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

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

Scot: Wow. Man.

Mitch: Whoa.

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

Scot: Yeah. How about you, Mitch?

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

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

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

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

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

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

Troy: Hey, Scot. Good to be here.

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

Mitch: Hey. Happy to be here.

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

Jonathan: Hey, guys. Good to be here.

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

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

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

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

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

Mitch: Literally?

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

Troy: This is in your 20s?

Jonathan: In my 20s, early 20s.

Troy: Wow. Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

Scot: Yeah, let's get it right.

Troy: A jaunty hobble.

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

Troy: It was a spirited, jaunty hobble.

Jonathan: A spirited hobble, yeah.

Troy: That's right.

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

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

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

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

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

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

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

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

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

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

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

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

Mitch: Oh, interesting.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scot: What is a physiatrist then?

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

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

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

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

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

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

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

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

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

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

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

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

Scot: And what did you do, Jonathan?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scot: Yeah, totally.

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

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

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

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

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

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

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

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

Jonathan: Yeah, I did.

Troy: Nice.

Jonathan: Pulled the thread on that a little bit.

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

Troy: That's great.

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

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

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

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

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

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

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

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

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

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

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

Mitch: "You can hobble."

Scot: Yeah, you can hobble.

Troy: Exactly.

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

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

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

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

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

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

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

Mitch: Yeah, catch a bus.

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

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

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

Thanks for listening, and thanks for caring about men's health.
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Interviewer: This Thanksgiving and Christmas, it's going to be very different than Thanksgivings and Christmases in the past. It used to be you would get together with family and friends, and now health officials are saying that perhaps you should reconsider that because of the spread of COVID-19, that you should maintain that family bubble.

However, even within families there are a lot of different opinions on how dangerous the virus is and what kind of safety precautions could be taken. So having those conversations with family members about whether or not to come to Thanksgiving or get the whole family together could be very, very challenging.

Dr. Benjamin Chan is a psychiatrist at University of Utah Health and in communication, communicating your thoughts and feelings is referred to as assertive communication, and it can be a very challenging thing to do. And I wanted to find out how somebody could be an assertive communicator, not aggressive, but an assertive communicator in talking about plans for Thanksgiving and Christmas. So is that what you call it? Is that what you call it, is assertive communication in your field?

Dr. Chan: Yes, Scot. And again, we're all in the middle of a pandemic. This is historic, unprecedented, and incredibly challenging. And in years past, Thanksgiving dinner would be a time that we get together, see and talk to long-lost cousins, aunts, uncles, grandmas, grandpas, maybe some neighbors, family friends. That is not safe this year.

And there's a lot of disagreement in the community about how to get together for Thanksgiving. A lot of people have different thoughts and feelings about COVID, and what social distancing is, and what masks are. And this time more than any other is the time for you to be assertive because you have to protect your own health. You have to protect your family and your loved ones. And COVID is silently transmitted. This is not the podcast that goes into it, but you can listen to many others. But there's a lot of different research and data out there that shows how pernicious and silent COVID can spread.

So assertiveness means behaving and communicating in a manner that equally values your rights and opinions on par with other people's rights and opinions. And the opposite of assertiveness is passiveness. And passiveness is when you put someone else's rights and opinions above your own. So now is the time to be assertive.

Interviewer: Have those assertive conversations beforehand. What does that look like? Because I mean, some people, myself included, we don't like conflict, right? So it's really difficult for us to know . . . I'm going to be talking to somebody in my family who thinks that COVID maybe isn't a big deal, that we should still get together, and it's going to be tough for me to express, "No, I disagree." How do you do that in an assertive way?

Dr. Chan: You do that in an assertive way by first recognizing that the other person has a different opinion and feeling than yourself. And then you segue into statements that start with, "I feel." So, "I feel scared for my own health because when I hear that you're going to host a Thanksgiving get-together and not everyone there is going to be wearing a mask or socially distancing, I feel scared that I might get COVID." And you frame things where you recognize the other person's belief or values, and then you maintain your own beliefs and values.

And people want to be heard, they want to be listened to. So my experience has been if you immediately start talking about what you believe and do not give the other person the recognition for what they believe, that's where conflict really starts escalating because the two parties don't feel like they're being listened to or heard. But if you can restate perhaps in their own words or maybe a summation of what you understand what their belief is and then give your belief, that gives an opportunity for that person to feel that you actually listened to them, an acknowledgement, and then you can present your belief.

Interviewer: I tell you what, I can see the spiraling for me pretty quickly, because I think people that do believe that COVID is a serious threat to the health, when they hear somebody that does not necessarily have that same belief, we just want to go, "Well, I understand you don't think this is a big of a threat impact as I do." Would that be the restating? Is that fair enough? Is that all I need to say? I mean, it's so hard not to do that judgmentally.

Dr. Chan: I agree, Scot. And it's credibly difficult. It might take practice. And I think when you, like, your example you just gave is a very quick response and people's responses tend to be much longer. So if you say, you know, "When I hear you, it sounds like you do not feel that the COVID pandemic is as serious as some of the public health officials have said or as serious as some of the hospital officials have said. I do believe those individuals, and this is why I believe them." I agree, it could start spiraling, but to me the key is to reframe it through core values. Just go back to values.

So people want to feel safe. They want to feel heard. They want to feel that they're being listened to. So if the core value is health, you can talk about like, "What is your value about the health," and they'll talk about the memories and the mental health of getting together for Thanksgiving. And you can use that as a springboard of, "Okay, this is my conceptualization of health. I'm worried about COVID. I'm worried about the fevers and the respiratory problems and everything else associated with COVID." If you have a discussion about values, the vast majority of people have core similar values, and then you can just explore those basic values together.

It's hard, Scot. It's incredibly difficult because people are drawing upon information from a wide variety of sources. Some of these sources might not have the same beliefs that you believe or might have different versions of facts. But you need to be assertive during this moment because if not, you will open yourself up to potentially being exposed to COVID and then a lot of hurt feelings will stem from that.

Interviewer: You know, being assertive doesn't necessarily mean the other person is going to react in a positive way. And if they don't, I guess you just have to go away with, you know, "I tried my best, but I have to make this decision for myself, or for grandma, or for grandpa, or for whoever." How do you deal with that? So again, I don't like conflict. I don't like it when somebody, you know, doesn't like me anymore. How do you deal with that? Is there a closing phrase you would use? Like, "I'm sorry we couldn't come together on this, but I still love you and care about you very much."

Dr. Chan: Yeah. Again, Scot, you did a great job. I think it's like you want to normalize this as best as you can during a pandemic. So this is an important holiday coming up. It's very important to a lot of people, but it's simply one day out of the year. And we have talked about previously, we're in a marathon. This is not a sprint. There's a lot of things happening in the country as we're trying to address this. So in my attempt to normalize, it's like, if everyone got together for Thanksgiving there's going to be disagreements. We've always had disagreements over the Thanksgiving table. Sometimes it's about the Dallas Cowboys and the Detroit Lions football teams. Sometimes it's about someone's political beliefs. Sometimes it's about someone not doing well at school or their job. It's normal to have conflict during Thanksgiving time.

This is a time when it might be normal to have a disagreement if we should really get together, or if we get together, it needs to be socially distant and safe with masks, or maybe we don't get together this year, or maybe we do a Zoom Thanksgiving and a virtual Thanksgiving. And that's okay because the most important thing is safety and health. And we want to stay together as a family in the coming months, and there's a light at the end of the tunnel. We all feel that. We all believe that. We want that to happen. That's still very much many months away.

So I try to end all these difficult conversations kind of like you gave with positivity. Let's say something nice. Let's say something that we can all agree on. I always like in these tough discussions kind of like a U shape. You start off high, you kind of go low, you go really deep, you kind of talk about feelings, emotions, values, and then you rise back up. You never want to end these discussions at the bottom of the pit. You want to rise to the top and say some nice things to each other, and agree to, you know, let's talk about something that's not as emotionally taxing, like the Dallas Cowboys or the Detroit Lions. Let's talk about something that we can agree on because these are difficult conversations. It's really hard to be assertive, but now more than ever it's really required.

Dr. Gellner: As a parent, I completely understand that when a child is sick, you want any medicine you can have to make them feel better and fast. However, antibiotics are not always a good choice. I'll discuss myths and facts about when antibiotics are really needed on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Remember that one thing that one person told you that one time about what you should or shouldn't do with raising your kids? Find out if it's true or not. This is Debunking Old Wives Tales with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Ask any pediatrician and the number one question when a parent brings a sick child to the doctor is, "Are you going to give them antibiotics? Often parents will bring in their children for fevers, coughs, or sore throats. So giving them antibiotics will make them better more quickly right? Not true. Most of these symptoms are caused by viruses, not bacteria. And so antibiotics will do nothing to make them feel better and may make them feel worse, especially since one of the big side effects of antibiotics is diarrhea.

When antibiotics are used, they kill all the bacteria in the body, good and bad, that are sensitive to that antibiotic. Too much antibiotic use means that the stronger antibiotic resistant bacteria take over and then the problem is sometimes, we see these new bacteria require heavy duty antibiotics that can only be given by IV, or sometimes we don't even have a good antibiotic to treat these resistant bacteria.

So if your child is given an antibiotic, it must be taken for 10 days to kill all the bad bacteria, right? Well, no, some antibiotics only need to be taken for five to seven days for treatment. The bottom line is be sure you give the antibiotic exactly as your doctor prescribes.

But what about if your child's snot is thick and green? This means antibiotics are needed, right? No again. Studies have shown that mucus color results from white blood cells and proteins fighting inflammation in the mucus and not any harmful bacteria. In fact, the longer mucus is produced, the greener and thicker it becomes. That's why a common cold lasting more than three to four days produces green mucus. Now, if the drainage has been going for an extended period of time and your child is getting worse, then your child's doctor will help you decide if antibiotics are needed at that point.

I've often heard from parents that this or that antibiotic doesn't work for my child. They're immune to it or it's not strong enough. Well, the fact is people don't develop immunity to antibiotics. If the antibiotic didn't work for your child in the past, maybe they were being treated for a viral illness and not a bacterial one, or the bacteria had developed resistance. The only time a child shouldn't be prescribed a particular antibiotic is if they have a true documented allergy to it.

Finally, some parents worry that if their child takes too many antibiotics, it will lower their immunity. False. Antibiotics have no adverse effects on the immune system. What too many antibiotics will do is cause all the good bacteria in your child's body to be killed and put them at risk for issues like chronic diarrhea and resistant bacteria.

So remember, when it comes to prescribing antibiotics for your sick child, trust your pediatrician. They have the training to determine when an antibiotic is needed and when it's not. And don't be afraid to ask about our decisions. We want parents to be involved in their child's health care decisions.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign me up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source, straight from the doctor's mouth. Here's this week's Listener Question on The Scope.

Interviewer: My daughter's two and has been admitted to the hospital, and they can't get her temperature to stay down. It's only down long enough until the medicine wears off. It varies between 103 and 105, and I can't help but wonder if something more serious is going on. This listener question is going to be answered by Dr. Cindy Gellner. She is a pediatrician at the University of Utah. Dr. Gellner?

Dr. Gellner: So we get this question a lot. Fever phobia is a common phenomena among parents, because it's scary. It's scary to watch your child have a fever that's high, and your child is miserable. But parents need to remember that a fever turns on the body's immune system. Fevers are actually one of the body's protective mechanisms, and it means their child's immune system is doing its job.

Parents worry about how long a fever lasts, but fever normally will last up to five days with most viral illnesses, and most fevers between 100 and 104 are actually good for sick kids. They help the body fight infection. Fevers with infections don't cause brain damage. That's a question I get a lot. And only body temperatures over 108 cause brain damage. The body temperature for that only gets really high with extreme environmental temperatures, like if a child is locked in a closed car in hot weather. That's when we worry about the brain temperature.

It's also important for parents to remember that fevers that don't respond to medicine can be caused by either a virus or a bacteria. And when the fever medicine wears off, the fever is going to return, and it needs to be treated again until the body's immune system overpowers whatever is causing the illness. And whether the medicine works or not doesn't relate to the seriousness of the infection. If the fever is really, really high, the cause may or may not be serious. The more important thing is looking to see if your child is very sick because if they're very sick-appearing, then it's more likely to be serious.

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Dr. Gellner: Old wives' tales about food and drinks, we've heard them all. I'll clear up which ones are true and which ones are not on today's Scope. I'm Dr. Cindy Gellner.

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

Dr. Gellner: Number one, feed a cold and starve a fever. False. Both high fever and colds can cause fluid loss, and drinking plenty of fluids can help prevent dehydration. And with both fevers and colds it's fine for your child to eat whenever they want and whatever they want. But don't be surprised if your kid doesn't want to eat at all. As a parent, you don't eat either when you're sick. They'll eat when they're ready. Hydration is more important.

Next, wait an hour after eating before going swimming. No. According to the American Red Cross, it's not necessary for anyone to wait an hour after eating before going in the water. However, if your child had a big fatty meal and they're on a swim team and have a meet, it might be a good idea to let their food digest some. No one wants puke in the middle of the pool. The Red Cross also advises against chewing gum or eating while in the water. Your child could choke.

Next, coffee stunts your growth. That's false. In that coffee won't affect your child's growth, but too much caffeine doesn't belong in a child's diet anyways. Not to mention the acid in coffee and what it does to their sensitive stomachs. Coffee and caffeine can prevent the absorption of calcium and vitamins as well. So don't just give it to them.

Fish is brain food. This one is true. Fish is a good source of Omega 3 fatty acids and it's been found to be very important in brain function. Certain fish like tuna however, have significant levels of mercury, which isn't good for kids either. So keep those fish down to once a week.

One we've all heard, chocolate causes acne. Thank goodness this one's false. Although eating too many sugary high fat foods is not a good idea for anyone, studies show that no specific food has been proven to cause acne.

Spicy food can cause ulcers. Yes and no. Spicy foods may aggravate ulcer symptoms in some people but in kids they're more likely to cause indigestion.

While these are old wives' tales, remember, eating a healthy diet is never old advice.

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Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: I think one of the concerns that people have in America now that the first case of Ebola is here in the United States is that we're going to have a situation similar to that of Africa. Dr. Sankar Swaminathan is the Chief of the Infectious Disease Division at the University of Utah and an infectious disease specialist.

Tell me why we shouldn't expect the same thing happening in the United States as, related to Ebola, as we've seen happen in Africa.

Dr. Swaminathan: The situation is dramatically different here in the United States from West Africa. With regards to transmission, there are two places where transmission has occurred, in the community and in the health care setting. The health care setting in West Africa is about as different from the health care setting in the United States as one could imagine. There are mud floors, no gloves, no running water in many places. So we have the capability here to protect our health care workers and our other patients from spread in the hospital. And that does make a huge difference. There has really been no such transmission in Western hospitals, even when cases have been brought here of other viral hemorrhagic fevers as well.

The transmission in the community occurs because of a variety of reasons. But a lot of it has to do with resources, a lack of trust in officials and in the health care system so that people are afraid to seek care. People even chase away workers when people have come to help. This leads to increased transmission in the homes where people don't have the facilities to deal with it. So that's very, very different. So we're not going to have unchecked spread in homes or in hospitals in this country.

The second is the transmission is really not as easy as people seem to think. Many of these studies that have to do with varieties of transmission have been done in a laboratory. But when you've actually looked at outbreaks of Ebola, even people who lived in a home with someone who died of Ebola did not get the infection unless they were directly in physical contact with the patient, or cleaning up their blood, or vomit, or other bodily fluids.

It's all relative risk. And as long as we have good public health facilities, which we do in this country, it should and will be possible to isolate, identify contacts, isolate those contacts and limit the infection so that one person cannot spread the infection to more than another person.

Now while one can't rule out a secondary case, it's very, very unlikely. Given what we know, from all the evidence that we have as to how it's transmitted, as to how long the virus can live on surfaces, as to how infectious people are, it's very unlikely that we would have the kind of transmission that's occurring in West Africa today.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.