know about the validity. Maybe the MD. Thanks though, Mitch.

Mitch: And joining us today is Dr. Scott Langenecker. He is a clinical neuropsychologist and professor of psychiatry at University of Utah Health.

Now, before we get into the kind of nitty-gritty, I just want to do a quick check. Scot and Troy, let's start with Scot, what would you say your relationship with mental health is? I mean, it's the Core Four. We talk about it a lot. Have you ever taken the steps to actually talk to someone?

Scot: What's my relationship with mental health? It's kind of like the person that's across the street that you think you know and maybe you wave at them just in case you do.

Mitch: There's a casual nod every now and then, yeah?

Scot: Yeah, I don't like to get to intimate or too close with it. No, I'm kidding. I don't know. That's a tough question to answer, Mitch. It's something that I consider. It's something that I've become more aware of. I think just realizing and acknowledging sometimes when I'm stressed, or when I'm anxious, or when I'm not feeling well. What was the question again?

Troy: Have you ever talked to anyone?

Mitch: Yeah, have you ever actually had help?

Scot: Yeah, I did. A lot of workplaces have those programs where you can have an appointment. And there was a particular time in my life where things were really, really difficult and I just wanted some insight and maybe some tools to help me work through it. So I had two or three meetings with a professional in that respect.

Mitch: And how was it? Was it good? Did it feel weird to be there?

Scot: I'm looking forward to this topic because while it was good, I don't know that I necessarily felt that I had a connection with that individual. And if I was to continue that, I think I would want to try to find somebody that I had more of a connection with. So I'm really looking forward to finding out more about that today.

Mitch: Perfect. And how about you, Troy?

Troy: Mitch, mental health is something I absolutely think about. Sometimes I worry that I think about it too much, and I'm like, "Am I overthinking mental health?" Is that kind of a paradox? I don't know.

Self-diagnosis is something I often struggle with. And I've said before I sometimes take the approach where I either diagnose myself physical ailments with cancer, or I just tell myself, "Don't worry about it. Don't think about it." So sometimes, maybe I do that with mental health as well. But I absolutely think about it.

In terms of speaking with people, I think it's been more of an informal thing for me. I've had a number of conversations recently with several of my colleagues that have been really productive and very helpful as a lot of us have struggled with wellness and mental health, I think coming out of the pandemic in particular, but maybe just general job stressors and those sorts of things.

So it's kind of a relationship. Maybe I'd describe it as an on-again, off-again relationship. Maybe that's the best way to put it.

Mitch: Casual. It's complicated. Yeah.

Troy: It's complicated. Yeah.

Mitch: So with me, I think I've had probably the most interaction with a mental health professional myself. When I was growing up, mental health was definitely kind of treated as a sign of weakness, right? This idea that if you have "big emotions," then it's some sort of moral failing, and to buck up, "This is how men are," etc.

But during COVID and during the last couple years of my life, I knew something was kind of off and something was really wrong. I was feeling stressed, anxious, couldn't sleep. Work was really tough. Feeling good about things was bad. Relationships took a nosedive. And it got to the point where I felt I finally needed to talk to someone, and it was really tough.

I'll kind of fill in as the conversation goes, but it took me a while to find someone that I could talk to with my situation and actually get a connection that could help me. I actually went through three or four mental health specialists until I found the person that I did.

And the reason I even came up with this idea for this episode is I wish I had known that it's okay to find the right person, to try a couple. It's not you. You're not the one that's screwed up. But that's kind of why I wanted to make sure we talked about this.

So I've been with my current therapist for over a year now, and we're making tons of great work. I wouldn't have been able to do that had I not found the right person.

So let's turn to the professional a little bit to talk about this process and a little bit about maybe some strategies and kind of how we can approach this. Scott, Dr. Langenecker.

Dr. Langenecker: Yeah, call me Scott.

Mitch: Call you Scott?

Dr. Langenecker: Call me Scott.

Mitch: We've got two Scotts.

Dr. Langenecker: I know that's confusing. We've got Scott squared here.

Mitch: Maybe I'll call you Dr. Scott, I guess.

Dr. Langenecker: That's a groaner. That's a groaner when you're talking about mental health, but we'll work with it.

Mitch: Gotcha. So what kind of person needs mental health help? I guess that's kind of where I wanted to start. Who can mental health assistance help the most?

Dr. Langenecker: That's a fabulous question. I think about it this way: What's the most complicated system you have in your body? The obvious answer is your brain. If your brain is not working the way you want it to, that's the time to find somebody to talk it out and figure it out and see if you can optimize what's going on.

It's not always about things are terrible. I feel awful. Sometimes it's,"I just feel off," or, "That didn't go the way I wanted it to," or, "I got angry there and I really don't like it when I get angry." There could be all sorts of reasons why it might be a good idea just to chat with somebody and check it out.

Mitch: Is there something that men kind of deal with more than, say, anyone else that maybe that's a sign you should probably go talk to someone?

Dr. Langenecker: Well, the big one for most men is anger, and even acknowledging that sometimes anger gets the best of you. It may be that you've got it under control. It maybe that it doesn't really affect anybody else except for you. But if you walk around, and you get home from work at night, and you just feel off or irritable or angry, that's kind of a good sign that maybe it's a good idea to talk to somebody.

Mitch: So let's go to that next step. You need to talk to somebody. And I've heard that exact phrase far too many times. "Go talk to somebody. Go find a professional." What am I looking for? Are there different types of specialists? Is there some place that I should start? Who is that "somebody" in that statement?

Scot: I mean, that's a great question because there are licensed clinical social workers, there are psychologists, there are psychiatrists. There are probably 16 other titles as well.

Mitch: I was actually sent to my primary care physician first. And I was like, "What? Why would I talk to them about this?"

Dr. Langenecker: Yeah, most people are actually sent to a religious person first, which can be a little bit complicated.

Mitch: What?

Dr. Langenecker: Yeah, the most common person that somebody talks to first would be a pastor or a priest or a bishop. And that can be helpful. But if you think about the first question you asked, "How do I know that things aren't really going the way I want them to?" if the answer to that is, "I don't feel like things are in my control," or, "I feel like there's too much weight on my shoulders," or, "I feel like I can't quite keep all the pieces together," that's a good example of when to say, "Hey, let's maybe talk this out with somebody else."

And then the next step is really to say, "Well, what is it that I think is going on? Is it my emotions? Is it my sleep? Is it my sex drive? Is it my body falling apart as I'm getting older?" That might sort of dictate where you go.

And what am I looking for? Do I want somebody who's just going to listen to me as a real human and care about me? That's pretty powerful all by itself. Or do I have some work to do? Maybe I've got this thing where I come home and I'm angry, and I drink and maybe I drink a little bit too much, and that causes trouble in my relationships or maybe it messes up my sleep. If I've got to do some work, if I've got to make some changes, then the kind of professional I'm going to look for is going to be different. Does that make any sense?

Troy: I was going to say that makes so much sense. And I love, Scott, how you said, "It's one of those things where the mind is the most complex system in the body." The brain is the most complex system, and I look at some of the advice that I hear people's family members giving them about the heart or the digestive system, and it is not good advice.

And then you think we need these supportive people. We need them in our lives, but oftentimes, we're going to them with very complex mental issues and really internalizing that advice when we probably need something more than that and a much higher level of expertise.

Mitch: It makes me think of my cousin and her mother. She was having heart palpitations and she was like, "Mom, I have heart palpitations." "Oh, I have those. They're the flutters. Don't worry about them."

Troy: Exactly.

Mitch: I'm just like, "Maybe you should go talk to a specialist, not just somebody."

Troy: Exactly.

Dr. Langenecker: Yeah, let's get that bit out of the way right away, because the first thing that you're going to get from people who care about you is, "I want to come to a solution for you." And how that's going to be heard in your mind might be, "I don't really care about your problem. Let's talk about something else."

Mitch: Yeah. That struck a chord.

Troy: Yeah. I mean, certainly as men as we talk to other men, I know that that is often a complaint about men, hearing people talking about issues that are of importance to them. We certainly are solution-focused. We want to find answers. And I am as guilty of that as anyone. But again, like you said, that may not or probably is not the best approach.

Dr. Langenecker: Yeah, that's going to come across as, "You're making me uncomfortable right now. Please talk about something else."

Troy: Yeah, like, "Let's put a bow on this. Let's move on. Let's talk about something else."

Dr. Langenecker: "Let's go play basketball."

Mitch: "Cool. Yeah."

Troy: Yeah. Exactly. "Cool. Okay."

Mitch: So your loved one is good for a lot of things. That's important. Those relationships are important, but maybe not the most helpful person to go to with some of these issues.

Dr. Langenecker: Well, it may be that the relationship with a loved one may be the thing that you're struggling with. Your loved one may be struggling, or you may be struggling and your loved one doesn't want to hear about it, or they don't know how to how to support you. That's a good time to go seek out a mental health professional.

Mitch: All right. Let's go to that next term then -- mental health professional. What am I looking for? If I type in "mental health professional," am I going to get what I need, or do I need to go in with a little bit more know how?

Dr. Langenecker: Well, to be completely frankly honest, this is a daunting thing for me, and I've actually been doing this for 25 years. So I do want to be completely honest with your listeners.

Your example, Mitch, is a perfect one, which is sometimes it takes a bit to find the right person. And so when you start out, you might be entering something into Google. "I've got anger issues, and I want to find somebody to talk to." And that may send you to a place that you don't ultimately ended up going, but it may send you to somebody who can actually give you some advice on where you need to go next.

So one of the things that I say in the first meeting when I meet with any patient is I say, "You know what? I'm a 51-year-old white male from rural Wisconsin. That may or may not jive with who you are and what you think of the world. And we're going to talk for a bit and hopefully you feel comfortable working with me. But if you don't, I want you to feel comfortable saying, 'Hey, Scott. I need to talk to somebody else. Can you help me find someone else?'" And then I do.

That's where we get to some movement, get to the place where you actually find somebody who you can jam with and jive with and feel comfortable with and do some meaningful work.

Troy: And you don't take offense at that, if someone is just like, "Hey, this is not working. I've got to find someone else"?

Mitch: It's not you. It's me.

Dr. Langenecker: Yeah, to be completely honest, as a therapist, I feel it too, if things aren't quite going. I'm working my tail off to try and make it work, but if it's not, and you're just being polite and saying, "Hey, let's work on this thing today," and it's kind of nails on the chalkboard, let's not do that. Tell me so we can find somebody who will work with you and you get a good experience out of it.

Troy: So I wish I could do that as a healthcare professional. "This isn't working. I'm going to go find someone else to take care."

Scot: "I'm going to go find another arm to fix."

Troy: I'm just joking.

Scot: Hey, Mitch, I've got a question for you. So what was the process for you? What was going through your mind as you were meeting with different professionals and you were trying to find that right fit? How did you know? What were the considerations?

Mitch: So I first went through the company work assistance program, and I'm just like, "Hey, I'm feeling off. I think I need to talk to someone." They're like, "Well, we'll connect you with someone." And they first asked me, "Do I have a preferred gender of specialists?" I'm like, "I don't know. No. I don't think so." And so the process, I think, was a little lacking as to . . . I just was given who I was assigned.

And what was interesting is I came in, I was at a really kind of downplays, I was suffering with severe anxiety, severe depression. I was trying to decide whether or not to get on medication for it. I was in a really dark place. And so I'm suddenly just on a Skype call with some random soft-spoken individual and there was something that felt off very early in the conversation with this person.

And what was interesting is that I think it's partially myself, but there's something that's . . . I just assumed that maybe mental health work was not for me, right? The fact that I wasn't jiving with this person, the fact that I felt the vibe was just wrong. I'm like, "Hey, I'm feeling really depressed, and I can't seem to get rid of it." And it's like, "Well, have you tried a gratitude journal?" And I'm like, "Okay. Cool. Yeah, I have. I think there might be something else that I would like to try." "Well, why don't we try that first? I think that's always a great place to start."

Nothing against the guy, but for me, that was just like, "Dude, I've read the self-help books. I've done this stuff. Please listen to what I'm trying to say." And rather than just saying, "Hey, this isn't working for me," I was very sheepish and I was like, "Okay. Yeah, sure. I'll trust the process. I'll trust the person."

And so it took me three or four weeks with this person. And finally deciding, "No, this isn't going to work for me. This isn't the person."

I actually had to talk to a friend who happens to be a mental health specialist for her to remind me, "You don't need to stick with it. You can keep trying people out until you find the person that works for you."

Troy: I was going to say, Mitch, hearing about that, it sounds a whole lot like dating. And I guess with that in mind, Scott, my question for you is how long do you give it? Do you have to go on a second date?

Scot: How many times?

Troy: Can you just walk out on the first date? Can you get 15 minutes into and just be like, "This is not working. I'm not wasting my time"?

Dr. Langenecker: That's a great analogy. And let me take that analogy one step further. "This date is not working, but do you have any close friends that are hot?"

Mitch: Yeah.

Troy: Can I go with your roommate?

Dr. Langenecker: I mean, that's kind of what it's like. The person that you're talking to, you may not jive with, but they're probably in the best position to point you to the next stop. So one, maybe two visits. If you're not feeling it then, then it's time to move on.

Let's be honest. We're all human beings. When somebody says, "Hey, you know what? It's you," we can be hurt by that. And so somebody might say, "I've got to take a minute to think about what you just said before I can be effective in giving you good advice." I hope for a day when that doesn't happen, but I think that's where we are right now.

Scot: I want to jump in with a quick question for you, Scott. I was listening to Mitch's story and just thinking what that would be like to go in and start revealing some of these very personal feelings, right? For some people, maybe that's going to happen on the first time. But for a lot of people, it's going to take time with an individual before you can really start getting at it. Is there any research or anything that shows how many times you have to go before you start developing a trust?

Dr. Langenecker: It's really tricky to answer that question. So some people feel comfortable with a person, and it's like opening the floodgates. It all comes out.

And then sometimes as a therapist, you're like, "Oh, man. We're just scratching the surface. We're scratching the surface." We're on the third session and I'm like, "There's something else here." And as a therapist, then you kind of just try and bring the warmth and bring in the energy and just say, "Hey, it seems like there might be something else on your mind."

And the funny joke we have as therapists is if it comes up in the last two minutes of a session, it's probably super important.

Scot: I have people in my life, that's their strategy. It's the "one more thing" strategy, I like to call it, where the one more thing is the thing.

Dr. Langenecker: "And by the way, my house is burning."

Mitch: Well, it's interesting that you said that because it took me three or four people and I actually started to talk to friends. And that was a really weird place myself, to be like, "Hey, do you go to therapy? Do you have someone that you could recommend?"

And it eventually got to the point where I had been working with some mental health specialists up at The U for another project, and I was talking to the person I was working with and she was just like, "I have the perfect person for you. Reach out, see if they have any openings, whatever." I got in.

If we're going to keep saying that it's like dating, there was just an instant connection. There's something about being able to find a mental health person that approaches your problems in the way that you need, who can talk to you the way that you need to be talked to. There's something about being able to just like . . . I curse like a sailor, and just to be able to curse freely and not feel inhibited by that and have the same energy brought right back and just . . . I don't know. There was something that very quickly I was able to really . . .

We talked about Kung Fu movies. There was just something instantly about this person and this connection, and all of a sudden he's making references to TV series as how they can be applied to my life. And I'm like, "I've seen that series. I love that series. Yes." And that's when the mental health work actually started.

Dr. Langenecker: As you're talking Mitch, it just makes me think of . . . Imagine you're going on a journey to a place you've never been before and you have to go on this journey with a blind date. This is kind of how hard it is. And so if you're not feeling that chemistry right away, it's probably time to find a different blind date.

Troy: And would you recommend you go into that search kind of with that mindset, like, "Hey, I've got to go on a long road"? Let's say it's a 24-hour train ride or something. Is that the kind of person you're looking for, the person you want to take that train ride with? Someone you enjoy that much that you would enjoy spending that much time with them?

Scot: I don't know what kind of problems Troy has, but 24 hours is your idea of long?

Mitch: That's long. That's terrible.

Scot: I thing we're talking like a summer backpack across Central America, perhaps?

Dr. Langenecker: Yeah, I was thinking more like a trip to the Lonely Mountain with Bilbo.

Mitch: Sure. Yeah.

Troy: Okay.

Mitch: You need a Samwise.

Troy: Twenty-four hours is the starting point.

Dr. Langenecker: Yeah. I mean, it could be. It could be 24 hours. Just to share a bit of my own experiences with mental health, I've been in sessions for other people who have needed support. I've obviously been on the other side providing the support. I've gotten support myself. Sometimes it's literally like I need to talk to somebody about this problem, it's going to take about 30 minutes, and that's it. And that sounds like such a male thing to say.

But sometimes it takes more. Sometimes it takes quite a bit more. And so you don't necessarily know. But it's fair to say, "If I got I trapped in a capsule on the mission to Mars with this person, could we make it? Could we do it?"

Troy: And not just do it, but enjoy the conversation, I guess.

Dr. Langenecker: Well, maybe.

Troy: Maybe.

Dr. Langenecker: This is hard work. So it's kind of like cleaning a bathroom. You know you've got to do it. You know if you don't do it, you're going to get germs all over, and it's going to be gross, and you're going to get sick. But it's not like somebody says, "I want to do this today."

Troy: One thing Mitch mentioned, too, kind of looking at this process, he started with the Employee Assistance Program. Do you find those programs are helpful? Is that a good starting point if someone is just like, "I don't know where to go. I don't know where to start"? Or do you recommend a different route?

Dr. Langenecker: That's such an important question. In our culture, right now, in the space we live in, most people don't seek help because they're afraid that it will affect their job. And so going to an EAP, that's the hardest thing in the world. If you feel comfortable with that, great. I mean, those folks are there to help you, and they're good at it, and they're in touch with being confidential about things. But if that's going to be a hesitation or a hitch for you, then let your fingers do the talking. Go to Google or talk to somebody who might know somebody.

Troy: Yeah, I think from a personal standpoint, it's a good point you make and it's interesting to hear that. I feel like if I went there, they would know my job title, they would know what I do for work. I would just worry that there would be so many assumptions based on that, and I would almost feel obligated to play that role. For me, personally, be the doctor role. "I'm the guy who sucks it up, and I deal with it, and I'm going to get through this." My doctor persona.

So I wondered if that's the best route just because maybe you are in more of that work mindset and that work role that you play, and if that would carry into those sessions.

Scot: I'm getting the feeling that you think that the person would know your job title. I don't know that that's the case.

Troy: I would think so. Maybe they don't. Yeah, I don't know.

Dr. Langenecker: Let's explore this from the headspace, the headspace of the person who's looking for some help. There might be some shame. There might be some shame about, "Oh, gosh, I've got to ask for help." First of all, men don't ask for help. And second of all, we do it while playing basketball, not in some cushy office. So that could be a really hard thing to start out with.

I just try and clear the air, right? Clear the air and be like, "Let's go to a place where you feel comfortable walking into the building, and that shame thing isn't going off in the back of your head."

Troy: Yeah, and maybe that's the EAP program, maybe it's not. Maybe it's somewhere else.

Dr. Langenecker: Yeah, it's not a one-stop shop and it's not a one size fits all.

I was sharing with Mitch before when we were chatting, finding a good therapist is kind of like finding a good pair of shoes. You've kind of got to know what you're looking for. Do I want running shoes? Do I want hiking shoes? Do I want dress shoes? But they've got to be super comfortable. You've got to be comfortable working with a therapist.

And the reason why I like using the analogy of shoes is once you put them on, you're going to go somewhere. If you're going to be successful, you're going to make some moves. You're going to make some changes.

Troy: See, that's a great analogy. There's nothing worse than a long walk or hike or run with a little rock in your shoe. And you think, "Oh, I can deal with this." But just that little thing in there just becomes intolerable. So I would imagine same with these relationships. If things just are not quite right, it's just not going to work.

Dr. Langenecker: Yeah, we've all been on that walk with that pebble in our shoe or we don't have the right kind of shoes, and we're not enjoying the scenery. We're thinking about the blister we're about to have.

Mitch: That reminds me of the time I wore cowboy boots on the Vegas strip. And that was the worst decision I have ever made. I think I could not walk the next day. My feet were so broken.

Troy: Let me guess that was probably the first time you'd ever worn cowboy boots.

Mitch: Absolutely. I bought them for the Vegas trip.

Troy: That's what people wear in Vegas. They wear cowboy boots.

Dr. Langenecker: I bet you they looked good, though.

Mitch: Oh, they were banging. But no, after walking up and down the strip all night, the next morning I was limping to a Walgreens to get some flip-flops.

Troy: That sounds so horrible.

Mitch: It was.

Dr. Langenecker: If I could carry the analogy further, there are some times where a person just needs somebody to talk to and they just need a super comfortable pair of loafers. They're not going anywhere. They just want somebody to hear them as a human and to feel the connection.

Scot: Scott, talk about for somebody that maybe does not have EAP assistance or doesn't have very good insurance, what are their options?

Dr. Langenecker: Yeah, that's a great question. So here in Utah, at the Huntsman Mental Health Institute, we have something called the Warm Line. And I hope it's every bit as warm as it sounds. You can call them and say, "Hey, this is the thing that's going on with me right now. Do you have any advice for me on where I could go next?" They're there 24/7.

And it could be like we were talking about before. It could be like, "I've got this blister on my foot." It's probably not a blister on your foot, but that's just sort of me giving you space to say if you think it's a minor thing, it may be, or it may be something bigger. Just call the Warm Line and they can help you out.

Mitch: Scott, thank you for being here so much. If there was one piece of advice when it comes to finding the right specialist, if someone is curious, if they're feeling the things you're saying, something is off, you need to talk to someone, what is the one piece of advice you'd give our listeners?

Dr. Langenecker: My best advice is don't delay. In your mind, especially for men, it's like, "Oh, I can deal with that later." I know you've covered this in other health topics on this podcast, which is, "Sure, it can wait, but it doesn't have to." Things can get better, and they can get better sooner.

Mitch: Well, thank you so much for joining us, and thank you for caring about men's health.

Dr. Langenecker: Thank you.

Dr. Tarbox: Hello and welcome to "Skincast." This is the podcast that helps you understand how to best take care of the skin you're in. You wear your skin your entire life. It is the most expensive garment you will ever wear so you want to take great care of it.

My name is Michelle Tarbox, and I am a dermatologist and a dermatopathologist. I'm an associate professor at Texas Tech University Health Sciences Center in beautiful sunny Lubbock, Texas, and I love helping people take better care of their skin. And joining me is my co-host...

Dr. Johnson: Hey, this is Dr. Luke Johnson. I'm a pediatric dermatologist and general dermatologist with the University of Utah.

Dr. Tarbox: So today we're going to go over acne basics. Acne is a common skin condition that affects most people at some point in their lifetime, and utilizing a few simple techniques you could really help minimize the impact of this condition on your skin.

Dr. Johnson: So acne is super annoying. I had pretty bad acne when I was a young lad. I still get the occasional pimple even though I'm 40. Really seems unfair. But when I, you know, became a dermatologist, we learned about what causes acne. And actually, I remember being a teenager sitting in my dermatologist's office and looking with fascination at the posters on the wall about the causes of acne.

So, in dermatology, we consider acne a disease of the hair follicle unit. So one of the first things that happens is that the hair follicle gets kind of blocked up with sticky skin cells. And the hair follicles are often connected to oil glands, and the oil glands produce oil. The special term for this kind of oil is sebum. And so since the sebum can't get out of the hair follicle because the hair follicle is blocked up, the hair follicle gets all kind of filled up with this sebum.

Dr. Tarbox: And one of the interesting . . .

Dr. Johnson: Who likes to eat sebum? Bacteria like to eat sebum. So bacteria come to eat it, and then that creates an inflammatory reaction from your immune system and that sort of really gets the whole ball rolling down the hill.

Dr. Tarbox: That's actually one of the things I like to think through as kind of fascinating that these bacteria, which are called Propionibacterium acnes — they're named after the condition that they cause — are almost like little farmers of the oil that they eat. So they actually make our skin cells more sticky to each other so it plugs up the hair follicle more, and that actually makes a little reservoir of oil that these bacteria can use as a food source.

Dr. Johnson: And you might wonder why this tends to get worse around adolescence. And hormones play a big role as you might guess. A lot of the hormones make your oil glands crank out more oil and they make your skin a bit stickier so it makes the whole thing worse.

Dr. Tarbox: Whenever you have that backup of oil, it can actually break open the edges of the hair follicle and then that skin oil and possibly those bacteria and the dead skin cells get into the part of our skin that's not supposed to have foreign bodies in it. So if you've ever had a splinter and it got inflamed and red and irritated, you know how much our skin doesn't like things that don't belong there. And that oil is just as inflammatory.

Dr. Johnson: I think it's helpful to understand why acne shows up because then we can understand how the treatments work. So the treatments for acne affect some of those factors that cause the acne to begin with. And our best treatments are those that can affect more than one of those factors at the same time.

Dr. Tarbox: Here on "Skincast" we are not sponsored, but we are going to mention specific trade products because it makes it easier for patients to find them and I think that it's a little bit less complicated than people scouring an ingredient list looking for a specific and very technical chemical name.

Dr. Johnson: Yes, we have no commercial interests. This is just stuff we found that is good for our patients. And if you've got some acne, then there is some over-the-counter stuff that's fairly helpful. One of my favorites is a medicine called benzoyl peroxide. Not hydrogen peroxide. That's something else. This is benzoyl peroxide. It's in a lot of over-the-counter acne treatment products. So if you stroll down the acne treatment section in your local grocery store, you'll find benzoyl peroxide in various concentrations. Usually it's something like 4% to 10% that's present in cleansers, in spot treatment pads, in creams, and in various other formulations.

Dr. Tarbox: Benzoyl peroxide can be a great help when you're dealing with acne. One thing you do have to be thoughtful about is that it has peroxide in it. So if you've ever bleached your hair or thought about bleaching your hair, you might know that peroxide can lighten things. And it's true that if you have a benzoyl peroxide product on and it gets on a bed sheet or a towel or clothing, it can lighten or bleach the clothing. If you have fine light brown hair, it can also lighten your hair color around the hairline.

Dr. Johnson: Yeah. So this is one reason why I like it as a wash or a cleanser. I figure most people are washing their face anyway. Might as well put some medicine in there so you don't have an extra step to do. I say wash your face in the morning with this stuff because then they're not immediately putting their face on a pillowcase and discoloring their pillowcase. You do want to use white towels though or you'll have some messed up looking towels. That's the main downside with this benzoyl peroxide stuff.

It can also be a little bit irritating to the skin. In general, the lower percentage, the less irritating it is. So how sensitive is your skin? If it's not that sensitive, just buy whatever's cheapest, like I do, the generic brand. But if it's a little bit sensitive, there's a couple brands out there that are especially gentle. There's one called AcneFree. All one word. You might have to get it online. It's 2.5%. And then CeraVe makes a good one called Acne Foaming Cream Cleanser. It's 4% benzoyl peroxide. Also, very gentle.

Dr. Tarbox: I really like that CeraVe product, and I think that patients can do really well with benzoyl peroxide. Some people can't tolerate it, and, in that setting you can potentially use a milder wash made from something called salicylic acid, which is actually a relative of aspirin.

Dr. Johnson: Yeah, I do prefer benzoyl peroxide, but salicylic acid doesn't have this bleaching property and is usually present again in the same sorts of products that benzoyl peroxide is found in. Usually it's 2%. And if the benzoyl peroxide is just too irritating or you hate that half of your clothes are discolored, then salicylic acid is a decent option.

Dr. Tarbox: If you are aspirin sensitive, you would not want to use salicylic acid, and if you're pregnant, you would not want to use salicylic acid as it is a derivative of an aspirin-like chemical.

There's another wash that I really like for patients who have very sensitive skin that can't tolerate benzoyl peroxide or salicylic acid. This is a product from Cetaphil that actually has zinc sulfate in it, and it's an oil control acne wash.

Dr. Johnson: So there's our cleansers. Something else that's really nice that's over-the-counter is a medicine called adapalene. The brand name is Differin, D-I-F-F-E-R-I-N. Differin the brand makes several products now I think. So you want the one that's called Adapalene, is the medicine.

Until about five years ago, this was a prescription product that cost about $220, and now it's an over-the-counter product that costs $12. So a rare example of medication costs moving in the right direction. It comes as a gel, and you put a little blob of it on your finger. I usually recommend that people do it at night. And then you get that blob on your finger and you kind of dot it all over your face and then you rub it in everywhere.

So neither of these approaches is a spot treatment. Both of them go over your whole face because they help prevent acne from showing up as well as treat acne that's currently there.

Dr. Tarbox: If you're looking for adapalene over the counter, there are a couple different brand names. Differin is the original brand name, but you also can buy it as a La Roche-Posay product. That's a French company that retails products across to pharmacies in the United States. And the name of that line is Effaclar.

Dr. Johnson: I did not know that. It can also be a little bit irritating. Usually not too bad. But I usually tell people if it dries you out, just give your skin a break for a day or two, let your skin recover and then come back to it. Most people's skin will kind of get used to it. If you find that you're using it every night and it's not irritating you at all, well, you could probably step it up to a prescription strength version of the same thing.

Also, this is a retinoid. So there are components called retinol that are in a lot of over-the-counter sort of anti-aging products. And they also work. They're pretty similar to adapalene. They tend to be a little bit higher priced though. But the reason that they are in these anti-aging products is because adapalene and retinol and all these things are good not only for acne but also for scarring, for wrinkles, for dyspigmentation, so pigmentary changes in your skin. Basically, anybody who's not pregnant or breastfeeding should probably be putting one of these things on their skin.

Dr. Tarbox: Yeah, I love my topical retinoid. I don't leave home without it. Speaking of irritation, sometimes people, when they have bad acne or acne that they're frustrated with, will really kind of go after it with everything and the kitchen sink and they can end up really stripping their skin and making it too irritated and dry, which can actually make the acne worse.

Dr. Johnson: Yeah. So just as important as knowing what to do, things like benzoyl peroxide and adapalene, are knowing what not to do. So your poor little skin doesn't need astringents, it doesn't need scrubs, and it doesn't need things that are just too expensive. So sometimes I have patients who come in and they bring their Ziploc bag full of products that they've been using and I love it when people bring them, but it kind of breaks my heart that they've been spending 20 or 30 bucks on a benzoyl peroxide cleanser because you can buy one of those for 4 or 5 bucks.

So things don't have to be expensive, in fancy bottles, and advertised on television for them to work well. You just want to look for these ingredients — benzoyl peroxide, adapalene, retinol, things like that.

Dr. Tarbox: Sometimes patients will also over exfoliate. There are products that are coming off of the market because they have microplastics in them with those little beads that sometimes were included in products for exfoliation. And there are also products that have ground up walnut shells and things like that, which are pretty abrasive to the skin and can do more harm than good. If you want to gently exfoliate, a gentle facial brush that you keep clean and use with minimal pressure is a great alternative.

Dr. Johnson: So those are pretty good things that you can do over the counter. But what if you've done those or your teenage kid has done those and they've still got acne? Well, it might be time to go to a dermatologist. Another reason to go is even if you haven't tried those things, if somebody's acne is moderate or worse and all of those over-the-counter things just aren't going to be good enough, come to one of us. There's really good acne medicines these days. Really the only downside for our acne medicines is that they take a little while to work. So I am sorry if you are getting married next week. There might not be a whole lot that we can do. So come early. It usually takes our medicines about three months to really kick in, but after that, modern medicine does a pretty good job of treating acne.

Dr. Tarbox: Yeah, I always remind patients if your acne is leaving footprints, if it's scarring, you want to seek professional help because scarring is permanent and while we can do a lot of things to help improve those sort of scars that are formed over the years, like chemical peels and microneedling, it's better to prevent than to treat those scars.

Dr. Johnson: I would like to have a little myth-busting section of our podcast here because I think there's a lot of myths out there around acne. One of the main things that gets bandied about is diet. So there's been a fair amount of research into diet and acne, and I will admit that, before I read some of this research, I just didn't think diet mattered at all. Now I think that diet matters... just a little bit.

So the research says that if you have a high glycemic diet — so that's a diet where you eat a lot of like sugar and fat and carbs and things — that can make your acne a little worse. And for some reason, skim milk specifically has been associated with acne. Again, I think the effect is pretty mild. So if you have a high glycemic diet and you drink a bunch of skim milk, instead of having five pimples a month, you might get seven. So it's not really going to make or break things, but there is some data out there. So if you want to listen to your grandma and not eat that bag of Doritos, it might help your face a little.

Dr. Tarbox: Yeah, the skim milk connection is really fascinating, because when you have skim milk, it's had the fat taken out of it so more of that product is protein. And our hormones are proteins. Animals that aren't raised organically sometimes have extra hormones added to make them big and strong and overproduce milk, and those can affect some patients. If you are sensitive to that, going for the organic alternative or going for a vegan alternative may help you.

What about cleaning the skin, Luke?

Dr. Johnson: Well, I don't think cleanliness is as important as a lot of, well, to be honest, mothers and grandmothers seem to tell their children and grandchildren. Obviously, you should do something, but blackheads, for example, are not black because there's dirt in there. That's the sebum, remember the oil, and it just gets oxidized when it's exposed to the air and it turns black. So it's not dirt in the skin. And you don't need to be overly vigorous, as we've discussed, with these scrubs and things. So I think washing your face once a day with something gentle, especially with something with some acne medicine in it, like we've discussed before, is probably all you need to do. But having acne does not mean you are an unclean person.

Dr. Tarbox: That is such a good thing to tell people because sometimes there is a stereotype that goes along with bad acne especially. If I have an active young person that's a student athlete, I do like for them to cleanse their skin after exercising, and the product I really like for this is something called Simple Face Wipes because they're little pre-moistened towelettes in a little convenient packet that can go right in the gym bag and the patient can just wipe their face down after exercising or sweating and it helps to decrease that kind of post-exercise gunk that sort of stops up the hair follicles.

Dr. Johnson: When we think about acne, we're often thinking about teenagers, but acne can show up in other people too. It can show up in adults, especially women, in which case it's often hormonal and we do have hormonal treatments. So there is hope out there if you are such a woman. Come in and see us. We can do stuff. And then I can see it in fairly young kids too. So, from hormonal standpoint, puberty supposedly begins around age eight. And, you know, having a couple of little kids of my own, that's rather terrifying. But I have seen acne show up in, you know, eight years, nine years. Usually, it's pretty mild, but I have had some significant acne in kids as young as about 10.

Dr. Tarbox: There's another special form of acne that can happen in young women called acne excoriée, and it actually has a French name. It's acne excoriée des jeunes filles ,which means 'the picked-on acne of the young woman'. And this is usually occurring in young women who are a little bit stressed out, often successful, intelligent, driven young ladies that sort of express a little low-level anxiety by picking at the acne lesions often sub, kind of, consciously. So bringing that to your attention, if you are a person that picks at the skin lesions, is a good idea and you should remember that the little scars and the marks that are left behind after manipulating or picking at an acne lesion are going to last longer and scar worse than the acne lesion itself.

Dr. Johnson: Don't pick at your acne. There. You heard it from some dermatologists.

There are some other sort of special forms of acne. Most of the time, when we see acne, it's standard acne or what's called acne vulgaris. But there's a form of acne called acne mechanica. So if you're wearing something like a mask, for example, on a part of your skin, then that can further occlude those little hair follicles and make acne a lot more likely. So maskne is a form of this acne mechanica stuff. People who wear a lot of sporting equipment, you know, goalie masks and things or fencing masks, I've seen it or surgical caps. I've seen that in surgeons because it occludes their forehead and they get acne there. I see it in military recruits who have to wear backpacks a lot. They get it on their back. That kind of thing.

Dr. Tarbox: You can also get acne from products that are put on other parts of your body. So if you use heavily oil-based products on your scalp, over the course of the day the heat from your body will melt those products and it just sub-clinically trickles down from the hairline to the eyebrows and patients can have a flare of acne on that forehead region because of their hair care products.

Dr. Johnson: Apparently, according to the textbooks, acne is also worse if it's really hot or humid. I live in Utah, where it's really hot, especially today, but it's not humid. But it has its own special name — tropical acne. So if you are a military recruit in some tropical place, I hope your back does okay.

Dr. Tarbox: There's certain medications that can also cause acne. Steroids, either steroid hormones, like the male and female type hormones, or steroids such as glucocorticoids or prednisone can cause acne to worsen as can other kinds of medications that are sometimes used to treat seizure disorders.

Dr. Johnson: But if you are taking one of those medicines and you get acne, we can help. So, you know, if you need to take testosterone or you need to take other hormone replacement therapies and things, then it makes sense to come see one of us if the acne is giving you trouble.

Dr. Tarbox: And especially if it's an anti-seizure medication. Those are not medicines you want to mess around with. So, you know, you would continue to take those based upon the recommendation of the doctor that takes care of you for those and then seek the expert advice from a dermatologist.

Dr. Johnson: I hope that you guys found this helpful. And we want to thank our institutions. Thanks to the University of Utah and to Texas Tech. And if you are a real dermatology nerd, you might be interested to know that Michelle and I co-host another podcast, which is really targeted at people practicing dermatology, but hey, maybe you'll find it interesting as well. It's called "Dermasphere," D-E-R-M-A-S-P-H-E-R-E.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

We started the Who Cares About Men’s Health podcast with the premise that if men focus on activity, nutrition, sleep, and emotional health, they would feel better now and in the future. Plus, men would also reduce the chances of developing diabetes, heart disease, and many other conditions, all of which are impacted by lifestyle choices.

Today, we revisit the Core 4 Plus One More and what it means to be healthy. Since some of you haven’t listened before, we’ve included links to previous shows so you can learn more. In today's episode, Troy, Scot, and Mitch talk about the Core Four 4, how they've implemented them, and what they’ve learned from doing the podcast during the past two years. If you are starting your health journey, this is a good episode for you.

What does it mean to be healthy? We take a different approach to health than other places on the Internet. Contrary to fitness magazines, health isn't an all-or-nothing thing. You don't have to be a health and fitness fanatic. The pursuit of health doesn’t need to dominate your life. We believe health is the currency that lets you enjoy your relationships today and in the future.

• Episode 1: The Turning Point
• Episode 3: Finding Your Motivation
• Episode 18: Mitch’s Personal Health Journey

To feel better today and in the future, you should concentrate on four areas: activity, nutrition, sleep, and emotional health. Lots of research shows that focusing on those four things will go a long way toward helping you function, feel better, and protect you from disease. The plus one more? You should be aware of any genetic-related health issues in your family and address those.

While some might enjoy weight training and spending time in the gym, it’s not for everyone. We intentionally choose the word activity over the term exercise. Exercise sounds like you need to join a gym. Exercise sounds like something that's detached from your life. Activity, on the other hand, is less formal and part of your life. Just do something that makes you break a sweat for 30 minutes a day. It might be running. For others, a brisk walk with the dog, playing basketball with the kids in the driveway, hiking, even raking leaves and shovelling snow is an activity that helps you stay healthy.

Find the activity that you enjoy doing every day and be consistent. Small, constant effort makes the difference. If you don’t enjoy what you’re doing, you’re not going to want to continue doing it.

• Episode 24: The Secret to Successful Strength Training
• Episode 54: Getting Active Again
• Episode 158: Kettlebell Curious
• Episode 168: Getting a Bodybuilder Physique Is More Involved Than You Think

What you eat impacts your physical and emotional health. That doesn't mean you have to eat perfectly. However, you should try to avoid processed foods and refined sugars. Eat more fruit, vegetables, nuts, and seeds. If changing your diet seems overwhelming, simply change one thing. Drink one less soda a day. Eliminate one fast food meal a week. Eat one extra serving of veggies. Small changes add up over time.

• Episode 12: The Importance of Good Nutrition
• Episode 20: Time Your Meals to Lose Weight
• Episode 42: Get to Know Your Macros - Protein
• Episode 46: Carbs Aren’t Bad
• Episode 49: Surprise! It’s Hidden Sugar
• Episode 51: Don't Fear the Fat

Many underestimate the importance of getting good sleep. The average adult needs 7 to 9 hours of sleep. Research has shown that lack of sleep impacts your health in multiple ways.

• Episode 11: How to Beat Your Insomnia
• Episode 38: The 4 Rules of Rest

Mental health is the state of your thoughts and emotions, and it impacts everything. If we're not functioning well emotionally, it can affect sleep, nutrition, and activity. If your emotional state is supportive of meeting your goals, that’s good. If our emotions are a barrier to doing the things we want to do in life or impacting our relationships, we need to do something. Sometimes seeking professional health is the answer. You’re not weak for talking about it. If you broke your arm, you’d go to a doctor. If you only listen to one episode about mental health, listen to Episode 39. The tools for your mental health toolbox are easy for anyone to use, and they do make a difference. If you need more help, check out Episode 45 to learn how antidepressants can help.

• Episode 7: What is Mental Health Anyway?
• Episode 19: Seven Steps to be a Better Listener
• Episode 39: Three Tools for Your Mental Health Toolbox
• Episode 45: Do I Need an Antidepressant?
• Episode 47: Therapy Isn’t Just for a Crisis

If you smoke, quitting has almost immediate health benefits. Excessive drinking can also have a significant impact on health. Quitting can be challenging, so if you're not ready yet, pick a few easier health changes first. For both smoking and drinking, you might need professional help. If drugs are an issue, you'll almost certainly need to seek professional help. In all three cases, these changes can have the most significant impact on your health.

• Episode 21: Opioids, Treatment, and Hope
• Episode 26: Trying to Quit for 7th Time
• Episode 53: The Line Between Unwinding and Drinking Too Much
• Episode 57: The Real Problem Isn't Drinking Too Much

Some people are at higher risk for certain types of cancers, cholesterol, blood pressure, diabetes, heart disease, and mental health issues. If you know where you're at higher risk, you need to focus more on those areas.

Guys love to take a "wait-and-see approach to health." But if you have an issue that has been around for a while, it's not likely going away on its own. Whether it's an old injury that prevents you from being active, a chronic cough, or any ongoing issue, you should have it checked out.

• Episode 5: Putting a Physical Therapist on Your Health Care Team
• Episode 48: Recovering from a Sprained Ankle
• Episode 59: Erectile Disfunction and Your Health
• Episode 67: Ask a Sports Medicine Doc

If you’re struggling with your health, just pick one of the four, make one small change, and be consistent.

• Be patient. Change takes time.
• Be independent. Health is very personal, and you can do it your way. Don't judge yourself compared to others.
• Be kind to yourself when you slip up.
• Congratulate yourself for all the small wins.
• Reach out. You can contact us anytime.

Interviewer: We're talking with Dr. Michael Good, who is the CEO of University of Utah Health. And here at thescoperadio.com, we got word that Dr. Michael Good was spotted in the hospital, so we wanted to find out what was going on. Now, I don't know but is it common for a CEO to be in the hospital late at night rounding?

Dr. Good: I don't know what other hospital and health system CEOs do. I hope they do that. Taking care of patients is both a real privilege and also a great responsibility. And we have great people here at University of Utah Health, and it was really a pleasure to get to meet and chat with many of them last evening.

Interviewer: Well, tell me more about why you were there, what you saw, and what happened.

Dr. Good: Last evening, I spent over three hours with our mobile nursing supervisor walking the hospital, checking in with our charge nurses, and just seeing the hospital at work in the evening hours. The daytime shift gets a lot of attention and focus. A lot of things happen in the hospital during the day that's really important. But I can tell you at 10:00 p.m. last night, there was really impressive health care happening, and that's where I wanted to spend my time last evening.

It was just really impressive to see our people at work. Many of the patients' care was following routine protocols, but I also saw our people really called into action. There was an infectious disease exposure, and Jared, the nursing supervisor that's one of his responsibilities is to see if the patient will consent for a blood specimen so we can help sort out the health of our healthcare provider. We had a patient sign out against medical advice last night. And health care is intense and it's challenging, and there's a lot of emotional discharge, if you will, from our patients. And particularly our nurses are on the frontline of that.

We had a behavioral emergency, where the team also included security and really having to help a patient understand what is acceptable behavior in our hospital and what's not.

And then really where I was most proud, pretty late into the evening, we have a rapid response team. It's where a patient on the medical ward, where their vital signs, their heart rate, their blood pressure, their oxygen saturation, their breathing rate crosses certain thresholds and the team rallies. It really was a multidisciplinary team that came together, physicians, both general and specialty physicians. There were nurses, both the nurse that was taking care of the patient, but as things became urgent, the charge nurse came in and also participated. As things became more urgent, the nurses that are part of our rapid response team came. An EKG technician came and performed that. As blood cultures and other laboratories tests were needed a member of our phlebotomy team came. And it was really like a great orchestra.

It's really hard to describe the sophistication, the teamwork, and the level of care that quite honestly you'll observe every night happening over and over again here at University of Utah Hospital.

Interviewer: Were there any takeaways from last night that is going to change anything that you do?

Dr. Good: You spend an evening in the hospital, and I was supercharged. It makes me want to come to work in the morning and work even more so to make sure our staff and our faculty have the tools, have the resources, have the things they need to do to excel in their work. I couldn't help but notice last night, as we moved through the hospital, how many of our team members were wearing their top 10 for 10 Patagonia vests. Last year for the 10th year in the row, University of Utah Hospital was recognized by Vizient, a national organization, as being in the top 10 for inpatient quality of care and being in the top 5 for ambulatory quality of care. And, of course, those Patagonia vests are now a year old.

And while a year ago, we were 10 for 10, one of the things that got lost, if you will, in the fog of the coronavirus pandemic was that this year University of Utah Health was number 1 in the country for inpatient care 11 for 11. So there was a lot of pride of ownership. One way that people display that is with they're proud to wear the vest, if you will.

It was just re-energizing to see great care being delivered late at night when there's not a lot of attention or not a lot of spotlight, but really special people taking great pride in their work and knowing that they made a difference in the life of their patient last night.

Interviewer: You had an opportunity to interact with some of the great providers and people that make all this possible, but you also, were not able to interact with everybody. So I'd like to give you an opportunity as we wrap this up to deliver a message to everyone, all the great individuals working at U of U Health. What would you say?

Dr. Good: I want to say thank you to each member of the University of Utah Health team. What you do is so impressive, so meaningful, so impactful, so often life-changing and life-altering for our patients. I couldn't be prouder of you. I couldn't be prouder to be a part of this team. And I am very optimistic about what you will do in the year ahead.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

If you've ever looked up your medical symptoms online, it can seem like every website assumes the worst possible scenario. These results can be alarming to say the least. So where can you find reliable health information online?

Dr. Troy Madsen has dealt with the stress of trusting bad online information personally and professionally with his patients. He's put together a list of websites he uses and has found to be the most reliable to find information on any medical topic.

• Centers for Disease Control and Prevention (CDC)
• The Mayo Clinic
• The Cleveland Clinic
• University of Utah Health
• MedScape.com
• UptoDate.com

Each of these websites are from reputable health organizations run by professionals. Dr. Madsen highly recommends using these sources over a basic web search to make sure you're getting the best information possible. How Can You Tell if a Health Article is Valid?

When it comes to research you see in your news feed, it's easy to get bad information. There are a lot of potential problems with online health journalism. Media groups often write articles about science and medicine in a way that can get them clicks. Due to limitations, the story is not always able to go as deep into a topic as is necessary to fully understand the complex nature of scientific studies. And finally, most journalists lack the medical or scientific background to accurately present the findings.

Dr. Troy Madsen has a list of tips that he suggests everyone follows when reading any study to help you decide if it's true.

• First and foremost, make sure the article links to a published scientific study. If there's no study, there's a good chance the information in the article is misleading.

• Make sure the linked study actually claims what the article says. Most scientific journals will give access to the abstract or short summary of the research for free. Read through to make sure the journal isn't twisting the findings.

• Make sure the study is published in a reputable scientific journal. There are "predatory journals" that allow any group to pay to publish research in official sounding publications. To be safe, only trust journals like The New England Journal of Medicine, The Journal of American Medical Associations, The Lancet, or The British Medical Journal.

• Avoid studies that make bold and definitive claims. Science is nuanced and seldom makes hard and fast claims about anything.

• Make sure the claims are backed up by multiple studies. For example, if chocolate really did cure cancer, multiple studies would be looking into it.

• Be sure to check the sponsor of the research. It's not uncommon for companies to back skewed research that shows the positives of their products.

Be a skeptic! Next time a scientific story comes across your feed, keep an eye out for these elements to make sure you really are getting reliable information. What Makes a Good Scientific Study?

Troy also suggests a few things to look out for when judging the validity of a study. A good scientific study should have the following:

1. Low "P-values." A p-value is a statistic that describes the likelihood of the collected data having errors. As such, a lower p-value means a more reliable study. Look for data with a p-value less than .05. That means there is less than a 5% chance of the data being wrong.

2. Large numbers of subjects. A scientific study about health should include over a thousand subjects minimum. Ten thousand is even better.

3. The best type of studies use "randomized control trials."

4. The gold standard for medical research are "prospective studies," where the scientist actively follows the patient and their behavior rather than rely on anecdotal information.

Maybe you didn't chew as well as you should have. Now you have a piece of food stuck in your throat. It's not obstructing your airway, but it's definitely uncomfortable or painful. The food won't come up, it won't go down. ER or Not?

First, make sure the food isn't obstructing your airway. Any blockage of the airway needs to be seen at an ER immediately.

If you can't get the piece of food up, you may need to go to the ER to get it removed by a professional. But first, there's a trick you can try at home that may save you a trip and the cost of an ER visit.

Take a drink of a soda, preferably a cola. Try to get a swallow of the cola down your throat and let it sit there for five minutes or so. Carbonated cola has some properties that will help the esophagus relax. It may be able to relax your throat enough to swallow the food the rest of the way. Repeat a few times if necessary.

If the cola trick works, it is important to go talk to your doctor afterwards. There are some conditions that can be related to getting food stuck in your throat that would be important to catch to diagnose and treat.

If the cola didn't help push the food through to your stomach, you will need to go to an ER. You will need to be treated by a gastroenterologist immediately. An urgent care will not have that kind of specialist on hand. Try to go to a larger ER that would have an oncall specialist. Housekeeping - Hello Ladies.

This podcast is called "Who Cares About Men's Health." The goal of the show was very focused and very singular. Create a podcast by men, for men. Yet our our most recent statistics surprisingly show that about 40% of our listeners are women.

Guess this just goes to show that women also care about men's health.

Listener Danielle recently gave us a shoutout on Facebook.

"I love listening to bits and pieces of this podcast Who Cares About Men's Health. You don't have to be a man to find it interesting."

Women, if you are listening, be sure to share it with the men in your life. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Troy would rather have a broken finger than a long-lasting cold, because he can't get sympathy. Scot has a moment of honesty about his personal health struggles and he reminds us that health is a practice with ups and downs, not a linear journey. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Dr. Chan: What is it like to move away from your family in Utah to attend Harvard University? How do you choose which college activities to be involved in with your limited time? How does one create a community or second family while far away from home? What's it like to be part of The Arts Board for the "Harvard Crimson"?

Today, on "Talking Admissions and Med Student Life," I interview Ha, a first-year medical student here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world. This is "Talking Admissions and Med Student Life," with your host, the Dean of Admissions at the University Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, welcome to another edition of "Talking Admissions and Med Student Life." Great guest today, Ha.

Ha: Ha.

Dr. Chan: Ha. All right. Start med school next week.

Ha: Yes.

Dr. Chan: How does it feel today with less than two days to go?

Ha: I'm very excited, but I'm also very nervous. So I think they cancel each other out and I just feel maybe Zen about it.

Dr. Chan: Zen. That's a good way to do it. What plans did you have this weekend? How are you going to . . .

Ha: So I hope to watch some movies, read a lot of books. I have a huge pile of books. And a couple of my friends from high school want to do archery. So I'll just be going to the archery place down at Sugar House for that.

Dr. Chan: Oh, fun. I've seen that place. Do you do archery?

Ha: When my friends want to, I come along with them. But it's been a while.

Dr. Chan: Do you help spot them? Do they need spotters? Does that exist in archery?

Ha: I don't think you need spotters, but definitely, it's just fun to have someone there with you to watch and congratulate you when you hit the target and things like that

Dr. Chan: Yeah. Especially if it makes that sound, like thwap.

Ha: Yeah. A lot of fun.

Dr. Chan: Cool. All right. So let's start in the beginning. At what point did you think about becoming a doctor? Was it when you were your young or was it more in college? When did that decision start solidifying?

Ha: So I started becoming really interested in medicine maybe when I was about around 10 or so.

Dr. Chan: Ten? Okay.

Ha: And that came from my experience with my grandparents. When I was growing up, my grandparents lived with us and they often had a lot of different health concerns and various issues. So the hospital just became a really big part of our lives. And even though I was too young to be brought along with them, I would hear a lot about their visits afterwards.

And for me, I think the thing that interested me in medicine was that it was a very scary time. I remember there was this particular moment like seventh, eighth grade, around that time, when my grandpa got diagnosed with melanoma. And then on the day that he got surgery for it, my grandma fell, fractured her spine. And then a couple of months later, we also found out that she had cancer too. And so, during those months, medicine was just really prevalent.

And I think that there was a lot going on, like factors outside, that could have caused a lot of troubles for my grandparents. They didn't really understand English. There are always concerns about the cost of treatments and everything, but my grandparents always loved seeing the doctors and they always respected them.

And seeing that, it just made me really think, "Wow, what is it about medicine that can take something that can be so raw and so hurtful, but transform it into something that makes people somewhat excited and can find hope?" And so that launched me into looking into medicine more.

Dr. Chan: Did you help translate or were you just . . .

Ha: When I got a bit older . . .

Dr. Chan: Technically, you're not supposed to use 10-year-olds to translate, but I know it still happens. Yeah.

Ha: Yeah. Basically, my mom would translate a lot more. But when I got older, sometimes if my mom couldn't go to the appointments, I would go in their stead and help translate.

Dr. Chan: This is in Salt Lake City?

Ha: Yeah.

Dr. Chan: And how are your grandparents doing?

Ha: So, during college, my grandpa passed away and my grandma moved back to Vietnam. But she's doing pretty well in Vietnam.

Dr. Chan: Okay. All right. We're going to talk about that. All right. You're 10 years old, and then you grow up in Salt Lake, and then you attended West. Correct?

Ha: Yeah.

Dr. Chan: So let's talk about West. IB program, I assume. I assume it was a really positive experience?

Ha: Yeah. I really liked West. I enjoyed being a part of the IB program because it gave me a lot of exposure into things that I don't think I got to do a lot. It's somewhat annoying when you're there in the moment, which is writing the extended essay, which is where you choose a topic of interest and research it. But it was actually pretty cool getting to get into it and to do that. And I met a lot of great friends there that I still keep in touch with and I'm still pretty close with. So West was definitely a very fun high school experience.

Dr. Chan: And then West helped prepare you for the next experience.

Ha: Yeah.

Dr. Chan: So let's talk about . . . how did that play out? Did you have a really good college advisor? How many schools did you apply to? What did that look like?

Ha: Yeah. So, for me, I just ended up applying to two schools.

Dr. Chan: Two schools?

Ha: I applied to The U and then I applied to Harvard Early Action. And so Early Action rules you can only apply to your state school.

Dr. Chan: So you're locked in.

Ha: Yeah. So those were the two schools that I applied to. There was definitely some advising, but I think that I just stumbled into a lot of things. I would reach out to counselors when I had specific questions and they would give us a lot of resources, but I sometimes go about things a bit confused, which is fine.

Dr. Chan: Why Harvard? Why early decision, early assurance?

Ha: Early Action I think it's called.

Dr. Chan: Early Action.

Ha: Yeah. When you take the SAT and everything, a lot of people . . . the schools start sending you information packets and everything like that. Harvard made a pretty good impression on me because I remember there was one moment, they sent us stuff about, "Oh, if you have questions about financial aid, feel free to fill out this form." And I did. And a few months later, the financial aid office actually called me and said, "Hey, we saw that you had some questions. We're happy to explain the Financial Aid Initiative, what we're trying to do here."

Similarly, the admissions office has this Undergraduate Minority Recruitment Program, and over the summer before senior year, I got an email from a student there and she was really willing to answer a lot of my questions. And what struck out to her answers was that she really loved the community there. And Harvard has a really nice built-in community system with their house system.

Dr. Chan: Interesting.

Ha: So it was something that really excited me because I care a lot about communities and I care a lot about creating second homes and things like that. So I think with all of that . . . like, the academics is definitely very important, but I think the community and all those other things pushed it over the edge for me. And also, they just felt a lot more approachable compared to some other communications I had.

Dr. Chan: Have you ever visited Boston before?

Ha: No. It was risky.

Dr. Chan: Okay. And did they interview you for Early Action, or how does that look like?

Ha: So anyone who applies for college gets interviewed and they do alumni interviewing.

Dr. Chan: So here in Utah?

Ha: Yeah. So I went to an alumni's home and we talked for an hour.

Dr. Chan: Okay. And so, you got in and I assume you got into The U, too, for undergrad.

Ha: Yeah.

Dr. Chan: And any conflict there or, definitely, you were committed to Harvard?

Ha: I guess, for a moment, we were trying to see if it worked financial wise, but after we realized that it did, I was pretty committed to going there.

Dr. Chan: So let's talk about Harvard. How was that? How was it going from Salt Lake City, Utah, to Boston to Cambridge where you've never been before? How was that jump? How was that experience?

Ha: It was an adjustment. I will have to say that. I definitely had . . . because I really was always in Salt Lake beyond sometimes traveling a bit out. So it was weird being really away from my family, which I was also very close with. And it was a very different environment than a lot of what I was used to. And it was really cool. I remember the first few weeks I was wide-eyed, very excited. But eventually, the excitement at the beginning dies down and you have to get serious, and it is a bit hard not having your family there.

Dr. Chan: I went to Stanford, similar to Harvard, but I would argue better weather.

Ha: I would not argue against that.

Dr. Chan: And I remember coming out of high school . . . I went to Skyline, and I took a lot of AP tests. We didn't really have the IB program back then. And I thought I was hot stuff, but then I get to Stanford and my dorm, it's like, "Oh, here's someone that took three times as many AP tests. Oh, they not only play violin, they can make a violin. They can construct one." And it was just overwhelming and intimidating because all of a sudden, all these people are really accomplished, really smart, really driven, really ambitious. And they're all just right there. So, yeah, it sounds somewhat similar.

Ha: Yeah. It definitely can get a little bit under your skin if you don't learn to realize that everyone has their own path and everyone has their own goals.

Dr. Chan: So talk about your path. How'd you find your path at Harvard? Because you did a bunch of activities. I mean, how'd you end up picking those and how'd you find your passion, I guess?

Ha: I think it just came to what . . . I think part of it was a lot of my values do come into community. So a lot of my activities were involved with being a part of a community and really getting to experience people's different perspectives.

For instance, one of my more memorable activities was being part of the Harvard Vietnamese Association. And that was really important to me because a lot of times . . . and a lot of people there also said the same thing. A lot of times at Harvard, when you do activities, it's for your resume or it's for an end goal. But at the Harvard Vietnamese Association, it was just really to be there for each other and to give support. And so, that's what I really enjoyed about it.

And so I definitely loved being part . . . I definitely tried a lot of different activities and dropped a lot of different activities. But the ones that stuck were the ones where I enjoyed the people that I was around.

And then secondly, I think when I came there, I knew that I was premed and I knew that eventually I'd end up in medicine, but I felt that I would never have four years to really explore things outside of medicine. So that was also where I took a lot of my passions, was to focus more on the arts, which was a field that I had a lot of interest in, but not something that I would want to make a career out of.

Dr. Chan: There's a lot to unpack there. So, going back to the Harvard Vietnamese Association, what kind of activities did you do and how many people attended? It sounds like a really cool group.

Ha: Yeah. It's a very small group because the Vietnamese community within Harvard is actually pretty small. So sometimes it would just be like only 10 or so people would attend activities, but we would do retreats where we would just go off for a weekend or a weekend night to just spend time with each other, cooking food with each other, playing games.

We also liked to do a lot of educational activities or to do activities that show the different types of Vietnamese food. One of the popular ones was in Halloween, we would do a fear factor where we would do different Vietnamese foods that look a bit gross, but are somewhat delicious.

Dr. Chan: Okay. I'm nodding my head. Yeah.

Ha: And so we would do that. And it would always be really funny just seeing different people reacting to different things.

And then during my junior year, one of the co-presidents of the Vietnamese Association decided to start this program called HVIET. So, at Harvard, there were a lot of different programs where students could go to countries in Asia and teach seminars for a week or so, and really help those students in those countries learn about different things. But they didn't really target Vietnam.

And so the co-president really wanted to have that because she felt that a lot of the education system in Vietnam can sometimes be pretty rigid as it is in a lot of Asia. And she wanted to introduce a lot of the liberal arts spirit to a lot of the students. So she started that and I joined along and helped with it. I never could go to the summer camp because of a lot of other different priorities, but I helped interview the students in Vietnam. I helped choose seminar leaders for it. And that was also a great experience.

Dr. Chan: The Vietnamese-American population, is it larger in Utah, or is it bigger in Harvard, or is it tough to say?

Ha: It's tough to say. It's also just because I think it is a lot larger than you would think in Utah. But then I always think about Texas or Southern California, particularly Orange County where it's really big. But I would definitely say that I feel that it might have felt maybe a lot bigger here compared to at Harvard.

Dr. Chan: In a way, it sounds, and correct me if I'm putting words in your mouth, like going off to Harvard, doing that jump from Salt Lake City to Boston, New England, this started to become your family away from . . . since you couldn't be as home as much if you had attended The U for undergrad.

Ha: Yeah. And that was definitely one of my families. I made a lot of different families there.

Dr. Chan: Yeah. Let's talk about the other families. Because I know you're being very modest, but I know you've done a lot. So I am just trying to . . . yeah, what else did you do?

Ha: So the other big thing I did was being a part of the "Harvard Crimson." So the "Harvard Crimson" is the independent college newspaper at the school and I was a part of the Arts Board. So that meant that we covered art-related events happening on campus in the greater Boston area. And we wrote a lot of book reviews, music reviews, film reviews.

Dr. Chan: So you got to get paid to go to art shows, and movies, and plays. Am I characterizing this right?

Ha: It wasn't a program that did get me paid, but for majority of the students it was more like we got in for free to all the things, and we got advanced copies of books that we might want to read that people haven't gotten yet.

Dr. Chan: Did you get to interview artists and authors?

Ha: Yeah, I did. For instance, when they had a special Boston Calling feature article, I got to interview a lot of the people playing at Boston Calling. So it was pretty cool.

Dr. Chan: Yeah. And I assume you've got lot of cool stories and met interesting people along the way.

Ha: Definitely. Yeah. Maybe not in the way that people think because I know that Hollywood and the media likes to portray things with the arts very crazy. But definitely, it was very interesting because even though I really liked the arts throughout high school, I was very much more focused on the sciences, and the arts, sometimes I would go support a friend when they were dancing.

And so it was really cool getting to meet all these artists and to talk about their passions, what drove them, what they were interested in, how they saw their art within the greater society. And so I really enjoyed it.

Dr. Chan: How did you get into the "Crimson"? I mean, did you do high school journalism?

Ha: Yeah.

Dr. Chan: Okay. All right. Because I just have this image of, again, this media, like "All the President's Men" or "Spotlight," which is a newer movie. Got deadlines, you have editors, and trying to make sure people aren't trying to censor you, and trying to have . . .

Ha: So, in high school, I wrote for the "Red and Black," which was the high school newspaper. Though actually, when I started college, I didn't want to do journalism. I thought four years of high school journalism was enough. But one of my entryway mates in my dorm got into the "Crimson" and he really loved it. And he kept telling me about the wonderful community and everything.

And then I guess there was a part of me that actually did miss getting to just sit and interview people and talk with them about their lives and their passions. And so I joined.

Dr. Chan: Before I turned on the pod, we had this conversation. Usually, the tables are turned. How am I doing so far? Would you rate me pretty okay as an interviewer?

Ha: No, I think you're doing wonderful.

Dr. Chan: Okay. All right. I try to be approachable. All right. So, the Harvard Vietnamese Association, the "Crimson." Anything else outside of class? Because again, there's just this image of studying, and doing all the premed recs, and then all these activities on top of it.

Ha: I also danced. So I primarily danced for Harvard College Bhangra, which was very fun.

Dr. Chan: Teach me about that. What is Bhangra?

Ha: So Bhangra is this dance from the Punjabi region, which is a region in India. A lot of times it's like . . . I don't quite know the exact history of it because whenever I would ask some of the captains about it, they would say something that was jokey. So I don't know if I can completely trust them with it.

Dr. Chan: No one really knows. It's a mystery.

Ha: But I'm pretty sure it sometimes was related to celebration, because it's a very joyous dance. And the thing I say about they would always make it very jokey is because whenever we danced, the captains would get very angry that we weren't smiling big enough. Because they would always say to us, "You guys are celebrating that you're getting crops. You are so happy that you are going to be fed for the next year. So smile like it."

It was really fun. It's very dynamic. A lot of jumping. A lot of squats. And a lot of yelling sounds halfway through to get the spirit up.

Dr. Chan: Any orthopedic injuries?

Ha: No. Though I guess now that I think about it, I do have a lot more ankle and knee injuries from hiking than normal.

Dr. Chan: Sounds really intense.

Ha: Yeah. It was definitely . . . I remember the first time I started it, it was because my block mate wanted . . . it was an open house, so she convinced us to go with her. And the first day I came out I was really sore. But after a while, you get used to it.

Dr. Chan: Awesome. So you're having a great time and you're still thinking about medicine. What was your strategy with graduation? Because you graduated and then you had a gap year or two, right?

Ha: Yeah, I had a gap year.

Dr. Chan: Okay. Yeah. So let's talk about that. What was your thinking?

Ha: So, I think, in the medical path, I decided to major in biomedical engineering because I felt that was a really . . . I really like to see science applied, and problem-solve, and design solutions. And I felt biomedical engineering could give me that background, and it also helped fulfill all the premed requirements within the course itself. And so I decided to do that.

And I did look into a couple of . . . I volunteered at a primary care clinic for a summer. And then I also did research. And so I did those little things, but definitely, I got really busy with the other activities that, by the time I graduated, I knew that there were still holes and that I might still need to do a lot more exploration to really figure out my place.

Dr. Chan: Holes in your application?

Ha: Yeah.

Dr. Chan: Or would you say holes in your desire? You weren't 100% sure you wanted to go down the medical path or what?

Ha: Well, I feel like a lot of moments you sometimes face a lot of self-doubt with medicine because it's so competitive and you sometimes wonder, "Am I good enough for this?" And so there is always that that you feel about it.

But it was more holes in my application and I felt that I didn't really quite understand what I wanted to do with medicine yet. All I knew was that there was something about it that really drew me in. And whenever I was in the clinic, or working, or hearing about medical problems, it made me really excited in ways that a lot of times a lot of other things didn't. But I knew that I needed more experience to really understand for certain about it.

Dr. Chan: So, when you graduated, did you decide to stay in Boston or what was your . . .

Ha: I was ready to go home. Yeah.

Dr. Chan: Okay. So came back to Utah.

Ha: Yeah.

Dr. Chan: How did that go? I mean, you're living in Boston, and I know it's a jump, and then you get used to the art scene and the restaurants. Yeah. So coming back . . .

Ha: I think the hardest adjustment was that when you graduate from a school like Harvard, a lot of people go their separate ways. And a lot of people end up focusing in Boston, New York, Bay Area, and D.C. And those are the main hubs. And so, going back to Salt Lake City, I felt a lot farther from all of these people who I had made a lot of wonderful memories with, a lot of people who I refer to as my sisters essentially. So that was the big adjustment.

It was definitely that these were the people that I would go every week to watch films and discuss the way that they were getting shot and making critiques about the film with. And suddenly I wasn't doing that anymore, so it was weird. It was definitely isolating for a while.

Dr. Chan: Because your high school friends, a lot of them are probably still around here, but they have their own lives and they're doing their thing.

Ha: So a lot of them also went out of state for college and then also stayed out of state after graduation.

Dr. Chan: Thus is West's high school's reputation. Yes. West High School does a great job of placing students around the country.

Ha: Yeah. So I did have a couple of friends here and they definitely helped, but as you said, they were very busy with their own lives. But I will say I was really happy to just be home.

There's one thing . . . you never really appreciate seeing mountains all around you until you leave to a place that's sea level and you don't see mountains anymore. And I really missed my family. A lot had happened in my family while I was gone and it was really hard for me to realize that I was thousands of miles away and couldn't be there for them when they needed me most. So I really wanted to just be home with them again.

Dr. Chan: So you come back to Utah. And how do you start plugging those holes in your application? What kind of stuff did you start doing?

Ha: So I returned to the research . . . well, I was working remotely for the research lab. I started throwing myself back into the research lab that I worked with in Utah.

And then I also started looking for more volunteering opportunities because I definitely realized I was a bit more . . . I did a bit of volunteering here and there when I had the time for it, but it wasn't something very longitudinal. So I started volunteering at Primary Children's Hospital. I started volunteering at the Utah AIDS Foundation. And then I also found another part-time job that I really enjoyed at the Hope Lodge.

Dr. Chan: Oh, okay. What were you doing there?

Ha: So I was a coordinator, and basically, it's when there's off hours so that the full-time staff isn't there, I'm there to make sure that the guests have all that they really need. And if there are any concerns, I deal with those concerns.

Dr. Chan: For the people who don't know, what is the Hope Lodge? What's their mission?

Ha: Yeah. So the Hope Lodge is . . . basically, it's cancer patient housing. And what it does is it serves people who live within a 40-mile radius away from Salt Lake City and have to come into Salt Lake to get treatment. So, for this Hope Lodge specifically, it was a lot of people from rural Utah, Nevada, Montana, Wyoming, and Idaho.

Dr. Chan: Interesting.

Ha: And they would come down here and it was completely free. And so they would be able to stay there and have a place to go to while they were getting their really long treatments. So, as a coordinator, I just made sure that if they had any issues with their rooms or any medical concerns, I referred them to the right person. I also just helped them. A lot of them had never been in Salt Lake, so I would help them find out where the markets are, and give them tips about restaurants, tell them about things that they can do.

And sometimes every month I liked to organize a food-related event for them. So most of the times, because I would work weekend shifts, there weren't that many people there because some people would go home for the weekends. Other people didn't have appointments, so they didn't need to be there. And so I would just typically just have cookies out or donuts or things like that. But sometimes I would make smoothies or cook waffles, which was always a hit with the guests.

So that was the Hope Lodge. And I really liked that because both of my grandparents dealt with cancer. So it had a really big personal connection to me.

Dr. Chan: It sounds like you did some really amazing experiences after you came back here.

Ha: I felt they were very important to me, yeah.

Dr. Chan: So you're doing these and I assume you have your eye towards the application process. What was your strategy going in? It sounds like you had a strong pull to stay in Utah. And they say for interviewers, you should never ask a question you don't really know the answer to, but I'm going to ask you a question. Did you apply broadly, or did you, again, put all your eggs in one basket?

Ha: Well, actually, if I had felt comfortable with it, I would have liked to have just applied to Utah early and make it my one school. But I did realize that in some cases my application wasn't the strongest. And so, when I talked with my advisor, they recommended that I just apply broadly because they felt it was just better to get into a med school than to not . . .

Dr. Chan: Not get into med school.

Ha: . . . get into a school. Yeah.

Dr. Chan: Like a good advisor would . . . all right. So how many schools did you apply to?

Ha: Over 30.

Dr. Chan: Thirty? Wow. Okay.

Ha: Yeah. A lot.

Dr. Chan: Okay. MD and DO, or just MD?

Ha: Just MD.

Dr. Chan: Just MD. All right. And then I assume, because again I've done this job long though, the secondaries started to roll in, and that in and of itself could be like a full-time job, right?

Ha: Yeah.

Dr. Chan: So how did you deal with that? What was your strategy? Bang them out as soon as they came in, or would you let critical mass and then . . .

Ha: So I ended up submitting my application a bit later than I wanted to, but that was also good because it took about a month for them to process my application and have the secondaries roll in. And during that time, secondaries were rolling in for people who had gotten them in earlier. So I would check Student Doctor Net, which this is the only time I would typically say to check Student Doctor Net.

Dr. Chan: Yeah. I know Student Doctor Net.

Ha: And I would look up all the secondary questions at the schools I was applying to that got posted and I'd start pre-writing. So that helped when the secondaries started rolling in. But there was a point where things were getting a bit overwhelming and I had to take some vacation time off of work just to lock myself in a cafe and write secondaries 24/7.

Dr. Chan: Yeah, you're on deadlines like "Crimson" time, right? Deadlines, you've got to get this stuff in. Yeah.

Ha: I will say I'm appreciative of all the writing deadlines because I got really good at cranking stuff out really quickly.

Dr. Chan: So all these medical schools are asking similar questions. Similar, but little different questions, and yeah, you just have to be careful. So 30 schools, how many interview offers did you get?

Ha: I got five interview offers.

Dr. Chan: Okay. Good.

Ha: But I only went to four of them because I got into The U before the fifth one came up.

Dr. Chan: Okay. You were able to save some money.

Ha: Yeah.

Dr. Chan: All right. And you go out and start interviewing. What did you pick up on the interview trail? What did you learn? I assume different interview techniques were being administered.

Ha: Yeah. It was really interesting seeing the different vibes from different schools and also . . . even schools that would do MMIs had a very different approach to it. And then similarly, the traditional interviews also very different. So it got interesting trying to figure out how to adjust to all of those.

Another thing was it was interesting seeing what each school would emphasize, and when you'd go there, you would definitely see what a school was passionate about, what they were driven with.

What I was really interested in was the interviews that I went to, I found that they all had very common chains. They were all very interested in community service and they were interested in really integrating yourself into the community. And I guess that made me think like, "Well, I guess my application must have said something that made those specific schools interested in it." Yeah.

Dr. Chan: It resonated. Yeah. Did you apply to Harvard Medical School, HMS?

Ha: Yes.

Dr. Chan: Okay. We had a joke at Stanford that you had to be really, really good to . . . they didn't like their own graduates. It was very rare for someone to graduate from Stanford undergrad and also enter Stanford Med. There's a handful of people to do it, but it was very . . . yeah.

Ha: Yeah. My advisor was just like, "Yeah, maybe." I just kept pushing it. And finally, I was like, "Okay." But at Harvard, they do take in a lot of Harvard grads too.

Dr. Chan: All right. So you're out interviewing, you're learning about the different schools, you're getting the vibe, and seeing what they emphasize. It's interesting because I think we try to emphasize certain things, but there are still students . . . applicants still . . . it's all about their perception, right? So sometimes there's a disconnect.

And then you got into The U. Were we your top choice or did you have this struggling period like, "Oh, I don't know"? How did you navigate that?

Ha: No, it was definitely . . . the moment I got into The U, I was like, "Good. I'm set." Because I was just really hoping that I would get into The U. It was where I really wanted to be.

Dr. Chan: Why did you choose the U?

Ha: Because first, definitely, I wanted to stay close to home. Four years away made me really just realize a lot of what you miss when you're not close there. And so I really wanted to be close, especially since now it's just my mom without my grandparents. So I wanted to be with her.

But also, I think . . . so a lot of the reasons, like the people and the reasons why I got into medicine, were here at this hospital system because my grandparents were always at The U, or the Huntsman. And I also had a lot of doctors that I really loved and that I got a lot from were also from The U.

When I was in high school, when I was still thinking about, "Would I be premed or not?" I did a hospital internship at the VA and that was what really solidified my decision to go into premed. The research that I really fell in love with and enjoyed was at The U. And so I think the things that brought me to medicine the most were always in Utah.

Dr. Chan: I do remember when I called you, you were a little shocked, but also very happy. I could tell.

Ha: Yeah.

Dr. Chan: Again, I got the vibe from you that you were going to stay here. But then again, with your Harvard background, like, "You probably got into other places," like Boston. So I said, "Okay." So, in my mind, I think you were leaning towards us, but I felt like, "Oh . . ." You know?

Ha: I was definitely very joyous. Actually, I was walking from a room where I was processing western blots to back to my lab and I passed by the VA, the building to VA lobby, as the call came. And I burst into tears afterwards. So I had to find a little corner in the lobby and just cry.

Dr. Chan: So sweet. So glad you're here. You're going to make me cry. Yeah.

So school starts very soon. And I'm not going to hold you to this, but where do you see yourself going? What kind of doctor do you think you will want to be? To be honest, I love this question because I'm going to have you come back on the pod, and I'm going to ask you again. But just to see, as you get more experience, if that starts changing. Because you have a wealth of experience already, so I'm just . . . where do you think you're headed right now?

Ha: Specialty-wise, I'm going to leave it open because I know that once you actually get into the rotations, you figure out which vibes with you a lot more. But I really want to work with underserved populations. I can't imagine not being involved in the community or doing some aspect of community health in the future.

And a lot of doing with my research lab, I've gotten exposed to a bit of academic medicine and I do really like teaching and mentorship. So, if I can somehow do that into it, that would be ideal.

Dr. Chan: Would you even touch . . . like global health, would you do a rotation back in Vietnam?

Ha: I would love to actually do a rotation in Vietnam.

Dr. Chan: How's your Vietnamese?

Ha: Proficient, but my mom always tells me I need to get better. So I guess not good enough.

Dr. Chan: All right. If you were to go to Vietnam right now and start talking, would people say, "Eh, you have an accent"?

Ha: They know I'm an American.

Dr. Chan: Okay. They would pick up that you're . . .

Ha: Yeah. Yeah.

Dr. Chan: Okay. All right.

Ha: Yeah. So I definitely need to get on that, but I would love to do either a health project with Vietnam or to go and rotate at a hospital.

Dr. Chan: That'd be so cool. Yeah. That'd be awesome. Well, last question. If there's anyone listening out there who's thinking about going to med school or might have some doubts, what would you say to them? What advice would you give them?

Ha: That's a tough question because I feel like I could go off for five hours with thoughts. But I think the thing that I would say is that a lot of times, choosing this path, it can be very scary, and there are a lot of times where you're filled with self-doubt. But if you're ever facing self-doubt and uncertain if it's the best path for you or if you're going to make it, I would just really think about why you love medicine. Follow that "Why medicine?" and do activities that really ground you in it.

Because I also do know that sometimes you're looking like, "Oh, I have to do 1,000 hours of this, and this, and this." But it's easy to get caught up in those numbers, in those statistics. But if you just figure out what drives you and really follow that, you'll eventually stumble into your own form of medicine that's really you and really personal. And you'll be very happy with it.

Dr. Chan: That's fantastic. Thank you for coming on.

Ha: Thank you for having me.

Dr. Chan: And we'll have to have you come back. I don't know if we have a student newspaper, but maybe you should help get it off the ground. I don't know if you'll have time.

Ha: I will say, even though I didn't do news, which was the most stressful, I did arts, which was very chill.

Dr. Chan: We do have an arts magazine. It's like an annual edition.

Ha: That sounds cool

Dr. Chan: Rubor. Am I saying that right? The Rubor people will talk . . . yeah, you'll learn more about Rubor when the school picks up. All right. Thank you, Ha.

Ha: Thank you so much.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio, online at thescoperadio.com.

Dr. Campsen: If you are being evaluated for an organ transplant, you're going to come in to the University of Utah for a full day workup, and one of the people that you'll meet is our social worker. Today, we're going to talk about that part of the organ transplant visit.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Dr. Campsen: My name is Jeff Campsen. I'm a transplant surgeon at the University of Utah and I'll be talking with Melissa Morales, one of our social workers at the University of Utah Transplant Clinic.

So we have people that come in who are in organ failure and need an organ transplant and we try to have them come in during a full day visit to meet a medical doctor, to meet our financial advisors, but also to meet you as the social worker. And I'd like to talk to you a little bit about what that visit's like and what is your role in that visit?

Melissa: Anytime I've kind of explained to patients what I do, I sort of start with, "I'm here to make sure that they are a good candidate and I want them to not be at risk." I take a detailed social history and some of the things that we talk about is their mental health history. We talk about having adequate support, this is family support, emotional support, making sure that they have sufficient resources. A lot of our patients are from out of state and so they have to stay here for up to four weeks.

And overall, it's about compliance. It's about making sure that they are going to be a good candidate, they're going to follow the medical team's recommendations so they have excellent results after transplant.

Dr. Campsen: So that's what they can expect from your visit. Is there anything else that they should be prepared for when they come in?

Melissa: I think it's important for them to know that the reason why we're here is because we want successful results. This isn't necessarily to rule someone out or to find out anything negative about them but it's really to see who they are and what resources they already have in place and what's available to them, how we can further help them if they need to be.

Dr. Campsen: So once you see them, you're going to give them recommendation to the Transplant Selection Committee on whether or not they should receive an organ transplant. And based on what you're saying, have you ever actually said no to somebody? And if you have, are there avenues for them to change and then proceed with their organ transplant?

Melissa: So I actually haven't ever said no. I would say that most of the patients are doing well. Again, they have this support, these resources in place. There are times where patients come in with unmanaged mental illness and they need additional support from either an individual therapist or a psychiatrist, and we help make those referrals to community services and get the help that they need.

Dr. Campsen: So as part of the transplant team then, how does your interview really affect the transplant process?

Melissa: So I sort of serve a dual role. I am there to evaluate and to assess how I think that they would do post-transplant. But I also am there to advocate, to link them to these community resources, to refer them out if they need to be. You know, we see these patients about once a year, and so there are times where I have to follow up with them more than that if there are any concerns on my end. So we get to build a connection, a relationship throughout their listing, and it's great.

Dr. Campsen: But this dual role is interesting because not only are you an advocate for the transplant program and helping the transplant program select the right people to give organs to, you're also a member of the team of the patient. And how do you navigate that dual role?

Melissa: You know, my goal, my purpose is to make sure that patients are successfully transplanted in a safe way and that they have the resources and support that they need, making sure that they're linked to exactly what they need that will help them have successful results.

Dr. Campsen: Well, I know what advice you've given me. What advice would you actually give a patient that was coming in to clinic to see you?

Melissa: I think something really important that I like patients to know is that their mental health really affects their physical health. If they are depressed or have anxiety, all those things are going to exacerbate especially after transplant, and I want them to know that we have these resources, we have ourselves, and we're available to help them through any sort of difficulties that they might have from an emotional, psychosocial side. You know, I really like making these connections with patients. Sometimes I do wish that I had more interaction with them than just once a year. But just seeing how successful they are, see how different their lives can be, a lot of them go back to work after several months and, you know, they talk about how grateful they are for our team and really for this process and having gone through that.

Dr. Campsen: I know that I always like to say that basically, once a patient gets listed and they get an organ, they're always a member of our team and they always have medical resources. But they also have social resources, correct?

Melissa: Right. Yeah, so we're available to them post-transplant. You know, we usually say for about a year after but we're happy to meet with patients any point whether it's been years out or, you know, within a few months.

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Interviewer: Are you considering a career as a nurse, but you don't quite know where to start? Matthew Anderson is a nurse at University of Utah Health Care, and we're going to ask him how he got to where he is, what kind of education it took, his experience with finding a job, and what he's learned about being successful. First of all, thank you very much for taking time to give us an insight into you, and your life and your career.

Matthew: Absolutely. I'm glad to do it.

Interviewer: What made you decide to pursue this path, to become a nurse?

Matthew: Yeah. So I was actually born with a congenital heart defect called coarctation of the aorta. At six days old I was life-flighted and had a surgery, and so I've had frequent contact with health care since. You know, I've a yearly check-up with cardiologist and everything and had a few procedures throughout my life, and as part of those was in contact with nurses. And having that right nurse that just demonstrated appropriate compassion, responded to you appropriately, made all the difference. And that's kind of where my desire to become a nurse, again, was just from those nurses that I had that made a difference in my care.

Interviewer: So you knew you wanted to do that. You had some very specific reasons why. What was the next step at that point? Was it to start looking at schools, or was there some preparation to do before that?

Matthew: Well, actually what I did was when I was in high school, my school offered a CNA course, Certified Nursing Assistant course. And so I said, "You know, that's the bottom of the food chain. I'll take that course." And because I wasn't quite sure if I wanted to do nursing. You know, there's kind of the stigma of a male nurse and everything on that. So I said, "Hey, I'll take this course. If I enjoy that, I'm pretty sure I'll enjoy nursing." And I did, and I really liked it. I love having a personal contact with people, you know, and just being able to help people in their time of need, in that really vulnerable state.

And so that's kind of what started it for me, and then I guess for it to continue on with education and everything, I actually did a little bit longer of a route. I went to community college first and got an associate's in pre-nursing, but then I transferred to Brigham Young University, and their nursing program once you get in, is three years long, as opposed to most universities it's two years once you're in their program. And so it actually took me about five years to get my degree.

So a little bit longer than most paths, but you can get an associate's in nursing. That's what my wife did, which it took her about three years. Usually it takes about a year of prereqs, and then two years in the program. Or if you get a bachelor's, you do about a year to two year prereqs, and then two to three years once you're in the program.

However, the Institute of Medicine recommends that all nurses get their bachelor's. So whether you start with an associate's and then go back and get your bachelor's, it is recommended that you get that higher degree. It just gives you more, kind of, a global training, and helps you kind of see a bigger picture than just direct patient care.

Interviewer: Yeah. So it sounds like you could get a career or a job in nursing, and then continue your education if you wanted to continue it that way.

Matthew: Absolutely.

Interviewer: And so, how difficult was it to get into nursing school? I'm of the impression that I've heard that it's difficult.

Matthew: It is. Yes. And it really depends on the program you apply to, but it's pretty competitive nowadays. It's one of those careers that's been growing. It's expected to continue to grow. The average GPA for the program I applied to at BYU was 3.88 to get in. So it's pretty high. And I think that's probably the highest in the state, but you know, I work with CNAs who've worked in the hospital for 10 years and they haven't even been able to get into nursing school. So it can be difficult. So you have to prepare and do really well in your prereq courses, kind of the GPA. Some prefer work experience. It kind of depends on the school. They all have a little bit different criteria, and that can be difficult for training people as well.

I have a co-worker who took classes here at the U, and then she's trying to apply to SLCC's program, but they didn't accept her classes at the U because it didn't have a lab. Even though they weren't different credits, it didn't have the lab, and so that can be really frustrating as well. And so, you kind of have to do your research in advance, know where you want to go and figure out, and talk to people who they're advisors, everything like that, really figure out what you need to do.

Interviewer: If somebody doesn't have that huge GPA, are there other routes that you are aware of? Or is that really kind of a roadblock right there?

Matthew: Well, for some programs. So BYU, that's a big part of theirs. It just kind of depends on the school. Some weigh in work experience more as part of their application. There are, you know, service and leadership components that kind of help with the application. Also, some schools will let you buffer at the SAT and your GPA. So if you do really well on the ACT or SAT or something, that can kind of buffer your score as well. So there's different things you can do. Really, just knowing your school, you know, your target market if you're trying to get into.

Interviewer: Yeah, and maybe talking to an advisor and just saying, "Hey, my GPA is not that strong, but I'm really passionate about it. What can I do here?"

Matthew: Absolutely. And it really depends on the semester too, because you know, as the average . . . I had friends at BYU that had a 3.4 and got in. And so it just depends on the year as well. Even not as many applicants apply this year, and there's a number of factors that go into it as well.

Interviewer: How hard is it then to get a job?

Matthew: It really goes . . . it fluctuates. So you know when there's nursing shortages, it's not hard at all. You can pretty much work wherever you want. They'll hire new grads to ICUs and EDs where they don't typically hire new grads to, and so it really just depends. You know, back in 2008, when there was kind of a hiring freeze on nurses, really hard to get a job initially.

When I got out of school, it was a little bit harder. So it took some of my classmates a few months, which really is not long. We took a few months to find a job, but in that hiring freeze, it was difficult to find a job. And so, it just kind of depends. Right now is a pretty good time. You can find a job pretty easily.

Interviewer: So there are opportunities then to move up and move around. I mean, what does that kind of look like then?

Matthew: Yeah, absolutely. It really . . . I mean, there are so many avenues. I remember when I graduated, one of my instructors gave us a list of things you could do in nursing, and it had like over 200 different positions. But just here, I work at the University of Utah here, and you know, on each unit you have your nurses, but then you also have charge nurses.

Also, they have clinical nurse coordinators, who are kind of are quality or scheduling, nurse managers, nurse educators. And there's quality nurses, there's infectious disease nurses. As far as advancing, leadership is a big thing as well. Education is a big thing. Research is kind of another field. Procedural areas, all kind of different areas you can go.

And so sometimes people are like, "You know, I did this for five years, and I got tired with this. So I went over here." And I love that flexibility in nursing.

Interviewer: It's also kind of cool that there are so many opportunities I think. A lot of people just think of the bedside nurse as the nurse, right? But there's a lot of responsibilities and roles that nurses will play and that's . . . continue to expand from what I understand as well, in health care. Yeah.

Mathew: Absolutely.

Interviewer: So what advice would you give somebody, you're at a party, somebody is talking about that they're considering becoming a nurse. What advice would you have for a person considering that career?

Matthew: I guess going back to that, just remembering your "why," remembering why you're doing it, because you'll have times you're like, "This is not what I signed up for. This isn't what I want to do," you know. Every program of study has their challenges, and in college you're like, "What did I do?" But I think sometimes, you really also kind of have a spiritual journey as well because you're working with people who are near death. And sometimes that can be really taxing, especially when it's somebody young or somebody who's close to death.

Or if I take care of a child who's the same age as my child, and maybe they pass away, that can be very difficult to deal with. And so those things that you don't really think about, that can be emotionally taxing, and so you have to just remember why you did it, and that you're there regardless of the outcome. You're there to care for them the whole way.

But also again, just going . . . If you're preparing to go to nursing school, just do your research. You work hard, but you've got work smart as well. Because I've known people who've worked really hard, and they've gone the wrong direction, and so they have to retake all these prerequisite courses to try and get into nursing school. And it's taken them much longer than it has to have.

Also, sometimes it's better just to plow through things. And we all have different circumstances with families and different things, where you have to take care of needs, but sometimes it's better just to get it done. I've seen people who have stayed in school for far too long, as well. They take the 10 year route, as opposed to a 2 year route.

Maybe work part time, and go to school full time, as opposed to working full time and going to school part time. And get through school, because the difference between HCA pay and RN pay is a big difference. And so just get it done, get it out of the way, and then also it opens opportunities further for advancement once you're a nurse, much more than when you're an HCA if that's kind of the route that you're doing.

But really, like I said, know your schools you're going to be applying to. Know what they need. Know what kind of sets them apart, especially if you're GPA is not as strong. Know what can set you apart, leadership things you can have, everything like that.

Interviewer: It sounds like try to get through school as quickly as possible, if you can work in the field while you're going to school. I'd imagine that there are a lot of advantages to that.

Matthew: For sure.

Interviewer: Not only, you know, being able to pay for your education as you go, but really, making what you learn in the classroom stick because you're using it.

Matthew: Absolutely.

Interviewer: And then just remember that "why."

Matthew: Yeah. Absolutely. Remember that "why." It makes a big difference.

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Interviewer: You had kidney stones once in your life, what you need to know going forward. That's next on The Scope.

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Interviewer: So you already went through the process once, the excruciating pain, then the re-passing of the stone or the operation to remove the kidney stone. Does that change how you need to look at your life from that point on? Well, we're going to find out right now. Doctor Gary Faerber is a urologist at University of Utah Health Care. If somebody has a kidney stone once, are they inclined to have another one?

Dr. Faerber: Yes, they are. If you have a kidney stone and you make no changes in your lifestyle or anything else like that, you have a 50% chance of forming another stone within five years.

Interviewer: So I suppose the general advice would go, regardless of the stone, you need to drink more water, you need to watch your diet, the salts, the sugars, reduce that kind of stuff. Does that apply across the board?

Dr. Faerber: That really applies across the board and of all of the things that you've mentioned there, keeping yourself well hydrated is the most important aspect of prevention of kidney stones. And I think in patients who have risk factors, for example, if they have a family history of stones, if this isn't their first stone and they've had several others, or if they have on their imaging studies more than one stone, those people really need to have an evaluation to figure out why they may be forming stones and what can we do to prevent them.

So in those patients, they'll get some blood test to look at their overall kidney function, we'll get serum calcium levels and if that's elevated we may get a parathyroid hormone level. And then above that, we'll also have them collect urine over a 24-hour period and look at the chemical composition of the 24-hour urine. And that will help us direct what medical therapies and dietary therapies would be appropriate for the folk.

Interviewer: So you might prescribe some sort of medication to help as well?

Dr. Faerber: Yes, absolutely.

Interviewer: Yeah. And would you prescribe a very restrictive diet more so than just eating healthy?

Dr. Faerber: I often will tell patients that a really good, healthy, what they call the DASH diet, which is used for patients who have cardiac disease, the DASH diet is a good diet to prevent kidney stones. It's made up of fruits and vegetables, low sodium, limitations of red meat, mainly poultry and fish, legumes and whole grains. Eating a diet like that, especially if you manage your calories and you're not eating too much compared to your activity levels, that's a great way to start limiting or restricting your incidence of forming stones in the future.

Interviewer: So you do the analysis, the tests, based on that result, you might prescribe a medication. Is there anything else that you would tell somebody that just had a kidney stone going forward?

Dr. Faerber: Well, if they have a family history, where their mom or dad or grandfather or grandmother or a brother and sister have a kidney stone, I often tell them, "Listen, you can't run away from your genes and you're sort of stuck with who you're with." And in that case, I will really push them to make sure that they keep their fluids up. I think the only other thing that is really important is to limit the amount of salt intake that you have, watch the potato chips and move that salt shaker away from the kitchen table.

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Dr. Gellner: No more flu mist means another shot for your child. How can you help your child prepare for this and other vaccines? I've got some advice today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: You've probably heard that the Centers for Disease Control and Prevention is dumping FluMist. I know, my kids are disappointed too. But a CDC advisory panel found that the spray is so ineffective at protecting from the flu that it shouldn't be used anymore. Vaccine experts aren't sure why the mist isn't working but none of that really matters to parents who are now wondering how to prepare their children to face the flu shot needle.

There's definitely a lot of hype when it comes to those dreaded shots. Needles strike fear into the hearts of many people, no matter how old they are. The most important thing a parent can do is to keep calm. If you're freaking out, your kids will follow suit.

Honesty is most important when it comes time to get any shot. Explain to your child that it may hurt for a second and tell them why the shot is important to protect them. Ask them to think about how strong their body is going to be, and how well the good immune systems cells will be able to fight the bad germs that this vaccine is protecting them against. Kids will be more receptive to shots if they understand why it's important for them to get them.

However, while honesty is key, don't give your child too much time to stew over the fact that a shot is coming. They may get more worked up, or they may be cool with a shot, it all depends on the child. And if they are going to be extremely anxious during the entire visit, I recommend telling them at the end of the visit. If they're older kids or kids that are not too afraid, then being honest with them before the appointment is best.

Once at the appointment, present a united front with the person who is giving the shot. Don't let your child cower, kick, or hide in your arms. That could end up hurting them more than the shot and may also result in an injury to the person giving the shot. Instead, help the person giving the shots put your child in the position that is the safest for administering shots, while still being there to comfort them.

Talk to your child while they're getting the shots. Make eye contact with them. Let them know you're right there and you'll give them the biggest hug when they're done because they've been so brave. I've sung to my boys when they were younger and had their kindergarten shots. That seemed to help.

Taking steps to help with the pain from shots can help as well. Give your child acetaminophen or ibuprofen but not until after the shot to reduce inflammation that may cause pain. We don't recommend giving anything beforehand anymore since some studies show that blocking the fever response may interfere with the immune system response.

With some shots, the pain, redness, and swelling may last for up to 24 hours. Pain may occur when medicine in the shot goes into the body and then again over the next few days as the body's immune system does its job building up antibodies. When all else fails, it may be time to make a deal with your child. One word: bribery. It goes a long way with kids. A special treat after the appointment for their bravery is always a hit.

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