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Scot: Just go to facebook.com/WhoCaresMensHealth.com. That'll get you there.

Mitch: No.

Scot: No?

Troy: Dot com.com/.com.

Scot: You don't have to have a Facebook page, Troy.

Troy: You just threw it in several dot coms.

Scot: All right, take two. I love how the guy that doesn't even have a Facebook page is lecturing me on how I did it wrong.

Troy: I know too many dot coms when I hear it. I know that much.

Scot: The podcast is called "Who Cares About Men's Health." We provide information, inspiration, and motivation to better understand and engage in your health so you can 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: I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Galli: I'm Dr. Nick Galli, an Associate Professor in the Department of Health and Kinesiology at the U, and I care about men's health.

Scot: Today's show is called "Perform Like a Pro." So whatever it is that you do when there's that moment that you've got to do it and you've got to do it well, but maybe you don't all the time, are there some things that we can learn from professional athletes and how they have to perform when they're on the spot? And that's one of the things Nick does. Do you continue to work now, still with the U.S. Olympic speed skating team?

Dr. Galli: I do. Yeah. I'm a performance consultant for short track and long track national speed skating teams. They're based out here in Kearns, Utah.

Scot: Yeah. And you were at the Olympics four years ago?

Dr. Galli: Yeah, almost. Yeah, two and a half years ago in 2018.

Scot: So they've got their own physical coaches and probably their speed skating coaches, but they take you along to help with the mental performance aspect. Do I have that right?

Dr. Galli: Correct.

Scot: I sure hope so, because this is the whole basis of this episode. So some of the other things that Nick does not only consulting the U.S. Olympic speed skating team, he's a certified consultant for the Association of Applied Sports Psychology. He has a PhD in the psychological aspects of sports from University of Utah, a master's in sports study, a degree in psychology. He's a professor and a researcher at the University of Utah, and the last time I think you got a full eight hours of sleep was like six years ago. Sounds like you're awfully busy. You getting that sleep you need, because it is one of the core four?

Dr. Galli: Yes. I think I do a pretty good job with that.

Scot: So when you're working with athletes, what are some of the mental things that you encounter with these high-level performing athletes?

Dr. Galli: In some ways, it's very similar to the challenges that a lot of us face every day in our other roles, but these athletes, they spend the majority of their time across several years preparing for this thing, you know, really this once every four years thing, and for some of them, they'll only get one opportunity for it. So, you know, it's this they have everything dialed in, but there's still the matter of can I bring my best performance when it matters the most.

And in a sport like speed skating, there's a lot of differences between a normal performance, certainly a practice and performing at a world championships or Olympics, because it's not a big spectator sport. So all of a sudden you have eyes on you, there's more media, there's just more buzz about the performance than you're used to, and it feels different. And so, you know, being able to acknowledge that, recognize that, even welcome that, but also just, you know, do your thing. That's the trick.

Scot: Do these athletes get inside their own head, like I get inside my own head when it's time to do it?

Dr. Galli: Absolutely.

Scot: And what does that look like? What are some of the things that you run into there that you have to work them through?

Dr. Galli: Sometimes it's a matter of, oh, it just doesn't . . . I don't feel 100% perfect today. This thought that they have to feel 100% perfect or look at that guy or look at that guy or look at that lady, you know, look how good they look going around the track or how good they look warming up or, you know, in a sport, like speed skating and there's some others too.

Ooh, my equipment doesn't feel totally dialed in, You know, there's these just little seeds that under stress can, you know, become much larger issues if the athlete's not prepared to deal with them.

Troy: And what's the . . . yeah, I guess I kind of imagine this scene before, you know, an event. I'm wondering, are people just like super anxious? Do they look pretty chill or they just have headphones on relaxing? Like what's the usual vibe in that sort of scenario?

Dr. Galli: It's a range. For some, you wouldn't know by just looking at them, you know, that they're nervous. Some are pretty casual. Some will isolate. Generally, you are going to see a more intense look in the hour or two before they have to get to the line. And for the most part, at that point, the work is done and the athletes are just, you know, most folks other than maybe their coach, you kind of lay off of them and let them do their own thing.

Some do like to socialize a little bit more, and that's actually part of the challenge that we deal with is it's an individual sport, but all these athletes train as a team and they also have to learn how to deal with one another on these high-pressure days, because some people will like a little bit of small talk and chat. Others just don't want to be messed with at all. And so we have to help them learn about each other's tendencies and preferences as well.

Troy: That's what I wondered. Yeah. I read a book recently and it talked about Michael Phelps' routine prior to events and, you know, he'd have this period I think about . . . . Well, he had the exact same routine he would go through every time and then, you know, had about a period, I think, of an hour where he just, you know, got his music in. And then when the time came, he would step on, there was the same process. So I just wondered if that's something speed skaters incorporate that you see, or if it's just kind of a range.

Dr. Galli: The good ones do. The good ones do. I mean, in terms of like within-person, right, they're going to be doing the same thing again and again because that's what's comfortable. And at the same time, they're also flexible and know how to adjust if they have to, because, at an event like the Olympics, things never go completely as planned.

Scot: So you talked about, you know, some people just look completely chill, like they're not even phased by it. Is that because they've done training with a coach like yourself, or is that more of a personality thing? Or can it be a combination of both? Is this a skill you can learn?

Dr. Galli: Absolutely. It's a skill you can learn. There are some who are gifted. I mean, we have some athletes who actually require very little work with me. We might chat on about specific things that come up, but, you know, they've been fortunate to have the genetics and the life experiences that have empowered them to really know how to control their emotions and focus. And so, you know, they may be nervous on the inside and that's okay, but they're also in some ways unfazed, and some are just kind of gifted in that way and others need a lot more help.

Scot: You said that the really good athletes do the same things. They have a sequence of events. They do the same things over and over again. Why is that? What is it about that sequence that's powerful?

Dr. Galli: Well, I think some of it is, you know, as simple as these are the things that I need to do to feel ready. I've got to eat, have these nutrients. My body has to get warmed up in this way. I've got to prime myself for performance. So some of it is just like it's what works, but there's also the psychological effect of this is what's familiar, this is what's comforting.

And that's something I preach to our athletes. You have to find that sequence of events early, and you have to be using it even in, you know, benign situations like, you know, go into practice so that when you bring it to a foreign environment or an environment that's very different, when everything else feels unfamiliar, the routine still feels familiar and comforting.

Troy: And one thing I heard too along those lines in this, like I said in this book I read, they talked about how when Michael Phelps, who was like, by the time he was on, you know, up there ready to start his race, you know, he was already, you know, 90% of the way through his routine. Like his previous routine, everything had been successful in that, the race was just the next step in that.

So it was almost like, you know, this preconditioning something he imagined many times in his mind, the success in the race, following his success and going through this routine beforehand. So I thought that was kind of interesting that it, you know, kind of played into that of saying, "Hey, you know, I've already succeeded up to this point. Now I just go out and do my race and I finish it up."

Dr. Galli: One interesting thing about him was that he had a coach who really knew and understood what Phelps would need to be able to do. I mean, he knew that Phelps obviously was physically gifted, but he also knew what type of preparation Phelps needed mentally so that he would be totally unfazed.

So Phelps' coach would really test his focus. He would break his goggles, hide the backup pair. I mean, and these are only things that you would only do if you had a pretty solid relationship, of course, with your athlete, because sometimes we'll throw this stuff out, you know with the coaches and athletes I work with, but, of course, you have to be careful when you do things like that.

But he wanted to make sure that Phelps not only would be prepared in the event of kind of an unthinkable circumstance, but also as importantly was that Phelps knew in his mind that he could handle anything that might come up because sometimes it's the fear of what might come up that actually holds you back more than something that actually does come up.

Scot: They would . . . the goggles thing. Would he do that in . . . he wouldn't do that during competitions. That was practice, right?

Dr. Galli: I think practice. I'd have to go back . . . maybe like a lower-level competition. No, probably not like the most important.

Troy: In the Olympics. Hey, let's mess with Phelps, guys.

Scot: That's not the time.

Troy: No.

Scot: All right, Nick, let's pivot this here for a second. Now you work with athletes who, you know, like you said, prepare for four years for one performance. The rest of us sometimes have to perform. We know that maybe we'll get another shot, but still, it's, you know, just as stressful. Troy, do you have any instances in your life where you have to perform like a pro while you have to go and just, you have to get it right.

Troy: Yes, I do.

Scot: Now, you're an ER doc, so I'd imagine that that's probably going to be your story.

Troy: The answer is yes.

Dr. Galli: No, not really.

Troy: Yeah. It's pretty chill at my job. It's pretty low stress. Yes, I do. Obviously, I have a lot of very high-stress scenarios I deal with, but there's one in particular that I think for me, you know, certainly raises my anxiety and I think across the board raises people anxiety.

And if there's one time I have to perform and I just have to get it right is intubation. So intubation is a procedure where you stick a breathing tube into someone's throat down through their vocal cords. Typically, I'm doing that if a person is unable to breathe, you know, they're struggling, or they're so out of it, either from a head injury or some reason that I have to put that in to protect their airway.

And it's a high-stress procedure. I mean, it's one of those things, oftentimes, you know, people are really, sick or else there's a lot of chaos in the room, it's in traumas, but it's . . . yeah, I think if there's one procedure I would say where it's like, okay, let's do this and let's get this right, that's it.

Scot: And you probably already have that figured out after your years in the ER, I'd imagine,

Troy: You know, I do, but it's one of those things I practice it on a regular basis. And the reason I do that is for exactly these reasons. It's one of those things when you're in that situation, you just want it to feel like, okay, I've done this, I've done it many times. I'm comfortable with this.

And, yeah, there are a lot of different variables that can go into this. Maybe this person is actively vomiting. Maybe they have blood coming up from their stomach, you know, stuff I'm having to deal with. But when it comes right down to the procedure, I want to feel comfortable with it.

But it's . . . yeah, it's one of those things, when I was in residency, it was probably the most anxiety-provoking thing for me was being comfortable intubating and doing that, because essentially, when I do that procedure, I take away a person's ability to breathe. I give them a medication that paralyzes them, and the only way they're going to be able to breathe if I can squeeze a bag and squeeze air into their lungs. And if that bag doesn't work and I can't get air into their lungs, I got to get some way to get a tube in there. So it's something that often has to happen quickly and you have to get it right.

Scot: You practice this? Like, you'll just go in on your own time. Like an athlete would practice their sport and practice this procedure?

Troy: I practice it every day. And this is a funny thing probably for even my colleagues if they heard me say this, but it is a procedure, like I said, over the years caused enough anxiety for me. I practice it every day, and I have a little simulation, you know, sort of things I have that I just go through that muscle memory of, okay, here's the laryngoscope. I get my laryngoscope, I get my endotracheal tube. These are the medications I'm giving. I preoxygenate, give them oxygen before the procedure. Just to walk through that process and I spend a couple minutes every day just practicing it.

And I know it's again if my colleagues are listening to this are probably laughing, but it's one of those things. It is the procedure probably in my profession that can go south pretty quickly and as is probably the most anxiety-provoking procedure. So yeah.

Scot: Producer Mitch, why don't you grab a microphone and join us? So the plan on this show is for each one of us to talk about, you know, that moment that we have to perform like a pro, but I don't want to follow that one. So Mitch, what yours?

Mitch: You're going to make me follow it?

Scot: Yeah. Maybe we don't. Maybe we just go to Nick's advice at this point, because I have a feeling Troy does a lot of the things that Nick might recommend. Like what's yours? What's yours, Mitch? Go ahead. I'll do mine.

Mitch: For me, I always try to . . . I maybe even over practice. I find myself preparing for when I give my lectures in class. So I teach at the community college these days, and I'm teaching a new course that I haven't taught before. And it's a curriculum that I haven't done myself, and I find myself having even nightmares sometimes about like, oh no, am I going to say the wrong thing? Am I going to sound stupid? Am I not going to remember some of the facts that I'm trying to share?

And so I find myself reading the content over and over and over again. But for me, at least, I don't know if it's actually helping. I find myself still kind of stumbling every now and then when . . . you know, I had a student ask, quiz me on some riot that I did not remember that was in a strange sidebar in the textbook I didn't get. So I don't know.

Scot: All right. Mine is kind of silly, but so difficult words to pronounce or difficult names stress me out. And I've been in performance long enough that when I see one, I will practice it before it's showtime. I will say it out loud numerous times. And then in the moment leading up to where I know on the sentence before now I'm in the sentence, I'm coming up on that word, I'm going to screw it up. And a lot of times I do, and I really wish that I could get away from that because I just totally psych myself out.

So, Nick, let's go over just kind of all three of these stories and give us some tips on what regular people, Troy excluded because he's like some sort of superhuman, ER doc.

Troy: I'm not.

Scot: What regular people . . .

Troy: I'm far from and that's why I practice every day.

Scot: What regular people can do in these situations where they have to perform to maybe, you know, help them not necessarily guarantee, but help them, you know, do better.

Dr. Galli: Yeah. I mean, and as I hear these three stories, it's great because there's contrast there. There are some similar things that would benefit all three of those scenarios, and then I think there's also a slight variation there unique maybe to Troy's experience.

One thing that there really is no substitute for is to prepare and practice, and that's what Troy was saying. You have to make sure that you feel comfortable and confident in what you're tasked with doing, and you also have to try it out maybe in different circumstances and situations with distractions, without distractions, maybe handicap yourself.

You have to really not only to keep it interesting for yourself, but also just to make sure that there's some transfer from, you know, the practice to the performance, and that's something I talk with my athletes a lot about is that's great that you can go out there and nail it in a very casual, low-key environment, but why don't we try and amp up the energy and practice a bit so that it more closely simulates what you're actually going to feel and see in a competition. So no substitute for preparation and varied preparation.

Troy: Yeah. I always enjoy the stories like a football team is practicing with the loudspeakers out there, just with this loudest like it can possibly be, so they can't hear anything. And, you know, like you said, it's one thing to do it in a low-pressure situation where there's no crowd noise or not that intensity of it, you know, some sort of Olympic event, but certainly something else when you throw those variables in.

Dr. Galli: The way I describe it is, you know, we're never probably going to be able to completely replicate the emotion that comes with high-pressure performance in a practice setting. And at the same time, we're never going to be able to make that high-pressure performance setting feel like a practice setting, but is there a way that we can . . . and if you could see me right now, I'm using my hands. Is there a way we can take that high-pressure situation, make it feel a little bit more comfortable, and take the really low-pressure settings and make them feel a little less comfortable so that, you know, we close the gap between them and they're not such different situations.

Scot: So number one there is prepare. It applies to Mitch. It applies to myself. It applies to Dr. Madsen Troy. What are some other tips that you would have?

Dr. Galli: Another tip would be to just, you know, take a new perspective on the situation. And I think even for Troy, I mean maybe especially for Troy, it's like, yeah, this is a big deal and it's very important, but again, this is also a really privileged position to be in, to be trusted to essentially save people's lives, or for Mitch, you know, it's a privilege to be able to sort of guide the learning process, or for Scot, it's a privilege to be able to, you know, give people a voice and educate the listeners.

So, you know, being able to take a step back and think about your situation in less of a threatening way and more of a way that, hey, this is a challenge that I look forward to tackling.

Troy: That's great, yeah. I love that advice because then it is sort of takes it off you. It's like, hey, this is not all about me. This isn't all about my performance. This is about someone here. Think about the people you're trying to reach out to, the people they're trying to help. I'm trying to help this person, or I'm trying to reach out to these people or connect with them, and I think that I agree. I think that really helps performance is like, hey, you know, this isn't about me. It's about me helping them, and this is about them.

Scot: Yep. I wonder if that perspective too might contain . . . sometimes I get a little self-involved. I don't have quite the right word, but I think, "Oh, I'm the DJ, I'm the one interviewing. I should get this right." And maybe that is a little, maybe I should take it a little less seriously that way maybe.

Dr. Galli: In psychology, we call that shoulding on yourself.

Scot: Well, I'm covered in should.

Dr. Galli: Can we leave that in?

Scot: Yes. We're leaving that in. So prepare, develop a new perspective so it doesn't seem quite so threatening. It's more of a privilege. What else do you have there?

Dr. Galli: Where we start to diverge a little bit, for Scot and Mitch in that situation, you know, I feel it's appropriate to, you know, make sure that you're also, you know, enjoying the experience, having fun with it, being a bit lighthearted.

I think that looks a little bit different in Troy's circumstance, because certainly you can't make light of the situations that you find yourself in, but I think have fun or enjoyment maybe it means something different. In that setting, it's more being fully immersed. You know, it's that flow experience of like, you know, the balance of skill challenge, and really, you know, just feeling at one with what you're doing.

So it's not like ha-ha this is fun, giddiness necessarily, but it's more like this is, you know, what I was put on this earth to do, this is what I was meant to do, and I am lost in this right now. So I still think it's about getting fulfillment and enjoyment, but it maybe looks differently across those situations.

Troy: It's interesting though, Nick, you mentioned that. And something I noticed, when I started my training in medicine, is that we would be in very, very high-intensity situations like codes. So you've got people you're doing CPR and you're doing these procedures, intubation, central lines, like all these high-pressure things, trying to get someone back to life essentially. And people would be cracking jokes sometimes. I mean, they were focused on the task, but, you know, it was almost like this pressure relief valve.

Dr. Galli: Yeah. That's true. They were talking about the possibility of my wife, you know, before having our first child, you know, for, in case of a C-section, you know, talking about do you want the doctors listening to music and chatting? And she was adamant that, "No, I don't want that. I want them to be focused." And my input was, "Well, you know, if that's what they do, then that's what you should want them to do." So I'm glad you brought that up.

Scot: It kind of comes back to the Michael Phelps thing, right? Trying to create some sort of normalcy in abnormal situations. Something that's familiar and comfortable.

Dr. Galli: Yep.

Troy: One of the more surreal experiences for me in med school was being at Johns Hopkins, you know, in inner-city Baltimore. And being in the surgery suite, doing these kind of high-intensity surgeries with the chief of surgery there, and he's got country music jamming. He had his favorites, Garth Brooks jamming there while we're in surgery, you know, in the operating room. And that's how he performed his best is, you know, having something like that to diffuse the tension a little bit.

Scot: All right. So prepare, try to bring a new perspective, think of it in a less threatening way, have fun, be lighthearted, or try to get into the task that you're doing. If you're Troy, get into that flow state, just be totally in the moment. It sounds like what you're talking about there. And how about a fourth one? How about one more?

Dr. Galli: This is where I feel it will be interesting to get Troy's take on this one as well, where it diverges also. I think as a teacher, as a host, I think it's okay to be vulnerable. And, you know, Mitch, I can really relate to your story because teaching is something I do a lot of and I've done a lot of for the last decade. And I can remember early on feeling like, man, I cannot make a mistake in that room. I'm going to kill my credibility.

But actually, you know, almost always I did know more, I was mostly one step ahead of my students. But the other part of it was at some point I let go of, okay, this is 2020, Dr. Google is really in charge of the facts. Everybody has access to the facts and the dates. That's not my job anymore. My job is to help my students learn how to ask the right questions and to think about things in different ways.

That takes a lot of the pressure off, and it's not my job to always get it right. But when I get it wrong, it is my job to acknowledge that I was wrong and talk about why I might have been wrong, and how we can get the right information.

Be okay being vulnerable, be okay with that. And I'm not saying try to make a mistake, but acknowledge that you're human. People appreciate that. People appreciate when their teachers are, when there's that power differential knowing that, like, that person's human too and that they're going to make mistakes.

And then similarly, Scot, for you, even if you've prepared for the name, there's still some trepidation about I might get this wrong. So it's okay. I think when you're going to introduce somebody to sort of couch it in, "Okay, I want to make sure I get this right. Is it . . ." And then you almost sort of build in some leeway to you're acknowledging that, like, you're not totally sure you have this and maybe you do nail it and then you look great. And if you don't, at least you didn't give the sense that, oh, you thought you knew it and then you didn't know it.

Scot: Or didn't care or whatever.

Dr. Galli: Or didn't care. Now I think, and this is maybe where I'll be interested in Troy's point of view, if I was in the kind of situation that Troy finds himself in, I really want to be talking myself up a little bit more and making sure that I understood for myself I'm the best person to be doing this right now. This person needs me, and I'm going to deliver because that's what I do. And, you know, there's not maybe as much room for that outward expression of vulnerability in the ER. But let's hear Troy's take on that.

Troy: Yeah. That's an interesting point you make Nick, and it's funny, something I have learned to do over my career and I have consciously tried to do, and I've told myself is allow yourself to make mistakes. And by that, I mean recognize that I will make mistakes and feel comfortable apologizing for that or reaching out in those situations where I've made a mistake.

I used to beat myself up over those things. I used to expect perfection of myself. And if someone contacted me and pointed out a mistake, I would sometimes become very defensive, and I think that affected my performance.

So honestly, I think that, you know, you talk about not expecting perfection of yourself. I think being able to acknowledge when you make mistakes and feel comfortable doing that, then helps performance because, you know, you say to yourself, "Yeah, I could make a mistake," but at the same time, like you said, you tell yourself, you know, "I've got this. I'm comfortable with this, I'm going to give this my best shot and do my very best with this." And then, you know, again, I think the outcome is often better than if you're just telling yourself, "I can't screw this up. I can't screw this up," when you're thinking that.

Dr. Galli: And there's degrees of mistakes. I guess maybe that's what I was missing there. And that's kind of the nuance that goes with different, you know, fields of expertise. In my mind, it's like, wow, you can't afford to make any mistakes, but really there's also a range even in the work that you do.

And I like what you said about kind of combining the, yeah, I've got this, I'm trained for this, I'm ready for this. And you know that you might slip up, but you've also got a team around you to help you, and you know that you're good enough that most mistakes or slipups you make, you're going to be able to rectify those.

Troy: Exactly. Yeah. And that's what I think is helpful. You don't want to make the big mistakes. You don't want to do it.

Dr. Galli: Which could happen because you're guarding against, you know, some mistakes. That's sometimes what happens.

Troy: Yeah, exactly. Or because you're so focused on the little things and not screwing those things up that, you know, you kind of lose the forest for the trees, that kind of thing, where it's just you get so worked up about the small stuff that you'll lose that big picture and like, hey, this is what really matters.

Scot: So some solid advice, I think, from the athletic world to the personal world. So prepare, try to take a new perspective, have fun, be lighthearted if at all possible, or at least in the moment. And then be okay, be vulnerable, realize that you might make a mistake. If it's a high stakes situation, you know, then realizing you might make a mistake, it's save somebody's life, because now you're going to start to account for it. So that's good.

Mitch, do you have anything you'd like to add? Do you feel a little bit better going in the classroom tomorrow? Are you going to be able to use any of this, do you think?

Mitch: I think so. I think that the idea of, you know, being able to be vulnerable and, you know, I don't have to know anything. That's right, Dr. Google exists. So why am I putting so much pressure on myself to be absolutely perfect? It is. It's really helpful.

Scot: All right. And Troy, you learn a little something today?

Troy: Oh, absolutely. Yeah. I think just talking through these things, it kind of helps reinforce for me a lot of, you know, a lot of what I think. I've learned the hard way honestly. A lot of this stuff has just been stuff, you know, over time I've just said, "Hey, I got to find a better way to deal with this. I've got to find a better approach." And so it's nice to have, you know, really, I think for anyone listening, have Nick just summarize this stuff that's been sort of a long process for me to try and learn.

Scot: Nick, you have a podcast that you participate on as well called "Becoming Headstrong." You talk about a lot of this kind of stuff.

Dr. Galli: Yeah, absolutely. Myself and three colleagues of mine. We put out three episodes a week, and they're typically very short, 5 to 10 minutes, and it's sort of designed for the athlete, but also just the regular person and tips on how to perform your best when it matters most.

Scot: All right. So check that out wherever you get podcasts, "Becoming Headstrong." Nick, thank you so much for being on the show, and thank you for caring about men's health.

Time for odds and ends on "Who Cares About Men's Health?" And we've got one item that we want to talk about. The Urology Q and A, where we asked for your questions for our urologist, went so well we've decided we're going to do it with a sports medicine doctor this time, because I know that there's a lot of people that have different types of orthopedic, muscular issues, bone issues, those sorts of things that they might want to learn a little bit more about.

Troy, I need you to clarify though what does a sports medicine doctor do and, you know, help our listeners too so they can start thinking about the kind of questions to ask.

Troy: You know, it's interesting. I think sometimes people misunderstand a little bit what they do because it's called sports medicine. So I think people think, well, these are for athletes, like high school, college, you know, whatever. Really the best way to think about sports medicine is just orthopedics doctors who don't go to the operating room. It's kind of like John Smith, our urologist, who described himself as a non-operative urologist. He's a urologist who doesn't work in the operating room. He sees patients in clinic.

Sports medicine, same kind of thing. They don't go to the operating room, but they'll do all sorts of procedures in clinics. So if it's anything you would want to see an orthopedic surgeon for anything to do with the bones, the joints, the muscles, the ligaments, the tendons, you know, your neck, your back, any sort of bony or muscular structure, that's what they do. That's their specialty.

Scot: All right. So I have cramps in my calves, sports medicine doctor could help me with that?

Troy: Absolutely. Cramps in your calves, back pain, knee pain, wrist pain, you know, anything like that. That's what they do.

Scot: All right. Mitch, what would you ask a sports medicine doctor?

Mitch: I slept weird and I feel old and because now everything hurts.

Scot: Oh, that's something that you could ask a sports medicine doctor?

Troy: They might want some more specifics, Mitch.

Mitch: All right. Well, we'll get a referral.

Troy: What hurts? Your neck? Your back? Everything hurts. We do get that in the ER occasionally like, "Okay, let's start somewhere. Like help me out here."

Scot: What about like tingling extremities, like randomly tingling? A sports medicine doc would understand that because they look at nerves and musculature, right?

Troy: Yeah. They would understand that, you know, sometimes tingling we think with more neurologic things, but if it's more just like tingling in one hand, absolutely. If it's like tingling all over your body, that's a little bit more neurologic. So, but yeah, like tingling in your hand, like weakness in your hand.

Like I've got this pain in my left hand that I finally got x-rayed and I didn't break it. I thought for sure I'd broken my hand, but, you know, that's the kind of thing I'd see a sports medicine doctor for. I've had this pain for two years. What do you think it is? What should I do about it?

Scot: Even though it wasn't even sports-related so that's good.

Troy: It was sports-related.

Scot: Oh, it was. What'd you do?

Troy: Or if it wasn't, I fell while I was trail running, but it's like one of those things, but I could say it's not because every time I type a lot, I feel it in my thumb. So yeah, so maybe it's . . . yeah, even though at this point it's nothing related to sports, they'd be great people to ask about that.

Scot: Okay. So you can ask your questions by a lot of different ways. The way that would be cool is we have this listener line. You can record your message at 601-55SCOPE that 601-55SCOPE. If you want to email us, you can do hello@thescoperadio.com and you could also do it at our Facebook page, facebook.com/WhoCaresMensHealth. Did I cover all the ways to get ahold of us, Mitch?

Mitch: Yes.

Scot: They're increasing. There's more and more of them. So it really you're taxing my memory here. Mitch keeps going, "We should let our listeners contact us this way." Like, who cares?

Troy: Maybe we should just give out our personal numbers. Let's just throw it out in there too.

Scot: Troy's cell phone number is . . .

Troy: Here's my number.

Mitch: You can follow us at TikTok. No, let's never get onto TikTok.

Scot: All right. So get those questions to us, and then next week, we will have them on the show. Just going to leave this here. It might be something to do with health. It could be something totally random. Troy, do you want to start, or you want me to start? I know you told me last time you feel the pressure of always going first. So I, you know.

Troy: I'm ready. I am ready. Trust me. I listened to what Nick said, and I prepared and I visualize what I'm going to say.

Scot: All right, go for it. Let's hear it.

Troy: I'm going to say it. So I'm just going to leave this here. You know, Scot, we've had Thunder on here, and one of my favorite episodes we've done was hidden sugars. So I tried to use hidden sugars to my advantage. Before I go out on a long run, it's funny like, you know, if you're running, you really fuel yourself with sugar. I don't know if you did that when you did your marathon, but, you know, you eat a lot of gels. You drink Gatorade. It's really just a lot of sugar.

And before I run, I like to have something with sugar in it and something with a high concentration of sugar. So I tried to find the one thing that's reasonably palatable that has a ton of sugar in it that I could eat before I run. And I didn't want to be eating candy, I didn't want to be eating gels. Guess what I found, best stuff to have before you run?

Scot: Wow. Okay. So a good food with hidden sugar that's not candy. It's not a sports bar. There's nothing like that. I'm just going to say, like a yogurt. Was that it?

Troy: Applesauce.

Scot: Oh, okay.

Troy: Cinnamon applesauce. Ounce for ounce, the cinnamon applesauce I found has the same amount of sugar as a Mountain Dew. It's remarkable.

Scot: Wow. That's crazy.

Troy: It's crazy. This is stuff that people are putting in their kids' lunches for school. Like, hey, here's your serving of fruit for school. Ounce for ounce, same amount of added sugar. I'm talking added sugar. Yeah. There's the natural sugar from the apple in there. This is the stuff that's added on top of it. And you can find variations across brands, but this is one of the most popular brands of applesauce. But like I said, I've used it to my advantage. That's what I eat before I run now. It tastes good. Sits well on my stomach. But the flip side of that is prior that episode with Thunder, you know, I never would have thought about this, but I looked at applesauce because of some of the stuff he told us about some of these foods we never would think of with sugar, and I was amazed at how much sugar was in it.

Scot: Just going to leave this here, do you have any white crew socks, Troy?

Troy: I have just kind of short ankle socks. I do not wear the white crew socks.

Scot: I've worn those pretty much my whole life. I think I might be retiring white crew socks for good.

Troy: Please tell me you wear white crew socks with like Birkenstocks.

Scot: No, I don't.

Troy: And shorts.

Scot: I wear them in the appropriate times, but I might be off white socks forever. I'm down to my last few. And it's hard to find a pair anymore because the levels of dirtiness don't match. So I might have one that's . . .

Troy: It's a bit more like a gray sock now.

Scot: One that's a little bit more white than the other.

Troy: Gray-ish, yeah.

Scot: They're starting to get pretty thin in the bottom. So I might be getting socks, other types of socks at other places, so I might be off white crew socks.

Troy: Well, you know, Scot, I don't know what this says about this podcast or about us, but this is now the second time one of us has used socks for our just going to leave this here.

Scot: It's the one fashion thing I think guys have permission to talk about.

Troy: Exactly.

Scot: We can talk about socks.

Troy: We can talk about our socks. Well, I've got black socks now. I went with the black socks, the black kind of ankle socks and I like them. They feel good. They're nice.

Scot: Yeah. And they hide the dirt so that's good.

Troy: They're great for dirt. Yep.

Scot: All right. It's time to wrap this up with the things that people say at the end of podcasts because we're at the end of ours. Go ahead, Troy.

Troy: Thanks for listening. Be sure and subscribe. You can subscribe anywhere you get your podcasts, whether it's Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you. We'd love to hear from you. You can contact us at hello@thescoperadio.com or reach out on Facebook, facebook.com/WhoCaresMensHealth.

Scot: And the phone number if you want to reach out now, this is not toll-free, but if you're calling on a cell phone, a lot of cell phone, you know, have unlimited long distance, it's 601-55SCOPE, 601-55SCOPE. And if you have any feedback, leave a message right there. Thanks for listening and thanks for caring about men's health.

Are young women getting more breast cancer? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health. And this is "The Seven Domains of Women's Health" on The Scope.

For women with an extended web of family and friends, it seems as if we are hearing about more young women getting breast cancer. Is that about our social networks being more easily accessed? Facebook, our news links, are friends' friends becoming our friends? Is it about early and more accurate screening picking up more cancers? Is it in the water? Let's think about what we know and what we think we know. Well, let's start off with who do we think of as young?

Well, young, of course, is anyone who hasn't lived as long as you have. However, in the world of breast cancer, young women are under 40. Although breast cancer in young women is uncommon, it's the most common malignant tumor in young women, 15 to 39. The lifetime, well, not all your life but life up to 40, risk of getting breast cancer was 1 in 173 when it was reported in 2009. Now, that's compared to the whole lifetime risk. Risk of getting breast cancer at any time of your life before you die is about 1 in 8.

A report in 2013 in the "Journal of the American Medical Association" looked at the incidence of breast cancer as reported to the U.S. National Cancer Institute's Surveillance, Epidemiology and End Results database. That is a mouthful, but it's commonly known as the SEER database. Everything cancer that happens in the U.S.

This study looked at the incidence of all breast cancers from 1973 to 2009. They categorized breast cancer by age of the woman in whom it was detected and whether the cancer was local, meaning just in the breast, regional, in the breast lymph nodes or chest wall, or distant disease in the bones, brain, or lungs. They found that the incidence of distant disease in older women over 40 was not increasing, but that the incidence of breast cancer that had spread far from the breast was increasing in women 25 to 39. This database is so large that it can look at rare cancers, women who live in cities and in the country, women who are black, white or Hispanic. This increase in young women was found in black, white, and Hispanic women and urban and rural women.

Now, the increase was statistically large but not numerically large. And this is a very important difference to me and my listeners. The rate of advanced breast cancer in young women almost doubled, which sounds like a huge increase. But in absolute numbers, it went from 1.53 per 100,000 women per year in 1976 to 2.9 per 100,000 women per year. An absolute increase of a little over 1 per 100,000 women per year over the 36-year interval.

Another finding was that breast cancers that were estrogen-dependent had increased more than those that weren't. It's important because estrogen-dependent cancers are more amenable to treatment. And that's really critical for all women, but particularly, for young women with kids.

So getting back to the beginning. Why are there more breast cancers among young women? Why do we hear about it more? Could it be their ability to see distant cancers is increasingly better since 1973? So that's why we might be seeing more? Well, maybe but the authors say there isn't enough to explain all the increase. They didn't mention other factors, but we do know that obesity increases the risk of breast cancer in women of all ages. And obesity in young women has increased dramatically over the last 40 years.

We worry that there are environmental estrogens that may increase the risk of breast cancers. We know there are more synthetic chemicals that fetuses are exposed to in pregnancy and change the way that breast cells see estrogens or chemicals that adolescents are exposed to as the breast is developing. We also know that we are much more connected to people we barely know through social media and other media. So we hear much more about young women with breast cancer.

So, all in all, it seems as if breast cancer in young women is increasing. So what do we do about it? Well, you could turn off your social media and your contacts with your friends and family so you don't hear about it. But that isn't the way of women who are connected by the Woman Wide Web. We can support research into the role of chemicals in our environment, our water, our cosmetics and our home that might increase the breast cancer risk or make breast cancer grow and spread faster. We can be personally aware of our breast anatomy, promote breast self-awareness, and bring any new changes in our breast to the attention of our clinicians. And we can try to remember numbers and put this small increase in breast cancers in young women in perspective. And thanks for joining us on The Scope.