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Scot: Troy, have you ever been in a situation where you had to advocate for your health? Like, something wasn't right, it felt like you weren't getting the correct diagnosis, people maybe weren't taking you seriously, something like that?

Troy: Oh, absolutely, Scot. Yeah, I had one time where I was just having high fevers and just felt miserable, and it just was not getting better. I went to a doctor and I felt like he just kind of blew me off. And I wasn't in healthcare at the time. I was in medical school, but I really didn't know anything. I was in my first year, and I really had to kind of push things a bit and go see someone else, and was ultimately diagnosed with a salmonella infection. It was kind of crazy.

Scot: Wow. Man.

Mitch: Whoa.

Troy: Yeah. It was bad. So I had to get IV antibiotics and get treated. So yeah, I think we all face those situations occasionally, but I definitely have.

Scot: Yeah. How about you, Mitch?

Mitch: Oh, for sure. And I've shared a couple on this show. I'll go to the doctor and it's everything from, "Hey, I'm tired all the time," and they're like, "I think you're depressed." I'm like, "Ugh, I'm doing all I need to with my mental health, I'm sure. I don't think it's depression."

And it took a lot of pushing and getting a second opinion to find out that the tiredness was linked to testosterone rather than, say, seasonal depression or activity levels, etc. It was an actual hormone difference.

Scot: Yeah. Sometimes we just know there's something wrong, but we can't seem to get the help we need. And it can be really frustrating and just easy to give up and just accept whatever is bothering us as the way things are.

This isn't about bashing on doctors or anything like that. It's just about advocating for your health. And today we've got a story from a guy who knew something was wrong, did some research, stood up for himself, and eventually was able to get a diagnosis that made a huge difference in his quality of life.

Today, on "Who Cares About Men's Health," it's dudes talking to other dudes about their health. We're going to bring in guys in our lives to talk about health,, whether that's friends, colleagues, neighbors, whatever. And the goal? Prove that just talking about health with other men can maybe, just maybe, give us some insight on how to improve our own lives. So that's today's show.

This is "Who Cares About Men's Health," with information, inspiration, and a different interpretation of men's health. I'm Scot Singpiel. I bring the BS. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. Good to be here.

Scot: Mitch Sears, a guy that's just working on his health, and he always brings a unique perspective to the show. Welcome, Mitch.

Mitch: Hey. Happy to be here.

Scot: And our guest, Jonathan, Mitch's longtime friend and companion, who had to work really hard to get his doctors to listen and take his concerns seriously, which really highlights the importance of self-advocacy when it comes to your health. Jonathan, welcome to the show.

Jonathan: Hey, guys. Good to be here.

Scot: First, tell us a little bit about yourself.

Jonathan: So I'm 36. I have been working with sort of chronic pain issues since my teenage years, and I have tried to figure out what the deal was. I was always told they were growing pains, it's not a big deal, and men don't cry. So what's the big deal? Why would you pursue it? But it got worse, and that's when I started to reach out to medical help.

Scot: And tell us about this pain. What was it like?

Jonathan: Yeah, so when I was a teenager, I had this weird pain in my heel, and it was pretty obscure. Everyone said, "Oh, you're growing. Your tendons are stretching out. They're growing pains. Don't worry about it." And that's fine. But then after a few years of this, I started to really struggle with lower back pain, hip pain. And you look into it and people say, "Is it a shooting pain? Is it a stabbing pain?" I didn't know. It just hurt.

It was bad enough that occasionally I would have to take time off of work and I wouldn't be able to bear any weight on my lower back and hips. I would walk across the wall with your hands. And some days, I really was crawling from one room to the other.

Mitch: Literally?

Jonathan: Literally. Like fox crawl across the floor. Yeah.

Troy: This is in your 20s?

Jonathan: In my 20s, early 20s.

Troy: Wow. Yeah.

Scot: That doesn't sound normal, Troy. Is that normal, Troy?

Troy: The doctor is going to say no, that's not. Yeah, that's really concerning to have pain that severe that you really can't even walk.

Scot: So you bring this pain up, up through your 20s, and when you do, it's kind of dismissed, it sounds like. Would you say that's accurate?

Jonathan: Yeah, it really was. My sort of family history, people were complaining about back pain. I had a grandfather that said, "Oh, it was the Jeeps in World War II," whatever it was. And so it was a subject of some concern, but ultimately, it was pretty strange as to how to deal with it or what to call it.

Scot: So then after being discouraged so many times talking about it or trying to seek out help, what finally then made you decide, "You know what? This isn't right. I have to do something. I have to find somebody that can help me"?

Jonathan: So I was really happy that I was lucky enough to get an apartment downtown. It was really close to TRAX, the light rail here in Salt Lake City. I was late for a train one morning, and I remember being unable . . . I had a little bit of a flare-up that day and I was unable to run. And it was more of an embarrassing, spirited hobbling that I was doing down the street to catch the train. And I missed the train.

I missed the train, I was late for work, and I kept my job and it was okay, but I was in my mid 20s at this point, and I figured, "This is dumb. This is really dumb that I'm not able to run or to have . . ." Even if I wanted to be more active in my lifestyle, I had a real barrier to that.

Mitch: So just going back, when you say you had a family history of it, did that even make you doubt yourself? I mean, you weren't doing Jeeps in World War II, right? When you talk to family members and stuff, did it make it seem like it was just something everyone had?

Jonathan: Well, totally. And it kind of coincides . . . So the first time I went to the doctor with really this being the complaint, the doctor sort of looked me over and, "Nah." He turns me around and he pokes my buttock a little bit. He's looking for the sciatic nerve, and he hits it and it hurts. And he goes, "Ah, sciatica. What can you do?" And I want to say, "Well, that's what I'm here for, dude. What do I do?" I don't know. But he said, "Look, it's ibuprofen, physical therapy, and off you go."

So one thing about physical therapy is that it's not always covered with insurance. And in my case, it was about $100 a pop and he wanted me to do it two to three times a month. So it was a considerable out-of-pocket expense. I was a little hesitant to start it, and ultimately felt a little dismissed.

Yeah, to Mitch's point, maybe that's all it is. Maybe it's just some genetic thing. I don't know. It's just something we struggle with and we carry on.

Troy: Yeah, it's funny how often that happens though. In your case, you just kind of wrote it off. You said, "Well, other people in my family have experienced this and this is just the way it is." Until it sounds like it got to a point where it was so limiting that that was a wake-up call when you finally just missed work because you couldn't even run. You're hobbling down the street where you're just like, "Hey, this isn't normal."

Mitch: A jaunty hobble. Wait, what was it? Was that the word? Yeah. Okay.

Scot: Yeah, let's get it right.

Troy: A jaunty hobble.

Scot: Yeah, try to give him some dignity, okay?

Troy: It was a spirited, jaunty hobble.

Jonathan: A spirited hobble, yeah.

Troy: That's right.

Scot: And not only did Jonathan dismiss it, the healthcare professional dismissed it. And I can't tell you how frustrating that is. With my dad, who was in his 80s, he would complain about things and the doctors would be like, "Oh, it's just part of getting old." He couldn't swallow. Eating was no longer something he could really do. And they're just like, "Oh, it's part of getting old." His legs would tingle and get cold. "Oh, it's just all part of getting old. Maybe you should stop drinking so much coffee." Just kind of that dismissive . . .

I don't know why that happens. Troy, do you have any insight why that happens? And it happened to Jonathan. "Oh, it's the sciatic nerve. I guess go do therapy."

Troy: Yeah. I mean, it happens because 90-plus percent of the time they're right, and you can't deny that. Ninety-plus percent of the time they're right, and in those cases, it may just be some sciatica and they go to physical therapy and they get better.

It's the same idea when you call computer support and they're like, "Well, did you turn your computer off and back on?" Well, of course, I did. But some people haven't done that. And then it's like, "Well . . ." So you're going to walk through all these steps before someone finally realizes, "Okay, you've taken all the steps, it's not working, something else needs to be done."

And I see this all the time in the ER because we get so many patients who have gone to doctors and gone elsewhere and have been frustrated and haven't gotten answers and have felt blown off. And they finally are like, "Well, I'm going to The U and I'm going to figure this out." I can't say we always figure it out, but they're frustrated.

But again, I think it's just normal human behavior where you say, "Well, common things being common, let's try the common things first." So you kind of have to expect that. And as you're working through the medical system, you kind of have to jump through the hoops, but then you just have to keep pushing when those answers aren't there.

Scot: So, Jonathan, did you do some physical therapy and do some of the things that were suggested at first? And then where did it go from there?

Jonathan: It took me probably a year to wise up to, one, the cost and, two, just sort of the embarrassment of the situation to actually commit to it.

When I first met with the doctor, one thing that I had noticed personally was this weird food sensitivity to when I would have flare-ups. And despite looking at the internet and trying to figure out if that's relevant to anything, I couldn't find much. And so I brought this up hoping that the doctor could illuminate this. And like the rest of it, he didn't really have much to say.

It was after that meeting, I'm on the app where you can look at your chart and whatever else, and I happened to find the note from the examination visit, and it goes on to say something like, "Patient presents lower back pain, hip pain, so forth, and advocates for the special diet of Dr. So-and-so, and I encourage him to eat healthily."

And this Dr. So-and-so I'm omitting intentionally because I didn't know who this guy was. So it was a note on my chart of a conversation I didn't exactly have. When I looked this guy up, he turned out to be a celebrity self-helpy, anti-inflammatory diet guy, the kind of guy that you'd buy his book in an airport or something.

Jonathan: At first, it was like, "Oh, they made a mistake. They switched my note with someone else." And then I thought, "Wait, did I just get profiled?"

Mitch: Oh, interesting.

Scot: Yeah. From a communication standpoint, I can completely understand what just happened there, right? That doctor has some sort of preconceived notion of that individual, which it sounds like could be accurate, right, Jonathan? I mean, you kind of maybe made the same conclusion. Heard that information and then just kind of didn't pay attention the rest of the time or just thought, "Oh, it's another one of these." Just goes with kind of their preconceived notions.

Troy, do you think that's right, or not?

Troy: Yeah, I do. And it brings up a great point. Doctors are human. They are prone to every potential bias you can imagine. There are so many studies out there that looked at physician biases for any sort of demographic characteristics or, like you said, even looking specifically at biases in terms of diet, or even diagnoses. If certain people have had certain diagnoses, that creates bias. So it happens. There's absolutely no question about it.

And it's something that I think, as physicians, we try to acknowledge that and we try to avoid those biases, but yeah, someone may hear a certain thing and it sounds like in this doctor's mind, he immediately associated you with this diet and this individual, and everything you said then kind of went back to that.

And I think when that happens, you just have to say, "Well, I've got to go see someone else." If you're already being kind of pigeonholed and saying, "Well, this is what your problem is," and it's clearly not the case, then I think you need to be willing to go get another opinion.

Scot: And you bring up a great point too. From my perspective, I think doctors know it all, right? But you're right, they're humans. And each doctor is going to have different areas that they're going to know more or less about. Even general practitioners are going to have . . .

And there have been times where . . . I have these weird thumb nails, and I, for a long time, would ask every doctor I visited, "What's causing this?" And they had no idea. And then one day I was at a dermatology appointment and the guy looks at my nails and he goes, "Oh my gosh, that's this condition and blah, blah, blah, and this is what causes it." It was crazy.

So sometimes you do have to remember they're human and maybe that particular one doesn't have the answers, or for whatever reason, you weren't able to communicate effectively with them and you have to try somebody else.

Troy: Yeah, that's exactly right. You've got to figure you go to four years of medical school, three years of residency, and then you have certain people who then go on and do another three to four years of fellowship training and specialization. And obviously, people with certain specialties are going to be more adept and more capable of diagnosing certain conditions.

So that's just a simple reality that, number one, there are limitations in terms of bias. Number two, there are knowledge limitations. And so yeah, just because you hear one thing from one doctor, you could go to another doctor and get something completely different. Again, that's why I think you have to advocate for yourself. And if you're not getting the answers you need, go get another opinion.

Scot: Want to get back to Jonathan and your story and continuing this, but I think another interesting point is if you're going to see a male doctor, if they have biases, that means they might also have this opinion that you shouldn't complain. To some extent, unless you're in there with a broken arm, you shouldn't complain. Men do not complain about their health, right? They would have those same potential biases, wouldn't they, Troy?

Troy: Potentially, yeah. I think that's possible. I would not say to assume that from a man, but . . .

Scot: At the top of the show, you even talked about you're a doctor and you still have some of these biases.

Troy: Oh, yeah. Well, there's no question. But again, I'm a horrible patient, so don't think I treat my patients the way I treat myself as a patient. Don't think that at all.

But you're right, I would not assume . . . Also, I think you have to be careful as a patient and your assumptions as well. I don't think you want to go in assuming because of a person's gender, race, anything else that they're going to have necessarily certain biases associated with that. But I think you just have to recognize that doctors are human, they have biases, they have knowledge gaps, and I think that's just the bottom line.

Scot: What happened to you, Jonathan, after that visit then? Where did you go from there? Were you discouraged or did you continue on?

Jonathan: So I do go to physical therapy. I decide that that is ultimately what's needed, but not without a follow-up where I learn kind of a double-edged sword of being an enthusiastic patient.

I came in a year later. Having felt dismissed, I come back to the same doctor. So I didn't look for a second opinion. I should have. I go back to the same doctor and this time I'm armed with many, many hours of WebMD/everything else you could think of, PubMed, anything that I could find. And I say, "Doctor, I have ankylosing spondylitis, and I think I need a referral to a rheumatologist." And I don't know how many doctors who may be listening to this enjoy it when their patient comes in and self-diagnoses.

Troy: It's usually a hit with doctors. Doctors don't have egos at all. They usually love it when you do that.

Jonathan: Especially when it's a particularly rare, bizarre genetic rheumatoid-arthritic type condition, right?

Mitch: Oh, yeah. When I was looking up some of the numbers, a Johns Hopkins study done just the last five years, it's like 0.4 out of 100,000 people. It's a really rare disorder.

Troy: Yeah, I'm sure that went over incredibly well. I'm curious what was his reaction when you said that.

Jonathan: "Ibuprofen and physical therapy." It was the same thing as a year prior. So I jumped through those hoops. I do about three months of physical therapy. There is improvement, but not as much as they were hoping. I can now run, or jog, which was pretty significant in my case. And so that was good.

And I go back to the doctor. I say, "Okay, are we good for a rheumatologist?" He says, "No, I'm going to refer you now to a physiatrist." And I had never heard of this before.

Scot: What is a physiatrist then?

Mitch: That's what I was about to say. A what?

Scot: You've got a couple other guys that haven't either.

Jonathan: Best I could gather, it's an MD, sports medicine, and he is certified to do sort of steroid injections into the spine to bring down inflammation. That's all I know.

Troy: Yeah, it's someone who's done residency training in physical medicine and rehabilitation, which we just call PM&R. So, yeah, that's exactly it. They work with people with . . . there's a sports medicine component to it, like you said, injections, those sorts of things. So you're right.

Scot: So, at this point, Troy, the doctors are no longer trying to look for the cause. They're just trying to manage the symptoms, it sounds like.

Troy: It sounds like it. Yeah, it sounds like whoever was seeing Jonathan was fairly convinced that this was just a sciatica thing. It sounds like he very much kind of anchored on this diagnosis of a bulging disc in the spine where you have a disc that bulges out the side and that pushes on the sciatic nerve and that causes pain, and that was the primary source.

It's a pretty common approach. Like I said, most of the time, that's what causes at least some of these symptoms. There were definitely some symptoms with Jonathan that didn't really make sense with that. But most of the time, physical therapy works. And then if that doesn't work, you can see someone who can do injections and they can do injections right there at that bulging disc. That can oftentimes help, with a steroid injection there.

But that's exactly it. It sounds like at this point it was very much like, "Well, this is the case. This is the treatment route we're going to take. Physical therapy didn't work. Let's try injections."

Scot: So same doctor, two different times. Is there something, Troy, Jonathan could have done with this doctor to perhaps continue this conversation of what Jonathan thought it was? Because it sounded like the doctor was very closed to that.

Troy: Yeah, I think at that point, if you really think it's something else and you're continuing to be pushed down this other route where he is very much anchored on this diagnosis of sciatica, and you're just like, "No, this isn't the case" . . . I just think at this point it sounded like it wasn't getting anywhere.

If someone came in, it is always a challenging situation because sometimes people come in and they have looked things up on WebMD and have looked things up on Google and it's just like, "No, that's not the case." Sometimes you can kind of go down the rabbit hole with some of the Google stuff you find.

But again, it sounds like in this case things just weren't going the right direction and none of this was effective. I would expect at least some response to physical therapy. It sounds like maybe there's a little response, but I would expect a bit more than that. So in my opinion, at this point, if things just weren't going the direction they needed to go, I think it's a great idea to go see someone else and see what they think.

Scot: And what did you do, Jonathan?

Jonathan: Well, I continued to do research, and something that had come up that didn't occur to me before . . . I was really hung up on this food sensitivity thing. It was one of the few things I had control over as a patient. If I eat, if I drank alcohol especially, there was a flare-up, and I could control that. The ibuprofen was starting to not help so much, and the physiatrist gave me a muscle relaxant at one point to do sort of as needed.

And it was at one point where I was interested in kind of taking it down a rheumatology route where it talked about iritis. And it just happened to be that in college, I had this weird stint of an inflamed eyeball such that you have a weird-shaped pupil. I happened to be with family at the time, and so they run me to the ER and they treat it with a topical steroid, and then it was done. It was a non-sequitur to me as a patient, as someone who didn't go to med school.

And so I bring this up, this extra piece up to now the physiatrist who says, "Oh, you mean iritis? Like the inflammation of the iris?" And it's like, "Yeah, that thing. I had that thing." "Have you had it since?" "No." He said, "Well, there is a blood test we can do for genetic markers for certain rheumatoid conditions. What do you think?" And I say, "Heck yes." And I didn't know about this. So finally, there feels like a breakthrough in movement there.

And long story short, I was positive for those genetic markers and I got the referral to the rheumatologist.

Troy: Nice. So you got where you needed to go then. I mean, it took a while, but eventually you got there and it's great that this other physician, this physiatrist, picked up on that.

Jonathan: Yeah, it really was. And unfortunately, it was like an eight-month waitlist. I don't know how much you want to lament the medical institution at whole here, but it was basically a two-year journey to get to the rheumatologist.

Troy: Yeah. Again, it's so frustrating, but that's not atypical, unfortunately.

Scot: How did the physiatrist know? How was that even in their wheelhouse?

Troy: I mean, it's something they may have seen before. It would be something that potentially a physiatrist would work with someone with ankylosing spondylitis maybe in some degree, just in terms of range of motion, mobility, those kinds of things. So that may be part of it.

But it also may be you were just fortunate to have a physiatrist who was very attuned to that and very open to making that connection, and finally got you where you needed to go.

Scot: Did you feel that the physiatrist was open more to conversations, that they didn't kind of have their mind pre-made up as to what was going on?

Jonathan: Yeah. And I also think I learned the lesson of not coming in and telling the doctor how to diagnose me. So that was stupid on my part.

But I do admit to going into the psychiatrist's office and saying, "Okay, look, I think it's this, but I'm not going to say anything. I will just report the symptoms that I know are in the literature that are true to me, I'm not making anything up, and add this one part that was missing."

And to be fully fair to the first physician, had I mentioned the iritis case, it could have been very different. From a patient's perspective, I didn't know that iritis was any more connected than chickenpox. So when you have that 15-minute window with your doctor and they say, "Well, what's happening? What's going on?" deciding what's relevant as a patient can be a challenge.

Scot: Yeah, totally.

Troy: Yeah, it is. But all that being said though, Jonathan, I think if someone has a specific concern about a specific condition, I do really appreciate it if they just say, "This is what I'm really concerned about."

It is frustrating that you specifically brought that up, and then it didn't really go anywhere with the first physician you saw, because I think it's at least worth saying, "Well, why do you think that's the case? Let's explore this further." And then maybe ask those questions, like, "Well, have you ever experienced iritis? Or have you ever experienced any of these other symptoms that are associated with this condition?" to at least give it some thought and explore it a little bit further.

I always tell people if you have something you're specifically concerned about, bring it up. Don't necessarily tell the doctor, "This is what it is," because again, some people are open to that, but a lot of people are just going to just shut down as soon as you do that. But I think it's worth at least bringing it up.

And in doing so, acknowledging, "Hey, I'm not a physician. I just had these symptoms. I've read some things about it. What do you think?" Just kind of that approach.

Scot: So then you were referred to the rheumatologist and you got the diagnosis?

Jonathan: Yeah, within a couple visits, she diagnosed me with . . . and I say a she. We mentioned the guy versus gal doctor thing. She's fantastic. She was very receptive to everything. She appreciated the way I was trying to problem-solve for things. And developing that kind of relationship, had that been possible with the first doctor, it could have been very different. She was great.

So yes, she diagnosed me with ankylosing spondylitis, put me on a pretty powerful medication. It's called a biologic. It's the general family name of it. I can run. I participated in the Mitch Sears . . . what was it called? The 5K.

Troy: Who Cares About Mitch's Health 5K.

Jonathan: Yeah, I did.

Troy: Nice.

Jonathan: Pulled the thread on that a little bit.

Scot: Oh, yeah. The pinnacle, I'm sure, of your health journey.

Troy: That's great.

Scot: Wow. What a journey. And how much time did you spend on the internet trying to figure this out? How many websites did you go to? I mean, if you had some advice to give to somebody about how to research something like this, did you pick up any pointers? Or is it you've just got to log the time?

Jonathan: There was a lot of garbage online, I want to say. There were a lot of weird rabbit holes with leaky gut syndrome, because I was hooked on this food sensitivity thing, and that was maybe a non-sequitur. Later, it turned out to be a sensitivity towards FODMAPs, which is a whole different thing. But these are different sort of complex sugars that some people have a hard time digesting, and maybe there are some co-factors there. I don't know. But it was just treated differently.

Stay humble. Realize that the guy or gal in the examination room probably, if they're doing their job right, really does want to help you figure things out. And find someone who is working with you.

And the normal relationship, I think, I hope, for a patient is to feel like they're being heard and being at least reasoned with. And it's up to the doctor to keep me from going down a rabbit hole instead of just outright dismissing me, and giving you ibuprofen and sending you to PT.

Troy: Yeah. And it is tough. I think you just always keep that in mind, that when you're going to a primary care provider, you're seeing someone who may be seeing three to four patients an hour, has a 15-minute window with you, and they may see 20 other patients that day who have similar symptoms and they may have that response.

So again, I think just accept those limitations and accept that you're trying just to work through the system, and then don't hesitate to go see someone else if you need to.

Yeah, I think that's my takeaway. Again, I see so many patients who are in a similar situation, who are frustrated, who have been trying to work in the system, just aren't getting an answer, and aren't getting the referrals they need.

And you did exactly the right thing. You jumped through the hoops and you followed the path that this physician laid out, and then you saw someone else, and they fortunately had an answer for you.

I'm sure you've met others who also have a diagnosis of ankylosing spondylitis, at least on an online forum or something. And I'm guessing there are others out there who have gone through that process for years and years and years, and it was maybe 10 years down the road and they finally got a diagnosis. So it can be something you just have to keep searching for answers until you find the right person who can help you.

Jonathan: It's so challenging because it's pain, and pain is subjective. And trying to figure out how that connects to a wider health story about a person, it's tough.

Scot: Yep. And especially as a man, right? Pain is subjective. "You should be able to deal with it. It's probably not that bad." Right?

Mitch: "You can hobble."

Scot: Yeah, you can hobble.

Troy: Exactly.

Scot: Jonathan, what is the one thing you would like a listener to take away when it comes to your health and being an advocate? If you could go on top of the mountaintop with our bullhorn here, what would you shout to all the men listening?

Jonathan: Yeah, don't be afraid to ask questions. I think one of the ways to keep it from being confrontational is to say, "Okay . . ." It's to not come in with a diagnosis necessarily, but to ask questions about it. Say, "Look, I have questions about this particular situation. It seems relevant. Maybe it's not." Keep it humble. Understand that it's a partnership with you and your healthcare provider.

There's been a change over the past few years of you listen to your doctor because doctor is always right to this more collaborative approach. And I've certainly seen it even being 36. People who are younger are going to be more accustomed to the new way of doing things. Older patients may prefer being told what to do. But asking questions I think would be the number one thing that I wish I did years ago.

Troy: Yeah, that's a great point you brought up too, Jonathan. There are more and more studies out there too on what's just referred to as shared decision-making where it's not like the doctor says, "Well, you need this test or you need this." As a doctor, I can say, "Well, I think the odds of it are this just based on what you're telling me. We could do this test to search more for it."

For me, it comes up a lot more with abdominal pain or heart attacks or diagnosing chest pain. I shouldn't really say heart attacks, but just chest pain of saying, "Well, it could be this. It could be this. These are the tests we can do. This is what I recommend. I think the odds of it being this are 2%, but if we need to get a CT scan, let's make that decision together."

So shared decision-making is very important, and it's a great point you make, Jonathan. It's a team effort, and don't expect for the doctor to have all the answers. And hopefully they're not in a position where they feel that they need to tell you, "This is the way it is," and you can at least talk through these things with them.

Scot: Jonathan, I can't even . . . the way you stuck with it was amazing and inspiring. Thank you for sharing your story with us today. And I'm glad that you finally found some satisfaction and you're able to get back to a quality of life. I mean, there's nothing more frustrating than not being able to do things that you want to do, or things that you have to do. Like, when you're late . . .

Mitch: Yeah, catch a bus.

Scot: Yeah. So you stuck with it, you had confidence to stick with it, you did a lot of research, you did work out that partnership with your physician, and I think it's just really, really awesome and it's a good lesson for all of us guys to learn.

Do you have a health issue that's been unresolved and maybe you need to advocate more strongly for your health, or maybe a story like Jonathan's? We want to hear it. You can reach out via our email. That's hello@thescoperadio.com.

And if you do have something going on, we hope this episode will motivate you to advocate for your health, even though it might be time consuming and it's a pain and it can be discouraging. In Jonathan's case, it was worth it, and it might be worth it in your case too.

Thanks for listening, and thanks for caring about men's health.
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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: So maybe you've heard about it on some ads or a TV show, or maybe you got a friend who's getting really into it. It's ketosis or the keto diet. And I just have a lot of questions about whether or not it really is as magic as everyone seems to make it sound. So we're going to find out today.

This is "Who Cares About Men's Health," where we try to give you some information, some inspiration, and maybe a different interpretation about your health.

I'm Mitch, and joining us today is Scot. He is the master of BS, and manager of The Scope Radio. Hello, Scot.

Scot: I am looking forward to hearing about ketosis as well. I hear it's a state that's hard to get into, but you can burn some major fat, so I want to find out if that's true.

Mitch: And also joining us is the MD that gives us a little bit of validity. That is Dr. Troy Madsen. Hey, Troy.

Troy: Hey, Mitch. Just a little bit. Don't overstate it.

Mitch: And to answer some of these questions, we have the wonderful nutritionist. Thunder Jalili is back with us to let us know about this particular process.

Thunder: Hi, Mitch. I'm happy to be part of the crew again.

Mitch: All right. So before we get into kind of ketosis itself, how about you guys? Have you ever tried out a low carb diet before?

Troy: Mitch, I'll just jump in right here and say no. I absolutely love carbs, so I can't . . .

Mitch: Carbs are the best.

Troy: Carbs rock.

Scot: Why would you do that to yourself? No, not really. I mean, the lowest I've ever had, I was on a diet called the Zone Diet, which I've heard is a low to moderate carbohydrate . . .

Troy: Carburetor?

Scot: Yeah. I've known people who've tried low carb diets, and they're not nice to be around. That's not just a cliché. That's actual truth.

Thunder: And I have tried a low carbohydrate diet. Very, very short-term for just a couple of days just to see what it was like, what it's like to follow this. Not for any weight loss reason, just more of an experiment.

Scot: Thunder, how did it go for you? What did you learn?

Troy: Yeah, were you super grumpy? I was going to ask that.

Thunder: No, not really. I mean, I still ate a lot of vegetables. Those were my carbohydrate sources. So I probably didn't have the classically super low carbohydrate diet. I mean, I don't think I was any lower than 30%, to be honest. So it was fine. I did it, and then after a couple days, I just wanted to have beans and some other stuff, so I just stopped. But it was mostly just an exercise to see how hard is it to do this? How limited am I from a practical sense?

Troy: And did you feel limited?

Thunder: Yeah, a little bit, I did feel limited. I don't mind eating salads and vegetables, but I don't like passing up fruit. You guys know how I love my smoothies. So I don't like trying to decide, "Oh, I can't put this fruit in the smoothie," and things like that. So, yeah, I felt limited in that sense.

I don't necessarily miss rice or pasta. But it's just when you start cutting the different fruits and beans and things, that's where it starts to get tough for me.

Mitch: So why don't we start the discussion here with what is ketosis itself? For someone who has never taken a physiology course, who doesn't have a degree in nutrition, Thunder, what exactly is ketosis and what does it do to the body?

Thunder: So ketosis is the metabolic state where your body is using fat for fuel. Basically, your liver has this ability to make ketones, which is kind of like a metabolic energy substrate in the liver, makes it in the liver. It can actually do this from fatty acids. To some degree, it can also do it from amino acids, which are the building blocks of proteins.

So your liver makes these ketone bodies, and it puts it into the bloodstream. And then those ketones can be used as a fuel for all the other cell types in your body.

There are a couple of particular types of cells that really need to use glucose, and if they don't have glucose, the next best bet for them is ketones. So it's important to have that. Your muscles can use ketones for energy, as an example.

So any time you're burning some degree of fat or you're using amino acids for energy, you're producing some of these ketones.

And then the last thing is "ketosis" is thrown around so much. Really, there's a window of ketone bodies, the level you can measure in the blood. And if the amount of ketone bodies circulating in your blood falls within this window, you're said to be in ketosis.

You don't have to be in ketosis to lose weight, but a lot of times, if you're doing something from a dietary standpoint or restricting calories, you are going to be in some degree of ketosis.

And you can actually have too much ketosis where the ketone bodies in your blood are so, so high, it can be dangerous, and it can cause an acidosis and potentially cause some harm, but that's pretty rare to be in that state.

Mitch: That's interesting, because one of the things I came across was what they call the keto flu. Have you ever heard of that?

Thunder: Yeah, so that's if you're just too hardcore about it and your ketones are just really high in the blood, and it just makes you kind of feel bad. It's not really the best thing physiologically. I would say that happens in people who really take the keto to the extreme.

Mitch: Bad breath, soreness, nausea, headaches, irritability. It doesn't sound super great to me, but what are some of the health benefits, I guess, of being in ketosis or using ketones? I guess even if you're not eating a strictly low-carb diet, does the body still go into ketosis? And is there any benefit from that?

Thunder: Yeah, you don't have to be in a low carb diet to have ketosis. If you just have a low-calorie diet, you would be tapping into your fat stores and producing ketone bodies that way, too.

There's not really any great benefit or great detriment of ketosis. It's just one of those natural metabolic states that we fall into from time-to-time. And it's just that in the modern context of people trying to lose weight, people will try to use that as a goal, to be in ketosis for an extended amount of time, with the idea that that means they are burning fat. But there's no specific benefit or detriment. It's just something that happens to us.

The only detriment would be if you go too extreme and you have such high ketone levels in your blood that it leads to keto flu, like you were talking about, or other similar bad effects.

Mitch: Would this be, say, maybe a dangerous thing for someone who's maybe diabetic? Or with how low the nutrients are or how many nutrients you might be missing out on from cutting carbs completely, could it potentially lead to vitamin deficiency problems and who knows what?

Thunder: So, in general, yes to a lot of the things you touched on. I'm also going to give Troy an opening here for the diabetes question if he wants to hop in, but for diabetes especially, diabetics can develop a dangerous condition called ketoacidosis, where basically there's just too much ketones, too much acidity in their blood, and it's very dangerous. They have to be careful with that. Troy, do you want to add anything to that?

Troy: Yeah. I was going to say for diabetics, they definitely would not want to do a ketosis type diet. And I'm sure anyone who's dependent on insulin, they know that. They know their carbs, they're tracking those things, and they're adjusting their insulin doses based on that. So to go to a very low-carb diet could be very dangerous.

Number one, unless they adjust their insulin, they could really drop their blood sugar low, which would be dangerous. But like you said, Thunder, one of the things I treat in the emergency department is diabetic ketoacidosis, where patients come in, their blood sugar levels are really high, but that blood sugar is not getting into the cells, so then their body is producing ketones. And exactly like you said, Thunder, they're acidotic. They're nauseous. They're vomiting. They're confused. It can be a life-threatening condition.

So certainly people with certain medical conditions, you would not want to do any sort of a low-carb diet or really be trying to achieve any kind of ketosis.

Thunder: Yeah. Correct. And the treatment for that is a lot of insulin.

Troy: Exactly. Yeah, that's how you treat it. We start them on insulin. We give them sometimes an insulin drip. Sometimes they go to the intensive care unit. It can be a very serious condition, and something I see on a regular basis.

Scot: I'm sorry. I might have just dozed off or something. I'm a little confused. I thought ketosis . . . People do like the Atkins diet or a very low-carb diet because that puts them in the state of ketosis, which helps them burn additional body fat. Is that not true? I'm kind of getting the feeling that that's not the case.

Thunder: No. One of the ways to encourage burning body fat is to do a lower carbohydrate diet, but a lot of times lower carbohydrate diets can also be lower calorie diets. You've got to get the energy from somewhere, so you mobilize your fat stores.

One of the ways of thinking about this weight loss, fat burning, and all these different diets, there are a lot of different ways to get around the same thing, trying to produce some calorie deficit. So, really, you're not comparing the merits of a keto diet to a high protein diet or whatever other diet you want to find. It's not so much that. It's what kind of diet advice can a person follow to produce the weight loss that they want? That's really the question. Not necessarily does it have to be exactly a keto type diet or whatever else kind of diet?

But yeah, bottom line is any kind of low-calorie diet will produce some kind of ketosis because you've got to tap into your fat stores to provide the balance of energy that you're missing because you're not eating as much food. Does that make sense?

Troy: It does, yeah. And, Thunder, along the lines of weight loss, I've wondered how much weight loss . . . I know with a low-carb diet and pushing yourself toward ketosis, a lot of people do see some fairly quick results in terms of weight loss. But my understanding is that a lot of that is water weight and you get ketones in the blood.

And again, I see the extreme of this with diabetic ketoacidosis where they have these ketones in the blood that pulls fluid from the cells into the blood. That's why you often hear of people who, when they have diabetes or when they're first diagnosed with diabetes, are urinating a lot more frequently, because they're losing a lot of fluid.

And I've wondered with these low-carb diets, where you're pushing yourself toward ketosis, how much of that weight loss is truly long-term fat breakdown versus just pulling a whole lot of water out of your body and losing weight because of that water loss.

Thunder: Yeah, that's a great point. There have been feeding studies, clinical trials have been done comparing different diets over longer time periods, like a period of months, sometimes even up to a year. And a lot of times, you look at the graphs of weight loss, and they kind of look the same. There's an initial big drop in weight in the first few weeks, and then actually, the weight kind of comes up a little bit, and then it stabilizes.

So there's definitely an element of what you said, Troy, in there. You have some water loss initially, but obviously, if you stick with it for the long-term, you're going to be also losing some fat. It's just probably going to take a few weeks for it to stabilize at a certain level. You can't say what you lose in the first three days is going to be the trajectory because that's probably not accurate.

Troy: Interesting. And maybe that's kind of self-reinforcing. You say, "Wow, look at the weight I'm losing." But probably, like you said, you're not going to keep losing that amount of weight over the longer term. You're probably seeing a lot of water weight loss, and then eventually, you're going to kind of level out to where maybe it's more realistic.

Thunder: Yeah. You just kind of settle in on an amount of weight loss, and then you hit a point of diminishing returns where, in these studies, people don't necessarily lose any more weight. They just kind of stabilize at a certain level. And then if you want more weight loss to occur, you have to try something different.

Mitch: So I guess to wrap up that idea, is a keto diet worth it, or are there other ways to lose weight? Is it comparable? For me, at least, it just seems like such a lot . . . I mean, we were kind of joking, but I do love carbs. Carbs are delicious.

Thunder: Especially in the form of cookies.

Troy: Sure.

Mitch: Oh, cookies, whatever, sure. But is it worth that amount of . . . are the benefits, the increased potential for weight loss, etc., enough of a difference that would make cutting all those things out worth it, in your opinion?

Thunder: I think with any kind of change in food behavior, you have to land on something that you can stick with. So, yes, you can lose weight following this keto diet. But the question you have to ask yourself is, "Is this something you can stick with for the next 40 years or whatever?" Forty or 50 years. And if you can't, then it's going to be something you do temporarily, and then you're going to stop and then maybe fall back into old habits.

So I'm not a fan of extreme diets of any kind for exactly that reason, because I'm afraid that this is something that people just can't stick with long-term. It's like a short-term fix.

Troy: Yeah, I agree. And again, it's a theme that seems to come up again and again as we talk about diet and exercise and all that. In my mind, too, it's all about sustainability and not just that short-term fix and getting ready for swimsuit season or whatever it is. It's like, "Hey, can you do this for the next 40 years and enjoy it and have this lifestyle that's rewarding for you?"

And I guess if ketosis is, if a low-carb diet works for you, and you're good with that, you enjoy it, then great. If it's something you're doing just to try and lose the weight and looking at as a short-term fix, it just doesn't seem like a great approach.

Mitch: So why do you guys think that the keto diet is so popular, then? I mean, some of the numbers that I was able to kind of pull up were saying that in the last year, 24.5 million Google searches were trying to figure out whether or not keto was right for them. It continues to have more and more people being a part of it. Why keto? Why cutting out all carbs? Why is that the diet of the time?

Thunder: That's a complex question to answer, but I think maybe some of the themes that are involved there are people are looking for some sort of program that they can easily follow that has noticeable quick results.

People are looking for any kind of crutch or help. A lot of times, if an individual is overweight and wants to lose weight, they don't feel great about it and they may be approaching it from a place of desperation. So if they can latch on to something that they see has worked for other people, and they're like, "Oh, all I have to do is cut out carbs. I can do that," I think that has a pretty powerful element.

And then there's also the element of marketing. I mean, not that there's a specific company marketing keto, but there are a lot of lifestyle-, nutrition-, exercise-based websites that market keto is the way to go. So you have also that marketing that's out there in the ethos that is always promoting keto. So that gets people to try it.

And then the last thing I'll say to that is keto diets have definitely been studied. Low-carb diets have definitely been studied in clinical trials. And the general conclusion is they don't work really any better for weight loss than any other diet. But a lot of times, people will see medical research like that and they will rationalize and say, "Well, that's the averages, but I think it'll work for me." And then they're willing to take the plunge that way anyway because they figure there's no harm in trying.

So that's my personal take of some of the things that are involved in keeping keto popular and really any other kind of fad diet or supplement that comes around.

Scot: Hey, Troy, what about the medical benefits of keto diets? I remember on thescoperadio.com one time we did an interview with a doctor that said there was some evidence that showed that for young children that had epileptic seizures, some of them responded really well to low carbohydrate diets that put them in that state, that ketogenic state.

Are there other health benefits that you're aware of? I mean, you'll see it on the web. People will claim diabetes, cancer, epilepsy, Alzheimer's disease. What do you know about that?

Troy: I'll say, in my opinion, and this is purely my opinion, I think the detrimental effects of a low-carb diet are probably greater than the health benefits. And the reason I say that is because I think a lot of low-carb diets lead to higher meat consumption, and primarily a lot of red meat consumption. So, right there, you have the detrimental effects there.

When we talked about that before, there are those rare exceptions where being in a state of ketosis does help maybe some children with seizure disorders.

Certainly, if you have weight loss, and it's a decent amount of weight loss, and you're able to maintain that that's going to help with potentially reversing diabetes, like a type 2 diabetes, and potentially helping with some of those long-term effects of being overweight. But again, in my mind, the sustainability of a low-carb diet I think is just a challenging thing for probably most of us.

And again, I think probably a lot of the protein intake in the form of meat . . . At least a lot of people I know who are on low-carb diets, they tell me they are eating a lot of meat. It's often a lot of red meat. And I think the health effects of that there, you're talking about increased risk of colon cancer, other types of cancers, certainly increased risk of heart disease, vascular disease, leading to risk of stroke, all those sorts of things. So I think it's kind of a mixed bag, quite honestly.

Thunder: Yeah. And if I could just add on to what Troy was saying, too, I think there are certain medical conditions, like you mentioned epilepsy, where this type of very high-fat, ketogenic-type diet may be required. Sometimes people have inborn errors of metabolism and they have to do kind of crazy special diets. Sometimes these patients are backed into a corner, so to speak, because they just may have to do that to move on.

But for most of us who are not in that camp of medical conditions that require it, then I would agree with Troy that the risks are probably outweighing the short-term weight loss benefits.

Troy: Yeah. And I will say anytime anyone asks me, "What kind of diet should I do?" and we say this again and again, I say the Mediterranean diet. The reason I say it is because there are so many good studies out there looking at long-term health effect impacts on heart disease risk, cancer risk, stroke risk, weight loss, and it does the trick.

And certainly, I don't consider it a fad diet. It's a very, I think, manageable, sustainable long-term diet. And it's certainly not a low-carb diet either.

So, in terms of just scientific evidence, that's the one diet that just seems again and again to come up over many years, lots of really good studies published in very strong reputable journals that really show beneficial health effects.

Thunder: Yeah, 100% agree with Troy. And also it's more of a moderate carb diet, and it's delicious because you get to eat a lot of delicious foods.

Troy: Yeah, exactly.

Mitch: Well, thank you so much for joining us, Thunder, and kind of enlightening us a little bit about keto and what it can and cannot do. I guess keto isn't really magic. So thank you so much, Thunder, and thank you for caring about men's health.

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So we've been dealing with COVID for a while now, and we are seeing kids who have what we call long-hauler symptoms. So what are these and is there anything that can be done?

In general, kids do pretty okay with COVID. Some have mild symptoms, some get pretty sick but recover after a week or two, and some kids have no symptoms at all. But more and more what I'm seeing are kids whose parents are saying, "I didn't know it would be this bad," or, "Why are they still having symptoms?"

Unfortunately, no one can predict who will develop long-haul COVID symptoms. There is a study out of England that shows that up to 15% of kids up to age 16 will still have symptoms five weeks after they initially test positive for COVID.

Long-haul symptoms can happen in kids who have minimal or no symptoms or in kids that have severe symptoms. That's the tricky thing with COVID. It doesn't follow any rules and it seems to do whatever it pleases on its own time frame.

So what are the symptoms of long-haul COVID? The most common are fatigue, brain fog or difficulty concentrating, breathing issues, chest, joint, or muscle pain, chronic cough, and headache. We also see changes in the sense of taste or smell, mood changes, or lightheadedness when standing up.

I know. It seems like anything can be a symptom of long-haul COVID. And not all of those symptoms can be attributed to having had COVID in the past.

How is long-haul COVID diagnosed? Well, that's tricky too. There are no specific tests that can be done. Your pediatrician can rule out other conditions and will usually refer your child to a specialist if their symptoms persist. But there are no good tests.

We have no idea how long it will last, we don't know what causes it, and we don't know what the treatment will be other than supportive care and treating your child's symptoms as best as possible. But there is no cure.

As we continue to move forward with COVID, hopefully we will have more answers as to how to help long-hauler symptoms. Until then, treating your child's symptoms and getting them set up with specialists to help with their specific medical needs is the best we can do.

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.

Scot: We got a couple of good emails, incredible emails. At one point I thought, "Mitch has put somebody up to these."

Mitch: And I thought that Scot had put . . . One of the persons who wrote in left their name and I just assumed it was you. It seemed like a made-up name.

Scot: Yeah.

Troy: Was it John Smith?

Scot: No, it was Scot, and Scot spells his first name with one T.

Troy: Oh, wow.

Scot: What are the odds of that?

Troy: What are the odds?

Mitch: I'm like, "Scot, come on. You've got to try harder than this."

Troy: He's like, "Scot . . ."

Scot: Scot made-up last name.

Troy: Yeah.

Scot: One was from a guy named Brett, and here's what he wrote. "Dear Who Cares team, I've been listening for a while, thought I'd ask a question after my last physical. I was diagnosed with fatty liver disease, but my physician didn't explain it too well and I've been searching for more answers on what it is, why I should worry about it, and what I should do to treat it. I Googled a lot of stuff, but I'm still unsure what to do. My doctor recommended I avoid fatty, greasy fried foods, but I wasn't sure if I should consult a dietitian or do anything else. I'm willing to share more if needed about my health, but is this something you could address in a future episode? Thanks again for a great show. Brett."

Troy: Is it Brett with one T? Then I know it's you, Scot.

Mitch: You got a Zodiac over here.

Troy: Exactly.

Scot: So that's awesome. I'm working on getting a couple of experts to talk about that. I'm working on getting a guy that's an expert in fatty liver disease. And I think Thunder would be a good guy to have on too being a nutritionist.

Troy: Yeah. It's a great topic. And it's so funny, this just came up in the ER the other day too. I had someone who same kind of thing. Looks like they probably have some fatty liver disease. We're talking about how do you treat it? What do you do about it? It's a fairly common thing and it would be, I think, obviously good for Brett and a good discussion to have.

Scot: Do I need to bring an expert in, or are you pretty good on fatty liver disease? I guess I didn't think . . .

Troy: An expert would be great. My recommendation, I think Thunder talked about, is it's not about fatty, greasy foods. A lot of it is about weight loss. If people can drop 10 pounds, they're going to find that the fatty liver disease often resolves or at least improves. But I'm curious too. It's something I will diagnose and I'll say, "Oh, CT scan shows the fatty liver disease, or your liver function tests are a little bit higher. It's probably what it is." But in terms of real monitoring and treatment and long-term stuff, that's not something I do.

So that's something usually a primary care physician does, and a GI doctor, or a hepatologist specifically, would be the ones who probably see this and give recommendations on it and can talk a lot more about why it happened. Is it genetic? Is it just because your diet? Is it because of weight? And do you treat with medication? Is it weight loss? What is it?

Scot: Cool.

Troy: Yeah.

Scot: And then the other one was from a guy named Scot. Scot said, "Hello, I really like your shows. I think you all do a great job. I appreciate learning about a wide variety of topics in an enjoyable format from knowledgeable people." That almost sounds like I made it up. I will admit.

Troy: Yeah.

Mitch: "Dear Scot, you're amazing."

Scot: Nobody writes . . .

Troy: "I love Scot."

Scot: It didn't say, "I love Scot." But nobody writes emails to shows. I've been in radio for a long time. You don't get that.

Troy: Yeah.

Scot: If you ever hear a DJ reading something that starts out like that, they wrote it.

Troy: Or their mom wrote it.

Scot: Yeah. All right. So anyway, after buttering us up, Scot goes on to say, "I have a question that might be applicable to one or more of your shows. I'm mid-30s male, that's in acceptably good health. BMI is 26.6. Overweight by NIH standards, but I run a 5k once or twice a week, go biking, I can do five pullups." Need to talk to him about how to do that.

"My right knee and feet give me some pain if I try running more than 7k, but generally not a problem at all. My blood pressure hovers around 128/75, elevated per NIH. My health has stayed pretty consistent over the last decade, even with me putting effort into improving it. So I'm trying to improve it but it's kind of stayed consistent, stayed the same.

"When I chose a primary care physician, I looked for someone that had a focus in sports medicine thinking they'd be supportive of younger people being their best selves, but the last time I went in for a yearly checkup and brought up my small health deficiencies, I was told flatly, 'If I got after everyone that came in here with a BMI of 26, I wouldn't do anything else.'

"I understand that medical resources are finite, but does that mean I'm doomed to become an obese senior citizen with high blood pressure because I can't find support how to push me to lose a little bit more weight and lower my blood pressure just a little bit more?

"If a PCP isn't the right person to help me, who should I look for? A physical therapist? A life coach? Accept my current situation is good enough? Find a new PCP? I wish I could just power through it, but I've been trying that for a decade without moving the needle one way or another. So I figure I need to try something different. Regards, Scot."

Troy: Ah, that's a good email. That's a great question too.

Scot: Yeah. So who should we hit up on that? Is that a primary care physician?

Troy: That's more primary care. I think his first issue is that he's gone to a sports medicine doctor thinking they will optimize his health. And sports medicine is really non-operative orthopedics. That's really . . .

Scot: I think they have some primary care physicians nowadays. This is where the BS talks to the MD kind of thing.

Troy: Yeah.

Scot: I think that they have some primary care physicians who do specialize in sports medicine, though.

Troy: Well, they do. And emergency physicians do too. Chris Gee is an emergency physician who does sports. In sports medicine, they're probably family medicine trained and did a sports fellowship, or emergency medicine trained and did a sports fellowship. But that being said, their practice is primarily non-operative orthopedics, so back pain, shoulder pain, that kind of stuff. They're not really like, "Hey, how can you drop down to a BMI of 24 from 26?"

Scot: Yeah. All right.

Troy: So, in terms of that stuff, I think . . . But it's true, though. I think a lot of people are going to give the exact response he got, like, "Hey, you're fine. I just had a guy here who's your same age and has a BMI of 40." But I don't think that's the answer a lot of us want to hear. We want to be like, "Okay. I recognize that. Yeah, I'm better off than most people, but I'm not where I want to be."

Scot: And I think part of the problem . . . and this is, again, the BS talking. I think part of the problem is our healthcare system, and I've heard experts say this, is not set up for optimizing health.

Troy: No, it's not.

Scot: It's really set up for you go in and "We're going to prevent . . ." It's not even really set up for prevention, is it?

Troy: It's not.

Scot: It's more set up for, "I've got a problem. Can you help me solve that problem?" And the problem needs to be . . . I don't know how to categorize what that problem is.

Troy: It's like a school teacher in a lot of ways. The school teacher teaches to the middle of the class. They're not teaching to the slowest guy in the class and they're not teaching to the sharpest guy in the class. They're teaching to the middle of class. That's where I think a lot of . . . in healthcare, it is like, "Well, hey, you're above the median. If you've got a BMI of 26 and you're running two 5ks a week, you're doing great compared to most of the people I see." So that's part of the challenge.

And you do find, though, a lot of programs do really, I think, try to then help people optimize and go to that next level. And it's not necessarily a primary care physician. I know PEAK Fitness at The U has different things. It's more about optimizing than just about being like, "Oh, you're okay." So I know they offer a number of programs with that, which I know we've talked about before.

I know Intermountain has their wellness centers where they do that as well where they really get into a lot more of getting you on the treadmill, seeing what's your VO2 max is, or whatever they're measuring there, getting a lot more into the specifics of diet and exercise routines, and that kind of stuff, where it is I think more about optimization.

Scot: Is that something, though, that Scot would really need? Because it just sounds like he wants to get his blood pressure, which is a little high, and his BMI, which is just a little high, lower, and you're talking about putting him on the treadmill and checking his VO2 max and . . .

Troy: I don't think he necessarily needs that. But they do offer I think a combination of services that do that sort of thing. So I don't think it's necessarily getting him on the treadmill, but I think they do a lot more than a primary care physician would where they really do get more into the specifics. Because it sounds like he wants to drop a few more pounds and he wants to improve his blood pressure a little bit. And honestly, his blood pressure is really . . . it's fine. 126 over 78? That's all right.

Mitch: That's what I was focusing on. Is this a conversation about a doctor minimizing what he feels is a problem, or is this something where the definitions are giving us a strange feeling of what is and isn't healthy?

Scot: Oh, yeah.

Troy: Yeah, and that's a good question too. We talk about BMI and we've talked about that before. Is his BMI of 26.2, is he truly overweight or is this just a guy who has a lot of muscle? And what's his body composition?

But that's where I think, again, teasing that out is probably going to be more . . . maybe a primary care physician would help with that, but it's probably going to be more like one of those programs where they get you in the BOD POD, they get your body fat percentage, they really look at the specifics of your diet and what you can do there, and that kind of thing.

Scot: Yeah. So this even comes back to a bigger conversation that maybe this is not the time or place for, but I want to throw this premise out there because I find it fascinating. It's this population health premise, which is where medicine I think would like to move, where instead of going into a hospital and the hospital gets paid for solving a particular problem or an illness you have, the hospital or the healthcare system is given a certain amount of money to manage the health of a population.

And now that changes the priority. It changes the priority to instead of curing disease, preventing disease. So then you would start to see infrastructure pop up where you could go into a clinic, and when you are a little bit overweight or your blood pressure is elevated, then instead of just having that conversation with your primary care provider where they're like, "Well, you need to eat a little healthier and maybe get some more exercise," you get to walk right on down the hall to some people that can help you figure out why that's not happening in your life and how you can make that happen in your life.

Troy: Yeah. So much of the healthcare system is about putting out fires rather than really . . . The forest analogy, it's just about, "Oh, put out this forest fire. Put out this forest fire," rather than creating a healthy forest and that kind of thing. I don't know who the best guests to talk to him about that would be to have on, but maybe . . .

Scot: I was thinking, Dr. Pohl because she is into lifestyle medicine. She seems to subscribe to that.

Troy: Yeah. That's a great point. She would be great. I was going to say either her or . . .

Scot: I always come back to Thunder because Thunder is our nutritionist, but he's also so smart on so many other things.

Troy: Yeah. Thunder would be great. She would be great. Who was our guy's name that did the culinary medicine? He kind of did some of that stuff. He was a little more bigger picture as well, but I think someone like that would be . . . But yeah. I think Dr. Pohl would be great.

Scot: There's another physician I've talked to before that . . . I guess at our Sugar House Health Center we have a clinic that actually does help people with these types of things, losing weight, improving their blood pressure, the thing that I just talked about where you go in and then you actually have experts in those particular areas. As you said, a primary care provider might not necessarily be the best person to spend an hour and work through, "What are you currently eating? What's your current exercise look like? What are your barriers?" that sort of thing.

Troy: Yeah.

Scot: So I can look at that clinic as well and see if there's somebody there that might want to talk to him.

Troy: Yeah. And if they've got that kind of clinic, that'd be great. That'd be a great way to highlight what they're doing there because that's . . . Yeah, if they've got that sort of thing where there are people taking that time with people, I think that would be a good resource to have.

Scot: All right. Is this the point, Troy, you tell us that you actually put these people up to these emails?

Troy: I didn't. I promise. I sometimes joke with Laura that she needs to call in on the listener line and say something, but she never has, as far as I know. I'm like, "Please call the listener line."

I swear I had nothing to do with this. That's really cool to see. I do get occasional emails too. I think I told you about the one I got, the guy who was concerned about rabies and recognized me as a national rabies expert or something. He was like, "I've been handling bats. My family thinks I should get the rabies vaccine. What do you think?"

Mitch: That's such a good story.

Troy: I'm like, "Yeah. I agree."

Mitch: "Go do that."

Troy: "Yeah. Right now. Don't wait."

Scot: That's the nationally recognized rabies expert, Troy Madsen.

Troy: This is what the expert says. Yep.

Scot: Quit playing with bats. Quit dressing them up in little outfits. They're not dogs.

Troy: They're not dogs. They're not mice.

Scot: You can have all sorts of other exotic pets, but bats are not the best choice.

Troy: Don't recommend it.

Scot: All right. Well, those are a couple of interviews that will be coming up. Both of those individuals said they would be open to being on the show.

Troy: Nice.

Mitch: Cool.

Scot: What I'm currently trying to do is just track down who it is that we're going to have them . . .

Troy: Oh, those specific individuals that sent the email?

Scot: What's that?

Troy: The people who sent the email said they'll be on the show?

Scot: Yeah.

Troy: Oh, that's awesome.

Scot: Yeah. Now, we just have to find the right people to have on the show to talk to them, which I think illustrates another interesting component of our healthcare system. I did struggle with that. I'm like, "Oh, is it really a primary care physician?" Because they do know a lot of things and they do get a lot done and there are some that do specialize in that kind of stuff, but infrastructurally wise, they're not really set up to be able to have those conversations with patients because they've got other conversations they have to have.

Troy: Well, Dr. Pohl might be great for both of those, because actually now that you mention her, she may be a great one to talk about fatty liver disease too. It does relate somewhat to weight loss and that optimization. It's one of those things where you don't worry too much about it, but I'm sure she sees it. I'm sure she deals with it. So maybe even ask her on that.

Scot: All right. I'll start reaching out. Those are a couple of episodes to look forward to coming up. And if you want to get a hold of us, you can do so a lot of different ways. Hello@thescoperadio.com. That listener line number, if you'd like to actually leave a voicemail, is . . . what is it? 601-55SCOPE?

Mitch: Yeah.

Troy: Yeah. 601-55SCOPE.

Scot: And you can also go to facebook.com/whocaresmenshealth and you can enter in just a private message to us there if you want to do that as well.

All right, guys. As always, it's a ton of fun talking. Thank you very much to the two listeners that reached out. We're going to go to work for you so we can try to figure out if there are some solutions to your problems.

Thanks for listening. Thanks for caring about men's health.