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Scot: Getting up at 5:00 in the morning and then grinding into the night to get things done, that's a badge of honor. "I'm not lazy. I'm getting it done. I'll just get a couple energy drinks and do it again tomorrow." Probably heard the saying, "I'll sleep when I'm dead." That feels pretty manly to say, by the way.

Regardless, if it makes you feel good to tell people how little you sleep, or there are other reasons you're not getting sleep, sleep has proven health benefits and not getting enough can have similar downsides as not getting enough activity or good food.

You could have the other three core four dialed in and if you're not getting enough sleep, it could sabotage at all. That's how important sleep is.

So today, on the "Core Four: Back to Basics" series, we're going to talk about sleep, how good sleep improves your life and how to get better sleep.

My name is Scot Singpiel. I bring the BS to the proceedings here, and the MD to my BS is Dr. Troy Madsen. And before you say hi, I want you to say, "I'm Dr. Troy Madsen, and I'll sleep when I'm dead," in your manliest voice.

Troy: I'm Dr. Troy Madsen, and I'll sleep when I'm dead.

Scot: Also we've got Mitch Sears in the mix. Same thing.

Mitch: I'm Mitch Sears, and I'll sleep when I'm dead.

Troy: Sounded like you were thinking about it. You're like, "I'll sleep tonight."

Scot: We have one opportunity for our manliness to be saved here, and that's Thunder Jalili.

Thunder: I'm Thunder Jalili, and I will sleep when I'm dead.

Scot: There you go. All right. So, today, we are going to talk about the benefits of good sleep. And for some reason, I think society kind of undervalues sleep. What do you guys think of that? When we think about being healthy, it's pretty common to come to nutrition or exercise, but sleep is just as crucial as we're going to learn in a couple of seconds. Is it just me, or does society kind of devalue it? And why do you think that is?

Thunder: I think actually American society maybe does devalue sleep. I think it's part of our work hard work ethic, get it all in and don't be a wimp, and get your stuff done, because other cultures around the world aren't like ours. The Spanish, they value sleep. They have a nap built into the day. We're not like that.

Troy: Yeah, I agree. I think we definitely undervalue it and it certainly is a badge of honor for a lot of people. And as someone who works in the healthcare profession, I can say it is absolutely a badge of honor. If you can talk about how little you sleep or let's say you say, "I just came off a night shift and I didn't go home and sleep, and now I'm here in the office working all day," that's a badge of honor. It's not like, "Wow. That's stupid." Yeah, no question about it.

Mitch: I remember when I was working in broadcast, you would come in and the night shift would be coming off and they would have their pile of energy drinks and they would just be very proud of how much caffeine they were functioning off of and "still getting a good job done." That was always very like, "What are we doing?"

Scot: Dr. Madsen or anybody, do you think that people just don't realize the benefit of sleep? Because a lot of times it's the first thing to get jettisoned, right? When things get tight in your life, that's where you'll cheat, either getting up early or staying up late to get things done. Do you think it's just because people don't realize what that tradeoff is actually costing them?

Troy: Yeah, it may just be that we don't quite realize the magnitude of the effect. I think we recognize, "Yeah, there's some detrimental effect, but those effects are more immediate. I'm tired, but I can use caffeine. I can drink some caffeine or whatever, and that will eliminate that short-term effect." But I do think we definitely undervalue the long-term effects.

Thunder: Yeah, I agree with that. I think cutting sleep is an easy thing to do in the short-term to get things done, and there are ways to get around it, like Troy said, with caffeine. So I agree with him completely.

Scot: All right. I think that's a good segue into talking about the benefits of getting enough sleep and how it can impact your health. Thunder, go ahead and kick us off on that.

Thunder: So there are many benefits to getting good sleep. I'll just share a couple with you. One is sleep is actually tied into maintaining healthy body weight. And I know that's a big focus of what we've talked about on this show in the past. We talk a lot about the exercise and the nutrition component, but getting enough sleep is also a valuable contributor to healthy body weight.

The other thing that's great about sleep is it helps you keep your stress levels low and it helps improve your mood. If you think about it, think about the nights that you haven't gotten a good night's sleep and you wake up the next day and you're just kind of a little grumpy or a little off and things are bothering you. That's something everyone has experienced, and that's really that function of not getting enough sleep.

So having that regular sleep schedule can definitely improve with that. It gives your mind a chance to reset at night and reduce your stress level.

Troy: Yeah. Thanks, Thunder. And the other thing too that I've definitely seen plenty of studies that have shown that sleep lowers your risk for diseases like diabetes and heart disease and cancer as well, like long-term studies.

It's a little scary because I've often seen these studies done with shift workers like myself, which is kind of depressing, but it is one of those things. They do find those who don't sleep well do have higher risk of diabetes, heart disease.

I think the obvious thing we've talked about already is it does help you to think more clearly. But this is something that's been quantified in multiple studies. They've kept people awake for 18 to 24 hours and just noted their ability to perform tasks just declines over time to the point where . . . At 18 to 24 hours, you're at a point where your technical skills, and your focus, and your attention are on par with if you were legally intoxicated. So definitely effects there.

I think we all know we've had those experiences when we don't sleep well, we get sick. Sleeping well helps us to stay healthier, get sick left less often, and helps us look better too. We look better. We look healthier. Our appearance is improved when we sleep well, when we're well-rested. So that's a big thing as well.

Thunder: Don't have those bags under your eyes.

Troy: Exactly. Get rid of the bags.

Scot: I'm noticing the last two episodes that that's been Troy's thing, appearance. So do you want to talk about something?

Troy: I'm feeling self-conscious about my appearance and I need to sleep more. Maybe that's it.

Scot: You look wonderful.

Troy: Thanks, Scot.

Scot: We're going to hit up here some of our sleep struggles and then what we've done to try to work through those or not work through those.

But first, Mitch, let's talk about, like we have in past episodes, the basics. These are kind of the rules that you want to try to incorporate when you're talking about sleep.

Mitch: Yeah. And these are the ones that have been kind of tried and proven from research and studies, etc. So these are kind of the things that have the most evidence behind them.

The first thing that you want to do with your sleep is to prioritize it. And it's important to realize that when you prioritize sleep, it also means that it's not just quality of sleep. It's also quantity of sleep.

So what they're saying is that you need to get at least a minimum of seven hours and that you can't really just make it up. You can't sleep four hours one night and nine the next and expect it to be as healthy as if you were to get seven hours each night.

The other thing is that in order to get a better quality sleep, try to go to bed at about the same time every night and wake up at the same time every morning, which is something that we've kind of talked about before with Kelly Baron on a previous episode about everything from your sleep hygiene to making sure that you're going to bed and waking up at the same time every morning.

Now, the other thing you want to make sure to do is to not underestimate how things you do during the day can impact your sleep. A lot of things you do throughout the day can really impact not only the quality, but the quantity of sleep that you're actually getting. So make sure that exercise, nutrition, and mental health are all big factors that go into your sleep.

Stress, anxiety, depression can all impact how well you sleep every night. Activity, exercise during the day is good, but not less than two hours before bedtime. They've shown that that can kind of interrupt your sleep cycle, if you work out too close to going to bed. And finally, caffeine, alcohol, and nicotine four to six hours before bedtime and big meals before bed can impact your quality of sleep.

So you just want to make sure that you're not working out too close to bed, but you should be working out through the day, and to kind of avoid some of these different chemicals that can really impact the quality of your sleep.

The other thing is that sleep environment needs to be dark, quiet, and a comfortable to temperature. By making sure all of those things are kind of in place, it will really improve the quality of your sleep.

And make sure that you are not doing things that engage your brain like screens, TVs, games, radio, talking on the phone. If you do those things too close to sleep, it can also impact the quality of sleep that you get.

And finally, if you've tried everything else and you are still having trouble with sleep, go talk to a doctor and rule out that you don't have a sleeping disorder.

Scot: Some good basics there. So let's hit the sleep struggles. I want to start with Troy because you work in the ER, you work crazy shifts, you might be working during the day for a few days and then you do an overnight shift. What is one of your sleep struggles?

Troy: My sleep struggles are so plentiful, it's difficult to choose from them. But like you said, Scot, I do shift work, so I end up working nights, evenings. And for me, evening means I get to bed at like 2:00 or 3:00 in the morning. Night means I get to bed at like maybe 9:00 or 10:00 in the morning.

Scot: Wow.

Troy: Yeah. And so I'm trying to do that and then turn around double back and do a 7:00 a.m. shift the next day and do a 10-hour day on that.

So I have no doubt, and I think talking to Kelly Baron, it was very clear I do suffer from shift work sleep disorder. It's not something I really had prior to doing shifts when I started my residency training.

I have plenty of times where I think I don't struggle so much to get to sleep. I generally fall asleep once I get back into my regular routine, but then I will often find that I'm awake four hours later and just lying there and not sleeping. So that's probably the biggest for me.

I feel like I can get to sleep, I can fall asleep, but then I'm often awake a few hours later and not sleeping at that point. So that's definitely a struggle and I think not an uncommon struggle, definitely for people who do shift work, but I think a lot of people I've talked to have that issue as well.

Scot: Yeah. I look forward to hearing if you have some things that you've figured out of work around that. I mean, you can't totally fix it, right? The best you can do is kind of make the best out of a worse situation.

Troy: Yeah.

Scot: Thunder, how about you? Do you have any sleep struggles or you do all right?

Thunder: In general, I do all right. But my sleep struggle that does come up from time to time, believe it or not, is temperature. If it's too warm, I have trouble sleeping. So I have to be aware of that. Most of the time it's fine, especially in my own house, but when I travel, sometimes you're out of your comfort zone and you're someplace where the temperature may not be right.

So I try to do what I can, make sure I'm not putting too many covers on the bed because if it's too warm, it's tough. Hopefully I can adjust the temperature in a room, things like that. But that's my main challenge.

Scot: I'm pretty fortunate that I haven't had a lot of struggles. I have a job that allows me to have a pretty regimented sleep schedule. And for the most part, I fall asleep. For the most part, I sleep through the night. And then for the most part, I'm able to wake up in the morning when I need to. So I am pretty fortunate.

I think my biggest challenge, though, is I'm always thinking. My brain is always going, and sometimes I'll just lay in bed and I can't quite shut it all off. And part of it might be my fault. Maybe I was doing something too close to bedtime, but that's kind of mainly the struggle that I have.

How about you, Mitch?

Mitch: So I guess I have a slightly different story here. I have always struggled with waking up feeling refreshed. Every single night, it just feels like I haven't gotten any sleep the night prior and it's day after day after day, month after month.

I've been working with my doctor for the last year to try to figure out what I should be doing. And from stuff that we've talked about on the show, I've made sure that I go to bed at the same time every night. I'm waking up at the same time in the morning. I've played around with using a little bit of melatonin sometimes before bed. I've tried making sure not to look at screens or anything beforehand, and it doesn't seem to help.

And it was just recently after trying all of these things, my doctor had me do an at-home sleep study and they think they have found that I have sleep apnea. So I am waiting to go to do a formal sleep study in the next month or so and kind of figure out what's going on.

The struggle I've been having is I try everything and I still feel so tired. And when it comes to the Core Four, I'm working on my nutrition, I'm working out, I'm doing all the mental health things I can, but sleep has been one that's been really troublesome. And it eventually led me to talk to the doctor and we might be able to actually fix it now that we can find what's going on.

Troy: That's great you did that, though, Mitch. You talked to them and you went and looked for help. Yeah, that's a common story I hear from people where they say exactly that. They feel like they're getting plenty of hours of sleep, but they are just awake and they are not refreshed.

And I'm guessing they talked to you about in your sleep study, or in the sleep study you'll do, if they do see that, you wake up so many times at night due the sleep apnea that you're really not sleeping a whole lot, or at least good, deep REM sleep.

Mitch: Yeah. And that's kind of what they've explained. It's like, "Hey, if you have a sleep disorder, whether it be apnea or . . ." They talked about some restless leg syndrome. They talked about all these different kinds of things that can keep you up through the night. It doesn't matter what you're doing. It doesn't matter how often you're going to bed. It doesn't matter how healthy you are with your sleep hygiene and your hours and everything. If your body has something a little messed up that is waking you up all night, it doesn't matter. So that's where I'm at.

Troy: You're going the right direction. That's good. That's good to hear.

Scot: Mitch, do you find that impacts you, any of your other Core Four, like your nutrition, your . . .

Mitch: Oh, yeah.

Scot: How so?

Mitch: So I find that on days where I have not had any restful sleep and it's been day, after day, after day, when your energy level is so low, the idea of cooking a meal goes right out the window, right? In my sleep deprived state, all I want is a Big Mac. You go straight to the fast food whenever you can.

When I'm tired, I find that I can't work out the way I'm supposed to. When I go out for a jog or something like that, I can't go nearly as far as I think I need to. The whole process is really kind of frustrating and your heart rate gets up higher than it's supposed to, etc.

And mental health-wise, things . . . We're living in a very stressful time right now and I find that on the days where I don't get enough sleep or I'm not able to sneak off and take a nap in the middle of the day, I get really stressed and my anxiety gets high and I'm quicker to be frustrated and all sorts of things.

And it's been really surprising, ever since starting working on this podcast, that I'm focusing so much on all aspects of my health, but sleep was the last one. Sleep was the one that was like, "Eh, that one will figure itself out." But here I am learning that maybe I have something else going on. And hopefully, by working with my doctor and finding out a treatment plan, maybe in the next little while I can start seeing better results elsewhere.

Scot: That's a great point about how "maybe it'll just work itself out," right? This notion of "something might fix itself," I think that can be kind of dangerous, and I think a lot of us guys have that.

Mitch: And that was kind of the thing that was interesting when I first started speaking with my doctor. He was like, "Well, yeah, if you're having trouble sleeping, you might be having mental health stuff. Why don't you go talk to someone about that?" and, "Oh, when you start getting more activity, I'm sure you'll feel tired by the end of the day," and, "Oh, if you improve your nutrition and drink less caffeine, I'm sure your sleep will kind of fall into place."

And so, for the last year, I've really been working under that assumption that sleep is easy, sleep is going to just happen if I do all these right things. But if you're out there and you've been trying everything, maybe it's time to talk to a doctor.

Scot: All right. Let's go ahead and talk about maybe three struggles or three things that we've learned and what we've done to overcome those. And again, the hope is that if somebody else is struggling with something similar, this might be a new, fresh idea for them.

So I'm going to kick things off with this notion of a dedicated bedtime, being sure that you get to bed at the time that you've decided to get to bed. For me, it was 10:00. And it was challenging because if it was 9:15 or 9:30 and my wife and I were up and we were hanging out and she wanted to start a show, I'm like, "Well, it's going to be 52 minutes. I can't do that. That's going to put me past my bedtime."

Or sometimes I feel like I don't have enough time in the day to get things done. And I'm sure that's something that a lot of men deal with. And so, as a result, you push into the night, or what I've learned is you kind of have to prioritize what's important or ask for help to get all the things done that you need to get done. You can let go of some of those things.

So a dedicated bedtime has really, really helped me, and it helps me wake up a lot more refreshed, but it is challenging for those reasons and other reasons as well.

Troy: Scot, I'm going to jump right on that, and I'm going to say also a dedicated wake-up time. That's been big for me. We talked about that also with Kelly and just saying, "I'm going to get up every day." For me, it's, "I'm going to get up every day by 7:00 a.m. regardless."

And certainly, I have shifts where I have to get up early. I don't care if it's the weekend, whatever. Granted, I did mention there those times I'm getting to bed at like 3:00 or 4:00 in the morning, so I might sleep in a little after that. But once I'm in my regular routine, I'm up at 7:00, and I know I'm going to get up at 7:00.

Just knowing that, it kind of helps mentally, because before, I would kind of give myself this nebulous wake-up time. If I didn't have a shift or if I didn't have something going on early, I'd be like, "Well, I'll just get up when I wake up, because I have to make up for my missed sleep."

And then during my night sleeping, I would just lie there and I wouldn't really fall back asleep and I would just be like, "Well, I don't really have to get up. Okay. Maybe 9:00. Maybe it'll be 10:00." Kind of this mental thing where I just kept putting it off in my mind.

But I think knowing, "Hey, I'm going to be up at 7:00," something about that mentally just lets me know, "This is my sleep time, and I'm going to take advantage of it and I'm not going to sleep past that, so don't think I'm going to be able to make up what I'm missing now by sleeping in until 9:00."

Thunder: So I'm going to jump on the regular schedule bandwagon as well. I'm also all about that, going to bed about the same time and waking up about the same time.

I will add one thing about the waking. I usually wake up around 6:30, give or take a little bit, and I never have to set an alarm because I'm used to waking up at 6:30. So all the things that you have to do in life that you have to wake up early for and you need to set an alarm for, I never do that, and I find it cuts down on my stress level the night before. You're not thinking, "Oh, I've got to wake up extra early," or, "My alarm is going to go off," or something. You just wake up at your normal time.

The new thing I'll add to that is I have a bit of a relaxation routine that I engage in almost every night, and that is I read a little bit before bed. And for me, that works. I'm talking reading out of an actual book, or a magazine, or sometimes I'll read on my Kindle with a black screen.

So that kind of helps my mind disconnect from whatever was going on during the day and get lost in something else for a little bit. And I don't last too long reading. Maybe I can do like 10 minutes to 30 minutes, depending on what it is. So that's part of my routine, that little relaxation moment.

Scot: All right. Mitch, you're up.

Mitch: So the thing that it really helped me out is I'm the worst millennial. I am on my phone up until . . . I used to be, at least. I was on my phone up until the moment of my bedtime. What I have found is that regardless of your phone, most modern phones, whether it be an iPhone or an Android, they have digital wellbeing settings. And if you can go into there and turn them on and respect them, it has really helped me make sure that I'm not doing too much screen time before bed.

On my phone, at least, I set in my bedtime. I'm like, "Hey, I want to start winding down. I want to stop using my screen for an hour before bed. Here's when I want it." And when the phone hits that time period, it turns off all my notifications, it turns super-duper dim, and black and white.

And it seems kind of dumb because it's like, "Well, I can still use the phone." But for some reason, the lack of color, the fact it's super dim, the fact that you can't hear anything, it really helps just kind of disconnect and set it aside before I go to bed.

Scot: That was a big thing for me too. Up until recently, I would go to bed and I'd get out my iPad and I'd scroll social media, and then I'd find something that enraged me and then I couldn't stop thinking. Somebody would make some comment and then I would spend the next hour coming up with what my comment would be back to them, right? So, for me, getting rid of that social media has been absolutely crucial.

And the other thing that I struggled with too, and, Mitch, tell me if you did this, are the Instagram Reels, which are like TikTok videos, right?

Mitch: Oh, yeah.

Scot: I'd watch those. And even if I'd quit an hour before bedtime, then I'd have one of those stupid songs playing in my head and I couldn't get it out and fall asleep.

Mitch: Well, it's so easy to just get sucked into that hole too. You're just scrolling, and swiping, and swiping, and swiping and the next thing you know, it's like, "Oh, man, I've been doing this for two hours."

Troy: And how much of our life do we waste just thinking about snarky replies to other people's snarky replies?

Scot: Right?

Troy: I totally hear you on that. It's like, "What am I going to say to this?"

Scot: That I would never ever actually enter in, but I'll spend a lot of time thinking about what it's going to be.

Troy: Yep. I'm going to think about it, and it's going to be good. It's going to keep me up all night.

Scot: All right. Number two for me. Now, I don't know if this is a type of meditation or what, but it's a little exercise I do. It could be considered maybe a form accounting sheep or whatever. But if I'm struggling falling asleep, I will pick a color. That kind of tends to be my go-to. So I'll pick the color green, for example, and then I'll just let my mind go and think about things in my life that are green or in my past that have been green.

Troy: Oh, wow.

Scot: It takes me down this kind of memory lane. My parents' first car that I remember was this big green Plymouth from the 1970s. And then I'll think, "Oh, I had a toy box. It was a frog, and it was green." I just kind of let my mind go where it wants to with whatever color I've picked, and I find that after a few minutes of that, I feel kind of tired or I might just fall right asleep. So it's a little weird, but it's worked for me.

Thunder: So it's so boring that it puts you to sleep?

Troy: I guess so. I just feel like that would be too engaging. You would really be thinking way back into your childhood and trying to come up with all different things. I don't know. That's interesting. You just kind of let your mind wander and somehow that puts you to . . . I've never heard of people doing that, but whatever works.

Scot: Yeah. I mean, I get the engaging part because I have caught myself in the trap where I'm engaging and thinking about it too much. I think, for me, the trick really is just to let your mind wander through your past and just those things that were green. So anyway, that's mine.

Thunder: It almost sounds like a type of meditation. You pick one thing and you just kind of reflect on it and just let your mind go on it.

Scot: I don't know why it works, but it works. Who's next?

Thunder: Another thing that works to me for me is related to . . . We talked a little bit about temperature of the room is important. So we have this Nest thermostat in our home and it's programmed to start reducing temperature around 9:00. And it's great in a winter because by the time I want to go to bed around 10-ish, the temperature of the bedroom is probably like around 65 degrees, which for me is a good temperature.

So it's kind of good. It's automated, so I don't have to do it. It just happens every evening, and that is part of what helps with my sleep schedule.

Troy: Well, kind of along the lines of making sure you're addressing external factors, for me, it's about white noise and sleep mask.

Six years ago, I reached a point where I said, "I'm going to do everything I can to try and optimize my sleep and do what I can to optimize it and control what I can in terms of environment." For me, that meant white noise.

And for me, white noise means I actually have earbuds I sleep with that are made for sleeping. They're comfortable. They're soft. And then I just have a white noise thing I play that I listen to there, just kind of a sound of a fan or something. And I wear a sleep mask.

For me, that's made a big difference just being able to have that, control what I can, trying to eliminate the light, and noise, and all those sorts of things.

Mitch: And even for people who aren't doing shift work where you might be trying to sleep during the daytime, there are a lot of little itty bitty lights that are turned on in every room, in my house at least, whether it be a little power indicator light, or whether it be the light on a fan, whatever. And it has been night and day since I've gotten my sleep mask how quickly I'm able to fall asleep and stay asleep.

Scot: Tell me more about these earbuds that you have in because I've seen Bose advertise these sleep-only earbuds, but they're super expensive, right?

Troy: Yeah, crazy expensive.

Scot: Yeah. So did you find a cheaper alternative, and how do they work?

Scot: Mine are super, super cheap. It's like $10. They're designed to be ergonomic flat. They're noise-blocking. So they're just earbuds. They're soft. It did take about a couple weeks to get really used to them and comfortable with them.

Thunder: Hey, Troy, have you ever tried just foam earplugs?

Troy: Yes, I have.

Thunder: I've done that on occasion when I'm somewhere where there's a lot of ambient noise.

Troy: Trust me, Thunder, I've tried everything. And once again, I'm probably going to admit things here that are very embarrassing, but I not only have tried foam earplugs, I've tried foam earplugs with construction-type . . . like those noise blockers, those big headphone things that construction workers wear.

Mitch: Oh, my.

Troy: I'm a side sleeper, so I actually took an old pillow and I actually hollowed out a little spot in the pillow.

Scot: Oh, my.

Mitch: Oh, wow.

Troy: I was that desperate to try and block noise that I tried it. And I actually used that for a couple months. I took a lot of heat from Laura, from my wife, making fun of me, that I was that desperate that I tried that.

Finally, just these ergonomic things, these earbuds with just white noise going through it, that's what worked for me. So trust me, I've tried it.

Scot: Mitch, what do you have?

Mitch: So one of the things that is a constant struggle for me is I'm a list maker, like, "What is my to-do list? What am I doing next?" And when I try to fall asleep, for the longest time, it would just be, "Okay. What do I have to do tomorrow? I'm waking up, I'm doing this, I'm doing this, I'm doing this."

And what I found is that I keep my day planner . . . When I'm going to bed, as part of my ritual, I take the day planner, I climb into bed, I take my little pen out, and I write everything down that I'm going to be doing the next day. And for me, at least, that has really helped cut down the anxious thinking about the next day that typically happens when I try to fall asleep.

Troy: Yeah. I've heard of people doing that. And just doing a notepad, not typing it on your phone because you don't want the blue eye to mess you up. You just have a notepad, something is on your mind, write it down, deal with it later. That's a great idea.

Scot: My last one is another weird one. It works for me. I don't know if it'd work for anybody else. But sometimes when I have a hard time falling asleep . . . I'm a side sleeper, but I will lay on my back with my knees bent. Can you kind of picture what that looks like? What? Why are you laughing?

Mitch: You're just curled up and thinking about colors, and that's . . .

Troy: That's called a fetal position, Scot. You're doing it on your back.

Scot: No, I'm not on my side in the fetal position. I'm on my back and I've bent my knees, right? So if you were to come in the room, you would see this big bump of where my knees are in the comforter, right?

Troy: Yeah.

Scot: So I will lay on my back with my knees up. I mean, 99% of the time, if I can't fall asleep within five minutes, if I do that, I will fall asleep.

Troy: Wow.

Scot: I don't necessarily fall asleep on my back, but I get so tired from that position that I will turn over to my side and I can fall asleep. I don't know why it works. I don't know how I discovered it, but there it is.

Troy: I just want to be a fly on the wall in your house, Scot, and just see this, just see you lying there and sleeping with your knees brought up to your chest.

Mitch: And then talking about snakes and cars.

Scot: No, it's not all way up to my chest. I'm not that flexible. It's just like a 45 . . . Yeah, it's like a 45- or 90-degree of your knees.

Troy: I'm trying to think of the physiology of this, how this might work. I will tell you there are certain things called vagal maneuvers that basically increase the blood flow to the head and slow the heart down.

If someone comes in with a very rapid heart rate in the ER and something called super ventricular tachycardia, we will do a procedure where we lay the head of their bed down and lift their legs up at the same time to increase that blood flow. And that sort of has a calming effect on the heart rate.

So I'm trying to think of this physiologically, Scot. I don't know if there's anything to that, but it's interesting you do that and you found that works. Maybe there's something to it.

Scot: Thunder, you're up next.

Thunder: Well, this last one may be kind of old fashioned, and it doesn't actually pertain to me exactly. But I think having a television in the bedroom, a lot of people have that. I think that could actually interfere with sleep. I've never done that, but similar to being on the phone, being on a tablet, laptop, whatever, I think having a TV on when you're in bed trying to go to sleep . . . Again, it's something to engage your mind and keep you active. So that's something I think we should consider.

Scot: And Kelly Baron, when she was on the show, talked about the bedroom is for two things. It's not to watch TV. It's to sleep and to . . . I guess we're going to go to Troy next.

Troy: And to make sweet love. Is that what you want me to say, Scot? Anyway, Scot, moving on from that, this third thing I'm going to say is something I am going to try. And I will tell you I recently celebrated a birthday. For this birthday, I received a gift, and my sister was so excited to send me this gift. She said, "This is something I heard about on the podcast." The gift I received was a toilet light. So Mitch suggested this. This is one of the gifts Mitch suggested getting.

Mitch: Yes.

Troy: And I have now been using it for about a week. It's awesome. It's got a motion sensor, Mitch. It's everything you described. You come in . . .

Mitch: I told you.

Troy: Yeah, it's so cool. It's like a joke kind of gift, but I've used it and I'm like, "I love it." You come in and it just . . . I've got it on this very dim, purple light. It just hangs over into the toilet. It just lights up the bowl like this little beacon in the night, like, "Oh, there it is." I don't have to flip on lights. I'm not struggling to find the toilet. It's great.

I think it definitely helps you to avoid those interruptions in your REM sleep where you're flipping on lights and you're too focused on the task at hand, so to speak. Instead, you've got the toilet light, great, in and out, go back to sleep.

Mitch: I love that. A couple of my friends also purchased. So I don't know how much reach we have in this podcast, but some toilet lights were bought this Christmas season because of what we were saying. And I cannot be more delighted because everyone has been saying, "This is ridiculous. I can't believe I spent $10 on this." And then the next day they're like, "It's wonderful. This is the best thing. I don't have to wake up. I don't have to turn on the lights."

Thunder: Yeah. Add me to the list. I also have a toilet light.

Scot: What?

Mitch: Yes!

Thunder: Yeah. And it is, it's awesome. The only thing that I don't like about the toilet light is it . . . or maybe it's just the one we have. When the batteries start to go low, it flashes red like a police siren.

Troy: Oh, no.

Mitch: Yeah.

Thunder: So that's the one thing. You walk in there and batteries are always like, "Flash, flash, flash." It's like, "Oh, my gosh." It's very bright red. But love it.

Mitch: It's interesting you thought police siren. I thought poltergeist the first time I woke up in the middle of the night and there was a flashing light in my bathroom. I was like, "My house is haunted. I've got to go figure this out."

Troy: Your toilet. Something is going to emerge from the toilet.

Mitch: Yeah.

Thunder: But all in all, it is really a great invention.

Troy: Well, we've got three believers here, Scot. I think you're next.

Scot: Yeah, I guess.

Troy: Now I know what I'm going to get you for your graduation.

Scot: Oh. Yeah.

Troy: Because we know that's coming up soon.

Scot: Oh. Mitch, you're taking us out with number three.

Mitch: So the last one is actually a tip for my partner, Jonathan, and it's kind of this same thing. If you have difficulty sleeping and it has something to do with not being able to turn your brain off or not being able to just let go of the anxieties of the day, the thing that he does every night as part of his sleeper team that he's come up with is he has a series of positive affirmations and mantras that he tells himself.

At the start, again, I think there's a touch of toxic masculinity where I'm just like, "You're doing what? You're positive self-talking before bed?" I don't know. I need to be better about that. But he has seen a significant . . .

Scot: Go ahead and incorporate that into your self-talking.

Mitch: Right. I've got to bring that in to me, right? But he's found a lot of real benefit from it. And I've been trying it out recently where it's just . . . If you are someone who's struggling with any sort of negative self-talk or any sort of . . . if you go to bed and you replay the bad moments that happened through the day, if that's you, this has been really helpful.

And it sounds cheesy and it feels ridiculous. You're looking in the mirror telling yourself something, but it works for him. And since I've been doing it, I've been finding myself able to go to sleep faster.

Thunder: Mitch, I think that's awesome because I think we're good at being hard on ourselves about different things and replaying those in our mind, but we're not good at the opposite, patting ourselves on the back when we need to.

Scot: This turned out to be a far more entertaining show than I could have expected.

Mitch: Not the snooze fest?

Scot: Yeah, not the snooze fest I thought it was going to be. I was like, "What are we going to talk about?" But I think we've learned a lot about each other.

Troy: And I'm so glad you shared, Scot. I'm so intrigued by your sleep techniques. Anyway, it's definitely been entertaining.

Scot: Yes. It's been a good show. So I think the takeaway is that the Core Four . . . Sleep is one of them. And a lot of times, if you get your activity, and your nutrition, and your mental health right, the sleep will take care of itself. But sometimes it doesn't. Sometimes maybe the sleep is the first thing that you need to tackle.

The Core Four don't live in isolation. They all impact each other. And like Mitch explained to us, how sleep impacts those other three for him is absolutely huge.

So hopefully you got some good tips here. Hopefully you have a better understanding of the importance of sleep, and thanks for listening.

We are going to talk about next week, in our "Back to Basics: Core Four" series, mental health. So that'll be next.

If you have a technique that you would like to share, you can get a hold of us. It's so easy.

Troy: Yeah. You can reach out to us, hello@thescoperadio.com. We're on Facebook, facebook.com/whocaresmenshealth. Call our listener line, 601-55SCOPE. I would love to hear who is going to try Scot's elevation of the knee technique tonight when they can't sleep and tell us if it worked. I'm going to try it, Scot. If I can't sleep, I'm trying it, and I'm going to give feedback.

Scot: All right. I look forward to that.

Thunder: I'm going to try the color technique.

Mitch: Oh, yeah.

Troy: The color technique. I'm going to start with color and then I'm going to move on to knees. That's my strategy.

Scot: I'm glad I had an influence on you guys today.

Troy: You did.

Scot: As always, it's awesome. Thanks for listening and thanks for caring about men's health.

Interviewer: Sharee Thompson is a registered dietician nutritionist at University of Utah. And today, we want to talk to her and find out how an RDN can help you. And it's more than just I think what a lot of us think about when we think of an RDN, which is losing weight. I was shocked at all the different things that a registered dietician can help with, conditions that are actually very much influenced by the food you eat -- diabetes, kidney disease, heart disease, cancer.

There's a whole bunch of mental health conditions, including ADHD, depression, schizophrenia, eating issues like food allergies, which makes sense, but poor appetite or eating disorders. And then, even things like your mood, or sleep, or digestion issues, or fertility issues. I mean, so many things that we're like, "What's the answer?" And maybe we search for answers, and the answer is no further than the plate in front of our face. So how is it that food impacts these things so significantly?

Sharee: So I think one of the things that we need to understand is that our physical health, our mental health, and our nutrition are all highly intertwined. And, well, oftentimes, if one of these things is compromised, one of the others is likely as well. And so what we eat and how we eat has a major impact on our mood, mind, and overall well-being.

Interviewer: Is it something going on chemically there, the way the food is interacting with our body? Or, I mean, like, what . . .

Sharee: Yeah. So a very simplified way of looking at this is the food that we eat provides our bodies with the information or instructions and materials on how our bodies will function. And so if we're not getting these materials, being the nutrients in the food that we eat, our bodies will have issues carrying out the metabolic processes that they need to. Some examples of these functions that nutrients play a big role in are building neurotransmitters, brain chemicals that influence our mood and our health. Some examples of these are serotonin, sleep and relaxation, dopamine, endorphins. In addition to those, we also have immune function, nerve impulses, tissue repair, and also metabolism.

Interviewer: I loved what you said, but I didn't quite remember it. The food provides the instructions?

Sharee: The food provides the nutrients or the instructions that our body needs to carry out these functions.

Interviewer: To do what it needs to do. Thinking of it that way kind of totally changes the way I think about the food I put in my body.

Sharee: Yeah. And so if it's not getting those nutrients or the materials that it needs, it can't carry out the functions.

Interviewer: Yeah, If I'm eating a lot of fast food, then now, all of a sudden, my body's not getting the proper instructions to carry out the metabolic processes it needs to, so things start malfunctioning. So a registered dietician nutritionist, what do you do when a client comes in then with one of these conditions to help them feel better?

Sharee: So, through assessment, I mean, we're getting a better picture of the person as a whole. We take a look at their history, their dietary patterns, what their symptoms are, their issues. And each condition or disease has a medical nutrition therapy component to it. So it'll be different depending on the various condition. But we are educated in all of those areas where we can kind of tailor the plan to meet those needs.

Interviewer: Sure. So the right food for the right condition. That's really the value a registered dietician nutritionist brings to the table. But I also have a feeling other than helping with those food choices and evaluating somebody's diet, there's a certain amount of motivation that you have to offer, behavior modification.

Sharee: Yes. A lot of what we tend to focus on are just lifestyle behavioral changes, making these dietary changes, but also incorporating physical activity into our daily lives. And, you know, registered dieticians can also provide that ongoing support and feedback and advice. You know, if you have a bad week and you come back to see a registered dietician, they can continue to motivate you and be there to talk through these things and keep providing that information to you.

Interviewer: I know that's helpful, because after you have a bad weekend sometimes, then you really get down on yourself, like, "I'm such a loser. Why am I even bothering with this?" But the reality is you can pick it back up again.

Sharee: Yeah. And there's that accountability piece too. So if you know you have an appointment with your registered dietician the next week, you're just more accountable for those behaviors.

Interviewer: Help me understand the difference here because I want to make sure that I'm going to the right person, right? So there's a lot of kind of monikers I see out there. I see dieticians, I see nutritionists, I see registered dietician nutritionists. Is there somebody that's a little bit more . . . I mean, like, what are the education behind that?

Sharee: You can become a nutritionist. It's a certification. But a registered dietician, that requires a four-year degree with an accredited nutrition curriculum, extensive internships, hands-on internships, registration exam, and so you're credentialed with the Academy of Nutrition and Dietetics, and it also requires continuing education. And so we're continuing to be able to offer that science-based information.

Interviewer: Yeah, the latest information based on science and not speculation or, "This works for a lot of my clients. You should try it too."

Sharee: And we're not only nutrition experts, but we also are very educated and knowledgeable with the human body and how food affects it biologically and physiologically.

Interviewer: From my point of view, you'd want to look for an RDN because you know they've got a lot of education and schooling and the practical experience behind them. That's what those letters indicate.

Sharee: Yes, definitely.

Interviewer: That's what you just told us, yeah. If you are referred by a physician for an RDN visit, does insurance generally cover that?

Sharee: For certain conditions, insurance will cover. Some common ones are for diabetes and kidney disease. But you will want to definitely reach out to your insurance carrier, because they all vary, to find out if visits are covered and also what the specific benefits are.

Interviewer: So if you're experiencing any of the symptoms we talked about at the top of the podcast, by all means, go ahead and talk to your primary care physician and see if perhaps a registered dietician nutritionist might be able to help you get some relief or get a cure.

Announcer: Health information from experts, supported by research. From University of Utah Health, this is thescoperadio.com.

Scot: Many people take fish oil for a lot of different reasons. Some of the benefits, well, there's a lot of mays in front of these benefits. May support heart health, may help treat certain medical conditions, may aid in weight loss and the list goes on and on. However, we might be able to take the may off of one of those. Dr. Tom Miller is an internal medicine doctor here at University of Utah Health.

What might we possibly be able to remove the may from, as to what fish oil helps with?

Dr. Miller: Well, it's interesting. Let's start with a little bit of history. Some time ago, probably back in the '60s, maybe '50s, we understood that the native population up above the Arctic Circle, Innuits had low rates of heart disease, and it was postulated that perhaps their high diet in fish contributed to this.

Now, Arctic fish have high levels of omega-3. The idea was that if you took omega-3s, you might have less heart disease, lower incidents of stroke. This went on for a number of years, in fact a couple of decades, and it was never really very clear whether omega-3 supplements actually made a difference.

But in the last year there have been a couple of landmark studies that have employed the large number of patients required to sort this out. And it does appear for people who have high triglyceride levels and have some type of event, like heart attacks or they have coronary artery disease or they might have had a stroke, that omega-3s supplemented to their diet will prevent and lower the risk of a second event.

The exact number that they came out with in this trial is 25% reduction if you were to take four grams a day. Now that's a higher dose than most people take. Most people take one to two grams a day as a supplement. I think what needs to be determined going forward is what would be the adequate dose for those who have had an event versus those who've never had that event. Should they just take a one gram, standard daily dose, or should it be more? We don't quite know that yet.

And then, secondly, there seems to be less evidence that's it beneficial in people who have never had an event.

So it does appear for the first time that we have some pretty reliable evidence, especially in people who have had cardiovascular events and high triglycerides, that the addition of omega-3 to the diet can lower the risk of a second event.

Scot: If they take a four gram dose. Dosage is important. That was the question.

Dr. Miller: That was the study that was done on four grams. Is that the optimal dose? I don't think we know just yet, but at least we have signposts that tell us that this is going to be beneficial.

Scot: Is this something you should talk to your physician about, or if you know that you fall into this category, should you just go ahead and start taking a four gram dose?

Dr. Miller: I think it would be wise to talk to your physician, because you also want to have the rest of your metabolic profile tuned up. So you want to make sure your other cholesterol subgroups are taken care of. And that's why people are on statins for preventing secondary events of coronary disease. And then, if you high triglycerides, which statins don't treat, then it might be wise for you to start omega-3.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Interviewer: Running from a doctor's perspective, that's next on The Scope.

Announcer: This is "From The Front Lines" with emergency room physician, Dr. Troy Madsen on The Scope. On The Scope.

Interviewer: When emergency room doctor, Troy Madsen, was thinking about running as his main exercise a few years ago, he was concerned about how it would affect his knees. So he did the research like any good doctor would do. And Dr. Madsen, what did you find out?

Dr. Madsen: Well, you know, like you said, my concern in running was, "Okay, great. I'm going to start running more." I said I'm going to run every day, do a couple miles every day, go from there, but in 10 years, I'm going to need a knee replacement. This is what I thought. This was what I grew up hearing. This is what people said. So I said to myself, you know, "I work in medicine, certainly I can look and see what kind of evidence there is for this. Are there any studies that have been done that show that runners have a much higher risk of needing knee replacements?" So the big concern here would be that you run a lot, you wear down the cartilage in your knees, you get osteoarthritis, which is bone on bone, and then at that point, it hurts too much, you need to have your knees replaced.

So it's a tough thing to study. You know, ideally, you would take a group of people and say, "You guys are going to run every day, you guys aren't. And then 10 years, we're going to see how your knees are doing." You can't do that. It's not practical. So you really just have to rely on people reporting how many knee issues they've had. Look at runners, look at non-runners.

Interestingly enough, at the time I looked, there were a few studies that had been done looking at this, and just this month, an editorial came out in the British Medical Journal that addressed exactly this question. So they summarize all the research that is out there. The bottom line is there is no convincing evidence that will tell you that runners have a higher risk of knee osteoarthritis and knee replacements.

The only thing they found, they said, okay, one study showed that in elite runners, they had a higher incidence of osteoarthritis where it was this bone on bone. This was one study that was done in the early 1990s. These were elite runners, meaning runners who had competed in Olympic marathons, and they had a little bit higher risk of this issue. I found studies that actually suggested in runners, they're 50% less likely to have any issues, meaning that maybe this running is actually helping the knees potentially helping build this cartilage up. You know, certainly, if you're having other injuries like ACL injuries or tearing ligaments, things like that, that's a different issue.

But just the whole wear and tear of running or this idea that you're just tearing your knees up, I can't find anything convincing that says, "Yeah, you're tearing your knees up, you're going to get bone-on-bone knees, and then in 10 years, you are going to need a knee replacement."

Interviewer: So had you found evidence to the contrary, would you be a runner right now?

Dr. Madsen: It's a great question. I don't know.

Interviewer: I'm trying to figure out if you're putting your money where your mouth is on this deal.

Dr. Madsen: Yeah, you know, at the time, and I think for a long time, that was my excuse for not running. I'll tell you the reason I ran is because my wife made me commit to run a marathon because we're moving, and that was part of the deal, "If we're moving, you have to run a marathon." I think she thought I was going to say that there's no way I'm going to run a marathon, but I committed to do it, and I've kept running since then. I think partly knowing that, "Hey, you know, this is a great exercise. It's a great sport. It's a great life-long sport. And the whole knee issue, I'm convinced that, you know, based on the evidence I can find that running isn't going to tear your knees up." I just can't find anything that absolutely says, "Yeah, you're going to have lots of knee problems because of this."

Interviewer: What about like somebody's weight or other issues like that? How is that taken into account in these studies?

Dr. Madsen: Yeah, it's tough. Again, these are not ideal studies.

Interviewer: Sure.

Dr. Madsen: I mean, they're small studies. They're combining these studies to create what's called a meta-analysis where you combine data from lots of different studies. I don't know that they can really control for those factors for weight and look at a person's weight. Because you're talking about people who've been running for 20 years, can you account for their weight 20 years ago versus now? What different effects are there? I don't even have an answer.

Interviewer: Yeah, yeah. I would imagine, too, something else maybe to keep in mind. So I think this is good that if running is something that you do, that's great, continue to do it. If it's something you want to do, there doesn't seem to be a lot of compelling evidence it's going to cause knee issues. But I'd imagine it would be smart to be safe and, you know, make sure that you're in with a reasonable weight, and maybe even make sure that you're running form is good, that you're not heel striking and doing some of those sorts of things. Because the runners in the study conceivably would be doing those things.

Dr. Madsen: Exactly. You don't want to force yourself into a sport. You want to make sure your heart is in good shape, that you're going to be able to handle it. Don't just go off the couch and go put in seven or eight miles. Like you said, you've got to consider all those factors. Find a sport you enjoy. But I think the bottom line from this is if you enjoy running, don't tell yourself you can't run or you can't run more because you're going to have major knee problems down the road. I just can't find anything that suggests that's the case.

Interviewer: And since you started years back, when you first started running, when you did this research, you've since run marathons, and how do the knees feel?

Dr. Madsen: Knees are great. Don't ask me that question after a marathon, but today the knees feel good. You know, after long runs, there's always the aches and pains.

Interviewer: Yeah, but not knees, right? It's usually muscular or . . .

Dr. Madsen: Yeah, it's usually muscular, it is. It is not the knees so much. Well, I'll take that back. I'd say usually about mile 24, 25, everything hurts.

Interviewer: Sure.

Dr. Madsen: And I'm telling myself, "I will never do this again." But, you know, you give it a day, you start to feel a little better, and then you're back at it.

Interviewer: And then for individuals that maybe currently run and they're thinking about wanting to run a little bit more, maybe they're kind of in this three to five-mile range, and they're afraid to go beyond that. Again, the research shows that probably not going to negatively affect you?

Dr. Madsen: Exactly. I think that's the big take home. But at the same time, keep in mind that if you're happy just doing three to five miles, keep doing it. You're getting the health benefits. And that's a whole different discussion. But if you're doing three to five miles, three times a week, you're doing great. And if you like it, if you're happy with it, keep doing it. If you want to increase those miles, maybe do a half marathon or something, feel free to do it.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Interviewer: Physical therapy. It helps in more ways than you might think. We'll examine that next on The Scope.

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

Interviewer: You know, many people only have kind of a tip-of-the-iceberg idea of what physical therapy is and what the benefits are, and, I guess, even for me, I primarily think about a physical therapist as somebody who helps me recover after, like, a knee injury, or surgery, or some sort of traumatic injury like a car crash, but Rob Singleton is a physical therapist at University of Utah Healthcare, and he says that there are actually other ways that physical therapists help, and you've been down many of the paths. You started out in the common one, which is, like, the orthopedics.

Rob: Yeah, about 22 years ago when I graduated, I started out in, you know, right out of school in sports medicine, orthopedic rehab. And I think that's kind of the common area that most people think about when they think about physical therapy, is like, you know, your typical ankle sprain, knee sprain . . .

Interviewer: I've got a wrist problem.

Rob: . . . football injury. Yeah, carpal tunnel, all that kind of stuff.

Interviewer: Sure. So you started out there, and then you got more and more specialized. Explain that path.

Rob: Well, I did that for about seven years, and then had an opportunity to come up to the university, and actually filled in for a therapist who was working in wound care.

Interviewer: Wound care?

Rob: Wound care. So physical therapy, we do a lot of wound care.

Interviewer: That just boggles my mind. I never imagined that. And what's the ultimate reason that you would seek out a physical therapist to do wound care?

Rob: Typically it's for ulcers, either like a diabetic ulcer, stasis ulcer, venous ulcer.

Interviewer: And then the goal of that physical therapy for that wound is to keep it from getting worse, to help it heal?

Rob: Yeah, keep it clean, help it heal.

Interviewer: Got you, all right. And then you've moved on from even that, now.

Rob: Yeah. So I did that for a while, and then got really interested in rehabilitation for neurological injuries, brain injury, spinal cord, stroke, and then was on the inpatient rehab unit for about eight years, mainly working on the spinal cord injury team.

Interviewer: Got you. So, boy, we've already learned a couple of things that I didn't know physical therapists did--wound care, and I guess, now that you've mentioned it, like, neurological things. That makes sense. What are some other areas a physical therapist might work in that I never would have guessed before?

Rob: Oh, wow! You know, there's therapists in pain clinics that works, you know, with pain management, and you have, of course, the orthopedic. There's acute physical therapists who work in the hospital, on the hospital floors with, you know, either in the intensive care units or the regular units. And really they're kind of the first line of defense as far as the hospital goes, you know, because your therapy starts right there. So they're the building block, really.

Interviewer: Gotcha. So there's a lot of different areas that physical therapists work. Is their kind of one overriding, though, goal or mission of what it is that you do, regardless of where you are?

Rob: Yeah. I guess if you could put physical therapy, define it by one word, it would be mobility. We're the profession that wants to get people moving, you know, either back on your feet, or moving in your wheelchair, or, you know, however you move. We want to get you back.

Interviewer: Regardless of the reason that is inhibiting your movement?

Rob: Yeah, back functioning, moving, being mobile, being as independent as possible.

Interviewer: So, like, even in the burn unit, it just occurred to me, like, when a young child burns their hands, that can cause mobility issues. A physical therapist would be there helping them with that.

Rob: There are physical and occupational therapists in the burn unit, you bet.

Interviewer: So when it comes to physical therapy and the overall kind of, what they call the continuum of care for patients, I'm trying to think . . . I was going to say, like, toot your own horn, you know. What is it you guys have, but . . . but let's maybe go the opposite direction. What would it be like without physical therapists?

Rob: Wow! That's an interesting question.

Interviewer: Like how it change . . .

Rob: People wouldn't get pushed as hard after their surgeries or injuries to get better, I don't think. You know, and that was, I think, probably historically how it was, that if you had a major surgery, or an injury, or an illness, you would be discharged from the hospital and go home, maybe have some nursing care, and then you'd kind of be just left to your own accord to get better.

Interviewer: To figure out on your own, yeah.

Rob: Yeah, to start getting up, to start moving.

Interviewer: So with physical therapists in the picture now, you push patients to get better, which helps them heal faster, get back to their life in a way that . . . like it was before, so it's not less than?

Rob: Yeah, and research is very clear that, you know, early mobility leads to faster recovery.

Interviewer: And the trend is getting, you know . . . get people up quicker and quicker. My mom had a knee surgery and she was up the next day.

Rob: Yeah, and I know they're doing a study now on in one of the inpatient acute units on really early mobilization in the intensive care units, and that's showing some really promising results because, you know, when I was up there, it was kind of, "Oh, you know, let him be for a little bit. Don't push him too hard. Get him moving." But towards the end of my stay in the inpatient intensive care units, it was really, you know, "We've got to get these people up as quick as we can, as safely as we can."

Interviewer: What are some common misperceptions about physical therapy or physical therapists that you run into?

Rob: I think probably the biggest misconception is that that we like to torture people.

Interviewer: You don't?

Rob: No, we're really . . . well, you know, I speak for myself, for the most part, very loving, giving, healing kind of people, tend to be very gentle, but we can push you. But we certainly don't want to inflict pain. Pain can certainly become part of the process, but it's not our goal to hurt you.

Interviewer: At kind of the end of the day, if, you know, somebody is just finally kind of having their mind broadened as to what physical therapists can do, and that they help in a lot of different areas, how would somebody know if maybe a physical therapist would be somebody they want to seek out for a condition or an issue they have, you know, beyond the obvious?

Rob: Well, I think you know, with the internet and Google, if you type in your condition and how it's treated, with most things, you're going to see therapy, in some sense, come up as a treatment option.

Interviewer: So maybe a good new paradigm for somebody to have is that physical therapists, instead of just being in one place, are probably everywhere.

Rob: Yeah, and I think people, you know, would be quite surprised when they come into clinics and there's a physical therapist there.

Interviewer: It's nice.

Rob: You know, we're in a lot more areas than people really realize.

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