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Interviewer: Amyloidosis is a rare and possibly debilitating disease, which affects about 4,000 people a year in the United States. If left untreated, the disease can cause severe organ damage, so early detection is critical. Dr. Aman Godara is an amyloidosis specialist at Huntsman Cancer Institute. Dr. Godara, first of all, what causes this disease?

Dr. Godara: So amyloidosis is a rare and complex disease where a protein misshapes itself, becomes the amyloid protein, and then deposits in different organs of the body causing damage.

Interviewer: So it collects in different organs?

Dr. Godara: Correct.

Interviewer: And for each patient, it could be a different organ. It could manifest itself differently.

Dr. Godara: The type of protein that's behind amyloidosis could affect what type of organ is involved in the body.

Interviewer: And the diagnosis for a lot of patients can be kind of an aha moment because it can manifest in different ways. Somebody could be experiencing some sort of abdominal pain and just really can't track down what it is, and it ends up being amyloidosis. Explain that a little bit more, that aha moment.

Dr. Godara: So the diagnosis of amyloidosis can be very challenging because, as we mentioned, there are several different types of protein that can cause several different manifestations in the body.

So usually, when a patient is being diagnosed with amyloidosis, the diagnosis requires a biopsy of an organ or a tissue in the body that we suspect would be involved with the amyloidosis.

There have been some newer developments in diagnosing amyloidosis, and that's the type of a nuclear scan that we have started using to diagnose a type of amyloidosis that we call as the ATTR amyloidosis.

Depending on the type of organ that's being damaged by the amyloidosis, the symptoms could vary along. If someone's heart is being damaged with amyloidosis, usually patients with heart damage from amyloidosis experience shortness of breath, they experience swelling in their legs, and when they go to see a cardiologist, they are usually identified to have heart failure.

When amyloidosis affects the kidneys, it can cause leakage of protein in the urine, which can manifest itself as a form of urine. Sometimes patients with amyloidosis have involvement of their nerves and that can manifest as painful neuropathy involving their arms or their legs.

Interviewer: So when somebody is experiencing some of those symptoms, they might go to their family doctor, right? And it sounds like this could be a lot of different things. Is it pretty easily misdiagnosed at first?

Dr. Godara: As the diagnosis for amyloidosis is so challenging, misdiagnosis occurs often because the type of symptoms that come along with amyloidosis can occur from other diseases and other conditions.

If a patient is experiencing symptoms of heart failure, that could manifest from a different number of reasons. When patients have kidney dysfunction, that can also occur from a list of different conditions that can damage the kidneys.

So often at the point of care, when these patients are experiencing symptoms that might be related to amyloidosis, the patients end up seeing multiple different types of specialists before they are diagnosed with amyloidosis.

And there are certainly some delays in diagnosis that, on an average, patients take 6 to 12 months to be diagnosed with amyloidosis from the time their symptoms start.

Interviewer: And that's important because time is really important with this diagnosis because the damage to that particular organ keeps occurring.

Dr. Godara: The damage from amyloidosis is progressive damage. So the longer we are taking to diagnose amyloidosis, the more damage would occur in that organ that's being affected by this disease. So timely diagnosis is of utmost importance.

Patients who are diagnosed earlier in the course of disease might have damage to that organ that could be reversible at that point. But ultimately, if we miss a diagnosis, and it takes a really long time for a patient to be diagnosed with amyloidosis, that damage to the kidney or to the heart could end up being an irreversible damage that even treatments would not be able to recover from.

Interviewer: That's really challenging because as a person that has a condition, sometimes you have to go through some multiple diagnoses to figure out what it is. Is there any piece of information that a patient might have that would indicate earlier than later that it is an amyloidosis?

Dr. Godara: So patients who are suspected to have amyloidosis usually require a comprehensive evaluation to identify the type of amyloidosis and to identify the manifestations of it. So the workup depends quite a bit on the type of amyloidosis that we are suspecting.

If we are suspecting lichen amyloidosis, that occurs from the excess of lichens, the first and the foremost test that we perform for those patients are blood and urine testing to identify if they have an excess of lichens, which could ultimately be causing amyloidosis.

If patients have an excess of immunoglobulin lichens in their blood or urine, the next step for those patients is to have a bone marrow biopsy to identify any clone in the bone marrow that might be producing these excess lichens and ultimately the amyloidosis.

The other type of amyloidosis that we commonly see is the ATTR amyloidosis, which occurs off a defect in the transthyretin protein that is being produced by the liver. Patients who have ATTR amyloidosis could either be patients who have developed this type of amyloidosis because of old age or this could also be the type of amyloidosis that runs in the family.

So if we are suspecting a patient with ATTR amyloidosis, and we suspect that they have some cardiac damage from it, there is a nuclear scan of the heart that can help us identify this type of amyloidosis. This scan is called as the PYP scan. Patients who have a more genetic form of ATTR amyloidosis, we have genetic testing that can be done either through a swab or a blood test that can help us identify the hereditary type of ATTR amyloidosis.

Interviewer: How reliable are these tests?

Dr. Godara: When patients undergo evaluation for amyloidosis, the blood and the urine testing usually helps indicate whether or not there is any damage that's occurring to the different organs in the body that we would suspect in a patient with amyloidosis. So they only tell us to a certain extent.

Ultimately, patients would require either a tissue biopsy or an organ biopsy to see that amyloid accumulation happening in that organ to have a confirmation of this type of diagnosis.

Interviewer: Many patients find information on the internet when it comes to this disease that can cause anxiety and apprehension. Why is that?

Dr. Godara: I think the answer to that lies in the complexity of the disease. When patients look up amyloidosis, one thing that they might not know at that time is the type of amyloidosis that we are suspecting that they have.

The workup for amyloidosis, the treatment for amyloidosis, and the prognosis of amyloidosis depends a lot on the type of amyloidosis that they have. So the information on the internet might not be very accurate to the fact to the type of amyloidosis that these patients have. And the generalized information can create a lot of confusion and apprehension.

Interviewer: So somebody could find out they have amyloidosis but not exactly know what kind, go to the internet, start doing some research, and then that can be scary place.

Dr. Godara: I think that's correct. When we see patients who are referred to us for amyloidosis, patients have very limited knowledge as to what this disease entails and why this diagnosis is being suspected. So my job for my patients is to explain to them why the suspicion exists, and what do we need to do to identify whether or not they have amyloidosis.

The information that's available for the patients before they have completed the evaluation could be very generalizable and might not be important to that type of amyloidosis that they have.

Interviewer: And let's talk about treatments for the condition. So you have a positive diagnosis, you know what kind it is, you know what it's impacting, I would imagine that the treatments that you would give depend a lot on the same kinds of things we've talked about up until this point.

Dr. Godara: So as there are so many types of amyloidosis that can inflict damage into the body, the treatment basically depends on the type of amyloidosis. So there have been a lot of developments and a lot of exciting work has been done for patients with amyloidosis in the last few years.

So when we see patients with lichen amyloidosis, just last year, we had a treatment that is specifically developed for patients with lichen amyloidosis that was approved by the FDA. This is a combination of four medications together that not only results in eradication of the clone that causes amyloidosis, but also helps improve the heart, kidneys, or any other organs that might have been damaged as a part of this condition.

So patients who have transthyretin amyloidosis have two different types of treatments available for them. One treatment focuses on stabilizing the transthyretin protein and preventing it from turning into amyloidosis. And the other type of treatment targets the liver and prevents it from producing the transthyretin protein, so that ultimately you cut out the source that would be causing amyloidosis.

So there's been a lot of progress and a lot of other new treatments that are in clinical trials for these two types of amyloidosis. For several other types of amyloidosis, we don't have any treatments available yet.

Interviewer: And for those patients, is it just managing the disease best you can, managing the symptoms? What's the strategy?

Dr. Godara: So patients who have types of amyloidosis that we don't have treatments for, our focus remains on the organs that are afflicted from this disease. We try to support the organs that are damaged as a part of amyloidosis, and sometimes these patients will end up receiving a kidney transplant, or a liver transplant, or a heart transplant depending on what type of organ was damaged, irrespective of whether or not we have any treatments available for that type of amyloidosis.

The first and the foremost thing for patients with amyloidosis is to identify these patients at the earliest, because the sooner we take to diagnose this condition, the sooner we can try to reverse this process.

Delays in diagnosis can ultimately hurt the patient, so we have to create awareness at all levels of our healthcare system to identify these patients who might or might not have amyloidosis so that they undergo the appropriate workup and have a confirmation on whether or not they have this condition.

So we need to create awareness not just at the level of the primary care doctor, but also the specialists that our patients see. And at the same time, we also have to increase the awareness about this rare disease with our patients, so that if they have one of the symptoms that we relate with this condition, our patients can come to us and be evaluated for the suspicion.

The one thing that patients with amyloidosis require is a comprehensive evaluation. So when we suspect amyloidosis in a patient, our patients require a multidisciplinary team to not just help identify whether or not they have amyloidosis, but also once the diagnosis has been confirmed, we can focus not just on the cause of what's causing the amyloidosis but also help support the organs that are damaged as a part of this disease.

So at the Amyloidosis Program at Huntsman Cancer Institute, our patients receive care under a team of specialists that includes representation from cardiology, nephrology, and neurology to provide the best possible care that our patients need.

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: Welcome to the "Who Cares About Men's Health" Sideshow. This is a fun little episode we're excited about. Survival tips, fact or fiction. You've heard these before. Don't eat snow, because if you do, it'll make you more dehydrated. To prevent hypothermia, you've got to get in a sleeping bag with somebody else naked. And then this is a good one. After an avalanche, what you should do if you get covered by snow is spit so you know which way to dig to escape. We're going to find out if those are true or not.

My name is Scot Singpiel. On "Who Cares About Men's Health," I bring the BS to the show. And the MD to my BS is Dr. Troy Madsen.

Troy: Hey, Scot. I am so excited for this because I've heard these myths and I want answers.

Scot: And Producer Mitch is in the mix.

Mitch: Hey. I also want to know if I should butter my burns at some point. That's what I keep hearing.

Scot: Oh, okay. Well, our guest, Graham BZ. Is that your last name? BZ? That's what we're calling you.

Dr. BZ: My last name is Brant-Zawadzki, but it's long and terrible, so BZ is much more . . .

Scot: Yeah, it's cool.

Troy: I have to say this, too. Scot has this fear, like this deep fear of mispronouncing people's last names. I was so excited for him to pronounce your last name. And then he just totally glossed over it. So I'm disappointed.

Scot: Well, I didn't even know what it was. Even his email says Graham BZ, so I didn't know what his last name was. I thought, "I don't know." So here we are.

Troy: Made it too easy for you, Scot.

Scot: Anyway, he is an interesting doctor that practices mountain medicine, and that's actually a thing. What exactly is mountain medicine?

Dr. BZ: So mountain medicine is a subset under wilderness medicine, which is a larger umbrella term, and it all refers to medicine in an austere environment. I'm part of the Wilderness Medical Society, and you'd be surprised how hard it is to come up with a good definition for what wilderness medicine really is. But it's basically when we're providing medical care beyond the scope of your typical medical system and infrastructure.

Scot: All right. And I actually went to the WMS, the Wilderness Medical Society website, because I was trying to figure out exactly what it was you did. They have a definition there. "Wilderness medicine, also known as expedition medicine, is a practice of medicine where definitive care is more than one hour away and often days to weeks away. Defined by difficult patient access, limited equipment, environmental extremes. Decision-making, creative thinking, and improvising are required." So does that sound fair?

Dr. BZ: That is fair. I will tell you that I'm part of a committee to currently update that definition. But I think that that pretty much sums it up adequately for now.

Mitch: Graham, when it comes to expedition medicine, all these cool terms, what's some of the cool stuff that you get to do?

Dr. BZ: I think the best teaching case or one of the most influential cases for me was actually we were training some Peruvian mountain guides down in Peru. It's kind of a train-the-trainer model where we go and train the mountain guys and then they go on and train these other folks within their own country.

And the course that I went to, we basically hike into the base of this 18,000-foot peak, and the base camp is at about 15,000, so it's pretty high altitude. And some of these folks flew straight up from Lima, which is sea level, into Cusco and didn't really take the proper precautions in terms of acclimatizing before coming up.

And so one of our cohorts developed pretty severe HAPE, which is high altitude acute pulmonary edema, and required more than just oxygen. So we actually had to deploy what's called a Gamow bag, which is a positive-pressure, kind of an inflatable, almost like a sleeping bag that you kind of crawl into and then pressurize.

We learn about that a lot as students, especially in wilderness medicine, but what we don't learn about is just how much effort it takes to maintain pressure in this bag. Basically, think about using a bike pump, or even a foot pump. You can use both. And you're continuously pumping nonstop for hours to maintain this pressure.

Scot: To keep a person alive?

Dr. BZ: To keep a person alive and to keep this person . . .

Scot: Wow.

Dr. BZ: Yeah. To keep their oxygen saturation up, you're just continuously pumping and pressurizing this bag. And the idea is that you do that to temporize them to a helicopter evacuation, or at least just improve them enough so that they can then get down on their own.

So for about four hours at 2:00 in the morning, we're all just sitting there pumping and keeping this bag pressurized so this person could oxygenate themselves and improve a bit enough to get walked out.

The whole experience was definitely a humbling one. And then trying to get this poor person hiked out to . . . I think it was about a four- or five-mile hike down to where we could actually access a vehicle and then get him out from there.

Scot: And all of that happened because this individual went from sea level to 15,000 feet too fast without actually taking intermediate steps to get their body used to it.

Dr. BZ: Exactly.

Scot: Wow. And how long would that normally take to get used to something like that?

Dr. BZ: So there are different . . . It kind of depends on your strategy. There are different strategies for acclimatization. For the course we were doing, we would recommend up to two weeks to really properly acclimatize. I think taking up to four to six days for that level of transition is kind of the minimum that you'd recommend.

Scot: All right. Let's get to it. Let's get to these myths here, these questions. We're going to throw these out here and I thought maybe we could all just kind of play along. Now, I don't know, Troy, if you know some of these answers since you've got the MD here. Don't participate. But Mitch . . .

Troy: I don't. That's why I want to know the answers. Yeah, these are questions we've talked about and I've heard these, and some of these, I'm really curious.

Scot: All right. So the first one, don't eat snow if you're out in the wilderness and you don't have any water because it'll actually make you more dehydrated. So this is one of those situations maybe you're out, it's wintertime, you've run out of water, you're not near a water source, you're not near your car, and you need to survive. Should you eat snow or not? This says you should not. I think that sounds silly. That's my take. Mitch, what do you think?

Mitch: I guess I don't understand how it would make you more dehydrated. For me, that's the thing. It's water. It's just super cold water, right? What on earth is in the snow that's going to make you more dehydrated?

It's like when coconut water came out. Does anyone remember when the coconut water craze was going? I was doing some volunteer work up at Sundance, and the lady I was working with, she's like, "Oh, coconut water hydrates you better than water." And I'm like, "That doesn't make any sense." So on the flip side, we now have snow and I'm like, "How does it dehydrate you if it's water?"

Troy: Well, this is what I've heard, though, Mitch. The rationale is that the water content of snow is so low, especially here in Utah where it's super dry, that it takes more effort and uses more energy to produce than water, just like putting snow in your mouth, than it really produces water. So that's the rationale I've heard. I don't know if that's true, but that's what I've heard.

Scot: All right. We heard Graham chuckling a couple of times, so we'll see if that's his tell or not. Is that true? True or not?

Troy: Yeah, what's the word?

Dr. BZ: I don't think anyone has ever looked at drinking snow in the Sierras versus Utah and wondered if they're . . .

Mitch: "Is it dryer?"

Dr. BZ: Yeah, exactly. But I think Troy is pretty spot on. So the problem with . . . Snow is mostly air, especially again here in Utah. So you'd need to eat about, I think, 8 to 10 quarts of snow to meet the same amount of just liquid water.

Again, it's much colder the body temperature, so every time you're putting that snow in your mouth, your body is spending energy to melt that snow so that you can drink it, and that burns calories. In the end, it does consume more total body volume water than you actually are receiving for it. So point to Troy. That is right.

Troy: So this is true. I'm going to say I can't take credit for this because I never would've believed it, and then I saw it in a Sundance film. And in this Sundance film, these guys were lost out in the snow, and one guy said to the other guy . . . This guy was super dehydrated. He was like, "You can't eat the snow. It's going to make you more dehydrated. It just takes up too much energy. You can't do it." And I was like, "That's stupid."

Then I thought about it more and I was like, "Maybe it makes sense." It's true. You just don't get a lot of water out of snow. The water content is really low.

Scot: And to make the connection, burning energy requires, in that chemical process, water is what we're saying, right? That's why it uses more water.

Dr. BZ: Correct. That's exactly right.

Scot: Okay. Yeah. Got to go back to my cellular biology class that I never took. So what should you do instead?

Dr. BZ: So what you want to do is you want to find another way to melt the snow that's not using your own body's energy. So if you can heat the snow up in any way, even just leaving it in the sun in a spot where it can be melted, then you can drink the liquid melted snow and that's going to be the best way you can hydrate.

Troy: I'm going to ask this because I know Scot is thinking it. What if you had a container and you filled it with snow and then you peed on the snow?

Scot: What?

Mitch: What?

Troy: And then the warmth from the urine . . . You're going to have some urine in there. Is that just going to be useless? Is it going to be just too . . .

Scot: You pee on the container if you've got the container, and then hopefully the heat transmits.

Troy: I don't know. Do you think it would?

Dr. BZ: That is an excellent question. So it would depend on how dehydrated your urine was to begin with, I think, because dilute urine is . . . You're still going to be able to pull . . . We always get asked this. "Can you drink your urine if you're dehydrated?" And the answer is if you're coming from a hydrated status . . . Well, an answer, I should say. If you're hydrated, you can kind of drink your urine over a couple of cycles before it really starts ruining your kidneys and other things as you're getting more and more distillate.

So if you're pretty hydrated to begin with, that's already urine that you've heated up and you've used those calories already. You might as well put it in the snow and dilute that urine a bit. And if you're in dire straits, I think that's an ingenious way to potentially temporarily hydrate yourself.

Troy: So maybe it would work then.

Dr. BZ: Yeah, I'd say.

Troy: It's better than drinking your urine, it sounds like. At least if you have a big old thing of snow and you can pee in it or . . . I don't know. Again, hypothetical here. I'm not recommending it.

Dr. BZ: I think last resort Hail Mary kind of stuff.

Troy: Yeah, don't do this every time you're out skiing.

Scot: Try to use the sun's energy first, I think, would be a good . . .

Dr. BZ: I was going to say, if you're going to use a container to try to melt snow, you want the back half of that container to be . . . Use dark clothing or something that's reflective so that that energy isn't just passing through the snow. You're kind of trapping heat energy in that container as well.

Scot: Oh, okay. Yeah, that makes sense.

Troy: Kind of dark container or something there. Okay. That makes sense. Yeah.

Scot: All right. Myth number two. To prevent hypothermia, you need to get the person who has hypothermia naked into a sleeping bag, and that body temperature helps warm them up, as opposed to just getting in clothed because you wouldn't be transmitting enough heat. So the question is, is that just a clever pickup line, or is that a legitimate survival strategy, Graham?

Dr. BZ: I don't want to discourage anyone from crawling into a sleeping bag naked with another person, if that's what seems like the right thing to do. But it will help. It'll definitely help warm someone up faster than just putting them in a sleeping bag and clothes by themselves because you're going to help transmit . . . Again, you're going to help heat that sleeping bag and help raise the temperature of that environment faster. So getting into that sleeping bag with that person will definitely help.

The reason we say get in naked is because the way a sleeping bag works is it radiates heat back at you. And if you're wearing a lot of clothes together, then you're kind of trapping heat under your clothes and it's not radiating to that person as effectively.

So technically, yes, that would be the fastest way to warm someone up. Do you need to do that? Probably not. There are, again, other ways to do it. I think putting someone in a sleeping bag with a heated bottle of water or another heat source can act in the same way.

Really, the best thing to do to warm someone up if they're not comatose, if they're still awake and alert, is to use their own body's thermodynamics. So get them active. Get them doing jumping jacks. Get them moving. If they are in the sleeping bag, have them moving up and down and doing kind of snow angels in that sleeping bag as much as possible to help burn calories as well from the inside.

So I hate to say it, but if you're going to be in a sleeping bag with someone, you also want to be active in that sleeping bag.

Troy: There's just so much more to this. This is one of the things I heard too. This is one they teach in Boy Scouts. It's like, "If this ever happens, you have to . . ." It's just like, "Huh, okay."

But it sounds like there are other alternatives and maybe better alternatives, like you said, like a heated water bottle or something like that to really get the job done. But it sounds like it makes sense if you're in that situation and you have to do it.

Dr. BZ: And again, totally naked is probably a bit dramatic. You don't want to be both in a sleeping bag but also covered in all your winter gear. If you're in long johns and underwear, that will be equally as effective.

Scot: All right. Question number three. After an avalanche, if you get trapped in an avalanche, in order to know which way to dig to escape, you should spit because then the spit is going to go down, because that's what gravity does. It pulls things down. Mitch, what do you think? Yes or no?

Mitch: When we were doing our pre-production, it was the first time I've ever heard of this. And I guess I never would have thought to . . . I guess you would get all turned around, but spitting is the last thing I would think of doing to try to figure out which way was up or down. I guess that's my first question. When trapped in an avalanche, do you get tossed around enough that you don't know which way to dig?

Scot: Yeah, hold on that answer, Graham. Let's go to Troy.

Troy: This is one I have heard for years. I don't know if it's also one of those things people just say, but it does make sense. If you're tossed around in an avalanche, you may not know which way is up. And I've heard that if you want to know which way is up, spit, because then if the spit just falls back on your face, you know your face is facing up, and if it falls to one side, you know the other way is up. If it falls straight down, you know that up is back behind your head.

Obviously, there are certain logistical issues if you are trapped in an avalanche, so that's probably the bigger question. But I'm curious, Graham. Is this something you've heard or something you've ever recommended?

Dr. BZ: So I think the bigger question . . . The first question is, can you get tumbled around enough to not know which way is up or down? I've never been in an avalanche, but talking to those who have, the answer is absolutely yes. I mean, if you've ever been just even in a whiteout, you can kind of get vertigo and lose your sense of your body in space. So you can definitely be disoriented like that.

The bigger question is what can you actually do about it. So we talked a bit about how snow is roughly one-tenth the density of water. And that, again, varies by the type of snow and where you are and how dry it is, etc.

But when you think about an avalanche . . . So snow just sitting on the ground is maybe, let's say, one-tenth the density of water. Once that avalanche is set off and all that snow is sliding down the hill and then sets at the bottom, all that snow is now compacted and the density has increased. It's at least doubled. There are some studies that show that it can go significantly more than that. And so that snow is no longer that nice, fluffy Utah powder we like to play in. That is now basically, for all intents and purposes, concrete.

And so even if you knew which way was up or down, the ability to dig yourself out is more or less impossible. Just being under a foot of cubic snow can translate into hundreds of pounds that are on your body.

And so I think a better way to know which way to dig out is if you can move any part of your body, it's probably under the least amount of snow. Or if it's even sticking out of the snow, that's the direction you'd want to go if you can move anything.

But what unfortunately kills a lot of avalanche victims, even those that are only partially buried, meaning that a part of their body is still sticking out of the snow or just very shallow, a shallow burial, is even in a shallow burial, people just can't dig themselves out. They don't have the ability.

Troy: That's an interesting thing too. Graham, I think we often have this image that people get covered in avalanches and they get tossed around and hit trees and rocks and they die from that. I think you kind of alluded to it a little bit there. What percent of people actually die from that versus just die because they're stuck there and they just can't get out?

Dr. BZ: Yeah, that's a great question, Troy. We looked at this locally here in Utah. And what happens is we actually compare a lot of our avalanche data in the U.S. and North America to European data and we see a stark difference in the rates of trauma for that exact reason.

A lot of avalanches in backcountry terrain and the Alps and other parts of Europe happen well above treeline, and so there are a lot fewer obstacles to strike, such as trees, boulders, things like that. And so we see a lot more deaths that are due to purely asphyxiation from suffocation under the snow versus patients here in the U.S. where maybe the rescuers get to them in time but they've suffered severe traumatic injuries, which have led to their decline.

So it's a great question. We see a much higher incidence of trauma with avalanche here in North America than in some other parts of the world.

Troy: Interesting. It sounds like, bottom line, you can spit if you want to spit. Maybe that will let you know which way is up. But it sounds like the more . . .

Scot: Just end up having a wet face.

Troy: Going to have a wet face. Yeah, it's probably not going to help a whole lot. But yeah, I like what you said there about if there's a body part that moves, it's probably by the surface or it's not covered, and if you can move any direction, that's the direction you want to go.

Dr. BZ: Exactly. If you are in that phase where maybe the slide is slowing but hasn't fully set up yet and you can still move any part of your body . . . You've probably heard of this idea of swimming with the avalanche, and that actually has a lot of credence.

We know that larger particles float to the top. If you think of an avalanche, it's kind of laminar flow of particles.

So the same way we call it the Brazil nut effect, that in a bag of nuts the bigger nuts always float to the top, or in granola, the bigger clumps are always at the top. And by the time you're at the end of the bag, it's all the crumbs at the bottom.

The same thing happens in an avalanche. So you want to make yourself as big as possible and you want to try to push all those particles, as many as you can, below you so you can float on top. So if you can do that to stay shallow in the pack, that's great.

And then another thing to do is, as a last resort, try to make as much space around your head to make a pocket of air that you can use to survive longer than you might otherwise.

So one of the things we look for in avalanche rescue to determine if a patient has a better chance of survival is if they have an air pocket around their face or if there's any snow impacted in their mouth. Because if there's snow in the mouth, or what we call an ice mask, where the snow in front of the face is kind of melted and then refrozen and sealed off, then that patient has a lot lower chance of survival because they've had less air to breathe while waiting for rescue.

Troy: So it sounds like just keep moving if you can move.

Dr. BZ: Yeah. Move as much as you can, as long as you can.

Troy: As long as you can, yeah. Hopefully, none of us are ever in that situation.

Scot: It sounds terrifying.

Troy: Absolutely horrible. Yeah, it just sounds awful.

Dr. BZ: I will say that the more I've learned about avalanche safety and snow science, I thought I would be able to use that to go further in the backcountry and do cooler things, and it's had the exact opposite effect. I'm much more conservative than I ever was before I recognized the danger.

Scot: Now that you know.

Troy: I can imagine.

Scot: The danger is more than what the average layperson realizes, then, is what I'm getting from you.

Dr. BZ: Yeah. I think we've made a lot of strides in avalanche science and snow safety, and we have these decision rules people use and what we call obvious clues where people look at terrain features and try to determine what the risk of an avalanche is. And those are all fantastic things.

But I think they also sometimes give people a false sense of security in terms of thinking that they can't be in an avalanche if those rules say that it's safe, but the opposite is true. An avalanche can happen anywhere at any time. I think a lot of us get very lucky when we're recreating in the backcountry, and we think that translates into good choices when it's just the luck that nature provided us that day.

Scot: Graham, thank you so much for coming on the show and using some of your mountain medicine experience to talk us through these rumors, and some good tips there too for any of our listeners that might happen to like to go out and recreate in the backcountry. We sure appreciate you being on the show. Thanks for listening and thanks for caring about men's health.

Dr. BZ: Thank you so much. Thanks for having me.

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 S: Today's episode of "Who Cares About Men's Health" is for guys who are doing pretty well with their health but maybe would like to do a little bit better and have been struggling to make progress. Who do you go see? Who can help you accomplish your goal? Is it a primary care physician? A nutritionist? A fitness bro with a YouTube channel?

This is "Who Cares About Men's Health," providing information, inspiration, and a different interpretation about men's health. We've got a great cast here today. First of all, he is the man that brings the MD. It's my co-host from the emergency, Dr. Troy Madsen.

Troy: I'm trying to think of something that rhymes with "C," but I don't have anything, Scot. But yeah, it's me.

Scot S: All right, and I'm Scot Singpiel. I bring the BS and ask the dumb questions so you don't have to. Producer Mitch is in the mix. Hey, Producer Mitch.

Mitch: Hey there.

Scot S: All right. Then we've got our all-around baller shot-caller with a PhD in eatology. It's Thunder Jalili.

Thunder: Hey, guys.

Scot S: And our guest today is a listener. He sent in a listener email and had some questions, so we're going to try to answer them as good as we can. It's an interesting situation that Scot has. Scot, how are you doing so far? Doing all right?

Scot: I'm doing all right. Glad to be here.

Scot S: Scot, tell us a little bit about what your situation was so we can set the stage for the conversation.

Scot: So my situation is I'm a mid-30s male. I'm in pretty decent health. I'm able to go running once or twice a week. I can run five kilometers at a time. They're not terribly fast, but they're not terribly slow. I do some biking. Back in the before times, I would go swimming. Two years ago, I did a sprint triathlon and I finished it, which was my goal. So things are going pretty well.

But I have a knee that doesn't really behave much beyond five kilometers. I weigh a little too much. Just kind of a lot of things that are a little bit off. My blood pressure is always up a little bit, no matter how much I exercise it seems. So just kind of everything is a little bit off.

And when I went and talked to my primary care physician about it, he pretty much just said, "If I bothered every person that came in here with a BMI of 26, that's all I would do every day," and kind of pushed me out the door. And so I sent in the question wondering, "Well, if it's not my primary care physician, who should I go see? Is it a physical therapist or whatever?" And now I'm here.

Scot S: All right. Fantastic. Hey, Troy, do you want to give the synopsis à la medical style like you would?

Troy: That's right. This is like residents when they see a patient that they come and present to me, and I would basically present Scot's case as a male in his mid-30s. He has a BMI of 26.6, which is a little overweight, with a BMI of 25 being that overweight category. Reports a blood pressure of 128 over 75, which that top number maybe a little on the high side by NIH standards. It's a little bit above 120, so maybe a little bit elevated. He sounds like he exercises fairly regularly, runs a 5k once or twice a week. He bikes. He says he can do five pull-ups.

Scot S: That's pretty impressive actually. Maybe we spend the rest of the episode talking about that.

Troy: Seriously. Yeah, five pull-ups.

Mitch: When I first read the email, I'm like, "Scot, it is the same story with me." Even down to the little bit of BMI, the running, whatever. But when it said five pull-ups, I'm like, "That's not me."

Troy: That's right. Mitch, similar to you, he does report some knee pain if he tries to run a little bit farther than 7k. So I know you've had some knee pain. You've had some ankle issues as well.

Well, I guess, Scot, is there . . . I think the first question is for you. Was there something that prompted you to really say, "Hey, okay, this is all right, but I want things to be better"? What was it that made you think this and start asking these questions?

Scot: I guess it's just kind of been over 10 to 15 years of adult life nothing has really changed. My weight has stayed at about 180. Sometimes it goes down a little, sometimes it goes up a little, but it kind of tends towards the mean.

Some thoughts of, "I'm getting older, and if I could get this under control now it might make life easier in the future instead of trying to be 55 or 60 and like, 'Oh, no, retirement is coming up and I'm going to be on the beach every day. I'd better start working on that.'" I don't think it would work. So it was really just a "nothing really seems to be working."

I guess I should state that as far as diets and exercise and stuff goes, I haven't tried anything extreme. So I haven't tried any of the "cut out all of the carbs" or "cut out all of the meat" or "only eat smoothies." I haven't done any crazy exercise regimes just because . . . It's important, but I don't want it to become my personality.

Scot S: Thunder, what's your take on that?

Thunder: Actually, I had just a couple of questions about the diet/exercise component of what you were doing. I have a general sense of it kind of in broad strokes, but could you give me a little bit of color? When you exercise . . . so it sounds like you run a couple of times a week. Is that the main thing you do? Or what else do you do to kind of burn calories, so to speak?

Scot: So that really is the main thing. I'm an office worker, so I do a lot of sitting, like exclusively sitting. So there's playing with kids and exercise. Before the pandemic, before I was working at home, I would walk to work, which was about a kilometer there and a kilometer back, which was nice.

That's pretty much it as far as . . . The exercise is the real thing. Other than that, it's just kind of walking around if we happen to go for a walk or do some yard work or whatever. It's just kind of incidental caloric burn.

Scot S: So are you going to put him on some extreme exercise program now and diet, Thunder?

Thunder: Yeah, we're going to start with the weighted vest for 24 hours a day.

Troy: But I think . . . yeah, go ahead, Thunder.

Thunder: Thank you for sharing that. One thing you mentioned that I think is great is you said you try to play with kids and walk around and do some of this kind of ancillary exercise. People don't consider that exercise, but actually, it is activity, and all that stuff counts.

So my other question is about the diet side of things. You mentioned you haven't tried anything extreme, but how would you characterize your diet in terms of variety of foods? Do you kind eat like a little everything, or are there things you don't like? And how do you feel about it? How much processed foods or fast foods do you typically have in your diet?

Scot: So I feel like we do pretty well. We generally don't have any sodas, just kind of as a matter of course. Throughout the day, it's pretty varied. However, we do lean much more towards the pasta and carbohydrate side of the spectrum than meat-heavy, but that's not to say . . . We usually end up getting a serving of meat in per day. We like eggs, so there's a decent amount of eggs involved.

Breakfasts are probably an . . . well, it's a guilty pleasure essentially because I don't really like waking up, so it's just "get up, get a bowl of sugary cereal, and be done." But that's more out of convenience than anything else.

Thunder: And are you a snacker?

Scot: So throughout the day, no, but it's not uncommon for me to have a snack with my young kids in the morning or the afternoon, but generally not both. It's apples and the goldfish crackers and a little bit of that.

Troy: What about sodas? I know, Thunder, you've talked about this before. Do you drink a lot of sodas or how does that factor into your diet?

Scot: Essentially next to none. Sometimes for birthdays or whatever it's nice to grab a ginger beer or something like that, some sort of fancy soda. So it's like a bottle or two a year.

Troy: You're doing great there.

Thunder: Yeah, great.

Scot S: And that was one of Scot's frustrations, is that he feels like he's kind of done those easy things. Not to say that you shouldn't ask about those easy things, but cutting out soda, that sort of stuff, and still not seeing . . .

Troy: Yeah, the obvious stuff is . . . he's really taken care of it.

Thunder Before we get into it, just as a little encouragement, it sounds like you eat fairly well. You try to exercise. You're really not that overweight. So don't get too down on yourself, right?

Now, having said that, a couple of things that I would think about if I were you. One is maybe some different kinds of exercise. It doesn't necessarily have to take more time out of your day, but it could be perhaps more efficient and maybe more targeted towards building strength and burning calories.

If you have any interest at all in ever going to a gym, and some people don't and that's totally fine, it'd be a great idea to hire a personal trainer for a couple of sessions. They're really good about giving you ideas of what kinds of exercises to do, how to use certain machinery, and just doing things that are maybe different, instead of just going to the gym like most guys and bench pressing and doing arm curls or something. But resistance exercise actually is good for your whole body. So that's one thought.

If you don't like that, then there are other ways to incorporate more exercise into what you do. Recognizing your knee limitation, I don't know if you can run more than twice a week, but that would be one option. Biking is actually a great alternative to that because, obviously, it's low impact and it can take about the same amount of time as running.

Scot S: How many minutes of exercise do you think you get a week?

Scot: Somewhere between 90 and 120, so an hour and a half to two hours.

Scot S: That's kind of in the ballpark, isn't it, Thunder?

Thunder: I think . . .

Scot S: A little higher?

Thunder: I think if it would be higher, it would be better just in terms of what I've learned about your weight goals and your health goals. I think if you did a little more, it'd be better.

Scot S: And that would be maybe just short-term to kind of get the extra weight off and then you could go back to a maintenance? I know time is important. He doesn't really want to invest a ton more time.

Thunder: I know. See, this is the tough part. I'll be honest with you, Scot. The way human beings are built . . . you look at the human being of 10,000 years ago, even 5,000 years ago, even now, primitive cultures, they spend a lot of physical activity, a lot of calorie expenditure, in the effort to procure and prepare food. That may take hours, right? And so they don't exercise per se, but just the act of getting food is a tremendous amount of exercise.

Now you fast forward to a modern society where we don't have to do that. We can just go to a store or go to a restaurant and we're just handed something. We cut out all that other stuff.

So when you try to incorporate exercise kind of in the modern sense, you've got to try to make up a little bit for all that lost calorie expenditure that we had in the past that we don't have to do anymore.

So having said that, probably you want to shoot for more than that 90 minutes or two hours a week. If you don't, it's just going to be harder to maintain your body weight.

Scot S: What's the number you're looking at? 210? Is it 30 minutes a day?

Thunder: Yeah, I would say 30 minutes a day is what I would recommend, just the baseline. It doesn't have to be every day. You could take a couple of days off and maybe do an hour five days a week, something like that. But the reality is you have to just have a little bit more of that activity in there, because we're just not built to maintain body weight on just a little bit of activity.

Scot: So when you're talking about activity, what are we really looking at? So when I was giving you the minutes, I was meaning . . . not really counting in the warm up, cool down, get done running and now walk for 10 minutes to cool down.

And when you're talking about other exercises, what should I really be looking for? Is it really just the fact that I am exercising? Or if we're talking about a pulse, are we wanting to get the pulse up above a certain level? Because my pulse is a lot higher when I'm running versus when I'm biking, but is a minute of running and a minute of biking comparable?

Troy: Scot, I'm going to give the quote that I know everyone loves. This is the Matthew McConaughey rule. I've quoted Matthew McConaughey before. His rule of thumb, which I love, is he says just do something every day that makes you sweat. And he doesn't . . . obviously, I'm sure he has a personal trainer and all kinds of other things, but there's something to be said for that, about not worrying about metrics and pulse and this and that.

I think if you can do something every day for 30 minutes, whether it's biking or running or a vigorous walk, or maybe it's, like Thunder said, doing some resistance training. Maybe you don't like going to the gym. So maybe if there's a way you can stand and do just some free weights or something while you're working. I think anything you can do just once a day that's incorporating it to get your heart rate up a bit, I think that makes a huge difference.

Scot S: Let me also throw in there too. So I have two or three kettlebells in my office, and every 50 minutes . . . Do you try to stand up every hour? I mean, I try to stand up every 50 minutes, every 55 minutes. But I take that 5 or 10 minutes and I'll do some push-ups or I'll grab those kettlebells, and it's called the rack position and I'll do some squats or something, some of those big muscle exercises.

Troy, you can tell me if I'm making this up, but I thought that there was some research out there that said exercise doesn't have to be the continual 30 minutes. You can do little exercise snacks. You could have a little five-minute session where you do some squats and deadlifts, some overhead presses with those kettlebells, and then go back to work. I find it gets my brain going again. It wakes me up and I'm better equipped to take that next hour or so.

Thunder: Can I add a couple of other perhaps easy things?

Scot: Sure.

Thunder: Scot, you like to go on after-dinner walks? That's an easy thing to do.

Scot: I do like to do that. Sometimes it's difficult with the little kids because we're all kind of getting tired and grumpy, but yes, we do like doing that.

Thunder: Yeah, so that's an easy one. I always encourage people to maybe do some of their own chores around the house. I mean, I know in my neighborhood everybody hires someone to do their lawn. I'm like the only one in a five-mile area that actually does his own lawn, but it makes me sweat, getting to Troy's point. So things like that, because it does add up.

Troy: And I think a great thing too . . . A couple of points here. Thunder, you talked about be sure and give yourself credit. You really are doing a good job. Obviously, you want to optimize things, but you're doing very well. You're doing a lot of exercise. It sounds like you've really focused on some of the big things on diet.

But I think it's really important . . . you mentioned, "I haven't done any crazy diets. I'm not doing any super extreme exercise stuff." And I worry sometimes that we feel like we have to do those things to really get healthy. But I think if you can just say, "Hey, this is where I am. What can I do to just do something every day?" Right now, you're doing stuff a few times a week. Is there a way you can incorporate stuff into just your daily routine, anything just to get 20 to 30 minutes of getting your heart rate up a bit just once a day every day? I'm sure after a month of doing that you'll start to see some returns from that.

Scot: Okay, that sounds good. I mean, while we were talking about it, I was worrying like, "Okay, this kind of sounds like, 'Do a little bit more and you'll see essentially more of the same.'" But I hope that there can be differences after a month or two of more consistent activity through the day.

Troy: Yeah, and I think that's important too, because a lot of times we jump in and we want to do something and we want to see results fairly quickly. But I think if you just say, "Hey, I'm going to do this, and I'm going to do something now every day where I've been doing something a few times a week, and I'm going to give it four weeks, and then I'm going to reevaluate and see where things are," I think it's important to do that just to make that commitment, that four-week commitment.

And again, just looking at where you are now, looking at how successful you've been to this point, and then just thinking adding that little more. You figure if you can do something every day you're going to increase your . . . at least those times your heart rate is up, you're going to increase that by at least 50% a week in terms of total time. I'm sure you're going to see some results with that.

Scot S: So I feel like we've talked about the physical part of the equation. Thunder, is there a nutritional part that you would like to explore a little bit further? And then I want both of you gentlemen to think about if there's anything else.

Thunder: Thanks, Scot. So yeah, there are a couple of things with nutrition that come to mind. One thing that I ask people to evaluate in their own diet, and I haven't obviously seen your diet in detail. I just kind of know the broad strokes. But what are your portion sizes? Think about that. Are they just right? Are they a little much? Are they chronically too low? That actually can be a bad thing, because if you're always kind of semi-starving yourself you're actually reducing your metabolic rate and it'll make it easier to gain weight and harder to lose weight. So portion size is one thing to consider.

And the other thing to consider is how much meat and animal products you eat. Now, I'm not telling you that you have to be a complete vegan or anything, but people who eat less meat also tend to have a little easier time maintaining their body weight.

And actually, I know Troy has had some personal experiences with this, so he can perhaps share a personal story. But I know when I went to a lower meat diet, I think I lost like a couple of pounds, which doesn't sound like a lot, but on me a couple of pounds is a lot, and right away. And it never really came back as I kind of kept that vegetarian or semi-vegetarian approach. So that's another thing to think about as you look at your own diet.

Then the last thing is think about visiting a dietitian. And I'm saying this because one of the things you were kind of a little disgruntled with is, "I don't have any time to talk to my physician. I don't know where to go for some of this information." If you talk with a dietician, if you book an appointment with a dietitian, they will give you half an hour or an hour as part of your appointment and you can just talk. You can ask them questions. You can tell them about your diet. You can get their opinion. That time is there for you.

I think that's something that you just don't find in the modern medical system, because a doctor may only have 10 or 15 minutes or whatever to see you, or 20 minutes, and then he has to move on to the next patient who perhaps is much sicker than you and actually needs the attention. So I would consider the dietitian.

Scot: I have a question about the first point that you brought up as far as portion sizes. I haven't done calorie counting or anything like that, because it's kind of hard when you're preparing your own food. I mean, if it comes from a box, it's pretty easy to look on the box and say, "I ate this much." So as far as portion sizes, I just try and make it so that I stop eating before I'm full, and that's kind of just been how I've been doing it. But I do recognize I could probably eat a little bit less without starving myself, which is probably something that needs to happen.

Thunder: That's a very intelligent way of going about it, stopping to eat before you're completely full. And another trick is perhaps try to eat a little slower. Again, I have no idea if you're a slow eater or a fast eater, but that's another approach that I know people have used.

Scot S: And smaller plates too. I use a smaller plate. You get those big dinner plates. I take the next size down and I find that . . . Because you see the big plate, and you want to fill that plate with food. Otherwise, it doesn't look right. So that might be another thing.

I know that some of the stuff we're talking about kind of . . . What's your honest opinion of it, Scot? Do you just kind of feel like it's more of the same? Or do you feel like, "Oh, these are dumb. These things won't work. They're too easy"? Where are you at?

Scot: I was expecting a little bit more of like a cheerleader type thing of, "Yeah, you can totally do it." Whereas I feel like we've touched several times about, "Yeah, you should just be chill. You should be happy for where you're at right now."

But it is nice to sit here and talk and have people say, "Hey, when you get up from your chair while you're working, if you just do some push-ups, grab some weights, do something, get your heart rate up for a couple of minutes, you might actually see some changes." That is something that I have not really tried. And so I'm excited to try that out.

Troy: Yeah, I guarantee you'll see differences here, Scot. And it doesn't have to be a dramatic effort. Thunder kind of alluded to this a little bit, and I've talked a little bit about my experience previously. My big issue was my cholesterol. My cholesterol levels were surprisingly high when I got them checked. And so I tried a vegetarian diet, which I've continued now for many years, and that definitely helped.

And then I got to a point where I just started . . . you said you're doing a 5k a few times a week. I just said, "I'm going to try and run just two miles a day." So just two miles a day every day. And I said, "I'm going to do that every day because then I don't have an excuse not to do it," because I'm like, "Well, I do it every day." And I found that just made such a big difference doing that and just trying to incorporate that. Then it allowed me to look and say, "Well, this is where I am. Can I increase this?" and then kind of build from there.

But I think these small changes . . . again, looking where you are now and just making a small change to increase that to every day, something to get your heart rate up, something to make you sweat, get working out a little bit, I definitely think you're going to see a difference with that.

Like Thunder talked about, maybe some things with your diet as well you can look at there and maybe portion size, maybe not eating until you're completely full, things like that.

And again, in your situation, we're kind of talking about fine-tuning things. Again, I know your primary care physician said you're doing well, and I think you are doing really well, but I also see exactly where you're coming from and I think this will help you get more to optimizing things.

Thunder: Hey, Scot. In full honesty, I actually exercise every day like Troy. Six to seven days a week I'll do something. So like I said, there's sometimes no substitute for volume because our bodies are kind of meant for a lot more activity. It's just that our context of our modern society makes it kind of tough. So that's something to consider.

But really talking with a dietitian, you'll get a lot more of what we're doing here and really a chance to explore the nuances of your diet that I don't think we could do on a show, because I'm not looking at your five-day food diary or anything to have specifics to kind of jump on.

Scot S: Hey, Troy. I got a question for you. So if Scot tries to amp the activity up to 30 minutes a day and then goes to a dietician and finds a few little small changes in the diet, is that going to help the blood pressure? I mean, I think we all can agree those types of changes could eventually help the BMI and the cholesterol, as Thunder said, but what about the blood pressure?

Thunder: Before Troy answers that, let me just say one thing. Blood pressure taken in a doctor's office, as Troy can probably attest to, is not always the most accurate because there's . . . some people are nervous and their pressure is a little high. So I would say if you had your blood pressure checked a lot and it's always around there, then it's legit. If that's just one measurement you've done and that's what it happened to be, I wouldn't put too much stock in it.

Troy: Agreed. Yeah, I always tell people that, especially in the ER. I say, "Do not base anything on what your blood pressure is here." You really need readings over months and months, and usually at home while you're relaxed, home blood pressure cuff. And if there's any concern, usually your doctor will do that.

So honestly, as I see your blood pressure, I'm not really concerned. I can see you're concerned with BMI being a little high, cholesterol being a little bit high.

But I think the answer to your question, Scot, is absolutely. I think you're going to see differences across the board. As your weight comes down a little bit, maybe you lose 5 to 10 pounds, I think you'll probably see your blood pressure come down a bit as well probably as a response also to just the regular exercise. I think that's going to make a big difference there.

And before you get your cholesterol checked, I'd give it six months in a new routine and see these other things come down, and I think at the six-month mark you'll get your cholesterol checked and I think you'll see improvements there as well.

Scot: How important is it to have variety in your exercise life? I can't remember who it was. It was probably Troy that said that he went running two miles every day. Is it better just "variety and the spice of life" sort of way? Or does our body really care that much? Thirty minutes of sweating is 30 minutes of sweating.

Troy: The big thing I'd encourage is try to bring in some resistance training. I think just from what you're telling us, that's one thing you could really do right now, and just bring that into your routine while you're working with some free weights, just some dumbbells or kettlebells or whatever you like, and do that along with what you're doing with the running. Then maybe throw in some biking or, like Thunder mentioned, maybe an evening walk, things like that that are easy enough to add on.

Scot S: Hey, Troy. Do physical therapists, physical therapy places you go for that, do they teach any strength training, like resistant-band training if that's what Scot wanted to try, or anything like that?

Troy: I think a physical therapist . . . I think, Scot, if you went to someone for your knee specifically, and some of the joint issues you've had, that might be helpful. Typically, I think most physical therapists are going to focus on weak areas and pain that you're having. So I'm sure they could talk to you about that.

And if that's a limitation in terms of what you're able to do cardiovascular-wise, whether it's running or whatever else you're trying to do at this point, that may be a consideration. I think if you just went in there and generally said, "Well, I want resistance training, etc.," I don't know that they would be the best person for that. But for some of these chronic issues, I think they could be helpful.

Thunder: And one other kind of plug for the personal trainer. If you find a good trainer, the other thing that they'll do, Scot, is they'll kind of try to evaluate where you're at with your current condition.

I'll tell you right now most men in their 30s and beyond have weak hamstrings. They have weak low back muscles. They have kind of weak core muscles. So those types of areas can be augmented with resistance training, right? So that's another reason to seek out other kinds of help.

Now, a physical therapist would be a great trainer. It's just you'd have to go through the medical route to get that, and as Troy said, it would be kind of targeted towards maybe an area that's injured that needs to be rehabilitated. And I think part of what we're trying to get you to think about is not just dealing with your injury, but going forward, increasing your whole-body resistance training not only to burn calories, but to also keep you strong as you go forward in years.

Troy: Scot, originally when we got your email and we talked about this, we thought, "Wow, that is certainly a common dilemma of really trying to optimize where do you really go in the healthcare system to get that." And yeah, you can try on self-education and reading and all that, but there are different health systems that will have certain programs set up that incorporate so many of these different factors.

The University of Utah has PEAK Fitness that has different things, like Thunder talked about, a dietitian. They do the BOD POD testing. They have other specialists you can consult with, personal trainers, all those sorts of things. Intermountain Health also has a similar thing through their LiVe Well centers. So depending on your insurance, that may be something to look into.

Usually with these, there is an out-of-pocket fee, but they can also offer a lot of these people who can help really look at where you are and help give you this advice. And like Thunder said, you can really pick their brain and try and learn from them.

Thunder: I think this is why we have so many people now who market themselves as health coaches and nutritionists and trainers and wellness coaches and so on and so forth, because they're trying to address the gap that's existing now in the healthcare system.

Scot S: Going to try to wrap this episode up. So through the process of communication, we are trying to kind of come up with solutions and solve problems. Unfortunately, sometimes that can get a little overwhelming. I'm overwhelmed for you, Scot, and I have a fairly decent understanding of all the issues here.

So I want to ask you . . . Now, I've been taking notes so I'm prepared to give a summary, but I want to ask you what you think your steps forward might be, keeping in mind that it doesn't need to be a wholesale change. It's just those small little things. Are there a couple of small things you think you could do now consistently that you heard today? What do you think?

Scot: I think that some of the low-hanging fruit would be having some sort of weights, some sort of resistance training that when I stand up periodically, do something. I mean, there's bodyweight training, like push-ups and sit-ups, whatever. So I think that that's something that I could definitely do.

Maybe eating a little bit less. I am planning on contacting a dietitian. That seems like something that I would be able to do pretty easily. It wouldn't require much face-to-face stuff, or only once or twice, versus a personal trainer-type situation.

But I am very interested in getting a personal trainer. I think that if I tried to get more minutes of exercise in the week and then go and meet with a personal trainer once a week for a month, and then see where I can go from there.

I feel like there are a lot of directions to go. And I feel like this has been a very helpful conversation, I guess, to wrap it all up.

Scot S: And you don't feel overwhelmed right now?

Scot: Oh, yeah, definitely.

Troy: Well, let me just wrap it up then, Scot, because I think the big point I want you to understand is you're doing great. I mean, that's the bottom line. You really are doing well. Your numbers are, it sounds like, just a little bit off. Certainly give yourself credit for everything you've done. Again, it sounds like you've got some very specific things you can do. I think it's important to implement those things. Give it a month. Commit, give it a month, and then reevaluate. But it sounds like you're on the right track.

Scot S: You're talking about small changes, right? Because like Troy said, you're close to where you want to be. So just the fact you want a small change, that just requires small change. It's not like you're completely in terrible health and it's going to be a complete lifestyle overhaul. So I think those small changes would really make a difference. Consistency, we hear time and time again, is cool. And don't do anything crazy. You don't have to do anything crazy with your diet.

Scot: I'm so glad to hear that.

Scot S: Hey, Scot, we would like to check back in with you maybe in four weeks, six weeks, eight weeks, and see where you're at.

Scot: I'm okay checking back in, in a couple of weeks. Honestly, the pressure of needing to come back onto a podcast and tell them, "Hey, there's been progress," is probably one of the most effective tools that . . .

Troy: Yeah, the accountability. It really does make a difference. Well, let's do it. Let's have you back on. And like I said, you want to give it enough time to really get a chance to do it. So maybe six weeks.

Thunder: I think that six weeks would probably be a decent indicator that there should be some movement on one of these dials by then.

Scot S: And I think you hit at the very end of the conversation another component that we could've talked about, and that is having somebody that you're accountable to, have an accountability partner. When I used to work out with a partner, there were days I didn't want to go but I would go for that partner. We're kind of your accountability partners right now.

So that might be something else somebody is listening might find benefit. If you've got a couple of people you got running with and you're accountable to them, then that can make a huge difference.

Scot, we look forward to talking to you in six weeks. Send us any emails along the way. If you have questions, feel free to let us know. If you just even want to check in via email if you have any questions, that would be awesome. And thanks for caring about men's health, Scot.

Scot: Oh, thank you for caring about men's health. I really appreciate it.

Scot S: I wanted to thank Dr. Madsen and Thunder coming with some great advice today. Hopefully Scot got a little something out of that conversation. Hopefully you did too.

So if you're kind of in a similar situation, maybe a couple of your tests from the doctor came back a little high, whether it's cholesterol or blood sugar, or blood pressure, a couple small changes, if otherwise you're doing pretty good, can make a big huge difference. It certainly worked for Troy. So hopefully you picked something out that you could work on as well.

If you did, or if you'd like to give some advice to Scot, you can hit us up on our Facebook page. It's facebook.com/whocaresmenshealth. Go ahead and DM us there or put a post up on the wall. You can also email us hello@thescoperadio.com. And you can leave a voicemail message too if you call 601-55-SCOPE.

And the most important thing, I should've put this first but I put it last, is if you found value in this podcast and you know somebody else in your life that would find this episode useful, sharing it goes a long way to help us get word out about our podcast.

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

Scot S: Mitch, Scot, Troy, can you hear me?

Scot: Yes.

Troy: I can hear you.

Scot S: All right. Great. All right. Hey, Scot, I just need to get this recorded too. I just want to confirm that that was your signature on the release form that you emailed me.

Scot: That is correct. That is my signature.

Scot S: Okay, great. And I also need to run this disclaimer. This conversation does not constitute a physician-patient relationship. It's for informational purposes only, to be more informed, and then we encourage you to seek out a provider for advice specific to your situation.

Scot: I understand.

Scot S: Great. Cool. Here we go.

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: Great. Yeah, Mitch is our producer, and he doesn't even listen to the podcast. What hope . . .

Mitch: I'm listening to the podcast right now.

Troy: What hope do we have?

Scot: What hope do we have beyond the walls of these microphones?

Mitch: I'm sorry I didn't remember what you were . . . okay.

Scot: I love how frustrated you get, Mitch. That cracks me up every single time. "Okay, fine. Yeah. Right. We're doing this now. Okay."

Helping provide the inspiration and the information to care about your health, this is "Who Cares About Men's Health." My name is Scot Singpiel, I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Scot: All right. Today, we're going to talk to Troy about five things that you figure are common-sense medical things, but they really aren't true. So, Troy, how long have you been an emergency room physician?

Troy: Scot, I graduated from medical school in 2003, so I started residency in emergency medicine 17 years ago. Man, I say that and it makes me feel really old, but it's been 17 years of emergency medicine. Fourteen years since I finished my emergency medicine residency training, so it's been a little while.

Scot: What's the average career expectancy of somebody in emergency medicine? Because I'd imagine it's not like just being a family physician. I'd imagine that burnout is higher, or maybe not.

Troy: It is a bit higher. Yeah. Studies have been done and it used to be they'd look at burnout in emergency medicine and say, "Well, it's because it's a lot of people who didn't train in emergency medicine," but I think since then we've seen that yes, there is, unfortunately, a higher rate of burnout in the ER.

So you don't see a lot of really old ER doctors. That's why I think I'm starting to feel old. You don't see a lot of white-haired guys going around talking about the old days 40 years ago. It's not something you see in the ER.

Scot: Yeah. And all the ER docs talking about the old days 14 years ago, so . . .

Troy: That's right. I feel like the old guy now. There are guys older than me, trust me, but I'm starting to feel the years.

Scot: So point being you've been doing medicine for a long time and emergency doctors sometimes see a lot and hear a lot and experience a lot, some that might make most of us shake our heads, probably make you shake your head as well.

And today, Troy came up with a topic that I just absolutely love, and I would love it if you'd share this with us. So "Common Sense That Doesn't Make Sense." So in your experience as an ER doc, these are five things that you have seen and heard from people and patients that think are common sense medical things, but aren't really true.

Troy: That's right. These are things that I grew up believing. And maybe even in medical school, I still thought, "Yeah, this makes sense to me. It's common sense." These are things maybe your mom told you as a kid, like you need to do this if this happens, or it's just stuff your friends have told you. Maybe even a doctor told you at some point.

But from my perspective as an emergency physician who deals with certain things and sees these things, it's just, from my practice, it doesn't make sense. These are things I've heard, and then I've heard them again after years of experience. I'm like, "Wait a sec. I believed that at one point, but it doesn't make any sense." It's not something you really need to know or you really need to pay a lot of attention to.

Scot: All right. So we're going to run down through this list right here. And some of them, I'm like, "Really, that's not true?" Number one here, for example. Number one, putting rubbing alcohol to clean wounds is on Troy's Madsen's . . .

Troy: Yeah. It's something you always hear.

Scot: Yeah, common sense that don't make sense. So that's not true? That's what I did all the time. That's what my mom did all the time.

Troy: Oh, I know. Me too. Do you put rubbing alcohol on your wounds now still? I mean, is that something you do?

Scot: I don't live a life that I end up with a lot of wounds.

Troy: You don't have a lot of wounds on your regular wounds?

Scot: But if I was to get one, I would come home, I'd get a cotton swab or a cotton pad, I'd probably put rubbing alcohol on it, and I'd try to clean it up.

Troy: Yeah. I mean, it makes sense. You've got to get that wound clean and that's what you're thinking. Like, what better thing to do than pour some rubbing alcohol on it and just scrub that thing out? You think back as a kid, just the pain and agony from that. Your mom grabbing some rubbing alcohol and rubbing it on your wound or that sort of thing. It's like, "Well, you've got to get it clean." Or even soap, just getting a bar of soap and rubbing it on a cut or just scrubbing it in there. It's not something we do.

And it's not only not something we do in the ER. It's something I tell people not to do. Let's say you get a wound on your hand. And there have been a lot of great studies done on this. All you have to do is run that wound under some kind of lukewarm tap water for five minutes. That does a great job. It washes it out. It gets it clean.

If you do have a lot of debris and dirt and rock stuck in the skin, maybe you do have to get a little scrubbing brush or something really that's not going to tear the tissue apart, but something to kind of rub that stuff out. But you don't want to use rubbing alcohol.

And the reason I say that is because rubbing alcohol or a lot of these things kills a lot of that healthy tissue in there. So that can actually affect the wound healing and even make things worse than if you just did nothing.

Just putting that rubbing alcohol in there can do some damage, so I tell people don't put rubbing alcohol on. Just run it under some nice lukewarm water for five minutes. Just get things irrigated really well with that. It doesn't have to be sterile water. You don't have to boil the water on the stove for five minutes. Just tap water is perfectly fine. It's going to clean the wound out great and keep that healthy tissue there.

Scot: All right. And cleaning out the debris, you just want to be gentle, it sounds to me. You don't want to get in there and really make sure . . . better to have a little debris. I mean, is that damaging the tissue as well if you get in there and, even without rubbing alcohol, just really scrub?

Troy: Yeah. It's a tough balance because you've got debris in there and you've got maybe some chewed-up tissue that's just going to die off anyway. But you don't want to just get in there and really scrub it super hard. I mean, that sometimes is just going to tear things apart and damage the healthy tissue you've got there.

Scot: All right. "Common Sense That Doesn't Make Sense." This is five things you figure are common sense from a medical standpoint, but they aren't true. Troy has encountered people that still believe that they are true. He even believes some of this stuff. I even believe of this stuff.

Number two, know your blood type. I have a memory that back in the day didn't they have blood type bracelets?

Troy: Yeah. You can have cards you carry in your wallet. Because you know your blood type, right?

Scot: Yeah. I'm A-positive.

Troy: I know you know that because you say you have special baby blood or something like that.

Scot: Yeah. Well, first of all, I know my blood type because I donate blood, but I also have baby-saving blood because apparently. I don't have some virus or something that most adults have. I don't know what it is. I'm pure.

Troy: You're pure.

Scot: Yeah, I'm pure apparently.

Troy: You don't have the coronavirus. You are pure.

Scot: Yeah. But the average person doesn't need to know their blood type. That's not something I'm going to be asked if I'm in an accident. "Hey, what's your blood type?"

Troy: The reality is if you come to the ER and you need a blood transfusion, there is absolutely no way I would ever trust you to tell me your blood type, and then I would give you the blood. Scot comes in and he's like, "A-plus." "Okay, let's order up some A-positive blood for Scot." Because if I gave you the wrong blood and you told me, "I'm A-positive," and you're not A-positive, you're B-positive or AB-positive or AB-negative, and I gave you the wrong blood, I could kill you. That would be a really, really bad thing.

So the reality is you don't need to know your blood type. You're never going to get a blood transfusion based on what you say your blood type is. We're either going to give you blood that's what we call universal donor blood that's essentially the blood type that is okay for anyone to receive, or if it's not an emergent thing and we've got time, we'll do cross-matched blood. What that means is we just test your blood, tell what type it is, and then we get you that type right then.

So, again, like I said, it just always kept . . . I can't say it kept me up at night, but it worried me as a young boy to know I didn't know my blood type. "What's going to happen?"

Scot: Well, that's interesting. All right. And it makes total sense too. "Common Sense That Doesn't Make Sense." Number three, speaking of the ER, this was a favorite one of moms everywhere, including my mom. "You better wear clean underwear in case you end up in the ER." I always thought this was just a vanity thing. Did other people have the impression it's a health thing, or was it always just a vanity thing?

Troy: It's a vanity thing, but it's one of . . . yeah, you always hear it too. "You better wear clean underwear because if you end up in the ER and you've got dirty underwear on, it's like . . ."

Scot: "Sorry. Can't help you."

Troy: Sorry. But it's this idea that you're just going to be absolutely humiliated going in the ER and like, "Oh, I haven't changed my underwear in three days," and you're going to have nurses pointing their finger at you, like, "Look at this dirty little kid," or something. But no one cares. I mean, honestly, no one cares.

Number one, no one is going to look at your underwear. But the only time we ever see anyone's underwear is if they come in as a critical patient or a trauma patient, and there, I'm not looking at their underwear. If they're a trauma patient, we've got these scissors, trauma shears, and we're just cutting their clothes off all in one fell swoop, and everything just gets bundled up and tossed in a bag. I don't care. Like I said, it all gets bundled up.

Scot: Not on your list of concerns.

Troy: It's not. No one is going to look at your underwear or judge you for your underwear, whether it's clean or not.

Scot: All right. That was a fun one. Number four, getting a little bit back more to the seriousness. "You should go to the ER if you have high blood pressure so you don't have a stroke." Now, I can't say that I believe this. So I'm hard-pressed to believe what situation this arises in. So maybe you could shed some light on that.

Troy: Well, have you ever checked your blood pressure? Like, just gone to the grocery store or at a pharmacy and sat down on one of those machines and it squeezes on your arm and tells you your blood pressure? Is that something you ever do?

Scot: Yeah. Usually screwing around, but . . .

Troy: Yeah, like, "Hey, what's my blood pressure today?" It is not at all uncommon for us to have people come into the ER who have done that exact thing, and they checked their blood pressure and they got a high reading.

The reality is, number one, we don't base a whole lot off a single blood pressure reading. People's blood pressures fluctuate when you're exercising. If you've been kind of worked up, like you walked in from outside and it was hot outside, maybe that raised your blood pressure.

But the other reality is that you're not going to have a stroke from just high blood pressure like that. It's not going to just somehow cause you to rupture an aneurysm necessarily or do something like that. It's one of those things where the body tends to respond pretty well to fluctuations in blood pressure.

And unless you're having other symptoms with high blood pressure, like chest pain or stroke-like symptoms, like numbness, weakness, difficulty speaking, anything like that, just a single blood pressure reading at a grocery store or a pharmacy or home blood pressure cuff, it's not a reason you have to rush to the ER.

You could call your doctor. You could see them in a week or two. They may check your blood pressure there. And even then, they're probably going to say, "Well, let's see what your blood pressure does over the next three months. We're not going to start you on medication. Let's just keep an eye on it, and then we'll see what it does over the next few months and then kind of make some decisions from there."

Scot: So without the symptoms, if your blood pressure comes back a little high, don't worry about it too much. Maybe check it again a little bit later if it's a home cuff.

Troy: Exactly.

Scot: Okay. That's good advice.

Troy: And you know what happens 90% of the time? When people come in with high blood pressure and maybe they're in the waiting room, as they're getting triaged, they do have a high blood pressure. We get them back to the room, turn the lights down, let them relax, check their blood pressure 30 minutes to an hour later, and it's come down. And it's kind of like, "Well, we don't need to start medication. Don't need to rush to do anything. Sometimes just different things make our blood pressure fluctuate."

So, like I said, it's one of those things where we see it often enough that it's . . . certainly, I think people worry about that, but no reason to rush right in to get things checked out.

Scot: Is there a number that I should be concerned about?

Troy: No. I'm not going to say any number.

Scot: All right. Fair enough. The no other symptoms part, that's the key there.

Troy: That's the important piece, yes. As long as no other symptoms.

Scot: Five things you figure are common medical sense, but they aren't really true. This is "Common Sense That Doesn't Make Sense." And we are up to number five on Troy's list. "Get an annual physical to get a clean bill of health."

Yeah, I've heard this before, but that's not true. That's going to make a lot of guys feel good because we don't necessarily want to go in every year, do we? I mean, does that mean we don't have to go in every year?

Troy: Well, I think the "common sense that doesn't make sense" piece of this is this whole idea of a clean bill of health. Occasionally, I'll see people in the ER who are coming in with chest pain and they say, "Well, I just saw my doctor last month and he gave me a clean bill of health."

Scot: "So this couldn't be a heart attack."

Troy: So it's kind of this idea of I saw my doctor, he listened to my lungs and my heart, maybe did a little bit of blood work. You've got a clean bill of health. It's a funny term because you think about that and you're like, "Wow, that sounds really reassuring. It means everything is good. It means I must be healthy. There are no impending heart attacks or strokes." But there's no way of predicting those things.

You could go to your doctor and get your annual physical and get whatever you might consider a clean bill of health. They say everything checked out, and your blood work looked okay. You could still walk out the door and have a heart attack. Nothing about their testing is going to be enough to predict whether or not you could have a heart attack within the next hour or two hours or week or month or whatever it is.

So I guess kind of the point of that isn't to say don't get an annual physical. It's more to say this whole idea of a clean bill of health really doesn't hold a lot of weight.

Scot: Got you.

Troy: Basically, what it's telling you is during the visit things looked okay, your vital signs look good, everything checked out. Stuff can still go wrong. You could still have strokes, heart attacks, etc. So still a reason to take those symptoms seriously if you do have those, even if you just saw your doctor a week ago.

Scot: Got you. So the danger for the average person is "I was with my doctor a month ago. He said I had a clean bill of health." Now, somebody has these symptoms and they're like, "Well, it can't be anything. I have a clean bill of health. It's written right here. It says on this piece of paper."

Troy: "It says I have a clean bill of health, so I must be fine."

Scot: So then people will ignore those symptoms to their detriment.

Troy: Yeah. They ignore those. It may create a false sense of reassurance.

Scot: And get that annual physical. Sure, it might not predict that you could become sick a week or two from now, but a lot of times those numbers that they get can actually start to recognize a trend that you can turn around, as in Troy's case with cholesterol, and my case with my higher blood sugar.

Troy: Yeah. And I want to be careful there in saying, "The common sense that doesn't make sense." The annual physical makes sense. I think you want to do that to predict stuff and prevent stuff down the road and potentially uncover issues. But if it doesn't uncover an issue, stuff can still go wrong.

Scot: All right. There you go. Five things that you figure are common medical sense, but really aren't true. "Common Sense That Doesn't Make Sense" according to emergency room physician Dr. Troy Madsen.

Any final thoughts as we wrap up this segment of the show on "Who Cares About Men's Health"?

Troy: Like I said, these are all things that are just funny thoughts I've had over the years of stuff that I've just thought, "This used to be a really big deal for me. I used to think a lot about this and now I realize it's not worth worrying about it. It doesn't make any sense."

So maybe you've had some other ideas, other questions that you've wondered about, like, "Is this really something I should worry about? Is this sort of a medical myth?" Feel free always to contact us at hello@thescoperadio.com or reach out to us on Facebook. I'd love to get your questions and explore some more of these things as well.

I would sing it, but I . . .

Scot: Na-na-na-na-na. Thunder. Thunder. Troy, do the honors of singing, "You've been Thunder debunked."

Troy: I can't do that, Scot. Come on.

Scot: Thunder debunked.

Troy: I have to maintain some sense of dignity.

Scot: Thunder debunked.

Troy: I'm sorry. I can't . . . I think you already did it.

Scot: All right, Troy. Excited again to have Thunder. Thunder is back. We love it when Thunder comes on the show. He's our resident nutritionist here at "Who Cares About Men's Health." Thunder Jalili on the show.

Troy: Yeah, Thunder.

Thunder: Thank you.

Troy: Thanks for being here.

Scot: Where else do you go in life that people applaud you like that when you show up?

Thunder: I'm pretty sure you two are the only ones.

Scot: Yeah. Well, me. I mean, Troy, he never claps for anybody.

Thunder: He didn't even applaud? Okay, it's only you, Scot.

Troy: It was just Scot, but I was clapping in my heart for you, Thunder.

Scot: All right. We have a listener question. That's why he brought Thunder on the episode today. So how can you gradually improve your eating habits? That is one of the questions that we got. There are a lot of ways to contact us, which we'll give you at the end of the podcast, but this individual is interested in improving their eating habits, just doesn't quite know where to start. Where do you start? Do you just the next day decide, "Oh, I'm eating healthy. Let's go"? Is that what you do?

Thunder: No. I think it's really hard to do anything cold turkey like that. We are kind of creatures of habit, so really, what we have to look at is how do we build new habits? And that requires maybe making some smaller changes and going from there.

So what would I tell someone who wants to try to improve their eating habits? First, I would say take a look at how much natural versus processed foods you consume, and how many beverages that may contain sugar you consume, and pick a couple of the low-hanging fruit, easy things to modify, and go with that. And then build on that over time a little bit.

Because it is really hard, especially if you're not sure how to eat well, to just wake up one day and say, "It's all over. I'm going to the store and all I'm buying is quinoa and green beans." You have to build up into it. So that would be my advice.

I find that when people start doing that, and they get kind of used to maybe a different way of shopping, a different way of preparing food, then they can . . . it's like a snowball rolling effect. They can kind of build on it and it increases over time. But it is daunting if you just try to go all-in in one day, because you don't even know what to buy, how to cook, when to eat, everything.

Troy: Yeah, cold turkey never seems to work well, that 0-to-60 thing. Same thing of someone going out like, "I'm going to run a marathon," so they go and run 10 miles and they're injured and then they're just done. It seems like the same thing happens with diet. You're just like, "I'm just going to go cold turkey and eat great." It seems like people are miserable. It just doesn't go well.

Scot: Interesting take. At first, it's just getting rid of some of the stuff that's not optimal. Just one or two of the things. You don't have to all of a sudden get rid of all of it, but maybe you just decide, "All right. A couple of meals this week, I'm going to try to get rid of some of this suboptimal stuff and replace it with something that's a little bit better."

I'm going to also say, Thunder, at least from my experience, you've got to be kind to yourself. Because at first, you're not going to get it right. You're going to have setbacks. You're going to have moments of weaknesses. So don't beat yourself up. Just go, "All right. Well, try again next time."

Thunder: Yeah. If I could give a quick concrete example too, because this is something I've talked to people about. There's a bigger push, I guess, in society that maybe we should eat less meat, some of the health effects associated with meat intake.

I've had people say, "Well, I'm not really sure. If I don't eat meat, what do I eat? I don't know what kind of foods to eat." And I tell them, "Well, why don't you try to pick one meal in one day and make that a vegetarian meal? And if that works out, then try to pick one day and make that your vegetarian day. And this just gives you time to think about it and practice a little bit and buy some different foods and build into it, and you can just keep adding days."

So I think that is a good way to go, because if you tell somebody, using the meat example, "You're going to go vegetarian starting in an hour," you're like, "Okay, the only thing I can figure out is I'm going to have cereal for every meal of the day."

Troy: Right. When I went vegetarian, I just tried to replace everything that was meat with non-meat. So I used to eat turkey sandwiches every day, grilled turkey sandwiches. So I bought about all this Tofurky, this soy turkey, and that was disgusting. It often doesn't go well. You're right.

Scot: Time for "Just Going To Leave This Here." It might have something to do with health or it could be something completely random.

Just going to leave this here. I've been kind of into sayings lately, Troy, so I'm going to throw another saying down for "Just Going To Leave This Here." It might be a new paradigm to look at something if you've recently found yourself kind of at square one again on a project. For a lot of people, COVID has kind of put them back.

I like this. It says, "Don't be afraid to start over again. This time, you're not starting from scratch. You're starting from experience." So I like that. Just try to think about you're in a different place when you start something over again, and that different place is actually going to help you make the next part better. So I like that and wanted to share it. Hopefully, it helps somebody out that's listening.

Troy: Scot, I'm just going to leave this here. I mentioned recently on our podcast that we have a pull-up bar outside the ER. It sits outside the ER right there in the ambulance bay. I have been very intimidated to go out there and try and do pull-ups on it, but I've taken a couple of steps in my life recently, Scot.

Step 1 was during shifts, if I just kind of hit that lull halfway through the shift, I go out there and I do a few pull-ups. Fortunately, none of the EMTs have been out there who are generally pretty big guys.

Scot: They make it look easy, right?

Troy: Yeah, exactly. So, fortunately, none of them have been out there to laugh at me and no ambulances have pulled up while I'm doing it. But the other thing I've done, Scot, is I actually got a pull-up bar. So I'm now doing pull-ups at home too.

Scot: I want to know more about that. Is that one of those indoor pull-up bars, or where is it?

Troy: It's indoors. It goes over the doorframe. It's got a wide pull-up . . . kind of your arms wide and then a handle for closer arms. And you definitely find doing this, when you do the wide arms, those are tough. When your hands are in closer together, it's a little bit easier doing the pull-up. But I've been doing it now for a couple of weeks. I like it.

Scot: Does the pull-up bar feel safe and secure, the one that you put in between the doorway?

Troy: It does. Yeah, it does feel safe and secure. I was a little concerned about that, but the way it's set up, it loops up over the doorframe and it's got these pads. So as long as you have it set up correctly and it shows you the diagram to make sure it's safe and it's not going to flip off the doorframe or something, it's been fine for me. And I've been using it for a couple of weeks. I haven't had any issues.

Scot: I've been thinking about getting one of those pull-up bars, because you talk to just about anybody that knows stuff about exercise and doing resistance training, that is kind of one of the big exercises, the king of back exercises, because you're using so many of those back muscles.

Troy: Yeah, it's great. I'm enjoying it. I would be embarrassed to tell you the number of pull-ups I can do, but I'm enjoying it. You definitely feel like you've had a workout in a very short time. So I kind of like that.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE. And leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

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: Do you have some sort of a tagline when you leave, like "Be skin healthy"? Anything like that?

Troy: Leave and just say, "I'm the balm."

Dr. Johnson: I don't, but maybe I should come up with one.

Scot: Yeah. Like a toast, like, "Here's to your skin."

Troy: "Here's to your skin."

Dr. Johnson: I hope that was skinteresting.

Troy: Skinteresting. Oh, I love it. That's it right there.

Scot: The podcast is called "Who Cares about Men's Health," giving you information and inspiration to better understand and engage in your health so you feel better today and in the future.

My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Johnson: I am Dr. Luke Johnson. I'm a dermatologist at the University of Utah, and I care about men's health.

Mitch: And I'm Mitch and I care about men's health.

Scot: All right. Today, we're back with dermatologist Dr. Johnson, because we wanted to talk about acne. I've heard a statement that if somebody has acne that there's no reason that they should suffer with that, and we're going to find that out today. So if you have acne, if somebody in your life has acne, maybe your son or your daughter . . . I think I said Acme, which of course is the Road Runner coyote thing. It's Acme.

Troy: Acme with an M. Acme.

Scot: What can be done and is that statement that no one should have to live with acne true? So, first, we want to hit with Mitch's story, because Mitch has had a battle throughout his life with acne. So tell us about your battle and how it impacted you and your health.

Mitch: Yeah. So, during high school, I had really bad acne as I went into like junior or senior year, and it was scarring acne. So every time that I'd have a really bad set of breakouts, all of a sudden I would have these little scabs, I'd have these little marks, and over time I was getting pockmarks all over my face.

And you don't see them these days, but that's because I went through a whole lot of work with the dermatologist. We tried everything from topical creams to everything we possibly could for a year or two before they decided to finally put me on Accutane, which I don't know if that's standard protocol anymore, the isotretinoin. But I was on that for about a year and a half just to try to get the acne to stop so my skin would stop scarring.

I was on that for about a year. It was a pretty miserable process. You're dry all the time. It's like your lips are falling off. And so, my first year of college, I was a bit of a pizza face or whatever. I had really, really bad acne.

And by the time it was all said and done, I was left with some scars and it really impacted my self-esteem, really made me kind of nervous to kind of talk to people. And so I had to go through a whole bunch of treatments. We ended up doing peels and even some sort of beetle poison that they put on my face to try to remove one thing or another.

And after all of that work, after years and years of working to fight against the acne and then eventually to minimize the scars, I now have the clear "broadcast-ready skin" that my dermatologist wanted me to get when I was originally going to go into television.

Scot: That's a great story. So it impacted your mental health because it undermined your self-confidence.

Mitch: Oh, most definitely. I was nervous. Even during treatment, I would not want to go to parties and stuff because my face was covered in scabs. I had all these little scars. I looked a little older than I wanted. Yeah, I didn't feel good about it.

Scot: Dr. Johnson, is Mitch's story common? Uncommon? Where would you categorize Mitch's journey?

Dr. Johnson: I would say it's fairly common, and I'm glad it has a happy ending. I think our current acne medicines that we have available are pretty good and we can give most people a happy ending.

Scot: And the amount of time that it took him to go through this process, is that pretty common or are things a little bit better now?

Dr. Johnson: Well, our treatments are actually fairly similar to when Mitch was going through this, but I would say that usually we can get people better a lot faster than that.

Troy: I was going to say it sounds like . . . I mean, for Mitch, it sounds like things were pretty advanced, Mitch, when you got to a point when you saw the dermatologist. At what point, Mitch, in that process did you see a dermatologist? Then, Dr. Johnson, is this something where if he maybe had an opportunity to see someone like you earlier, could it have prevented a lot of the peels and the interventions he needed down the road?

Mitch: Well, at the time, I went to a dermatologist relatively early when we started seeing the scarring and the over the counter stuff was not quite cutting it. And at the time, the dermatologist said that they would not escalate to Accutane until other things were tried and necessary.

I don't know if that was an insurance thing, I don't know if that was a best practice thing, but we had to try some other treatments for a month or two at a time before we went nuclear, essentially, with the Accutane.

Dr. Johnson: Well, I think probably that dermatologists are a lot more comfortable with Accutane now. There's been a lot of research that's come out showing that it's a pretty safe drug. And also there's been a lot more interest in the last 10 or 20 years in what we call antibiotic stewardship, which means limiting the number of antibiotics we prescribe to people in general in order to reduce the resistant bacteria that exists in the world.

So I have a pretty low threshold to go ahead and start Accutane on people these days.

Mitch: I got my treatment back in 2008/2009, so the last 10 years. I mean, it was a controlled substance. I had to get tested, I had to do a psych evals, everything, every month or two that they would give me my refills.

Dr. Johnson: We're getting a little farther afield here with the Accutane discussion, but what I would like to say about Accutane is that it's a great medicine. I also took it. And it sounds like you had a fairly significant reaction to it since you described yourself as being fairly miserable for a year or a year and a half on it, but that's an extreme reaction. I would say most people definitely get dry, but they don't find it too bad. And then six to seven months later, their acne is better. So it's a great medicine, it's pretty safe, it works well, and dermatologists use it plenty.

Scot: This is a part of the show where Scot goes, "But, Doctor, if Mitch would have just changed his diet, that would have taken care of the problem, right?"

Dr. Johnson: Oh, yeah. You were probably getting too many vegetables.

Troy: Yeah, chocolate. Mitch, were you eating just tons of chocolate? What's your deal?

Mitch: Oh, I did. That's all I ate. Then I'd smear it on my face.

Troy: Take Hershey bars and smear it around . . . you probably never bathed either.

Mitch: Nope.

Dr. Johnson: These are myths, so thanks for bringing them up. There has been a fair amount of research into diet and acne. And lately, there's actually been a couple positive spikes where it looks like if you drink skim milk, not other types of milk, but skim milk specifically, or your diet has what we call a high-glycemic load, which means it's got a lot of simple sugars in it, it might make your acne a little bit worse. So instead of having five pimples a month, you might have six pimples a month or something, but it doesn't make a big deal.

And also cleaning and hygiene doesn't seem to have a lot to do with it either. However, there are particular medicated cleansers that people can use that can really help out their acne.

Troy: I was going to say there's a certain brand that you see advertised all the time on TV. Does that make a difference? Is that something that people should be trying?

Dr. Johnson: So here's one of the heartbreaking things that I see in my practice. Somebody has significant acne and they have spent hundreds of dollars on over-the-counter products to try to make it better.

Scot: Advertised by celebrities, right? Is that what we're talking about?

Dr. Johnson: Many of them.

Troy: Perhaps Kristen Bell.

Mitch: That's what I used.

Dr. Johnson: I won't name any names, but she's awesome in "The Good Place."

Troy: She's awesome in "The Good Place."

Dr. Johnson: So people spend a bunch of money on products that maybe help a little bit, but if they had just come to a dermatologist's clinic, we could get them better a lot faster and a lot better and a lot cheaper.

So there are over-the-counter products that are pretty good for acne, and some of these expensive, fancy products that you see advertised contain some of those ingredients, so that part is good, but you can get them a lot cheaper in sort of generic forms.

My favorite over-the-counter acne treatment is called benzoyl peroxide. It's not hydrogen peroxide. It's benzoyl peroxide. It comes in a lot of different forms. It comes as washes, it comes as creams, it comes as spot treatment pads. I like it best as a cleanser or a wash because I figure most people who care about acne are going to be washing their face anyway, so you might as well put some medicine in there to avoid having something else to do.

This will bleach towels, however, so all of my towels are white or bleached.

Scot: The red ones are now pink.

Dr. Johnson: Yeah. My wife says I owe her a set of teal towels sometime when I stop using this medicine, but I don't think I'm ever going to stop using it.

Troy: And that's interesting that you point that out. This isn't just about maybe someone in their teens or early 20s when a lot of us have dealt with acne, but you're talking as an adult, maybe into your 30s, 40s, this is still stuff that people are using and you're recommending.

Dr. Johnson: I'm 16.

Troy: Oh, I'm sorry. My mistake.

Scot: Were you born on a leap year? What's going on?

Dr. Johnson: I just turned 40. Still get some acne.

Troy: We talked about this in the previous episode, but I think a lot of us are dealing with acne outbreaks right now just for mask use, the whole maskne thing where you have that moisture there and that seems to be leading to some more acne. Is that something you're seeing more of as well?

Dr. Johnson: Yes, and I think maskne is a real thing. Medicines like this benzoyl peroxide can help. So let me offer a couple of specific pointers for your listeners. If your skin is not particularly sensitive, then you can use whatever benzoyl peroxide is cheapest. I just buy the Walmart brand 10% benzoyl peroxide stuff. But if you have more sensitive skin that gets irritated by the benzoyl peroxide, then you want to use something with a lower strength.

So my favorite gentle version is called AcneFree. It's a 2.5% containing benzoyl peroxide cleanser, extremely gentle. And the brand CeraVe also makes a good one called Foaming Acne Facial Cleanser, or something like that. Both very gentle. So if you try the normal stuff and it's too irritating, try one of those instead.

There's another product that I think I mentioned in the last episode called Differin. The medicine is adapalene, which is in there. Also good for acne, good for scars, also good for wrinkles, etc.

So what I normally recommend is you do the benzoyl peroxide cleanser in the morning, you put on something like Differin at night, and that's all you need to do for your acne. Don't use astringents. Don't use apricot scrubs. Don't use random creams from Mexico. Just those two things are the best things you can do that are over the counter.

And if they're not working . . . and give them a few months. It takes four to six months really, so be patient. But if you try it for that length of time and you don't get where you want to be, then see a dermatologist and we can help.

Troy: I love it. And it's such a simple regimen. Like you said, it just gets to the basics. Forget all the expensive products. Forget the mail order stuff. Simple stuff. Like you say, you can buy the cheap stuff at Walmart. It sounds like this is a regimen that in your experience sounds like works for the large majority of people with acne.

Dr. Johnson: If it's mild, then this works pretty well. If it's not mild, then it probably needs prescription medicines, but we have some pretty good ones.

Scot: All right. Well, I guess it is true that you shouldn't have to live with acne. You shouldn't have to go through what Mitch went through. And just to be clear, you could try those two over-the-counter products that you've talked about. You would recommend a patient does that first, and if after how many months they're not seeing success, that's when you'd want to come to dermatologist? Or would you recommend a trip to the dermatologist before you try any of those products?

Dr. Johnson: I would say if you're in doubt, see a dermatologist because we can tell you if all you need is that stuff or if you need something stronger. You can start using that stuff while you wait for your appointment to come up.

Scot: All right. Perfect. Do you have a final kind of thought when it comes to the topic of acne and men and our health?

Dr. Johnson: I 100% agree that nobody should have to suffer with it. We have really good treatments, so come see us.

Scot: All right. Dr. Johnson, thanks for being on the show, and thank you for caring about men's health.

Dr. Johnson: Happy to.

Troy: Scot, a common question I get asked when people find out what I do is "What is the craziest thing you have ever seen?" People love to ask that question. You've probably asked me that question at some point. I think you might have. But you've got to figure if you're going to see crazy things, it's in the ER.

And sometimes I think I've seen just about everything, but then I'll read different case reports about things people have seen in other ERs, and then it's such a unique thing. Then they write about it and publish it in a journal and I think, "Wow, I have not seen that and that's fascinating."

Scot: Have you ever run across one of these crazy cases in the . . . is it a medical journal?

Troy: Yes.

Scot: Have you ever run across one of those cases that then eventually you see and you're like, "Oh, I know how to handle that now"?

Troy: Yeah, I have. And sometimes you will see things and you think, "Wow, this is crazy. I've never seen it. I need some more insight into it." So you'll search for an article and you'll find a case report. That's the beauty of these case reports. You're like, "Oh, wow, someone else saw this and this is what I need to do, and this is their insight into it."

And I've published case reports too of things I've seen, like crazy cases that others haven't seen. So it's a cool thing. It's a process. You publish what you see and then you read what others have published as well. And these are in obviously reputable medical journals.

Here's a crazy case report, Scot. First question for you. Do you like black licorice?

Scot: Not really. No.

Troy: Some people love it and some people hate it. I really like black licorice. I really like it.

Scot: I'm more on the hate side. You can have all my black licorice.

Troy: That's so funny, because oftentimes if I ever get candy, I'll buy Good & Plenty. It's this black licorice coated in candy, and Laura's like, "I think you bought the one that's been on the shelf since 1950 because no one else eats that stuff."

Well, here's a case of a person who . . . this was reported in "The New England Journal of Medicine," one of the top medical journals. A 54-year-old man who came into the emergency department after experiencing a life-threatening heart rhythm.

So he was in a life-threatening heart rhythm. He was unconscious. And as they tried to resuscitate this patient, it sounds like they were able to get a blood pressure back and he improved somewhat, but they're trying to figure out why in the world this happened.

And so they talked to his family and this is what they found. They said this individual did not have a very good diet. His diet seemed to consist only of black licorice. In the past couple of weeks, he had been eating one to two large packages of black licorice every day.

I mean, that was his diet, essentially. His entire source of nutrition was nothing more, it sounds like, than black licorice over the past couple of weeks prior to this.

You might think from a health standpoint that doesn't sound particularly healthy. You're basically just consuming a lot of sugar and that's what's keeping you going. You're missing out on a lot of other nutrition, but besides being unhealthy, what's the risk?

Well, this is something I did not know. Apparently, black licorice contains a compound called glycyrrhizin. I have never heard of this compound before. It's derived from the licorice root, which is what gives black licorice its flavor. And if you consume too much of this, it actually drops the body's potassium levels.

Now, this being said, I have seen people come in the ER with life-threatening low potassium levels, and it does bad things to the heart. If your potassium is low, it affects the heart's activity and it can kill you.

So this person was consuming so much black licorice and so much of this substance, this glycyrrhizin, that it actually lowered their potassium level to a dangerously low level and caused their heart to go into some crazy heart rhythm. They lost their pulse.

The sad ending of this story is this individual went to the intensive care unit and actually passed away 32 hours later. So he did not survive.

But the point of this is there are certain hidden risks in some of these foods and kind of the whole thing of "all things in moderation." You eat too much of one thing, especially black licorice, it can have some kind of crazy, very severe detrimental effects.

Scot: That's exactly what I was thinking. I was just thinking that we think . . . well, first of all, black licorice is natural, so how could that damage somebody? But over-consumption of anything, natural or not, could possibly lead to bad outcomes or something going wrong.

And it just really reinforces when you're doing stuff, taking medications, or whatever, and you're like, "Oh, I'll just take a couple extras," if black licorice can do that, medications can have a quite a larger impact I'd imagine.

Troy: Yeah. The good news of this is at least half of our population is not at risk of this because they absolutely hate black licorice. I think it's like cilantro. There's something about cilantro that it's so polarizing, and black licorice is the same. People just think it's disgusting, and other people love it.

I'm on that side that loves it, but after reading this, I thought, "Well, once in a while I might eat an entire package of Good & Plenty in one sitting," but I thought, "Maybe I should be a little more cautious about that." I'm just kidding. Obviously, it's a huge amount that would take to do this.

Scot: An accumulation over time.

Troy: Yeah, it's an accumulation over time.

Scot: It built up, built up, and built up, and he just wasn't able to get rid of it fast enough I'd imagine.

Troy: Yeah. I think it was that part of it and then also the part of probably not eating the other good stuff, things that would provide potassium. So you've got something that's lowering your body's potassium and then probably just not consuming other things.

There are lots of things that can do this in diets. We see this a lot with alcohol, chronic alcoholics who their only source of nutrition is alcohol and they just drink tons and tons of alcohol. And then that affects their thiamine levels, thiamine and folate, and they can come in with severe nutritional deficits that cause some really severe neurologic issues. So it's not limited to licorice. There are lots of things out there that can do that.

Scot: Time for "Just Going To Leave This Here." It might have something to do with health. It might not. Could be totally random. Just something that might not have someplace else to live on the show.

Troy: Scot, I'm going to go first here. I'm just going to leave this here. I had an experience recently, and you were part of this experience. I have been speaking to you now for, I don't know, 10-plus months. I have not actually seen your beautiful face until just a week ago.

Scot: That's so sweet. Big old sweetheart you are.

Troy: Yeah, it is. It's crazy. It was a kind of a surreal experience to feel like I've been talking to you this long. And it's so funny, because at work that day, I had a little downtime between patients, so I was listening back just to a couple of our recent episodes. It was so funny having listened to you and it just felt like I'd been talking to you all morning, and then to actually see your face, I was like, "Whoa, there's Scot. I haven't seen this guy since March 10th," or whenever it was. So I'm just going to leave this here. It was good to see you. It's been a while.

Scot: Thanks. I appreciate it. I want to clarify. We record on a platform that does not have visuals, so we literally have not seen each other for that long. And it was a little weird for me, I'm going to have to admit. I think I'm a little awkward socially anyway unless it's behind a microphone because I feel comfortable there. So I'm standing there. You're looking at me, I'm looking at you, and I'm like, "Well, I guess that's . . . I don't know. What should we talk . . ." I could talk all day like this, but . . .

Troy: Exactly. We needed to turn away from each other so we couldn't see each other and then we could speak to each other.

So first impression. Any first impression, Scot, after not seeing me for 10 months?

Scot: Your hair is redder than I thought it was, because usually I think you keep your hair shorter. It's a little bit longer. I think there's some red in there that I never noticed before, but you look good. I mean, you had your mask on.

Troy: Yeah, you look good too. First impression, you look healthy. It's like, "You look healthy. You look good."

Scot: Thanks.

Troy: You've been staying healthy. I'm glad to see that.

Scot: Just going to leave this here. I love this little saying that I stumbled across the other day. I'm always trying to think of a new way to look at something to motivate myself or that might motivate somebody else, kind of a new paradigm, because sometimes just even a new paradigm can make a huge difference.

The saying is "You do not design your future. You design your habits, and your habits design your future." I love that, because what that speaks to is instead of thinking about what you ultimately want to accomplish, think about the things you need to do to accomplish it. Make those your habits, and then eventually that's going to become part of your future. Does that make sense to anybody other than the guy talking right now?

Troy: It makes sense. That sounds like something that Nick said recently. And he also kind of said that too. He talked about not just going for the end goal, but being more process-oriented. I mean, it's more enjoying the process and developing that process and then you take whatever comes as a result of that. Hopefully, it's a good thing. So it makes sense.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE, and leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

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.

Dr. Galli: Most of us take for granted the things that we see as normal and expected. So hopefully, we've at least parked the thought of, "Oh, hey, maybe that's not how I have to be. It's how I think I should be," and where is that coming from?

Scot: All right. Welcome to the podcast "Who Cares About Men's Health." What we've got here are some guys who care about their health, and they're not afraid to talk about it either. We get this bad rap. Guys don't care or want to talk about their health. That's not true, proving it right now.

My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I'm glad that for the first time in the history of this podcast I actually sound better than Scot on this, and I care about men's health.

Dr. Galli: And I am Dr. Nick Galli. I'm an associate professor at The U in the Department of Health and Kinesiology, and I care about men's health.

Scot: So today, we're going to talk about a force. It's a force that controls us as men, and a lot of us don't even know it, but it's this invisible force that impacts how we think about our health, our body, and it could be responsible for a lot of bad health decisions. It's reinforced in magazines, TV shows, movies, social media, and communities. We cannot get away from it. As a matter of fact, the World Health Organization thinks it's the reason why men tend to live six to eight years less than women, this invisible force. What is it?

Troy: Dark matter.

Scot: Kind of. It's the notion of what makes a man a man, the forces called masculinity. Nick is an expert in this topic. I actually did for my master's program a research paper on masculinity and men's health, and what I found was fascinating. I don't know about you guys, but I hate the thought that anybody or any force is controlling what I'm doing.

Troy: Especially if it's shortening our life by six to eight years. I had no idea. Wow.

Scot: Yeah. Isn't that crazy?

Troy: That's crazy.

Scot: So, before we get going, Nick, maybe you can give us a definition of what masculinity is, because it's not a real thing. It's what's called socially constructed. It's just something that we as people made up.

Dr. Galli: Yeah. Let's say it's sort of the set of attitudes, beliefs, behaviors that dictate how men should behave, what they should think, what they should value. And as you said, Scot, it's pervasive. We're primarily talking about Western cultures and even more primarily the U.S. It cuts across everything that we do.

Scot: So an example of this and how it might impact our health is somebody offers you a steak or a salad and you take the salad, what happens? What happens if you've got your guy friends around?

Dr. Galli: Well, of course, it depends, but yeah, you're going to get . . . I mean, when I think back to when I was sort of in the prime of . . . Because it changes, right? So, for me, when I was in my late teens and in my 20s and spending a lot of time with my guy friends, now you're immersed in that. And so, for sure, you'd get some looks.

I mean, even on that specific topic, I remember going out to lunch and dinner with my guy friends and it was almost, "How much fatty food can you eat?" Like, it was a challenge. Everything is a challenge in the world of masculinity. Everything is a competition, including how much you can eat.

Troy: Nick, I wonder how much of this is learned, how much of this is just the fact that as a man you've got testosterone and testosterone tends to lead men often maybe to be more risk-taking or maybe more competitive. I don't know. I mean, are there certain elements there versus . . .

Dr. Galli: I think there's a biological component, but that becomes accentuated for sure by messages that begin very early on.

Troy: And by masculinity then, are we talking about . . . again, is it the way we're interacting with others? Is it the expectation I have for myself? Is it just this idea that I can't show emotion? What is it about this that's kind of the core element of it? And getting to that, what is it about it that's so detrimental that's really shortening our lifespan?

Dr. Galli: Well, I think too, before we go much further on it, true experts and scholars in gender studies and masculinity would probably argue that there are multiple forms of masculinity. And the kind that we're talking about here today and that tends to be especially problematic is sort of that dominant, what we call a very . . . this is a very scholarly term . . . hegemonic masculinity. Hegemonic is just a fancy way to say dominant.

I think one of the tasks and one of the goals is to try to diversify. There's nothing inherently wrong with masculinity, femininity, but building in some flexibility into those concepts that there's not just one way to be masculine or one way to be feminine.

What's problematic about this dominant form that, as Scot alluded, seems detrimental to our health is that, yeah, we box ourselves in as men into a certain way of being, and that's fueled by things that we see and expectations that we hold of ourselves and that others hold of us. And really, what needs to happen, and this is maybe skipping ahead to more practical, is there needs to be a much more flexible conception of what it means to be a man in society.

Scot: And that's difficult, right? Because I bet you we could all tell our stories . . . I don't know. I can only speak for myself I guess, but I grew up in a ranch environment in western South Dakota and there was a certain kind of way that guys were supposed to be there, which is all just created in our own brains. There's nothing inherent about a lot of it. And I didn't fit in, right? I was a little bit more sensitive. I was a little bit more delicate. I wasn't a big muscular guy, right? I didn't like to ride bucking broncs and bulls and I didn't like to fight. So that made me less than.

Dr. Galli: Absolutely.

Scot: And I spent a lot of my life, and I still think about it to some extent, but not as much, trying to come to terms with, "Oh, I'm not a man. I don't look for a chance to . . ." Like, if somebody gets in my face, I don't get right back in their face. That's not how I choose to handle it. Maybe I choose to talk it out. That's not manly, right? That doesn't fit that masculine definition. So, for a long time I've . . . and especially then comparing myself to my dad who was all those things.

Dr. Galli: Well, thanks for sharing that, and I think that speaks to one of the earlier manifestations of how this can become problematic, is when we see young boys in school who maybe prefer different types of activities that aren't perceived as masculine or act in ways that aren't perceived as masculine, and then they can become the subject of bullying. We know well the consequences of bullying on mental emotional health.

Scot: And also just my own emotional health not living up to this ideal.

Dr. Galli: That you're not good enough. That you don't . . .

Scot: Exactly.

Dr. Galli: . . . meet that standard. I relate. I mean, where I grew up in a mid-sized city in central California, at my high school, for the boys, there were sort of two ways to be popular: one if you were a tough guy and/or two, if you were good at sports, and physical sports particularly, so football or the mainstream sports. If you couldn't check either of those boxes, you were sort of on the fringes of popularity or of acceptance.

Troy: Scot, it's interesting to hear you talk about that because I think I too . . . I mean, I didn't grow up in a ranching community. I grew up in a coal mining community, a small town. And as a skinny nerdy kid, middle school was miserable. I got beaten up. Not just bullied, but physically beaten up by kids in school and it was awful.

Scot: Wow.

Troy: And that kind of stuff sticks with you. I think probably over my entire life that element or that definition of masculinity, that's probably affected me.

And it's funny. I think back to two years ago, Scot, when you approached me and said, "I want to do a men's health podcast. Will you co-host with me?" It was like this sense of this imposter syndrome, like, "Who am I to talk about men's health? I am not a manly man."

And obviously, as we do this podcast, you realize that masculinity or that sense of the manly man, that's not who most men are. I don't think that's really who most men are. I think, like you said, Nick, that's the image that's out there and that's what we feel we should be. But you look at the men you know in your life and the men work with, most men are not that way.

Dr. Galli: If we were to all Google "men's health" right now, what would come up is probably very different than the things that we're discussing today. I mean, there's even a magazine called "Men's Health," and what do you get in that magazine? You get chiseled muscular bodies, very much an aesthetic and physical version of what health is.

Scot: Yeah. And not only that, but you get these attitudes of a man in "Men's Health" is great in the bed and takes care of his woman, and just all of these images and these thoughts that . . .

Troy: Well, not just takes care of his woman, takes care of multiple women. If you read "Men's Health" magazine, it's like . . . yeah, that's been my image of men's health is "Men's Health magazine. How often do you see a thin guy on the cover of "Men's Health" magazine? It's usually dudes who are just totally ripped and built and just these massive dudes.

And all the articles there, it's about that. It's about living a lifestyle. Not all of them, but a lot of them have to do with maximizing that lifestyle, live hard/play hard, work hard/play hard lifestyle, and a certain element of sexual prowess or whatever else some of these articles . . . and so it's a . . .

Dr. Galli: This makes the battle even harder, right? Because now we have sort of the big media hijacking the concept of men's health. Not just masculinity, but men's health, and selling it to the masses.

Scot: Yeah, it's that either/or, right? So it doesn't leave you any in between. It's either you're working out and you're doing high intensity exercise and you're eating just perfectly, or if you can't live up to that ideal, which sometimes I think I can't do that. So then it's just like, "Well, why even bother if that's not what I'm going to get?" So I think it's a little dangerous that way as well.

Troy: For sure.

Scot: Hey, Nick, I want to share another little aspect and then I want to kind of steer the transition of the conversation into how maybe each one of us can claim our own form of masculinity, because I think ultimately that's what we should be able to do.

So I can't speak for Troy, but I wasn't very confident and I lacked confidence for a long time in my life because I didn't fulfill this ideal of masculinity. And that can lead to mental health issues. That can lead to feelings of inadequacy. But I have noticed, too, that there are some men that are very confident in themselves and they might not fulfill that norm of hegemonic masculinity, but yet they create their own, right? To some extent, showing control and restraint in not doing all those dangerous behaviors can be a form of masculinity.

How exactly does that work and what are your thoughts on developing your own version of it? And then how are you confident in that version as you interact with the rest of the world?

Dr. Galli: That's a big question.

Scot: Hey, listen, I gave you a little bit of warm-up to get to this point. So I figure you should have all the answers by now.

Dr. Galli: Okay. There's not going to be a simple answer to this, but there are forces at play. I think two of them come to mind, as I think about folks who are sort of able to transcend what we've been talking about here.

One is just time and maturity. The young adult males are the ones who are kind of most at risk I would say for really trying to live this ideal that can be dangerous. As we get older, we care less about what other people think, we have different priorities, and so it becomes easier as we get into more middle adulthood to just sort of be our own person and not give a crap about what people say I should be. Now, that said, there are definitely some people who struggle with that. So I think time and normal development is an asset.

And then I think another asset that some folks have are support of influence and people in their family who are just unconditionally okay with a boy being how they want to be, and for that matter, a girl being how they want to be. Of course, there are forces outside the family, but that primary family tends to be the most powerful force for a lot of kids. And I think that goes a long way.

And as a young boy, if you want to play with Barbie dolls, that's fine. If you want to watch "My Little Pony," that's fine, or whatever. That's what it was when I was a kid growing up.

I think it seems very subtle, but when you are surrounded by folks who are just okay with you being you and not making snide comments or forcing you to be something that you don't want to be, then I think that allows for the possibility of just, as you said Scot, being comfortable in your own skin, even if that doesn't align with what you're seeing of other boys and men.

Troy: And I guess though, Nick, as we talk about this . . . I mean, certainly there are some elements of masculinity that are valuable, but at what point do you feel like that truly becomes toxic? We talk about masculinity or toxic masculinity. When does that sort of thing become toxic? And are we talking toxic to others, toxic to ourselves? How does that play into it?

Dr. Galli: Yeah, I think both. I mean, any time that somebody has fully internalized . . . I think of heavy drinking, womanizing, or having multiple partners and not exhibiting safe and thoughtful sex behaviors, over-imbibing in alcohol, drug use, steroid use, not going to see the doctor on at least a yearly basis because "I'm invincible." I mean, I think it's all about the behaviors, and underlying that is the thought that, "I am impervious to a lot of these issues, and also I don't need to talk about what's bothering me because that would suggest weakness."

And going back to something you said there, Troy, too about some of the advantages, I do think there are advantages, and in many ways I think our society is set up to favor and advantage men who do exhibit these dominant traits. So it's reinforcing, right?

Look at who we see as CEOs and in leadership positions. And that's starting to change, but it tends to be men. And there are some positive characteristics for sure. There are also positive characteristics of . . . and I keep pointing to femininity as sort of the other side of the coin here. Things that we associate with femininity that are also very positive, such as compassion and having a nurturing side, sort of those stereotypical feminine qualities, that many men feel like, "Well, that's not what I'm supposed to do." So they deny themselves the opportunity to explore that side of who they can be.

But in many ways our society is set up to really favor folks who exhibit these dominant alpha male qualities.

Troy: And it seems that in terms of just where masculinity truly becomes detrimental, it may be that it's that masculinity at the point where we really try and push away any sort of feminine qualities within ourselves, any sense of nurturing, any sense of emotion, those kind of things and . . .

Dr. Galli: Except for anger. Anger is okay. Anger is okay for a man.

Troy: It's okay for a man.

Scot: I think that's the only emotion, isn't it?

Dr. Galli: When a woman is angry, oh, there's something wrong. It's so true, right?

Troy: Yeah, but it seems though that that often . . . as I'm hearing you talk about this and talk about these different elements, it seems that when masculinity really becomes an issue and a problem, it is when we, like you said, take that masculinity to the extreme in terms of risk-taking, detrimental behaviors, in terms of how we treat others and interact with others, and then we push aside anything that would be associated with that feminine element, again the nurturing, the caretaking, all those sorts of things.

Scot, as you talked about, the years lost on our life, I would imagine that those are the things that really caused those years to drop off when we are pushing aside our ability to feel emotion and ability to care, and nurture, and those sorts of things, and then add on to that the risk-taking behavior and everything else there. That seems like that combination is what is truly toxic and what really hurts us.

Scot: As we wrap this up, here are a couple of my takeaways, Nick, and I'd love to hear yours as well. So I think the goal of this particular episode is just for those that weren't aware that this is an invisible force in one's life that is actually impacting your decisions or how you feel about yourself, just to become aware that it's out there and it's a thing. I think, obviously, awareness is the first thing.

And then I think developing your own definition of what you are as a person. Maybe just abandon the notion of men and women. What are you as a person? And I'm guessing that the super toxic masculinity individuals have dropped off this episode way before this point. So we're not talking to them necessarily.

Dr. Galli: But we could be talking to parents of children who have a role in shaping them.

Scot: Yeah. I mean, the way you shape them could either empower them to go out and accomplish great things, and feel good about themselves, and be mentally well off, or it can burden them if we're forcing those types of things, I suppose, on kids.

So I think becoming aware and I think realizing that it's okay to be you. I tend to be more sensitive, I tend to be more thoughtful, I don't react and come to anger as quickly as maybe some men, I don't believe in fighting. That's okay. That's my outlook on life, and that's fine.

Troy: Have you ever been in a fight, Scot? I'm just curious.

Scot: Actually, I never have, believe it or not.

Troy: Like a physical fistfight? Not even in elementary school?

Scot: No. I was a "doorman" at a bar for a couple years, and I never got in a fight.

Troy: You were a bouncer.

Scot: I know, right?

Dr. Galli: A bouncer. Yeah.

Troy: Scot is like the world's worst bouncer.

Scot: Actually, I wasn't.

Troy: He's like, "It's all right, guys. Let's talk this out."

Dr. Galli: He's actually willing to talk and . . .

Troy: I know. I was just joking. Yeah, you're totally breaking the mold of the bouncer. You're like the negotiator. I love it. That's great.

Scot: Nick, any final thoughts or takeaways from this episode? What do you hope that it accomplished today?

Dr. Galli: Oh, yeah. Raising awareness primarily. I talk about internalizing, and I think most of us take for granted the things that we see as normal and expected. So hopefully, we've at least sparked a thought of, "Oh, hey, maybe that's not how I have to be. It's how I think I should be," and where is that coming from? Maybe more men or women willing to have conversations, like we just did right now, about these topics.

Troy: Obviously, we say, "Be yourself." Sometimes that's hard because it's like, "Well, yeah, but there are different elements of myself." I think it's be your best self. There are elements of masculinity that are, I think, good.

Scot: Yeah, but it's also tough to sometimes be yourself if you're not in the environment. There's no way as a young man I would have been able to buck the trend, I don't think, of what was expected of me. I don't know. Maybe there could have been had I been more confident.

Troy: Still.

Scot: You've just got to try the best you can.

Troy: Yeah, embrace the best of these things and don't . . . I think that's it, too. Again, getting to that thing about, "Well, these things are associated with femininity in terms of emotion and caretaking and all that," but if that's part of you, embrace it. Embrace that and just . . .

I think one takeaway too, like I said, Scot, is just that most men are not that stereotypical man. I think that's been one thing that's come to me in terms of this podcast as we talk to so many experts. It's just opened my eyes and I look at the people I work with, and the patients I see, and all these things. Most men are not the stereotypical manly man that we sometimes think we should be, and that's not the norm. Maybe what's held out there is what we should become, but that's not what most men are.

Scot: And there's a certain strength . . . I guess if I was to give advice to young Scot, like how you could still be yourself and be in an environment where there's a different definition of masculinity, I think . . . and I could be completely full of crap and might get the crap kicked out of me. I think there's a certain strength in knowing who you are and owning that and making no apologies for it.

I think you can stand up to people, most people. I mean, there are going to be outliers, like anything, but I think there's a certain strength in that. And I think if you do it enough and you're resolved enough, that can help.

Nick, what do you think? Am I completely crazy?

Nick: I think for the most vulnerable people, which is kids and adolescents, they need support from parents, from teachers, from church leaders, because . . . I mean, when you're 8, 10, 12, 14 years old, we could be delivering this message to them all day, "Love who we are, own it, be okay with it," but they need to see more than that. And they need role models who they can look up to, who are confident, but also caring, but also strong, but also compassionate. They need to see that, I think, to really buy in.

Troy: Yeah. And it's a lot easier as an adult I think to do that than as a kid with the perils of just the peer groups and all that. That's a tough place to be.

Scot: Yeah. As an adult, you to some extent can choose where you go. As a kid, you can't. You have to go to this place called school and everybody's thrown in there, and it's just a big old free-for-all. But I can avoid the type of people I want to avoid in my work life.

Troy: Yeah. It's a lot easier, but for those listening who you're an adult, you can embrace that. And if you're in a work . . . because there are certain work environments where I think it's difficult. I think certain work environments it may be difficult to truly be who you are, and maybe certain co-workers, but you can always find a new job or even switch professions, or all those sorts of things.

I think it's a lot easier as an adult, but I think that's probably the point, is to really embrace that, embrace who you are, and not feel like you have to fit a certain mold that's held out there.

Scot: Yep. Realize that masculinity is a thing. It's not a real thing. It's just created by all of us in society that have come to these assumptions, and these assumptions can be challenged, and you can define your own way.

One of the things I love that you said, Nick, is question why we call things normal. I think that can even go beyond this notion of masculinity. Why is this considered normal? Do I subscribe to this thought that this is normal? What are my thoughts on it? When you start asking those questions, I think you can start really kind of building your own confidence and go in your own way.

Nick, thank you very much for this conversation. Appreciate it as always for being on the podcast, and thanks for caring about men's health.

Dr. Galli: Absolutely. Thanks for having me.

Scot: Time for "Just Going To Leave This Here." It might have something to do with health or maybe it's just a random thought that's kicking around in our brain that we need to let free. Troy, do you have any random thoughts you need to set free?

Troy: Totally random thought, Scot. I am . . . and you probably are too. But I'm kind of a grammar nerd. So this is a grammar issue that has really bothered me and I've got to get your insight on this. So if I sent you a text message yesterday, how would you say that phrase? "I text you yesterday" or "I texted you yesterday"?

Scot: The thing that feels natural and normal is "I texted you yesterday."

Troy: I know. Me too. I mean, text has become a verb. It's a noun. A text is a noun. It's become a verb. In our daily usage it's become a verb. But people say "text" all the time, like, "Oh, I text you last week," "Oh, I text you yesterday," "Oh, I text . . ." And they're not saying texted, they're just saying text. I looked this up. I'm like, "What's the proper use of the verb text if I sent you a text yesterday, if I texted you?" And there is no proper use because it's just this noun we've turned into a verb, and we're all just using it. Some people are saying, "I texted you," and some people are saying, "I text you." Probably the best way to say it is, "I sent you a text message yesterday."

Scot: Yeah. I mean, if it's a noun, that's how you would say it.

Troy: Yeah, be on the lookout. Now it's going to start driving you crazy. You're going to hear people saying it all the time, like, "Oh, I text you this picture," or, "I text you this whatever." And you're like, "Text me right now, or you texted it two hours ago?"

Scot: I'm just going to leave this here. Thunder Jalili, our nutrition expert, has talked a couple times about time-restricted eating. So there's a lot of confusion when it comes to fasting because it can mean a lot of different things, but time-restricted eating is just taking the time that you allow yourself to eat during the day and keeping it limited to 12 hours or 10 hours or 8 hours so then you have a fast between then and when you eat again.

I started doing this when COVID first started, just before COVID first started. I've actually loved it. I felt great. I felt clear in my brain. I slept better. So I've started doing that again after Thunder came on, and it's only taken a couple days and already I feel so good.

Troy: Oh, nice.

Scot: So if you've ever considered time-restricted eating, there's also a documentary out there I just watched. I'm going to say right now that this documentary probably only needed to be about 40 minutes long, and it's an hour and a half. So you can just fast forward through the stuff you're not interested in.

Troy: One of those. I've seen too many of those documentaries.

Scot: Right? But it's called "Fasting" and it's on Netflix.

Troy: Nice.

Scot: First of all, go back and listen to some of our Thunder episodes. But if you're interested in time-restricted eating and fasting in general and why it works, you might want to check out that Netflix documentary.

Troy: So what are you restricting yourself to? Ten hours or 12 hours? What's your . . .

Scot: Yep. I've started it at 12, and I'm going to see how that goes. Now, Thunder has said that's a good maintenance kind of timeframe. And then in a couple of weeks I think I'm going to move to 10 or 8 because I have some body fat that I'd like to lose. So I decided to start with 12 because I thought that was doable, and then I'm going to try to get it 10 or 8. That's the plan.

Troy: Nice. That's great.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55-SCOPE. That's 601-55-SCOPE, and leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

This is a transcript for the main segment of the show. You can read it if you like, but we encourage you to subscribe and listen for the full experience. It's more fun that way.

Dr. Galli: Most of us take for granted the things that we see as normal and expected. So hopefully, we've at least parked the thought of, "Oh, hey, maybe that's not how I have to be. It's how I think I should be," and where is that coming from?

Scot: All right. Welcome to the podcast "Who Cares About Men's Health." What we've got here are some guys who care about their health, and they're not afraid to talk about it either. We get this bad rap. Guys don't care or want to talk about their health. That's not true, proving it right now.

My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I'm glad that for the first time in the history of this podcast I actually sound better than Scot on this, and I care about men's health.

Dr. Galli: And I am Dr. Nick Galli. I'm an associate professor at The U in the Department of Health and Kinesiology, and I care about men's health.

Scot: So today, we're going to talk about a force. It's a force that controls us as men, and a lot of us don't even know it, but it's this invisible force that impacts how we think about our health, our body, and it could be responsible for a lot of bad health decisions. It's reinforced in magazines, TV shows, movies, social media, and communities. We cannot get away from it. As a matter of fact, the World Health Organization thinks it's the reason why men tend to live six to eight years less than women, this invisible force. What is it?

Troy: Dark matter.

Scot: Kind of. It's the notion of what makes a man a man, the forces called masculinity. Nick is an expert in this topic. I actually did for my master's program a research paper on masculinity and men's health, and what I found was fascinating. I don't know about you guys, but I hate the thought that anybody or any force is controlling what I'm doing.

Troy: Especially if it's shortening our life by six to eight years. I had no idea. Wow.

Scot: Yeah. Isn't that crazy?

Troy: That's crazy.

Scot: So, before we get going, Nick, maybe you can give us a definition of what masculinity is, because it's not a real thing. It's what's called socially constructed. It's just something that we as people made up.

Dr. Galli: Yeah. Let's say it's sort of the set of attitudes, beliefs, behaviors that dictate how men should behave, what they should think, what they should value. And as you said, Scot, it's pervasive. We're primarily talking about Western cultures and even more primarily the U.S. It cuts across everything that we do.

Scot: So an example of this and how it might impact our health is somebody offers you a steak or a salad and you take the salad, what happens? What happens if you've got your guy friends around?

Dr. Galli: Well, of course, it depends, but yeah, you're going to get . . . I mean, when I think back to when I was sort of in the prime of . . . Because it changes, right? So, for me, when I was in my late teens and in my 20s and spending a lot of time with my guy friends, now you're immersed in that. And so, for sure, you'd get some looks.

I mean, even on that specific topic, I remember going out to lunch and dinner with my guy friends and it was almost, "How much fatty food can you eat?" Like, it was a challenge. Everything is a challenge in the world of masculinity. Everything is a competition, including how much you can eat.

Troy: Nick, I wonder how much of this is learned, how much of this is just the fact that as a man you've got testosterone and testosterone tends to lead men often maybe to be more risk-taking or maybe more competitive. I don't know. I mean, are there certain elements there versus . . .

Dr. Galli: I think there's a biological component, but that becomes accentuated for sure by messages that begin very early on.

Troy: And by masculinity then, are we talking about . . . again, is it the way we're interacting with others? Is it the expectation I have for myself? Is it just this idea that I can't show emotion? What is it about this that's kind of the core element of it? And getting to that, what is it about it that's so detrimental that's really shortening our lifespan?

Dr. Galli: Well, I think too, before we go much further on it, true experts and scholars in gender studies and masculinity would probably argue that there are multiple forms of masculinity. And the kind that we're talking about here today and that tends to be especially problematic is sort of that dominant, what we call a very . . . this is a very scholarly term . . . hegemonic masculinity. Hegemonic is just a fancy way to say dominant.

I think one of the tasks and one of the goals is to try to diversify. There's nothing inherently wrong with masculinity, femininity, but building in some flexibility into those concepts that there's not just one way to be masculine or one way to be feminine.

What's problematic about this dominant form that, as Scot alluded, seems detrimental to our health is that, yeah, we box ourselves in as men into a certain way of being, and that's fueled by things that we see and expectations that we hold of ourselves and that others hold of us. And really, what needs to happen, and this is maybe skipping ahead to more practical, is there needs to be a much more flexible conception of what it means to be a man in society.

Scot: And that's difficult, right? Because I bet you we could all tell our stories . . . I don't know. I can only speak for myself I guess, but I grew up in a ranch environment in western South Dakota and there was a certain kind of way that guys were supposed to be there, which is all just created in our own brains. There's nothing inherent about a lot of it. And I didn't fit in, right? I was a little bit more sensitive. I was a little bit more delicate. I wasn't a big muscular guy, right? I didn't like to ride bucking broncs and bulls and I didn't like to fight. So that made me less than.

Dr. Galli: Absolutely.

Scot: And I spent a lot of my life, and I still think about it to some extent, but not as much, trying to come to terms with, "Oh, I'm not a man. I don't look for a chance to . . ." Like, if somebody gets in my face, I don't get right back in their face. That's not how I choose to handle it. Maybe I choose to talk it out. That's not manly, right? That doesn't fit that masculine definition. So, for a long time I've . . . and especially then comparing myself to my dad who was all those things.

Dr. Galli: Well, thanks for sharing that, and I think that speaks to one of the earlier manifestations of how this can become problematic, is when we see young boys in school who maybe prefer different types of activities that aren't perceived as masculine or act in ways that aren't perceived as masculine, and then they can become the subject of bullying. We know well the consequences of bullying on mental emotional health.

Scot: And also just my own emotional health not living up to this ideal.

Dr. Galli: That you're not good enough. That you don't . . .

Scot: Exactly.

Dr. Galli: . . . meet that standard. I relate. I mean, where I grew up in a mid-sized city in central California, at my high school, for the boys, there were sort of two ways to be popular: one if you were a tough guy and/or two, if you were good at sports, and physical sports particularly, so football or the mainstream sports. If you couldn't check either of those boxes, you were sort of on the fringes of popularity or of acceptance.

Troy: Scot, it's interesting to hear you talk about that because I think I too . . . I mean, I didn't grow up in a ranching community. I grew up in a coal mining community, a small town. And as a skinny nerdy kid, middle school was miserable. I got beaten up. Not just bullied, but physically beaten up by kids in school and it was awful.

Scot: Wow.

Troy: And that kind of stuff sticks with you. I think probably over my entire life that element or that definition of masculinity, that's probably affected me.

And it's funny. I think back to two years ago, Scot, when you approached me and said, "I want to do a men's health podcast. Will you co-host with me?" It was like this sense of this imposter syndrome, like, "Who am I to talk about men's health? I am not a manly man."

And obviously, as we do this podcast, you realize that masculinity or that sense of the manly man, that's not who most men are. I don't think that's really who most men are. I think, like you said, Nick, that's the image that's out there and that's what we feel we should be. But you look at the men you know in your life and the men work with, most men are not that way.

Dr. Galli: If we were to all Google "men's health" right now, what would come up is probably very different than the things that we're discussing today. I mean, there's even a magazine called "Men's Health," and what do you get in that magazine? You get chiseled muscular bodies, very much an aesthetic and physical version of what health is.

Scot: Yeah. And not only that, but you get these attitudes of a man in "Men's Health" is great in the bed and takes care of his woman, and just all of these images and these thoughts that . . .

Troy: Well, not just takes care of his woman, takes care of multiple women. If you read "Men's Health" magazine, it's like . . . yeah, that's been my image of men's health is "Men's Health magazine. How often do you see a thin guy on the cover of "Men's Health" magazine? It's usually dudes who are just totally ripped and built and just these massive dudes.

And all the articles there, it's about that. It's about living a lifestyle. Not all of them, but a lot of them have to do with maximizing that lifestyle, live hard/play hard, work hard/play hard lifestyle, and a certain element of sexual prowess or whatever else some of these articles . . . and so it's a . . .

Dr. Galli: This makes the battle even harder, right? Because now we have sort of the big media hijacking the concept of men's health. Not just masculinity, but men's health, and selling it to the masses.

Scot: Yeah, it's that either/or, right? So it doesn't leave you any in between. It's either you're working out and you're doing high intensity exercise and you're eating just perfectly, or if you can't live up to that ideal, which sometimes I think I can't do that. So then it's just like, "Well, why even bother if that's not what I'm going to get?" So I think it's a little dangerous that way as well.

Troy: For sure.

Scot: Hey, Nick, I want to share another little aspect and then I want to kind of steer the transition of the conversation into how maybe each one of us can claim our own form of masculinity, because I think ultimately that's what we should be able to do.

So I can't speak for Troy, but I wasn't very confident and I lacked confidence for a long time in my life because I didn't fulfill this ideal of masculinity. And that can lead to mental health issues. That can lead to feelings of inadequacy. But I have noticed, too, that there are some men that are very confident in themselves and they might not fulfill that norm of hegemonic masculinity, but yet they create their own, right? To some extent, showing control and restraint in not doing all those dangerous behaviors can be a form of masculinity.

How exactly does that work and what are your thoughts on developing your own version of it? And then how are you confident in that version as you interact with the rest of the world?

Dr. Galli: That's a big question.

Scot: Hey, listen, I gave you a little bit of warm-up to get to this point. So I figure you should have all the answers by now.

Dr. Galli: Okay. There's not going to be a simple answer to this, but there are forces at play. I think two of them come to mind, as I think about folks who are sort of able to transcend what we've been talking about here.

One is just time and maturity. The young adult males are the ones who are kind of most at risk I would say for really trying to live this ideal that can be dangerous. As we get older, we care less about what other people think, we have different priorities, and so it becomes easier as we get into more middle adulthood to just sort of be our own person and not give a crap about what people say I should be. Now, that said, there are definitely some people who struggle with that. So I think time and normal development is an asset.

And then I think another asset that some folks have are support of influence and people in their family who are just unconditionally okay with a boy being how they want to be, and for that matter, a girl being how they want to be. Of course, there are forces outside the family, but that primary family tends to be the most powerful force for a lot of kids. And I think that goes a long way.

And as a young boy, if you want to play with Barbie dolls, that's fine. If you want to watch "My Little Pony," that's fine, or whatever. That's what it was when I was a kid growing up.

I think it seems very subtle, but when you are surrounded by folks who are just okay with you being you and not making snide comments or forcing you to be something that you don't want to be, then I think that allows for the possibility of just, as you said Scot, being comfortable in your own skin, even if that doesn't align with what you're seeing of other boys and men.

Troy: And I guess though, Nick, as we talk about this . . . I mean, certainly there are some elements of masculinity that are valuable, but at what point do you feel like that truly becomes toxic? We talk about masculinity or toxic masculinity. When does that sort of thing become toxic? And are we talking toxic to others, toxic to ourselves? How does that play into it?

Dr. Galli: Yeah, I think both. I mean, any time that somebody has fully internalized . . . I think of heavy drinking, womanizing, or having multiple partners and not exhibiting safe and thoughtful sex behaviors, over-imbibing in alcohol, drug use, steroid use, not going to see the doctor on at least a yearly basis because "I'm invincible." I mean, I think it's all about the behaviors, and underlying that is the thought that, "I am impervious to a lot of these issues, and also I don't need to talk about what's bothering me because that would suggest weakness."

And going back to something you said there, Troy, too about some of the advantages, I do think there are advantages, and in many ways I think our society is set up to favor and advantage men who do exhibit these dominant traits. So it's reinforcing, right?

Look at who we see as CEOs and in leadership positions. And that's starting to change, but it tends to be men. And there are some positive characteristics for sure. There are also positive characteristics of . . . and I keep pointing to femininity as sort of the other side of the coin here. Things that we associate with femininity that are also very positive, such as compassion and having a nurturing side, sort of those stereotypical feminine qualities, that many men feel like, "Well, that's not what I'm supposed to do." So they deny themselves the opportunity to explore that side of who they can be.

But in many ways our society is set up to really favor folks who exhibit these dominant alpha male qualities.

Troy: And it seems that in terms of just where masculinity truly becomes detrimental, it may be that it's that masculinity at the point where we really try and push away any sort of feminine qualities within ourselves, any sense of nurturing, any sense of emotion, those kind of things and . . .

Dr. Galli: Except for anger. Anger is okay. Anger is okay for a man.

Troy: It's okay for a man.

Scot: I think that's the only emotion, isn't it?

Dr. Galli: When a woman is angry, oh, there's something wrong. It's so true, right?

Troy: Yeah, but it seems though that that often . . . as I'm hearing you talk about this and talk about these different elements, it seems that when masculinity really becomes an issue and a problem, it is when we, like you said, take that masculinity to the extreme in terms of risk-taking, detrimental behaviors, in terms of how we treat others and interact with others, and then we push aside anything that would be associated with that feminine element, again the nurturing, the caretaking, all those sorts of things.

Scot, as you talked about, the years lost on our life, I would imagine that those are the things that really caused those years to drop off when we are pushing aside our ability to feel emotion and ability to care, and nurture, and those sorts of things, and then add on to that the risk-taking behavior and everything else there. That seems like that combination is what is truly toxic and what really hurts us.

Scot: As we wrap this up, here are a couple of my takeaways, Nick, and I'd love to hear yours as well. So I think the goal of this particular episode is just for those that weren't aware that this is an invisible force in one's life that is actually impacting your decisions or how you feel about yourself, just to become aware that it's out there and it's a thing. I think, obviously, awareness is the first thing.

And then I think developing your own definition of what you are as a person. Maybe just abandon the notion of men and women. What are you as a person? And I'm guessing that the super toxic masculinity individuals have dropped off this episode way before this point. So we're not talking to them necessarily.

Dr. Galli: But we could be talking to parents of children who have a role in shaping them.

Scot: Yeah. I mean, the way you shape them could either empower them to go out and accomplish great things, and feel good about themselves, and be mentally well off, or it can burden them if we're forcing those types of things, I suppose, on kids.

So I think becoming aware and I think realizing that it's okay to be you. I tend to be more sensitive, I tend to be more thoughtful, I don't react and come to anger as quickly as maybe some men, I don't believe in fighting. That's okay. That's my outlook on life, and that's fine.

Troy: Have you ever been in a fight, Scot? I'm just curious.

Scot: Actually, I never have, believe it or not.

Troy: Like a physical fistfight? Not even in elementary school?

Scot: No. I was a "doorman" at a bar for a couple years, and I never got in a fight.

Troy: You were a bouncer.

Scot: I know, right?

Dr. Galli: A bouncer. Yeah.

Troy: Scot is like the world's worst bouncer.

Scot: Actually, I wasn't.

Troy: He's like, "It's all right, guys. Let's talk this out."

Dr. Galli: He's actually willing to talk and . . .

Troy: I know. I was just joking. Yeah, you're totally breaking the mold of the bouncer. You're like the negotiator. I love it. That's great.

Scot: Nick, any final thoughts or takeaways from this episode? What do you hope that it accomplished today?

Dr. Galli: Oh, yeah. Raising awareness primarily. I talk about internalizing, and I think most of us take for granted the things that we see as normal and expected. So hopefully, we've at least sparked a thought of, "Oh, hey, maybe that's not how I have to be. It's how I think I should be," and where is that coming from? Maybe more men or women willing to have conversations, like we just did right now, about these topics.

Troy: Obviously, we say, "Be yourself." Sometimes that's hard because it's like, "Well, yeah, but there are different elements of myself." I think it's be your best self. There are elements of masculinity that are, I think, good.

Scot: Yeah, but it's also tough to sometimes be yourself if you're not in the environment. There's no way as a young man I would have been able to buck the trend, I don't think, of what was expected of me. I don't know. Maybe there could have been had I been more confident.

Troy: Still.

Scot: You've just got to try the best you can.

Troy: Yeah, embrace the best of these things and don't . . . I think that's it, too. Again, getting to that thing about, "Well, these things are associated with femininity in terms of emotion and caretaking and all that," but if that's part of you, embrace it. Embrace that and just . . .

I think one takeaway too, like I said, Scot, is just that most men are not that stereotypical man. I think that's been one thing that's come to me in terms of this podcast as we talk to so many experts. It's just opened my eyes and I look at the people I work with, and the patients I see, and all these things. Most men are not the stereotypical manly man that we sometimes think we should be, and that's not the norm. Maybe what's held out there is what we should become, but that's not what most men are.

Scot: And there's a certain strength . . . I guess if I was to give advice to young Scot, like how you could still be yourself and be in an environment where there's a different definition of masculinity, I think . . . and I could be completely full of crap and might get the crap kicked out of me. I think there's a certain strength in knowing who you are and owning that and making no apologies for it.

I think you can stand up to people, most people. I mean, there are going to be outliers, like anything, but I think there's a certain strength in that. And I think if you do it enough and you're resolved enough, that can help.

Nick, what do you think? Am I completely crazy?

Nick: I think for the most vulnerable people, which is kids and adolescents, they need support from parents, from teachers, from church leaders, because . . . I mean, when you're 8, 10, 12, 14 years old, we could be delivering this message to them all day, "Love who we are, own it, be okay with it," but they need to see more than that. And they need role models who they can look up to, who are confident, but also caring, but also strong, but also compassionate. They need to see that, I think, to really buy in.

Troy: Yeah. And it's a lot easier as an adult I think to do that than as a kid with the perils of just the peer groups and all that. That's a tough place to be.

Scot: Yeah. As an adult, you to some extent can choose where you go. As a kid, you can't. You have to go to this place called school and everybody's thrown in there, and it's just a big old free-for-all. But I can avoid the type of people I want to avoid in my work life.

Troy: Yeah. It's a lot easier, but for those listening who you're an adult, you can embrace that. And if you're in a work . . . because there are certain work environments where I think it's difficult. I think certain work environments it may be difficult to truly be who you are, and maybe certain co-workers, but you can always find a new job or even switch professions, or all those sorts of things.

I think it's a lot easier as an adult, but I think that's probably the point, is to really embrace that, embrace who you are, and not feel like you have to fit a certain mold that's held out there.

Scot: Yep. Realize that masculinity is a thing. It's not a real thing. It's just created by all of us in society that have come to these assumptions, and these assumptions can be challenged, and you can define your own way.

One of the things I love that you said, Nick, is question why we call things normal. I think that can even go beyond this notion of masculinity. Why is this considered normal? Do I subscribe to this thought that this is normal? What are my thoughts on it? When you start asking those questions, I think you can start really kind of building your own confidence and go in your own way.

Nick, thank you very much for this conversation. Appreciate it as always for being on the podcast, and thanks for caring about men's health.

Dr. Galli: Absolutely. Thanks for having me.

Scot: Time for "Just Going To Leave This Here." It might have something to do with health or maybe it's just a random thought that's kicking around in our brain that we need to let free. Troy, do you have any random thoughts you need to set free?

Troy: Totally random thought, Scot. I am . . . and you probably are too. But I'm kind of a grammar nerd. So this is a grammar issue that has really bothered me and I've got to get your insight on this. So if I sent you a text message yesterday, how would you say that phrase? "I text you yesterday" or "I texted you yesterday"?

Scot: The thing that feels natural and normal is "I texted you yesterday."

Troy: I know. Me too. I mean, text has become a verb. It's a noun. A text is a noun. It's become a verb. In our daily usage it's become a verb. But people say "text" all the time, like, "Oh, I text you last week," "Oh, I text you yesterday," "Oh, I text . . ." And they're not saying texted, they're just saying text. I looked this up. I'm like, "What's the proper use of the verb text if I sent you a text yesterday, if I texted you?" And there is no proper use because it's just this noun we've turned into a verb, and we're all just using it. Some people are saying, "I texted you," and some people are saying, "I text you." Probably the best way to say it is, "I sent you a text message yesterday."

Scot: Yeah. I mean, if it's a noun, that's how you would say it.

Troy: Yeah, be on the lookout. Now it's going to start driving you crazy. You're going to hear people saying it all the time, like, "Oh, I text you this picture," or, "I text you this whatever." And you're like, "Text me right now, or you texted it two hours ago?"

Scot: I'm just going to leave this here. Thunder Jalili, our nutrition expert, has talked a couple times about time-restricted eating. So there's a lot of confusion when it comes to fasting because it can mean a lot of different things, but time-restricted eating is just taking the time that you allow yourself to eat during the day and keeping it limited to 12 hours or 10 hours or 8 hours so then you have a fast between then and when you eat again.

I started doing this when COVID first started, just before COVID first started. I've actually loved it. I felt great. I felt clear in my brain. I slept better. So I've started doing that again after Thunder came on, and it's only taken a couple days and already I feel so good.

Troy: Oh, nice.

Scot: So if you've ever considered time-restricted eating, there's also a documentary out there I just watched. I'm going to say right now that this documentary probably only needed to be about 40 minutes long, and it's an hour and a half. So you can just fast forward through the stuff you're not interested in.

Troy: One of those. I've seen too many of those documentaries.

Scot: Right? But it's called "Fasting" and it's on Netflix.

Troy: Nice.

Scot: First of all, go back and listen to some of our Thunder episodes. But if you're interested in time-restricted eating and fasting in general and why it works, you might want to check out that Netflix documentary.

Troy: So what are you restricting yourself to? Ten hours or 12 hours? What's your . . .

Scot: Yep. I've started it at 12, and I'm going to see how that goes. Now, Thunder has said that's a good maintenance kind of timeframe. And then in a couple of weeks I think I'm going to move to 10 or 8 because I have some body fat that I'd like to lose. So I decided to start with 12 because I thought that was doable, and then I'm going to try to get it 10 or 8. That's the plan.

Troy: Nice. That's great.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55-SCOPE. That's 601-55-SCOPE, and leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

Dr. Chan: What's it like moving from Boise, Idaho to Middlebury, Vermont? How can an outdoorsy lifestyle influence you to pursue a career in medicine? On this episode of "Talking U and Med Student Life," second-year med student, Joe, talks about rural medicine, why he ended up in Utah, and how to get started snowboarding in the great Utah mountains.

Welcome to another edition of "Talking U and Med Student Life." Fantastic guest today. Joe, how are you doing?

Joe: I am excellent. How are you?

Dr. Chan: I'm hanging in there, and we'll talk about that later. Living life in a pandemic. It's been interesting, difficult, and challenging, and beautiful all wrapped into one. All right, so Joe, what year are you now?

Joe: I am currently a second-year, MS2.

Dr. Chan: All right, second-year med student. And we're going to talk about what medical education looks like in a pandemic. But I want to go into a quick time machine. All right? So let's go in a time machine together and go back, back, back, back. So, Joe, what prompted you to become a doctor? What event in your life or were there a series of events, and how old were you? When did this start entering your brain?

Joe: Ah, sure. So I've always really been interested in science, and I sort of knew I wanted to do something in science probably starting in about third or fourth grade. But one of the real inciting events for me, and, you know, you read personal statements all day. And the thing that I talked about in my personal statement was, when I was 15, I was whitewater kayaking and a man dislocated his shoulder right in front of me. And one of the other members of our team was a wilderness first responder, and they kayaked over and reduced this man's dislocated shoulder while they were floating down the river next to each other. And so I immediately thought, "You know, that's a skill I want to have." And so I started with wilderness first responder as a wilderness EMT. I worked as an EMT. I did a bunch of wilderness sort of medicine-related things in college. And sort of every step of the way I wanted more and more knowledge, more and more skills. And fully pursuing medicine seemed like the perfect place for me.

Dr. Chan: Awesome. I mean, so a lot to unpack there. So this is back during high school, correct? You said you were 15?

Joe: Correct.

Dr. Chan: So college, where'd you end up, and how'd you pick that school?

Joe: Yeah. So I grew up in Boise, Idaho and I absolutely love Idaho, still go back every chance I can. But I wanted to try something a little different for college, and so I traveled out to New England, to Vermont, and I went to Middlebury College. And then while I was there, that afforded me a lot of opportunities to do some outdoor things, do a lot of wilderness, medicine-related stuff with teaching, with instructing rock climbing and kayaking, and things like that. And . . .

Dr. Chan: How was it going from Boise to Middlebury? That sounds like a big jump. Or wasn't that a big jump?

Joe: It was very different.

Dr. Chan: Yeah.

Joe: It was . . . Yeah. Yeah, I mean, it was interesting. I always say think of Boise as a pretty small town. I mean, I think currently it's about 200,000 people. The whole valley's got 500,000 or so. But Middlebury, Vermont, the college itself makes up about 3,000 humans and the town itself makes up about 6,000 humans. So it's the kind of place where the general store will say, "We close at around 5 p.m." or things like that. So you've got to come in a little early in case the owner is feeling like going home or you might not get your groceries.

Dr. Chan: Wow. And then, so when you went to Middlebury, was there like a premedical program, or did you start to waver, or like how did that go? How did your metamorphosis go during your undergraduate days?

Joe: Yeah, I started out as a physics major, but I knew that medicine was sort of my goal overall. We didn't have a premedicine, really, track. It was sort of you do whatever you're interested in, and as long as you check off enough of the boxes of which classes you need to take, then you were sort of granted the blessing of the premedical committee. And if you wanted to, you could do a committee letter or things like that. The University of Utah was at the top of my list when I was applying. And I knew that the University of Utah was not interested in committee letters. So it was nice that I had the option, but yeah, they had a group of people that could guide you if you needed assistance or needed direction. But I ended up graduating biochemistry major because it meshed a lot better with not only the premed requirements but of what I became interested in as I went through college.

Dr. Chan: How did you get all those necessary activities, like the research, like the community service? How did you do that at Middlebury?

Joe: Yeah. We had the distinct privilege of not having any graduate program, which sounds a little funny because I also did research at the U after my sophomore year working for a Ph.D. student in a chemistry lab. But being the only students on campus as undergraduates, it meant that when I pursued a research opportunity, I got to sort of be in charge of my own project working on Lyme disease. So they were all small labs, maybe three to five students. And it was 100% undergrad-driven. So it was a wonderful experience. I really loved it.

Dr. Chan: That's great. And then, you know, when you talk about Vermont, I also think about Ben & Jerry's ice cream. Do you have any stories to share? What is your favorite flavor?

Joe: Ooh, my favorite flavor of Ben & Jerry's is Half Baked. They were about, you know, 55 minutes north of us in Vermont, which means you had to pass by five or six creameries on your way there. But if anyone's from the East and they know of Maple Creemees, they'll know that that's really the best ice cream in Vermont. And we had it on tap at our college from 8 a.m. to 8 p.m. every day.

Dr. Chan: So I guess it was so common it wasn't that unique to you. To me, it's like very unique out here, but I guess back there it was just like water. Like it was everywhere, right?

Joe: Yeah, exactly. Yeah, you could hardly walk, you know, 100 yards without bumping into an ice cream dispensary.

Dr. Chan: Wow. And then, you know, you're hitting your senior year, you're looking at med schools. What was your strategy going in? What schools were you looking at, and how were you going to do that?

Joe: Sure, yeah. So being in Vermont and being sort of that . . . I guess about half of Middlebury students are from like the just outside of Boston, New York, Pennsylvania, that kind of area. And so all of my friends were really looking at schools in that area. And the few of us Westerners were sort of split up and didn't particularly know where to look. So I sort of looked all over the West, and being from Idaho without a program of our own when I was applying, I mean, Utah was by far the most attractive option. And mostly, I mean, from a financial perspective, from an outdoor-access perspective, Utah really checked all the boxes for me. But, you know, I applied everywhere and couldn't believe it when it worked out.

Dr. Chan: So Idaho technically does not have their own medical school. But University of Utah, University of Washington, through the WWAMI Program, do take Idaho residents. And we take 10 and they take 40. Did you apply to WWAMI? What were your thoughts about WWAMI? I mean, I'm just curious, Joe, like I've never had this conversation with you. How did you end up in Utah?

Joe: Yeah, absolutely. Yeah, so I definitely applied to WWAMI. And I have . . . I'm trying to think, I have at least four or five close friends who are at the WWAMI Program up in Moscow, Idaho. And yeah, I liked a lot of things about their program, but I think for me, the U is a more attractive option because it gave me a lot broader of options. I wasn't particularly sure of what kind of medicine I wanted to go into, whether it would be primary care or emergency. All I've done is emergency work in my life. And so I'm still leaning that direction.

But at the WWAMI Program, it felt a lot like they were University of Washington students who were sort of off on their own. It felt like they had a good strong sense of community with those, you know, 40 students living in and amongst each other in that same location. But it felt more like a satellite campus than a full-blown medical school the way that the University of Utah does, where it feels like we have all of these enormously beneficial resources right at our fingertips.

Dr. Chan: Yeah. I like how you said that, Joe. I think there's 125 medical students per class and there's 10 Idaho students. And I would argue the 10 of you are fully integrated into everything that the other students do to the point where I don't think people, unless you self-identify as from Idaho, people don't realize you're probably from Idaho unless you tell people, correct?

Joe: Exactly.

Dr. Chan: Yeah. And I think, yeah, we're a quaternary, tertiary care center and we just have a lot of opportunities. And our students get to have first access, first pass at all those activities. And yeah, I agree with you. Like I think WWAMI is a fantastic program. But they are based, the Idaho piece is based in Moscow. So yeah, I just think the two wonderful programs serving the state of Idaho. It's all good. So, all right.

So Joe, you get here, and then what was your impression? Because like let me frame this question. Like everyone has this conception of what med school is like, right? And I think that's born from the media or tales that are told around the dinner table. Everyone has an idea of what med school is like. But then you come here and then you start medical school. So what was that first semester like? Was it doable? Was it overwhelming? How would you describe your experience jumping from premed to med?

Joe: Sure. Yeah, so the sort of . . . the way that I like to think about it is there's all of the work that I did in undergrad where I was a biochemistry major, and so I was taking all of these biochemistry classes. And then I graduated, and I studied for the MCAT by doing a 10-week intensive course. And it felt like I was learning an entirely different side of medicine when I was studying for the MCAT. It felt like nothing I had actually learned in undergrad.

And then when I got to medical school, it felt like a whole other switch, where it felt like every time I had, you know, heard about some process when I was in undergrad or some process when I was studying for the MCAT, when I got to medical school and we approached those same topics, we would spend part of our time sort of getting everyone caught up on, oh, I don't know, like what the Krebs cycle is or something like that. But then we would always take it a step further, and you'd have to really, really be familiar with every single aspect of what was going into every single process we were learning about, even when we were doing that Foundations of Medicine, first six months to catch everyone up.

And I was mostly surprised at just how cursory of an understanding I actually had about so many topics before going to medical school and how much sort of work I had to put in to really understanding the nuances. But I felt personally like the first six months were difficult but doable. I had a strong group of people around me that I could study with and we could bounce ideas off of each other. But we could also, you know, really get outside, or exercise, or in some form almost every single day during my first year of medical school. So I was surprised at how much outdoor activity I was able to get in while simultaneously studying.

Dr. Chan: Was it hard, Joe, going from . . . And I'm just going to put my own projection out there. You're kind of big fish in little pond Middlebury because just being kind of at the top and just doing so well, and then you come to medical school and then everyone just knows . . . so smart, knows what they're doing. Was that a transition for you, or you felt you did that pretty well?

Joe: I think that when I was at Middlebury I was very much a small fish in a big pond as well.

Dr. Chan: Okay, okay. I'm just trying to use outdoor analogies.

Joe: Yeah, oh, absolutely. So I felt like when I got to the University of Utah that that sort of imposter syndrome really carried nicely through and I got to maintain my sensation of imposter syndrome through undergrad all the way into medical school. I'm constantly astounded at the students I get to spend time with.

Dr. Chan: How would you describe your imposter syndrome? Because it has different definitions depending on who you are. So how would you describe it?

Joe: Sure. So I feel like when you first get into any program, and I'd be fascinated to ask this question to a current MS1 because they're all seeing each other simply over Zoom, and it's a less personable space. But for me, when I arrived here, a lot of it was, holy cow, what did this person sitting next to me do in undergrad? Or realizing that they're, you know, 4 or 5 years older than me and have 17 more publications than I do and things like that.

So for me, it's the, when you get into Foundations of Medicine, you get into that first six-month course. Everyone's starting from a very different place, and we all had to, you know, be our own interesting person. But when you first arrive, it's really astounding to see how impressive sort of the accolades of your peers are. And then sort of as I've moved through, now as a second year, and especially with COVID when a lot of our opportunities that were, you know, in-person were shut down, or moved off, or things like that, and we're already starting to feel the pressure of taking Step 1, and thinking about our CVs, and our applications to residencies. It's seeing just how much your fellow students can be learning and also, you know, participating in their extracurricular activities while they're here, while they're in their second year.

Dr. Chan: Joe, you mentioned maintaining outdoor activities, or learning, or growing. And it sounds like you've struck a pretty good balance with, you know, life, and wellness, and academics, and personal time. What was your secret? How did you do that? Did you like map it out ahead of time? I mean, did you put it down on your schedule, or was it more spontaneous, you know, a couple of hours here and there? Like how did you do that?

Joe: Yeah, so one of my favorite expressions I ever heard in undergrad . . . And I've been so extremely privileged in where I've gone to school because I've always had outdoor access so immediately close by. But the sentiment that stuck with me most from a professor was, "If you do not have 30 minutes per day or in your day to do something for yourself, either physically outside or for your mental-emotional health, if you don't have 30 minutes in a day where you can sit down and do that, you need to take 60 minutes that day to do it."

And so there's sort of a point of diminishing marginal returns on studying for a lot of us. And I found pretty early on that if I got, you know, seven or eight hours of sleep every night, and I spent at least, you know, 30 minutes to an hour either walking or hiking in the foothills that come straight out of the medical school, or going to the climbing gym nearby, or things like that, if I took that time, I performed better and better than if I spent that hour, you know, re-reviewing notes from a lecture or something like that. I didn't actually perform better and I didn't retain anything better.

So I've tried to keep a really strong crew of people where we can sort of spontaneously say, "Hey, does anyone want to go, you know, climb in Big Cottonwood Canyon at 5 p.m. today?" And you'll always find one or two people who are willing to do that. I wish I was a more organized person who kept a tight-knit schedule to include that, but I absolutely know students who write in one-hour run at 4 p.m. and when their calendar goes off, they put on their shoes and go out.

Dr. Chan: Wow. Joe, that's fantastic. And I also know that, you know, like you mentioned, hiking, and walking, and I think you said rock climbing, I think you also have the skill of ski and snowboarding. So I'm curious, how long have you been a skier or a snowboarder?

Joe: Sure.

Dr. Chan: And yeah, just like what's your favorite resort here? And I think another great selling point of Utah, just access to a lot of different areas where you can do that.

Joe: Yeah. I don't know that I can say that the University of Utah has the best skiing of any medical school in the world because I don't know enough about the world, but in the United States, I think you'd be hard-pressed to make an argument that there's better skiing anywhere else. Yeah, so I started skiing when I was two years old. And in my family, it wasn't really an option. You were a skier, and you were a skier at age 2. And so I grew up racing a little bit, and when I was 15, or I guess, yeah, right when I was about 15, I was diagnosed with osteochondritis dissecans, which is a bone disorder. And we'll get to learn all about it in a couple of months here in skin, muscle, bone, and joint. But basically, I had to take about five years off of skiing, almost six years off of skiing because I was getting several knee surgeries to sort of reconstruct the bone at the end of my femur. And then luckily, about halfway through college I got to get back into it.

And yeah, so my favorite resorts here in Utah, this year we keep an Excel doc, a Google Excel doc called the All-Class Shredders List. And it's everyone who's interested in skiing writes in their phone number, they write in their email, and they write in what pass they're getting. So I know that last year it was about 70% Ikon Pass and, boy, about 30% split amongst the Epic Pass, and things like that. I was in Ikon Pass last year, and I think as of either later today or tomorrow I'm going to be buying my Ikon Pass as well. But for the University of Utah students, the price is marked down from $1,200 to $400. So it's hard to not take advantage of that. But in terms of favorites, I don't think I can confidently choose a favorite. I got unlimited days of solitude last year through the Ikon, so I certainly went there the most but . . .

Dr. Chan: So Joe, I don't even know what they call them, are you like a quadruple, Olympic, black diamond skier? Is that your level? Is that your . . .

Joe: I will say that I am very comfortable on black diamonds and comfortable on double black diamonds. But that being said, I am maybe the 15th best skier in the MS2 class. So there's a . . .

Dr. Chan: I love how you phrase it, yes. You cannot humblebrag, I will humblebrag for you. All right? That's awesome, Joe. So what if . . .

Joe: There are . . .

Dr. Chan: What if you're a brand-new . . . you know, what if there's a med student listening and they want to get interested in skiing. Like what would be some good, you know, equipment and maybe a good place to start out?

Joe: Yeah.

Dr. Chan: Obviously, our time machine isn't real. We can't go back to when they are two years old to get that experience you got. Like so how would like a 20-something-year-old start?

Joe: Sure, absolutely. So yeah, we have . . . I can't remember what the actual number is, but I think we have 60 students or something in our class, the MS2 class on the All-Class Shredders List who do ski already or snowboard already. But we had about five or six students who started skiing last year. And all of them, they skied together in a group, and they would ski with their more experienced friends and get their lessons that way. But we had a lot of students who went from either never having skied before or not having skied in 10 years to being really confident skiers on, you know, the intermediate and advanced ski terrain.

One of the things I love about the University of Utah is the rec center has gear rentals. And so you can rent skis from either the University of Utah rec center for a day or a weekend. And I think it's $25 for a day and $40 for a weekend for the ski boot, pole setup. So if you're interested in learning and you have some fellow MS1 students who come in with you and, you know, they're your good friends that you've already made and you want to run flashcards on the chairlift, which is absolutely a thing I recommend doing with your friends, then yeah, it's about $25.

And lessons, you can get access to professional lessons through Solitude. I was looking into this recently for a different friend, and it was $75 a day for college students on top of the pass for the day, which I think is in the $75 to $100-range. So skiing has always been a very expensive and exclusive sport. And I think that having the $25 rentals through the University of Utah makes it a little more accessible to people than having to do, you know, the $125 rentals from the resort.

But yeah, there's a few different options for renting equipment at the U for pretty reasonable prices. You can do seasonal rentals as well. There's a couple of companies in town that do seasonal rentals on skis. So yeah. My biggest recommendation is if you've got that study group and you've got some experienced skiers in your group, and they're willing to teach you, then I can't recommend enough that you reach out to them and reach out to your whole class and see who else is new to skiing and try and get a little . . . a crew together. It's a great community, and it'll be interesting to see what COVID does this year. We're all on the edge of our seats on that.

Dr. Chan: I love how you mentioned doing Anki cards on the ski lift. I did not know that was a thing, but my hats off to all of you who are doing that. That's like combining a lot of . . . Your generation, the ability that you guys have to multitask, it's amazing. So that's so cool.

And then, Joe, do you have like a favorite memory or a memorable time when you were skiing or boarding? Like something that just stood out to you, like this crystallized beautiful moment where it was like epiphanous and you hit nirvana or a scary situation where it got resolved. I'm just curious, because you've been in the backcountry doing all sorts of difficult hills, and yeah, so I'm just curious like if you have any memories you can share.

Joe: Oh, man. There's two moments that come to mind. One is more on the idea of Anki and studying, but it was, I was up with two fellow students [Stany and Alli 00:25:07] and we were sitting on the chairlift in between runs. And it was, you know, a Sunday before a Monday exam. And we couldn't resist, because I think we'd gotten 60 inches of snow that week or something like that. And so we had to go out even though we had a test on Monday. And we talked through questions on the chairlift of what we thought we were going to get quizzed on and what we thought we needed to understand, and filled in the memory gaps. And the next day during the test, there was somewhere between 6 and 10 questions that were exactly covering the topics we talked about on the chair. But I think the more salient moment, like one of the happiest skiing moments I've ever had was last year at the end of the year, at the end of the first semester, this is obviously pre-COVID, we had 31 of us MS1s go down to Jackson Hole, Wyoming. And Jackson Hole is on the Ikon Pass. So we just rounded up 31 students who had the Ikon Pass. We rented three houses in Jackson Hole. And I think everyone, overall, for lodging and food, we cooked all of our meals together for five days. I think the average . . . I think the price that every student paid was $105 for 5 days' worth of skiing, food, lodging in Jackson Hole. But there was one day where we had all 30 of us out on the slopes together riding as one giant group, and it was one of the coolest things I've ever seen, to see, you know, these 30 students that were sort of struggling together through academics but then also getting to get out and ski together.

Dr. Chan: Joe, that's beautiful. I love that image. Maybe when we post this pod, we can like throw up an image. I want to throw up an image of that, and then maybe you and your awesome beer that you're rocking.

Dr. Chan: All right, last question, Joe, we've talked a little bit about it, but pandemic, like because it was at the very end of first year, right? And then things started to kind of go . . . you know, the announcement came out. Like how was it from your perspective as a med student? And as a follow-up, like what's it like to be a med student during a pandemic, and what does your day look like? So I'm just going to throw that out there. I want to hear your perspective.

Joe: Yeah. It's been very interesting. And it's been varied as well, which has been sort of one of the things that we, as students, do talk about is how different units feel different. I think that when you're in Foundations of Medicine, it's all about getting as much time talking between students to make sure that everybody's on the same page of how well you need to understand something, how in-depth, and what nuances you think the professors care about or things like that, things you think you should care about.

And then once you move into the second semester of your first year, which is when COVID hit for us, you're in the host and defense. We were in what's called host and defense, which is the bugs and drugs course. And that one is just so much more memorizing that it felt more like an individual course. So it felt more like, you know, you're watching your videos, you're watching these things. You're running your hundreds of cards a day to try to get all of these little facts, you know, nailed into your brain. So there's a little bit less of a student community during that.

But when COVID hit, it was, you know, March 13th. That Friday, the 13th, I actually had a hernia repair that day, and I was completely laid up for about six weeks after it. So that was the first day we also shut down classes, which was, you know, perfect because I didn't have to come into school but also very socially isolating. But when we switched, the Monday after they shut down classes unexpectedly, we had . . . I think we missed out on one hour's worth of lecture. And the professors seamlessly transitioned to Zoom. I was really, really impressed. We basically lost zero time, we lost zero material with host and defense. When we finished this summer and we came back, it felt a little bit like there was still so much hope that we would be able to be in person that the course wasn't as well established for the second-years to be ready for online. So it was a little grating for the first couple of weeks to try and suss out exactly how we were going to be maneuvering through COVID and our second year of med school.

And I think a lot of us felt really isolated from a summer apart and not feeling comfortable getting together with our big study groups that we did previously. And then sort of as this second year has gone on, we've sort of come to accept more and more and more that it's most important to stay distant, to stay online. But yeah, it was interesting that the spring when that massive change happened it wasn't that bad, but then I think a lot of us, really mentally and emotionally, struggled. I know personally, I mentally and emotionally struggled with the fall semester more than the spring. Yeah.

Dr. Chan: And then, is it every single day Zoom? Or like what does a typical week look like now in the middle of a pandemic for a second-year med student?

Joe: Yeah. So right now we have asynchronous and we have synchronous. So it's usually, for this current unit, we're currently in CR and R, which is like the circulation and renal and respiratory. And that has mostly, most of the days has been asynchronous. So, you know, you just click on and watch the prerecorded lecture whenever you're interested. But then maybe two or three days a week we're in-person. We're digitally, you know, synchronous, where we'll all Zoom in at the same time and we'll have a team-based learning or a case-based learning. And they'll break us up into small groups and things like that. So that's usually like Wednesday mornings, Fridays. And then actual in-person activities when we're learning our clinical skills on Wednesday afternoons. We've been in-person probably just over 50% of the time. So that's from maybe 1 p.m. to 5 p.m. on Wednesdays every other week for the last, you know, four months we've been in-person. But everything else is Zoom. And for . . . Yeah.

Dr. Chan: Oh, go on. Sorry.

Joe: Oh, I was going to say for a person like me who, you know, I've got, I certainly have some attention deficit problems. And sitting in front of a computer for hours a day is sort of the antithesis to the way that I like to learn. But I found ways to, you know, set my computer up on a dresser or a desk or something like that and, you know, jump around my apartment, my living room, and try and run cards, and things like that, keeping my body moving. But yeah, I am ready to be back in person when that day arises.

Dr. Chan: Do you like the synchronous or asynchronous model better, Joe?

Joe: I think the asynchronous model works better for me because if I'm sitting in front of a computer for eight hours a day watching a lecture, probably about every 15 minutes my brain will wander off. And if it's a synchronous session and I just missed, you know, 20 seconds of material, then I desperately am lost or I don't know exactly what I needed to know from that. But if it's asynchronous, I can pause. I can back it up 30 seconds, and I can restart, or I can pause, stand up, get a drink of water, back it up 30 seconds, and restart. So, for me, the asynchronous works much better because I can pause, I can make sure I'm really understanding what they're saying. Sometimes I have to repeat a section four or five times just to figure out what the professor is trying to emphasize there.

Dr. Chan: Joe, I love it. It sounds like you're adaptable, resilient. And I think you, the faculty, the students, I think everyone's trying to do the very best job they can in really extraordinary, challenging, unprecedented circumstances. And it sounds like it's coming together.

Joe: Yeah.

Dr. Chan: Fits and starts though, fits and starts.

Joe: Yeah, absolutely.

Dr. Chan: Joe, we're almost out of time. I guess my last question is what advice do you have for anyone listening out there who is thinking of applying to medical school? What would you say to them? What counsel would you give them?

Joe: Yeah. I think the most important thing for me is to take your time. I took two years off after graduating and I absolutely loved it. I spent time working. And actually, I was talking to a professor yesterday during a small synchronous session. He shot me a message in the Zoom Chat privately asking what my prior experience with that topic was because we were talking about pulmonary embolisms. And I was an emergency department scribe for almost two years. And things like that, things that are extremely clinically relevant to scribing, you just excel at when you're an actual medical student. And so I can't recommend to people enough that they, you know, take a breather after undergrad, work a job, you know, build up some money, and be able to have a ski pass, be able to do things like that. Be able to have some sort of different nonacademic life experiences before you get here. And if you have the opportunity to scribe, that was the most helpful preparation for medical school I've ever had.

Dr. Chan: Great. Joe, well, I appreciate coming on the pod. We'll have to have you come back and share more of your adventures as you continue to go through our medical school. It sounds like you're doing really, really well.

Joe: Oh, absolutely. It was wonderful to talk to you.

Dr. Chan: All right. Thanks, Joe.

Joe: Hey, have a good day.