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Scot: Today, we reflect. You're really killing the mood when you laugh. Who was that?

Troy: It was Mitch.

Mitch: I'm sorry. You're just so serious. Oh my god.

Troy: That wasn't me.

Scot: Killing me.

Troy: Scot is really trying. Come on, Mitch.

Mitch: I know.

Troy: Scot is trying really hard.

Scot: I'm going to say it again. Today, we reflect. Each of us is going to come up with our top three episodes from 2022. It's a best of the best and maybe a good place to start if you're listening to the "Who Cares About Men's Health" podcast for the first time. Maybe we're going to talk about an episode you missed, and we will make you want to go back and check it out.

This is "Who Cares About Men's Health," offering information, inspiration, and a different interpretation of men's health. My name is Scot Singpiel. My favorite episodes are the ones where I talk about me. I also bring the BS to the show. Countering my BS with his MD, it's Dr. Troy Madsen.

Troy: Hey, Scot. We've had so many great episodes it was tough to choose from, but it was fun to think about.

Scot: And Mitch Sears. We had a lot of episodes about him this year.

Troy: We did.

Mitch: Yeah, not my favorite ones. But we did a lot this year too, so I'm really excited to revisit a couple of these.

Scot: Good. Was this hard for anybody else, picking out specific episodes that you were going to name your favorite, or that were the most meaningful for you this year?

For me, it was a little difficult because I think for me it was more of the entirety of the year, and all the information and everything that triggered my thinking. Some of this stuff I can't put back to one episode. It might have been a couple episodes that helped lead me to someplace that I was at. Anybody else have a hard time, or no? Troy?

Troy: I didn't. I just specifically looked for episodes where I thought, "This changed something I do." Like, I can point to a specific change. And it was surprisingly easy. So it was fun to go back and see what has changed as a result of guests we've had.

Scot: How about you, Mitch?

Mitch: Actually, no. There are episodes in the past year that I listen to again. I revisit to kind of get one perspective or another again, and remind myself of one idea or another. No, I just picked the three that I play over and over again.

Scot: That's awesome. All right. Here we go. Our top three episodes. Each one of us is going to come up with three episodes. I'll go ahead and start with Episode 103, "How Emotional Availability Can Improve Your Life."

Mitch: Oh, with Kirtly Jones? Sure.

Troy: I did not pick that one, but I almost did.

Scot: Did you? All right.

Troy: Almost did.

Scot: So, for me, that episode was good. And again, it kind of brought some thoughts that I've had in my mind together and helped me on this journey. First of all, to start to pay attention to my emotions and acknowledge them as real. There's more than anger, and there's more than nervousness.

Mitch: There's a whole wheel.

Scot: And understand that it's okay to have these emotions and it's okay to acknowledge them and it's okay to feel them, and it doesn't make you any less a man or any weaker.

And also, we all experience these emotions differently. We all handle these emotions differently depending on who we are. And there's no shame in that. It all has to do with our background and how we've experienced them before and what tools we were given by our parents and other people in our lives.

And the thing that really changed it for me, though, was in my interactions now, and this was a suggestion by Dr. Jones, I don't tell the person how they're feeling. "Oh, you seem angry." I'm curious. "I noticed something is a little off today. Do you want to tell me about it? Is there anything I can do to help?"

So just opening myself up to asking somebody about how they're doing without assigning to it and then asking them to define what it is and asking permission if they want to talk about it has been a kind of a game changer in some of my relationships. I feel a lot more confident when I can ask that question as opposed to what I used to do, was ignore it.

Mitch: Sure.

Scot: Just ignore it, right? Because it's scary. It's scary to ask those questions, because what if it's about you?

Mitch: Oh, no.

Scot: What if it's an emotion you're uncomfortable with? And I think a lot of us guys can be uncomfortable with other people's emotions.

Troy: Right. Yeah, like you said, the anger piece of it was really interesting because she pointed out anger is often a manifestation of deeper emotions. And the challenge for us is identifying what those deeper emotions are leading to anger. Yeah, I agree, that was a game changer.

Scot: So we can actually do something about it.

Troy: Yeah.

Scot: All right. Favorite episodes. Troy, you are number two.

Troy: So my favorite episodes, I'm going to go with Kirtly Parker Jones as well. And I'm going to start with the obvious one for me, and that was "Tips For Expecting Dads."

Mitch: Oh, sure.

Troy: Episode 109. I mean, how could I not go with that? It was just basically an episode for me, which I really appreciated. She gave such great advice. And it was as we were moving toward the third trimester that we had that episode, so a lot of things she talked about I thought about through the third trimester, a lot of things as we were there in the hospital awaiting the birth of our child, and as our baby was born. My mind went back to that episode quite often. So she was very insightful. Great advice. Really appreciated it.

Scot: What was it that that episode helped? Can you give us a specific example?

Troy: I think, again, it kind of got back to the emotional availability piece that we talked about in the other episode, but also there were specifics about what to expect in terms of the pregnancy itself that I found very helpful.

But also just that general theme of, number one, being emotionally available, and number two, being willing to experience and express those emotions myself. We talked about, "How are you going to feel when your baby's born? What if you feel like crying? Are you going to be okay with that?" And I was okay with that. I did. I wasn't sobbing.

Scot: Oh, no.

Troy: Of course not. My eyes might have teared up a little bit. And we talked, too, about kind of putting aside the doctor piece and just being there and just being a dad, and that's what I tried to do. I mean, I was tempted to go into doctor mode there and overthink everything and watch everything that's happening and get nervous, but I was like, "Hey, I'm just here. I'm just a dad." And it was nice to do that.

Scot: Just enjoy the moment. If somebody is not a doctor and they don't have that kind of baggage, just really just try to be in the moment and enjoy it.

Troy: Yeah, exactly.

Mitch: Troy, do you think you would've had that same approach to the entire experience had you not had a moment to talk with Kirtly Jones?

Troy: I think I might've approached it a little more clinically, like I said. So it was nice to have that, just to have my mind go back to that and have that as a reminder to myself, like, "Hey, we've talked about this. I'm ready for this. I don't want to go into this and be a doctor here." Not trying to bark out orders, but just trying to be there to . . . I didn't want to overthink things. I think that's kind of what it came down to. So it was nice just to be there, just be a husband, be a dad, and just enjoy the moment.

Scot: All right. Mitch, your favorite episode?

Mitch: So the first one we're going with Episode 106, "Robb Has a Heart Attack." And what I really liked about this one was not only did it feature a friend who's become a role model and a real supportive character in my own health journey . . . I mean, we chit-chat about . . . I've never had before a friend who's like, "Hey, just got back from the doctor and this is what happened." It's like, "Oh, wow. Great. Like, thanks for sharing that." There's this really interesting back and forth that happens.

But more importantly, talking through the episode, health is something to be grateful for, right? Health is something that is not necessarily guaranteed even if you're the healthiest guy, kind of like Robb was. He was extremely healthy and he still got hit with this very intense heart attack, right?

And the line that has always stuck out to me . . . Right now I'm back in physical therapy because I've hurt my ankle again, and any time I'm getting frustrated with my workouts, with that kind of stuff, etc., the quote that he said was, "Even in my workouts, they're less 'I have to go to the gym' and more 'I get to go to the gym' or 'I get to go for a walk.'"

And I just love that takeaway in the conversation that we had. It's just this idea that health is not some gold star that you get for working really, really hard. It is something that you are . . . There is a certain amount of luck and it's a privilege. It's something to enjoy when you have it. And that is something that I really, really appreciated.

Troy: Yeah, and it really hit home to me when you talked about getting on the treadmill after the heart attack.

Scot: Oh, yeah.

Troy: And how he kind of teared up just the fact that he was on a treadmill and exercising. It was just so meaningful to him. That was really cool to hear that.

Mitch: Oh, yeah. And compare that to Mitch of like years ago where I'm on a treadmill hating every single minute of it.

Troy: Exactly.

Mitch: And then it's like, "Oh, man. Yeah, I get to do this."

Scot: Cool. All right. Round number two. Each one of us has three episodes from 2022 that we liked, and this is round number two. Mine kind of dovetails into yours. Mine is Episode 120, which we just did not too long ago, "Just a Bunch of Dudes Being Grateful."

Mitch: Yeah.

Scot: Was that on your list, Troy?

Troy: It was a great one. It's not, but that was a great one.

Scot: Yeah. And it is just a mindset that I get to exercise, that gratefulness mindset that "This is something I can do and it's something that I enjoy," not "It's something I have to do."

How fun was it on that episode hearing what other people were grateful for? It was fun to do, and it was fun to listen to, and just all of us talking about the things we were grateful for, it was infectious. And I felt good after doing that episode, right?

Troy: It was fun.

Scot: And it made me think about power. How we talk about things and the way we frame things is really super powerful. And we talk about how you can set up your own gratitude practice, and I've done so. I was doing it before that. But it's just really cool when you go out and you start recognizing more and more things in your life that you're grateful for.

I'm grateful that I live a half mile away from this park that I can spend time with my dog in. It's a great place to play Frisbee. I never would've thought of that before I was doing my gratitude journal, but it makes me smile every time I'm walking there, and I get to spend some time with him, right? So that's pretty awesome.

It was so much of a fun episode hearing other people and talking about it. I don't know how I'm going to do this, but I might start throwing this topic of gratefulness, like "What are you grateful for?" into conversations with friends. And like I said, I don't know how, but once you start doing it, it is a little infectious and it's fun.

Troy: Yeah, that was a fun one. I loved just having everyone on there, just so many people from the past years that we've talked to. It was just, number one, fun to bring them all together in one place, but like you said, really fun to hear their perspective on gratitude and the things they are grateful for.

Mitch: Yeah, it was really cool.

Scot: All right. Troy, your number two?

Troy: Okay. Number two for me, Episode 113, "Anxiety - The Hidden Tiger of the Mind."

Mitch: Oh, man.

Troy: Scott Langenecker. Was that on your list too, Mitch?

Mitch: It's on my list too. It's okay. We can talk about it.

Troy: I won't steal your thunder because it's on . . . Yeah, we can talk about it together because that's your next one too. I think, for me, he just had so many good insights into anxiety and what leads to anxiety and ways to address it.

I've mentioned it before, but anxiety is one of those things, one of those emotions in my life that I'm trying as much as I can to reduce it. And I've talked about it before. I've sometimes even leaned on anxiety as a motivator, and I don't want to do that. And so it was so good to hear his perspective on how you can reduce anxiety.

Number one, how do you identify it, which is super important when you're feeling anxious. Number two, how do you reduce it? And so I think it kind of relates to other episodes we've had as well talking about anxiety. But I think that one really got down to the crux of the issue and coping strategies and ways to hopefully try to reduce anxiety in your life, which I found very helpful.

Mitch: Yeah. So Episode 113, this is on my list too. There was something about understanding why we have it, right? There was something that I really appreciated that Dr. Langenecker brought in where it was just like, "This helped cavemen survive. There's a reason all of us have it in one way or another."

And so as someone who has struggled for most of their life with anxiety, to have that kind of perspective of, "This isn't a pathology. This isn't 'you're sick.' This isn't 'you have a problem with you.' It's just everyone has it. How do we experience it? How do we manage it?"

I actually incorporated clips from this episode into my lecturing I do at the community college, and we did a whole section on speech anxiety. They had to give a speech in front of the class and a bunch of people were very, very nervous to do it. And we talked about anxiety, what it is, what causes it, how we feel it, how we can trick it, how we can breathe and manage it. Man, oh, man, just to see them respond, to give them that kind of perspective and understanding was extraordinarily satisfying.

Troy: That's cool. That's really cool you incorporated it. I love that you actually took clips from that. I mean, there's so much that you could just re-listen to and quote from what he said.

Mitch: And that's just it. I wish I had had this perspective younger. I wish I had had this perspective earlier in my life being like, "Hey, worrying about stuff or feeling these types of sensations does not mean that there's something wrong with you. It's just something that happens and it's something that is there to help protect us. And if we can understand it, we can have a better relationship with our own mental health," which is way cool.

Scot: It was on my list as well for the reasons . . .

Troy: No way.

Scot: Yeah, for the reasons you . . .

Troy: Well, that makes it easy.

Scot: Yeah, it does, right? We'll wrap this thing up here in short form.

For all the reasons that you both said. I know that, Mitch, you've struggled with anxiety. And for some that struggle with a higher form, more anxiety than others, you might have to get some sort of other medical attention. It's not just necessarily something you can manage on your own.

Mitch: Yeah, anxiety disorders.

Scot: Right. So I don't want to oversimplify it because I know that it's been a lot more severe for you. But for me, also understanding that this had a purpose and then in our modern world, when we get anxious about things to an extent where it kind of makes us not want to act, it's just our warning system that's kind of gone wrong, right?

And knowing that and being able to go, "All right. Let's just really take a look at this situation. Is this threatening to me?" and being able to work through that and figure out if it is or not, that made me feel a lot better.

And just knowing that it's just natural. It's just like if you go swimming, you're going to get water in your nose, right? If you do certain things in your life, you should have some anxiety and it's not necessarily a bad thing. It just happens. And it might be because you want to do really well. So how do you manage it so you can continue to do the thing you want to do really, really well?

One of the things Dr. Langenecker had talked about, I don't know if you remember, is that your ability to handle that might change as you get older, and that's okay.

He told a story about firefighters. That's a very physically and emotionally demanding job, and being able to deal with that can change over time. I'd imagine, Troy, you could speak to this as well. There are not a lot of old firefighters, right? And there's a reason for that. And it's okay. Just like we physically aren't able to do the same things we used to do, sometimes mentally we can't. You have to change.

Troy: Yeah, that was great. Very insightful. Like both of you said, I love that he said, "We all experience this. You're not abnormal because you experience it." So I think that's a great takeaway.

Mitch: And just to echo what you were saying, Scot, as someone who has kind of dealt with anxiety disorders in the past and stuff, it doesn't belittle it in any way, shape, or form. It just makes me think of it differently, right? Why am I medicated? Well, it's because my system is too hyper-tuned. It's not that I'm sick. It's not that I'm broken. It's just I have a very sensitive system, and that's so much of a better approach to thinking about it than, "I'm broken, I'm wrong, I'm oversensitive."

Troy: It's like Spidey-Sense almost. Your Spidey-Sense is a little too strong.

Troy: That's right.

Scot: It's telling you things are dangerous when they're not. All right. Troy, what's your number three?

Troy: Okay, number three. We're going to jump back all the way to January of this past year, and it is Mitch "Project 50."

Mitch: Oh, no. That's the one you chose?

Troy: That's the one I chose and I'm going to tell you why. Like we talked about then, the whole Project 50 I found, I just couldn't put that much time in. But the thing I loved about it was that idea of working on a new talent every day.

Mitch: Oh, sure.

Troy: That was really cool. And so I went back actually to an old talent. I talked about piano playing, but I will say that episode stuck with me. In March, I purchased a trumpet.

Mitch: What?

Troy: I purchased a trumpet.

Mitch: Are we starting a ska band?

Troy: We're starting a ska band. I played the trumpet in junior high school and dropped it after that. Never really played it again. Never picked it up. I don't even know where my old trumpet is, but I said, "I'm going to get a trumpet and I'm going to learn to play this thing again." And at this point, I play the trumpet just about every day.

Mitch: Oh, that's awesome.

Troy: Granted, I don't think Laura is thrilled about that.

Scot: Or the new baby.

Troy: She actually likes it. She kind of likes it. At least she acts like she likes it. She seems to enjoy the trumpet. I don't know that the neighbors love it. But I play the trumpet every day now and I really enjoy it. So that piece of it stuck with me, and I've stuck with that since then.

Scot: What songs do you play?

Troy: I've just got this book of popular songs. A lot of them are '60s songs and stuff, and so I just play through that. I've picked out the songs in that that are easy enough that I can play it on the trumpet and just kind of cycle through it. I'll play two or three songs a day and just pick it up, and it's just fun to pick it up and play it. It's cool.

Scot: That must make you happy.

Troy: It is. It's fun, yeah.

Mitch: I just find it so interesting because just a month or two after that episode, we had the "Mitch fails the Project 50." I don't remember what we called it. But it's so fascinating because we tried the Project 50 Challenge. You rolled your eyes at some of the requirements. I could not keep up with a lot of stuff. But that hour of no phone, I still do it to this day, that morning startup, whatever, the reading non-fiction to educate myself every day. Even if something doesn't quite work, 100% of it, at least try it out. We're just figuring out what works for us, right?

Troy: That's what I thought was cool about it. You can try it or you can modify it and do it, and then after you're done, "This is what I liked. This is what I took from it." That's kind of how I approached it. So that was the thing for me, was the talent piece. And it sounds like for you, the no phone thing and all that. Yeah, I thought it was cool.

Scot: You can find one gold nugget in each episode. It's worth it. That's what I like to say. Mitch, what is your third?

Mitch: So my third is one that I actually have favorited on my Spotify playlist and everything. And it is Episode 104, "Letter From your Past Self."

Scot: What?

Mitch: I know.

Scot: You both rolled your eyes at me when I brought that up.

Mitch: And I will continue to roll my eyes publicly every time you bring it up. But today I just want . . . There is something about . . . And I think the gratitude episode is going to be right in there with it. But as someone who struggles with mental health, as someone who is constantly working on it, I cannot tell you how much being able to go back and hear positive words being spoken aloud of both to myself, from myself, to things that you said to yourself.

If I'm in a funk, I will just play that episode. And there's something about just going through that practice and hearing other men be positive with one another. It gets me out of my funk, and I love that.

And I think the gratitude episode is going to be that same way. It's something that I don't think we do too often. We joke about things, we don't treat ourselves very seriously, etc., and just to know that we could do that and to hear those types of words, I come to it a lot.

Scot: So being kind to yourself. That was one of the rules, that you had to be kind to yourself or . . . I can't remember. That's the part of it you really like, is saying nice things about yourself.

Mitch: Well, it sounds oddly simplifying. But we spend so much of our time being so negative and hard on ourselves, to be able to have an authentic appreciation for yourself is very powerful.

Scot: And hearing Troy also do the same thing was good for you. That came off wrong, Troy. I mean, you're laughing, but we liked listening to other men talk about gratitude. It's nice to hear other men talk about themselves positively or being kind to themselves.

Troy: Oh, I thought you were joking because I didn't get my letter. I timed mine for a year from when I wrote it, so I didn't have a lot to say.

But your letter, I thought, was very insightful and really profound in so many ways. I thought it was really cool to listen to. And I wish I could write a letter as well written and insightful as yours was. That was a fun episode.

Scot: All right. And before we go, I want to just throw one last thing in from my perspective. I've really enjoyed, Mitch, the "

Mitch: It's Complicated" series that we've done with your health journey. Just hearing you go through this health journey as you've kind of been trying to uncover what it is that has been giving you issues throughout your life has just been so motivational and so informative. And the fact that you're sticking with it, it just is . . .

I've really enjoyed that, so thank you for being brave enough to talk about all of those things, which is really . . . I think if anybody gets the award, the bravery award on this podcast, it's Mitch. Troy and I, I think, are still a little guarded, right?

Troy: Yeah, without question.

Mitch: Someone has got to say it. I'm sorry. We don't have these conversations and I wish that there was one other person out there talking about this kind of stuff. So I'm going to talk about mine.

Scot: And I love that you do that.

Troy: No, it really is. I think it's helped so many people and I appreciate your insights and your experience. I draw a lot from what you've gone through and what you've talked about, and I think it's helped me open up a little bit more too. So I appreciate that.

Scot: And it's what this podcast is about. It's about men opening up, talking about their health, talking about their concerns, the things that stress them out or the things that they're happy about, or proud about, or grateful for. We don't have these conversations enough. So hopefully this podcast gives you some tools and gives you some inspiration to want to have those conversations in your life as well. And if not, just maybe listening to these has been helpful as well.

Gentlemen, as always, it's been a great 2022. I look for forward to new episodes in 2023. We'll do this at the end of 2023 and see where we're at. I bet you it's going to be in a different cool place.

Thank you for listening, and thank you for caring about men's health.
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This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

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

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

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

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

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

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

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

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

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

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

Mitch: Carbs are the best.

Troy: Carbs rock.

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

Troy: Carburetor?

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

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

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

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

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

Troy: And did you feel limited?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thunder: Especially in the form of cookies.

Troy: Sure.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Troy: Yeah, exactly.

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

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Dr. Chan: What's it like being a star on reality TV? How do you apply all of your non-traditional pre-med life experiences towards a medical school application? On this episode of "Talking U and Med Student Life," hear from first-year med student Alan's story and inspiration towards becoming a doctor and how he balances his studies, work-life, and family all while here at the University of Utah School of Medicine.

Welcome to another edition of "Talking U and Med Student Life." I've got a fantastic guest today. Alan, how are you doing?

Alan: Really good. How are you doing?

Dr. Chan: I'm doing okay. Hanging in there. Lots going on. And we'll talk about it a little bit. And Alan you're a first-year student, correct?

Alan: Correct.

Dr. Chan: Correct. All right. So and we were kind of talking about it earlier, but you know, first-year med student during a pandemic. I'm sure we'll get into the details, Alan, but I want to hear your story. Let's go back to the beginning. When did you start thinking med school? Let's talk about kind of your journey that got you to this point.

Alan: So I think it's important for everybody to know that I'm an older student, I'm 41, so my pathway to medicine took a little bit. I think it kind of started . . . I've always kind of wanted to do something important for society. I've always wanted to be like this really key cog, making a difference in the world.

And so my dad was a construction worker. My mom, she grew up in the Philippines. She has like a fifth or sixth-grade education. It wasn't really in the books. My dad was a construction worker, became a prison guard, and I didn't find out till my 20s that my dad had a degree. And I asked him why and he didn't really like it. He didn't care about it. He didn't find importance in going to school and education. He felt like his degree didn't help him at all. It's just a waste of his time.

So just medical school was like never . . . it wasn't that it was that I couldn't be a doctor, but that just wasn't the path that was for me. That was for people that were naturally gifted or wealthy or any of those things that just kind of wasn't in the works for me. That's just kind of the vibe that I grew up with.

So I went to school, did terrible, and then I left and this was like back in '97. I left and decided I'm just going to go into construction. And I worked my way up, and I said I'm going make a difference in construction. I'm going to be part of this important cog of a society. And I started building elevators because I felt elevators were so important. It's going to be such a good career. And, you know, with time it kind of grew stale with me.

Dr. Chan: Is this in Utah, Alan? Did you grow up in Utah? Where's this going on?

Alan: I grew up in San Diego. This is San Diego.

Dr. Chan: San Diego. Okay.

Alan: Yeah. So can I tell a funny story?

Dr. Chan: Sure, go ahead. We are all about funny stories.

Alan: So I went to this urgent care and I just needed this little procedure done and the doctor there was this kind of older white guy from South Africa. And when we're going through the procedure, it was so unprofessional. He's coughing on me. He definitely had a cold. There's no question he had a cold. He wasn't wearing a mask. He's coughing and he's cussing and he's talking to me about American politics and capitalism and all this other stuff. And we get about three-quarters way through the procedure and he says, "Okay, I got to step out for a second. I've got to go Google to make sure I'm getting all the right nerves." And he walks out.

And I'm going, "Oh my gosh, did my doctor just say, 'I got to go Google . . . I got to go Google how to figure out how to do this'"? He walks back in, he finishes the procedure, and I sound like I'm really talking bad about the guy. It was a really unprofessional experience, but it was fun. He was really relatable. And the procedure went fine. It was fine. Like there was no complications. There was minimal scarring. It was fine. And I left there going, you know, if that guy can do it, I can do it.

And this is kind of like in my mid to late 30s. This is the first time in my life I had ever learned that doctors were real people, that, you know, they don't know everything, that sometimes they have to check on things, and that as funny as it is and as weird as it was, that was a really good experience for me to learn that I could be a doctor. And I still kind of felt like I was a little old, so it still took a little more convincing. And then, yeah the, "Wipeout" experience and kind of all history from there. Should I talk about that?

Dr. Chan: Yeah. So when did this doctor experience happen? Like in the 2000s or when did this go down?

Alan: So I was probably about 35-ish. So we're talking maybe six years ago around there. Six, seven years ago.

Dr. Chan: So you had to go back to school. And so what was that process like? What did that look like for you?

Alan: So I still hadn't quite made that decision yet. So can I jump into "Wipeout"? Is that okay?

Dr. Chan: Sure. Let's talk about "Wipeout." I love it. Let's get all the stories out. I love it.

Alan: Well, this is all part of the journey. And so I got injured in high school. My shoulder was just in shot. I couldn't sleep on it. I couldn't throw a ball. I saw a doctor. He said it would heal. It never healed. And so I just, okay, 20 years, I'm just going to live with the shoulder and I did. That was going to be my new life, just the shoulder that didn't work.

Then I was on this TV show called "Wipeout" where I just got wrecked. I got hurt so bad, and my shoulder was wasted. The very first round, we ended up going through and we won. It was a really cool experience. But by the end of the show, my shoulder was done. I couldn't use it. I couldn't lift anything. So this is 20 years after the original injury, 20 years of like just can't sleep, thinking that my life is going to be messed up forever.

And I go get surgery, and after surgery, I would say probably within three months, my shoulder was mostly there within six months, 100% like before high school. All the strength was back. This whole part of my life that I thought was gone was restored. I thought it was gone forever. I thought I would never teach my kid how to throw a ball. I mean, that really hurts a dad's feelings. And it was amazing. I didn't think that part of my life would ever come back.

And so now I have this experience where I know that I can be a doctor and now I have the strong desire to be a doctor. It was just like kind of a push over the edge later on. I just became very unsatisfied with how stale construction was getting for me and that was it, man. I took three years of undergrad schooling to get back, but I jumped ship and here I am.

Dr. Chan: I want to go back to "Wipeout." How did you get on that show? What's the audition process like? Did you have to like send in a video of you like jumping on things or jumping off the things and diving into large vats of liquid? I mean, how did that look like?

Alan: I actually applied, I think, three or four times. It looks so fun. It's not. It's a really good experience, but I wouldn't call it fun. But yeah, so they don't want athletes. They want people that can wipe out. They want people that can be on a TV show and not be afraid to look like a moron in front of millions of people. And I'm your guy. I am not afraid to look like a moron in front of millions of people.

So you just, you apply. You kind of show that you have a personality, that you're kind of larger than life. And I think that they liked that. I had applied many times, so I kind of learned what they're looking for. And then I found somebody who was a lot like me, just a knucklehead, and it was a team episode and we both got on.

They started asking us questions. They started asking us questions during the interview. We didn't really work together. The episode was like boss and employee, but he and I didn't really work together. We were both elevator guys, but he worked for a completely different company, but he had the personality that I wanted. So I called them beforehand when they invited me to do the audition. You have to do a written audition. Then they invite you to come to an in-person audition. And they said, "We want you to audition for this boss-employee episode." And I said, "Well, the guy that I'm going to audition with doesn't really work with me." And they said, "We don't care. Just make up some stories and we'll go with it."

Dr. Chan: Are you telling me reality TV isn't completely real? Is that what you're saying, Alan?

Alan: Yeah. You wouldn't think, right?

Dr. Chan: So were you the boss and he and employee or vice versa?

Alan: Yeah, we just did paper rock scissors on the way up. And so we were in San Diego. We had to drive to Burbank. It's like a two and a half-hour drive. And so we're just like, I don't know, who wants to be boss? I don't know. I'll be boss. So ended up I was boss, he was employee.

We go to the interview, and, you know, we're acting like knuckleheads and jumping around and make up these funny stories. And so the guy goes okay, "Okay, okay. Tell us a story that's really funny about you two guys working together." Remember we don't really work together, so I'm going, "Oh, shoot," but we had told a lot of stories. That's important, right? So then we finished the audition, and we go to the real show and the producer comes up and he says, "Okay, everybody I'm going to prod you guys to tell a certain story on camera." Anyways, anybody watching . . .

Dr. Chan: If we tell too many stories and it's hard to keep track of what's right . . . what was . . . to keep it consistent. Or do they not even care about consistency?

Alan: They don't care. They just want to laugh.

Dr. Chan: And so, okay. Because I've seen the show, what's the show like when the camera's off? Is it everyone relaxes, or it's just full-on everyone's in character? I mean, do they encourage wipeouts, I assume? I mean, do they encourage you to kind of put your life and body on the line.

Alan: Yeah. So that's a really good question. That kind of is one of the reasons that it's a really good experience. I wouldn't call it fun. So the first round is the one that we love to watch, where everybody is like getting hurt and that one's controlled by people. They're like pushing buttons. So you're going to wipe out. You know you're going to get a hit, so you take a hit.

But then when you're not on camera, you're kind of in the trailer in the back lot and you just sit there and nobody's like really excited. Some people are already hurt in between rounds. Everybody's for the most part friendly. There's a few people. I go back and watch that episode. I'm like, oh, that guy was a jerk. I'm so glad he lost. Oh, man. But yeah, there's a lot of downtime.

During one of our episodes, they were filming an episode for "The Bachelors," I guess like the bachelors and bachelorettes, that TV show. They did an episode of "Wipeout," and so they were filming the same day we were filming, and so on that day we weren't allowed to come out of our trailer. They didn't want us to look at them or see them or whatever.

Dr. Chan: Or spoil it for the masses about who made it, the rose ceremony. Yeah.

Alan: Speaking of reality TV, I don't watch "The Bachelor" or "Bachelorette," but I made an excuse that I had to go to the bathroom. And you have to leave the trailer to go the bathroom, and the bachelors were coming out and there was one girl, I guess, that she was really like high drama on the show. And so now there's no cameras rolling, this is just people walking to the trailer. Everybody's exhausted. Everybody's hurt. There's no cameras. And I hear this girl going, "I don't even know, like, this is so stupid. I don't even know why I'm here. I don't need this. I've got more publicity than this. I don't need this show and I don't need these people." And she's the blah, blah, blah, and I have no idea who she is.

So when the season like actually ran, when it aired, I went back and watched and I guess she was like a high drama person on camera and I can tell you off-camera she was also a high drama person. She ran half the course and quit and then, yeah, walked off the show.

Dr. Chan: Wow. So Alan, how far did you make it on "Wipeout," and what's the secret if myself or any of our listeners want to do well in "Wipeout"? How far did you go and get, and what's your secret to success to win this?

Alan: Oh, my gosh. I hope you go, Dr. Chan. I hope you go.

Dr. Chan: It's on the bucket list. Might not get to it to be quite honest.

Alan: The secret is to not be afraid. You're going to get hurt. Know they're going to hurt you and you got to take the hit. You got to take the hit and keep going. When you're watching the show, it's each event is like three, four, five minutes long. When you're doing the show, the events are like 30 minutes long. They're really aggressive. People are yelling at each other, cussing at each other. You got to remember, this is like Hollywood. This isn't Provo, right? So they're really letting each other have it.

The staff is yelling at the contestants. It's pretty aggressive. So you got to have thick skin and you just got to keep going. You're exhausted. You're swimming fully clothed with your shoes, life jacket for 30 minutes. It's really hard. So you just got to be the type of person who's going to take the hit, who's going push through it, who's not going to get upset.

There was one person. She did take an injury, but I think the stress was getting to her and she was like, "I need to stop. I need to stop. I'm hurt. I need to stop. We just need to stop." And they're like, "We are not stopping. If you want to stop, you're getting in an ambulance." "I need to stop. I need to stop." Boom. Pulled her, yanked her, put her in the ambulance, and took her out.

So yeah, it's a high-stress environment, but push through, be willing to take a hit, and might win some money.

Dr. Chan: Yeah. So how far did you get, Alan?

Alan: We won. So we won our episode. It was me and my partner. We won 25 grand each. And then they had another episode where the champions of each episode come back and compete again. I can tell you right now, I knew all the champions. I saw the champions. I met all the champions in the trailer on a different day, and nobody wanted to come back to that episode. Everybody was hurt. People are hobbling around. People's arms are in like wraps. Everybody's hurt, nobody wants to come back, but all of us were afraid that if we didn't come back, we wouldn't get paid for winning our previous episode. So most of us came back, like 9 out of 10 of us came back, something like that. But it was a good experience. Happy I did it. Wouldn't do it again.

Dr. Chan: Sounds really traumatic behind the scenes. I don't know, like I've talked to other folks who've tried out for "Jeopardy" and "The Price is Right." Like this "Wipeout" sounds like it's yeah, it sounds really dangerous. It's not like those others. All right. So you mentioned kids. And so at the very beginning, you know, you said you're, you know, mid-thirties, early forties. So in the world of admissions, that makes you a non-traditional student. And like what was that like going back to school and doing your pre-med reqs with a family and how did you make that work? Again, what are your tips? What's the secret to your success?

Alan: That's a really good question, thanks. So I think first you have to accept the fact that life is going to change. A lot of people kind of want to go back to school and think I don't really want to disrupt my life, but that's not really an option especially if you want to get into medical school. There's a lot of requirements get into medical school, so you have to accept that your life is going to change. You're going to miss some things.

So, you know, you're going to miss some dance recitals. You're going to miss some cheer tryouts, whatever it's going to be. And so then you kind of have to be creative. And so one of the things that we did . . . oh, first of all, let me say this is the number one most important thing going back to school, especially going to medical school, is make sure your spouse is just as invested as you are or even more so, because every minute that I'm not home is a minute that she's alone with the kids. And so as much as on the surface, it looks like getting into med school is hard for me, it's probably harder for your spouse. So make sure they're totally invested in this whole goal.

So, but then going to school, like one of the creative things that I try to do to try to combine schooling with kids is I was going to BYU, and so what I would do is I would have my wife . . . I still wanted the one-on-one time with my kids, so I'd have my wife drop off a kid with me at school for about an hour, maybe two hours, and they would have alone time with dad and I would get them treats from the vending machines and we would just kind of talk.

And we would walk from building to building into these large . . . BYU has a lot of these large classrooms, and we would just kind of walk around these large classrooms and pick up all the pencils, all the mechanical pencils and highlighters and erasers and whatever that the students left behind that day. And then the kids were, you know, they'd walk off like 15, whatever.

Dr. Chan: Like a scavenger hunt. I love it.

Alan: Like a scavenger hunt. Yeah. The kids loved it. They were super excited. They got to have alone time with dad and I got to have time with them. And anyways, that was something we did. And you kind of have to make a lot of deals. I'm going to miss your cheer competition. To make it up for you, I'll give you some alone time on Saturday, and I'll take you to nickel arcade or we'll go on a date or whatever. So you got to be creative, but it's work and life is going to change for sure.

Dr. Chan: How many kids do you have, Alan, and what are their ages?

Alan: I barely have six kids, and my youngest is four years old. My oldest is 14, and they're every two years in between.

Dr. Chan: Okay. And I think that puts you, I think you have the most kids in medical school. I don't know of any other students that have six. Is that correct as far as you know?

Alan: As far as I know. I don't know if that's like something I want the trophy for.

Dr. Chan: All right. So you're going back to school, you're trying to find balance, you know, as a father, as a husband. As a pre-medical student, how did you do all . . . You mentioned BYU and classes, and there is an academic component to getting prepared for med school. But how did you do all the other activities, like the research and community service? How did you fit that into your busy schedule?

Alan: So one of the things that I think kind of is in the heads of these medical school students is we want to like see what other medical students have done. Like, oh man, you got into medical school, what did you do? And you start to try to build your résumé following the résumé of some successful students before you.

And I tried to do the same thing. That was kind of my mindset for my first year. And then during my second year, I had this opportunity to join the wrestling team. And I thought, well, you know, this is O Chem 1. Everybody says this is such a really hard time right now, and plus I have other hard classes as O Chem 1, Anatomy, and, oh gosh, I had a few other hard ones. And I said I can go and I could focus on studies and get an A or A-minus, whatever it's going to be, or I can follow my passion and wrestle and show the admissions committee who I really am and show them something they've never seen before.

I became like the second oldest person in history to ever qualify for the national championships, but I thought that that was more descriptive of who I am. And so that did cost my grades a little bit, but I decided at that point that my application would be a reflection of me, what I'm passionate about, and where I feel like I can make the biggest difference.

So when I was going out and volunteering and doing these extracurriculars, it didn't feel like I was taking time away from my family or taking time away from studies. It felt like I was developing me and showing the admissions committee who I really was.

I know that sounds really cheesy, but that's the absolute truth. And so I think my application looked very different than a lot of other students because I took that route.

Dr. Chan: And you mentioned the wrestling. So have you always been a wrestler, or where does that come from or is that something kind of came later in life?

Alan: So I was a wrestler in high school. I was a really good wrestler high school. BYU had a wrestling team back then, and they invited me to be on the NCAA team that they used to have back in '97, but they wouldn't give me a scholarship. And at the time their coach was this Olympic champion, Mark Schultz. And he called me on the phone and he says, he gives me a spot on the team. I had no idea that that was a big deal. I thought I was a stud. I thought I was going to, you know, go places with scholarships and whatever, and that's not the path for wrestlers.

So I ended up going to BYU, and I didn't take the spot that he offered me, so I had to fight for it. And there's a kid who came from Ricks College. This is like back before BYUI. This kid came from Ricks College. He had already wrestled two years of junior college, and he and I had to wrestle for the spot. Since I turned it down, we had to wrestle for it, and he kicked the snot out of me. He gave me the worst beating I ever had in my entire life.

He ended up winning the starting spot and going to the nationals, NCAA national. So he was a stud. But when I left BYU, I wrestled a couple of years of junior college, and then, yeah, so it was a 20-year gap. A 20-year gap between like, when I'd last wrestled in junior college and when I wrestled again at BYU.

Dr. Chan: So you're kind of the prodigal wrestler. You wrestled 20 years ago and then you came back and joined the same team. Am I understanding that correctly?

Alan: Oh, so yeah. So BYU, actually, I think I'm probably one of the only people that I was on the . . . well, I guess I wasn't on the team, so I turned my spot down, but I did wrestle with them back in '97 when they had a NCAA team and they closed the team and then I came back and wrestled for the club team and then they closed the club team. Either I have bad luck, or I don't know.

Dr. Chan: Wow. All right. So Alan, so you're finishing up your pre-med reqs, you're doing all the things you need to do. You have your large family, life is happening, and I think you're still working during this time too, right?

Alan: Yeah. So what I did is I couldn't afford to work like during the school year. So from September to whatever May, I just couldn't find the time to work, but I also couldn't take on the debt. I've got a mortgage. I've got to raise kids.

So what we did is the day that school . . . I would take my finals on like a Friday, and we bought a trailer and on Saturday morning I would have the trailer heading to San Francisco and I would spend the next four months in the San Jose, San Francisco area because they pay, I make about in one summer, I'll work 80 hours a week and I'll make triple there what I'll make here and they pay for all my expenses and everything like that.

So I'd go to San Francisco. I'd build elevators. And that would just be like hard, just 80 hours a week, Monday through Sunday. And then I would finish my workday on Saturday out there, pack up my trailer, boom, I'm back here for ready for school on Monday. So I didn't have a summer vacation, no breaks, no time to breathe, just boom, boom, boom. But, you know, that's what we had to do. It worked for us, but it was not free. It was a lot of work. Having eight people live in a trailer, that was a fun experience.

Dr. Chan: That's amazing. And so what was your strategy when you started looking at medical schools, like where did you want to apply? How did you approach this as, again, a non-traditional student with a lot of stuff on your plate? What was your strategy going in?

Alan: Okay. Number one, I don't have to kiss up to you. I'm already in. I don't have to kiss up to you. Number one was always Utah. That was always from the get-go, always number one. So all my GPA and everything that was always working to get the goal to go into Utah. If for some reason Utah didn't work out, I had to go somewhere where I could raise a family. Had to be affordable, had to be safe, had to have good schools.

As a matter of fact, there was one school . . . I kind of like, I applied wide. I applied DO-MD. I applied to like 40 schools. And then in one of the secondaries, I don't want to say the name, but one of the secondaries, it said, "Tell us why you want to come to our school." And so I Googled the area where the school's at and even like the surrounding area, I don't know why I applied. I thought it was going to be better than it was, and it just wasn't going to be a good place to raise my family. And I'm really glad they asked me to start with a secondary, because after looking at the map, after looking at the schools, after looking at the living conditions, I go like, "You know what, I actually don't want to go there." So I didn't fill out the application. Go ahead.

Dr. Chan: So you applied broadly, so 40 schools. And again, I can ask you this now, Alan, because like you're already in here, but like how many interview offers did you get?

Alan: So I got two MDs, and I got a lot of DOs. I felt like my story was very DO friendly. It's really important to point out that my GPA as a young undergrad was really, really bad, and I took a lot of classes and got bad grades in a lot of classes.

So when I came back to school, no matter how good I was doing and I did pretty well when I came back, but I couldn't get that GPA to come up. Like it just really wouldn't budge. So when I applied, my overall GPA was pretty low. Can I say that? I'm not ashamed of it. Can I say that?

Dr. Chan: Yeah, you can talk about it.

Alan: My overall GPA applying was 3.05, and the minimum for most schools was 3.0. So I took all hard sciences. All of my G's were done. I had nothing but hard sciences left. And so I ended up with like a 3.7, because you know, O Chem and cell bios is really a rough route. But so when I applied, I had to kind of like keep that in mind that my GPA was going to be a weed out.

So anyways, going back to your question, sorry to go on a tangent, but I ended up with two MDs and then I think like maybe six or seven DOs. But I also, thanks to you, I heard back from Utah early, and as soon as I heard back from Utah, I withdrew. And so maybe there's . . .

Dr. Chan: When you say "heard back," when I called and accepted you?

Alan: Yes. Sorry.

Dr. Chan: All right.

Alan: Yeah, go ahead.

Dr. Chan: Alan, with all your experiences, I'm just curious because . . . it's hard for me because I meet so many people. I do remember you on your interview day. I just remember you just had like a very positive energy, positive karma about you. I do remember you mentioning the "Wipeout" thing when we were doing like a little ice breaker.

So I'm curious, like, because you know, obviously, you've been on some TV shows, you've been a wrestler. So like, you know, you have some athletic experience. Did you have butterflies in your stomach? Like what was more anxiety-provoking, like being on reality TV, getting ready for that big match or interviewing for med school? Like how did you call that feeling? You know what I'm saying? Was it stressful or were you able to navigate? I'm just curious how you approached it.

Alan: There's no question med school was more nerve-wracking

Dr. Chan: Than being on reality TV show. Interesting.

Alan: Well, you know, okay. So before, Utah was my third interview. I don't want to say I did one . . . like I'll say because it's funny. Okay. So I did get invited to the DO down in St. George Rocky Vista, and I got an invite the day after I applied and I got invited to the very first day of interviews.

So I was so arrogant that, like, they really wanted me to go there. And then they sent me this email that said, just so you know, we accept 80% or 75% of all the students that get interviewed. So, you know, just because you're getting invited, know that you got a really good shot. And I was so arrogant. I didn't prepare. I was just so dumb. I walked in, I did the interview and I knew I blew it. I couldn't get through my thoughts straight. I didn't practice like expressing myself and getting to the point. And I just, I walked out, I knew I blew it and I got wait-listed. I got wait-listed. It was heartbreaking. But I'm so glad that happened because it prepared me to prepare.

So I started doing practices. I started doing MMIs and constant scenarios. I was interviewing myself constantly, constantly, constantly, constantly. So by the time I came to the University of Utah, the interview like I felt prepared, but I was still nervous because remember that GPA always weighted on my mind. I couldn't get that off my shoulders. That always weighed on my mind. I always felt like less of a student than everybody around me because I was carrying that stain on my record.

So as much as I felt prepared, I felt I was always nervous that that was going to hold me back from ever getting into med school. And I think if I knew then what I know now, I wouldn't be quite as nervous about it, but yeah, it was horrible. I couldn't sleep. It was rough, really rough.

Dr. Chan: Alan, I'm glad you're here.

Alan: Thank you.

Dr. Chan: And I just have a few more questions because we're almost out of time. So starting med school in a pandemic, what's your experience been? How do you do with all the Zoom? I mean, what's your perspective starting med school during the middle of a full-blown pandemic?

Alan: I guess the good news is that we're all in the pandemic, right? It's not just me. And so I don't feel like I'm kind of at any type of any losing position because everybody across the nation I think is doing the same thing. So I don't think it's really negatively impacting like how competitive we are or anything like that. So that part doesn't really weigh on me.

One of the key things I wanted out of medical school is to make some really good connections. That's been kind of hard. I do feel like the class right now is starting to break off into cliques. Not like in a bad way, but people are just kind of getting used to who they see all the time. And so even when I go to med school, you know, cordial hi's here and there but we don't really know that many people outside of like maybe 10, right?

Dr. Chan: Yeah. The small groups, the dedicated groups.

Alan: Yeah. Yeah. So that part's been hard. I'd I hope to kind of like network a little more, but the learning has, you know, most learning is going to be on your own anyways, so I don't think that has hurt me too bad. And in some ways, since I still live in like an hour away from campus, in some ways it's kind of helped me because I don't have to make that drive every day. Then I'm going to make do, and it's not that bad. Yeah.

Dr. Chan: And going back to being non-traditional, like how has that balance been now that you're in med school with your family? Has that been manageable? Has it been actually more manageable as a med student compared to pre-med life? Like how would you describe it?

Alan: No, this is harder. There's no question about it. This is harder. I'm trying to figure out. I really like, I really, really liked the way that the University of Utah sets up their first year, where we have all of these tests that don't count towards your grade. And I feel like I just really feel like the University of Utah has nailed the first semester. We call it foundations of medicine. I feel like they nailed it.

So it really kind of gives you a chance to figure out who you are, how you're going to dedicate time, how you're going to figure out your life, how you're going to reorganize things.

The first half of this semester so far, I'd say I did a really poor job of managing my time and finding balance. It's been really hard. Dude, I gained like 10 pounds, and it was hard. I was studying like 12 to 14 hours a day, but then you start to figure out, more efficient, be more aggressive. And I started waking up early to exercise, started an exercise group. And so kind of with time it's gotten better. And so I found time now, I could spend time in the evenings with my kids and go on weekends, but there's no question about it. There is less time now than it was before, but you make it work and that's all you can do.

Dr. Chan: Yeah. Can I pivot, Alan, and ask some more questions? Because you just have this wide variety of experiences. Just want to pick your brain a bit. Is that okay?

Alan: Yeah. Yeah. Whatever you want.

Dr. Chan: So how long have you been an elevator repair person?

Alan: About 14 years.

Dr. Chan: Okay. So help me because sometimes when I step on an elevator and it's really high and it starts to like shake a little I'm okay. It's statistically really small that that's going to plummet, right? We've all been there. Everyone listening to this has been there when you've been in an elevator and it kind of shakes a little bit extra and you just kind of have that thought that's in your mind, right?

Alan: Yeah. So it's not like the movies. So every elevator is held up by like six cables and one cable can hold up the whole weight of the elevator. It can be full with all the weights and all the people and one cable can hold up the weight of the elevator. So don't think that like if one cable breaks you're going to lose it. There's elevators running with one broken cable right now and the repairman hasn't gotten to it. That's really unsafe, but for different reasons.

The scarier part is there are emergency breaks on elevators, so it won't fall. If it falls, it'll fall a very short distance. The actual danger is number one, when we work on the elevators, we have to shut the doors off sometimes because the doors are what keep the elevator . . . Anyways, sometimes we have to bypass the doors and the door is like a safety circuit. The elevator won't run when the doors are open. Sometimes we have to bypass that feature and sometimes people forget to unbypass it. So what happens is people will get on the elevator, the elevator will think the doors are closed, and it will just take off. And when you're on the elevator, it doesn't feel like it's that fast, but an elevator takes off really fast. And so if you're halfway through the door when the elevator decides to take off, yeah, that's more common. Super, super rare. I don't want to scare people. That's super rare, but that happens way more often.

I think elevators have only fallen twice in the history of modern elevators, but people getting hurt by doors that were bypassed, yeah, I know people that have done that, that have hurt people because of that.

Dr. Chan: That sounds terrifying as well. Another elevator question. So, Alan, I'm just going to pick your brain. So there have been rare times when like elevators have been stuck and it's full of people. And I remember, you know, you kind of look at the plaque and say like not to exceed this weight limit. And then I started looking around at everyone in the elevator. So I'm just asking you, like that's just a suggestion the weight limit. I'm fairly sure that like there can be more like, there's probably like some leeway there. You can probably go a couple of hundred pounds above that weight limit, correct?

Alan: Yeah. A couple of hundred, couple of hundred is okay, but usually like with modern elevators, they have weight sensors and so it won't budge if it gets overloaded. It won't budge. But actually if you overload an elevator, that's really unsafe, but you can't do it with people so don't get too nervous about that.

Dr. Chan: Okay. I think we've all been there. We've all kind of looked at each other, going collectively, are we below the whatever the thousand-pound weight limit is? And then you start thinking like, okay, is this now in a danger zone?

All right, Alan, last question. You mentioned movies, which movie in your opinion has the best elevator scene? Again, it doesn't have to be . . . so I actually looked this up. So the two in my mind are "Die Hard" and "Speed," but maybe you have another one. I'm just curious, like, are those legendary among elevator repair people or because it was so farcical, but they are so action-packed?

Alan: "Die Hard," every movie has it wrong. Let me say that. Every movie has it very wrong. Like if we can't open the hatch, we can't get out. If I'm stuck in an elevator, I'm stuck in an elevator just like everybody else. There's no secret.

The movie I think that has it best is probably "Ocean's Eleven." At the very end, you know, they sneak into the vault and then they open the doors and they throw that little bomb out there. That's a real elevator pit. I can tell from the picture that they shot that in a real elevator pit. There's some things that are wrong with that scene too, but if we're talking like most accurate, that one.

Dr. Chan: Okay. I love it. "Ocean's Eleven." I'm going to have to pay attention. I know exactly. Is that where they kind of, yeah. The little smoke bomb and, yeah. Okay. That's fascinating. See, I thought it was going to be like "Die Hard" because I think there's a lot of elevator scenes in "Die Hard." It's kind of part of the plot.

So, all right. Alan, this has been fantastic. We're going to have to have you come back because I just know there's going to be more stories and more questions. So I just really enjoy talking to you and just hearing, you know, how you've gotten to this point and just how well it's going.

Alan: Hey, thanks a lot for having me. I really like the U. I'm glad I chose it. This has been an awesome, awesome place to be in medical school.

Dr. Chan: All right. Great. Well, thanks, Alan and take care. I'll talk to you soon.

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Scot: "Who Cares About Men's Health," providing information, inspiration, and motivation to better understand and engage in your health so you feel better today and in the future.

All right. Time to do a little roll call here. I need to know who cares about men's health. My name is Scot. I am the senior producer at thescoperadio.com, and I care about men's health. Who wants to join me?

Troy: I'll join you, Scot, because I think it's my turn next. I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Gee: And I'm Dr. Chris Gee. I'm a sports medicine physician here at the University of Utah, and I care about men's health.

Scot: All right, Dr. Gee. Welcome back to the show. Next time, I need a little bit more enthusiasm, though. Say like you mean it, okay?

Dr. Gee: All right.

Troy: Say it like your life depends on it.

Scot: That's right. Today, we're going to do a listener question episode. Some listeners have sent us some questions for Dr. Gee, who is a sports medicine physician. Why do I get cramps in a muscle, and can I fix that? We're going to talk about rotator cuff rehabilitation without surgery and is KT tape for real?

But before we get to the main topic, I have a question for you, Dr. Gee, or Chris, or whatever you want me to call you. Do you do time-restricted eating? Do you even know what that is? Like, fasting?

Dr. Gee: I've done some fasting, but I'm not very good at it. I hate fasting, let's put it that way.

Scot: So what does fasting look like? Because it means a lot of different things to a lot of different people.

Dr. Gee: The basic premise behind this is that it's probably not great for our bodies to get huge boluses of food and to eat just kind of grazing all through the day. And so the idea is to have a time for your body to kind of process things. Some religious groups do it routinely with monthly fasts and ceremonial fasts. But obviously, the time-related eating is more that you eat certain times through the day, and then at night, you stop eating overnight, or whatever it is that you decide to do.

Scot: Yeah, that's exactly right. It's that time-restricted eating. We've had another guest on who's a nutritionist. He's a big proponent of it, like 12 hours of eating, 12 hours of not eating. Or if you want to try to lose a little bit more fat, you can make that 10 hours of eating, the remainder not eating, or 8 hours. So you have done that time-restricted eating and just don't like it?

Dr. Gee: Yeah. I am probably the worst nutritional person out there as far as my diet is just not great. I've done a little bit of it and tried it and I have a hard time. Let's put it that way.

Scot: Yeah. What's your challenge to that? Because I just started doing it again. I did it for a couple weeks before COVID and then COVID came along, and every routine I had went out the window. But I felt better even after two weeks, and I feel good now after just a few days of doing it. So how did it impact you?

Dr. Gee: For me, whatever the problem is, I tend to be really great with a diet or with some time restriction or something like that for a couple of days. And then it just goes out the window for whatever reason. I'm just like, "Oh, I'll just have this snack. I'll just break it this one time." And so I don't know. I've kind of done that. I know I need to kind of adjust that, but for me getting through the first day or two is just hard.

Scot: Yeah, it is a little tough. Troy, have you been sticking with it? I know you had talked about doing it.

Troy: I have been sticking with it, yeah. I do 12 hours, Scot. That seems to work for me. And I just tell myself I'm not going to eat after 8:00 p.m. and I'm not going to eat before 8:00 a.m. Just restricting it to 10 hours of eating, I think, would be really tough because then I'd be looking at stopping eating at 6:00 p.m. So I find 12 seems to work and it seems to be working okay. But I agree, it's tough.

Dr. Gee: Can I ask Troy a question?

Troy: Yeah.

Dr. Gee: How do you do that with your shifts? Do you still do a number of shifts in the ER?

Troy: I do, yeah.

Dr. Gee: I always have a hard time with that.

Troy: You're right. Yeah, that's what really throws me off, is if I work . . . As you know, Chris, we'll do these shifts that are evening shift. We call it an evening shift, but you get out of there at like 1:00 or 2:00 in the morning and get to bed at 3:00. So those days, I'm probably not eating after 11:00 p.m. and I'm not eating before 11:00 a.m. So it's probably still working out to 12 hours because I'm trying to do better at eating at work. That's what I found. If I don't eat consistently at work, I get home and it's like 2:00 a.m. and I'm so hungry that I eat a ton, and then my stomach just hurts when I go to sleep and I can't sleep well. So that's how I've tried to adjust it, just by bringing plenty of food for work and trying to be consistent about eating so I don't come home hungry. But it's hard. With shift work, it's really hard.

Scot: And have you noticed a benefit, Troy? What does it do for you?

Troy: I have, Scot. When I first started doing it, I did feel like it did reduce my body fat somewhat. The other thing I like about it, I feel like I don't have to pay as much attention to what I eat. I know that's bad, but I kind of feel like it kind of gives me a little wiggle room there where I'm like, "I can eat more stuff that I was a little more concerned about eating before."

And then just going to bed, sometimes I would eat at 9:30 and then maybe I'm asleep at 10:30. And it wouldn't be until about 1:00 or 2:00 in the morning that my stomach would really feel okay, because that food just kind of sat there. So I felt like it's helped my sleep as well.

I feel like it's made a difference, and I feel like I've done okay with it. I've tried to do this since we first talked to Thunder about this. It must have been a year ago or so. And it's one of those things I've kind of taken from these talks we've had with Thunder that I feel has definitely been beneficial.

Scot: Well, I just was curious because I was curious to know, Chris, if you did anything like that as well and what your challenges were. I guess now we know. I feel like I wake up a little bit more clear-headed for sure and a little bit more alert.

By the way, I did see a documentary that talked about fasting. And there's some research out there that says even if you do it five days out of the week and two days you're not as religious, you still get the same benefits. So for somebody who works Monday through Friday, and then the weekends maybe they let themselves go a little bit. Maybe that would help. Chris, you think we can get you onboard or just no way?

Dr. Gee: You're tempting me for sure. I'll have to try it.

Troy: Maybe just three days.

Dr. Gee: I need to have a new plan. And so that'll be good. If I can only do a few days a week, maybe I'll start with that.

Troy: Scot, if there's benefit to five days, there's got to be benefits just to even three days, you know.

Scot: You would think.

Troy: You'd think so. Maybe you could say, "Hey, this is going to be my Monday, Wednesday, Friday thing," and start there. Don't eat after 8:00 p.m. Don't eat before 8:00 a.m., or whatever works, 7:00 p.m. and 7:00 a.m. Because I feel like 12 hours for me is doable. I feel like beyond that like, to consistently do it is . . . there are definitely days where I'm maybe restricted to 10 hours, but it's hard to do that consistently.

Scot: All right. Let's get to the topics here. So our listener questions, lots of ways you can get in touch with us. There's email, there's our listener line, and that's how we got a hold of these questions right here.

Dr. Gee, let's go ahead and start out with listener question number one. This individual says they get cramps, and they're wondering why they get cramps. What does a cramp mean, and is there something you can do to fix it if you have a muscle that's kind of consistently cramping? I've had this with my legs, my calves, for example.

Dr. Gee: There are a number of different reasons why a person may have cramps. First of all, and the most common, are related to maybe dietary things, or you're dehydrated, or you've been working out a lot and at a certain point during your workout or your run or whatever, you're getting cramps. So those are more nutrition-based recommendations where make sure that you're well hydrated, that you're not getting dehydrated through the course of your day or your workout.

Also looking at making sure that you're getting electrolytes with that, so some kind of Gatorade or something like that, that you're using to replenish those electrolytes as you are sweating.

But then the second group of cramping, the way I look at it at least, is that there are times where your muscle maybe isn't as strong as it should be. And so, if you imagine maybe you've got a calf cramp or something like that, and as you start to run and work out, maybe you're well-hydrated and you have good electrolytes, but the muscle is a little bit fatigued, it can't quite keep up with the demand that you're putting onto it, and it basically has to go into a bit of a spasm to hold the demand that you're putting onto it.

And that will often happen during workouts and things or even kind of after the fact as people are walking around. Those cramps, depending on where they are and what's going on with them, they can benefit from doing some more dedicated directed exercise at those areas.

There are different types of strength within muscles. A lot of times, the way we think of strength, we think of, "Oh, I can pick up this really heavy weight," and that is a type of strength, but there's also dynamic strength, which is basically where your muscles are holding your joints and your body through the course of motion. And if they are fatigued, if they are not up to where they need to be, they will basically have to go into spasm to try to hold that dynamic control, and that's oftentimes when people will start getting cramps.

Troy: Chris, imagine that you're mountain biking somewhere or you're running or competing in some kind of event, and your leg just cramps up. It's kind of like related to what Scot said. Do you recommend just stopping at that point and trying to massage it, or stretching, or just slowing down a bit, or just pushing through it? What's your typical advice when that happens?

Scot: What I love about that is Troy never, ever said, "Or just quit?" He never even offered that as an option.

Troy: I'm imagining, Scot, you're somewhere where you probably have to get home. You're on a trail. You can't just call Uber. You've got to get home somehow. So, yeah, how do you get through that?

Dr. Gee: Yeah, that's the next version of Uber, the mountain bike Uber.

Troy: The mountain bike Uber, just a little trailer on back.

Dr. Gee: That's a really good question. And I think all too often as weekend warriors and just recreational athletes, we tend to push through those things. And what I find is that that tends to make it worse. You really tend to have more problems as you continue to work out. And so I do suggest that you stop, you rest, try to stretch out that muscle, do a little massage. Think back on what you've been doing with your hydration. Have you been hydrating well enough? Have you urinated recently?

That's always a good sign to see where you're at with your hydration. If you've been pounding a ton of fluids and you're urinating really clear, you might be going a little too hard hydrating. But if you haven't peed for a while, and when you do try to go it's really dark, then you need to really try to push some fluids and recover and then kind of build your way back into your exercise. Try to maybe go just below that threshold at which you were cramping before, which can definitely be difficult if you're pretty far out and you're trying to work through a cramp as you're trying to finish.

Scot: So, in that situation, just want to make sure I understand correctly, and it's cramping, you should stop. Did you say you should rub it, try to massage? No, stretch it. You should stretch it.

Troy: And massage it sounds like, yeah.

Dr. Gee: Both. Yeah. Oftentimes, I find that when it's acutely in spasm . . . so we'll have an athlete come off the court or the field and they're acutely in spasm, really the only thing that's going to help or the thing that helps the fastest is to stretch that muscle. So really just try to stretch it back out, and then some gentle massage to try to work fluids around through that muscle to kind of break down some of the more tight areas that might be more likely to spasm.

Troy: That's good to know, though. Yeah, start with the stretch, though.

Dr. Gee: I've had people try, both personally and professionally, to just massage that cramp, and it takes a while to get it to release. And so I find stretching it first and then working into a massage is probably a better route.

Scot: If hydration was the issue and you started drinking some water, then would that clear itself up pretty quickly, the cramp, or not very quickly?

Dr. Gee: It can definitely help, but it's really hard, I find, once you start cramping to kind of turn that around, or at least within that exercise or that particular workout window. Usually, it's going to take some time for your body to try and correct the electrolytes and the fluid balance as such that it's going to ease it up.

So even as a recreational athlete, really listen to your body and know at what point you're going to start feeling that cramp come on. And if you can get to that point and say, "Okay, now I'm pushing it a little too hard," and start correcting those either fluid issues or technique issues, making sure that you're not pushing beyond that, it usually helps to prevent you from having cramps throughout the workout.

Scot: All right. Question number two. Boy, this is probably going to be a tough one. Rotator cuff rehabilitation without surgery. So do you see a lot of rotator cuff injuries? I find it fascinating that the rotator cuff is called one thing, but it's actually four different muscles.

Dr. Gee: Exactly.

Troy: This really hits home for me, because in high school I injured my rotator cuff. I never saw anyone for it, but I'm certain that's what it is. And I've convinced myself over the years, "I can do this without actually seeing someone for it." So I'm curious what you have to say, Chris.

Scot: You can hurt your rotator cuff like doing sports, but even if you fall, you could hurt it, right?

Dr. Gee: Exactly. Yeah, it's a very interesting joint. And it's one of those things that I see a lot of. We all hit the new year and we say, "Hey, I want to lift and get some definition in my body." So we go and we overdo it with shoulders and start getting some pain in the shoulder, or even getting out and biking and things like that we'll have people crash and have a trauma to the shoulder.

So, in general, just as kind of an educational piece with the rotator cuff, basically, when you look at the shoulder, you have the ball and socket joint. Now, the socket is really very shallow. I make the analogy it's more like a golf ball and a tee. So you have a big humeral head, or a big ball, that's trying to fit into this small little depression of the shoulder blade. And so there's a group of four muscles that come off the shoulder blade, and they surround the humeral head, and they move it around.

Now, because there's not a lot of bony restriction, it gives us great motion of the shoulder, but it's at the compromise of stability. And so that's always the problem, is that if those rotator cuff muscles aren't working together, and they don't have that dynamic strength and control I was talking about earlier, they will allow that ball to slide off the socket and cause things to get stretched and cause pain and impingement and other problems.

And so, when we're younger, when you're in high school and you injure your shoulder, usually that rotator cuff will just stretch. It'll stretch out. It'll cause some instability problems. But unfortunately, as we get older, ages . . . the rough estimate is 35 to 40, which that throws me in the old category. I don't like that. But as we get older, the rotator cuff doesn't tend to stretch as well, and it tends to tear.

And so those little things that maybe you can recover in a day or two as a teenager are going to do more damage as an adult and you can tear part of the cuff, and that may require more treatment than what you had as a youngster.

Troy: So when you say treatment, are you saying you definitely need surgery, or is it something where physical therapy or strengthening or those kind of things are going to help you recover?

Scot: Yeah, this listener is hoping without surgery.

Troy: Hoping you're going to say no surgery.

Dr. Gee: Honestly, I find the vast majority of these do not have to have surgery, which is great.

There are a few different buckets that these fall into with these rotator cuff injuries. If you're young and otherwise healthy and you haven't . . . like I said, it takes a lot of force to tear the rotator cuff when you're young. So most of the time, we'll put those people through some physical therapy working on rebuilding the rotator cuff. Working on shoulder blade positioning and posture helps with that rotator cuff, and that allows them to progressively get back to normal.

Even when you have an older patient that maybe . . . I've had patients that are in their 70s that are just pulling up something, maybe the sheet on the covers of their bed, and they've torn part of the rotator cuff. So, at that point, as everybody's rotator cuff gets weaker, believe it or not, you can do therapy with that group too. So getting out and getting some physical therapy, strengthening that rotator cuff, what's left of it, or the muscles around it, will actually calm their symptoms down and they do pretty well.

It's really the ones that have an acute traumatic injury. You fall really hard when you're skiing or you dislocate the shoulder and you acutely tear the rotator cuff. Those are the ones that more often need surgery. And the rest we're pretty successful with being able to rehabilitate the muscles and maybe doing an injection to calm down inflammation, but they do fairly well.

Scot: And I also think it's just always good if you have hurt yourself to go see somebody just because you start making those accommodations and then who knows 20 years down the road where that's going to get you. I think it's kind of gotten me into a bad place, and I'm trying to undo some of those things. It's not going to get better if I don't do some actively with it.

Dr. Gee: Exactly. Yeah.

Scot: All right. Question number three is KT tape for real? So this KT tape, this is the tape that sometimes you see athletes . . . I went to a chiropractor once and they put some KT tape on me. They cut it up and made it into some tribal looking design on my shoulder and my bicep. Is that the real deal? Is that legit or not?

Dr. Gee: KT tape has kind of been the rage over the last number of years and you see a lot of athletes doing it and Olympians doing it. When you look at really what it's doing, it's not going hold the joint into place because it's not connected to any muscle. It's not connected to any bone or anything like that. What it is doing, though, is giving a little bit of feedback through the skin, through the nerves that are in the skin, just to kind of remind you a little bit about that position.

So, for example, in the shoulder again, it's probably not going to keep your shoulder from sliding out. It's not going to prevent you from using your shoulder wrong. But what it can do is remind you as you start to slip into maybe a bad position, you start to feel a tug on your skin, and you go, "Oh, okay, I've got to bring my shoulder back, and I have to kind of get that better position."

The way I try to use it is maybe using it early on just to remind people of positioning. We'll use it sometimes around the knee and the shoulder just to kind of help people to think about positioning and activation of muscles. But over the long term, I definitely want people to get dynamic control and strength of their joints so that they don't have to use those things.

Troy: And do you find, Chris, it's more helpful than just wearing an Ace wrap or some sort of thin brace on your knee or something? I mean, does it seem like it does better than that kind of thing to provide that reminder that maybe you need to do things differently as you're going through those motions?

Dr. Gee: It can help in certain scenarios. So, for example, if somebody has an unstable knee, meaning their kneecap is kind of wanting to drift off to the side, sometimes taping it a certain way can help to encourage that to stay back and it can remind people. But you can get the same effect with even a sleeve over the knee that has a hole in the front that kind of encourages that kneecap.

So, as far as when you look at studies, they really say that any kind of proprioceptive feedback with an Ace bandage or a sleeve or a brace can help just to remind you of positioning of that joint, and it doesn't necessarily have to be the tape.

Troy: Duct tape?

Dr. Gee: Yeah, there you go.

Scot: I think it doesn't stretch as well as KT tape, right?

Troy: Maybe not as good, but . . .

Scot: In a pinch? All right. Dr. Gee, again, awesome job answering our listener questions. Sure do appreciate having you on the show. And thank you for caring about men's health.

Dr. Gee: Yeah, it's always a pleasure to be here. I love getting the questions and hopefully got some things answered.

Scot: All right. Welcome Producer Mitch to the show. I guess Producer Mitch has a question for Dr. Troy Madsen. Mitch, what was your question?

Mitch: I've been going to doctors and I've been reading the after notes in my chart. Is "generally pleasant" code for anything? I've been described by two doctors now as a "generally pleasant 32-year-old male."

Troy: That is great. It's not code for anything.

Mitch: All right.

Troy: It just cracks me up when people use that.

Scot: Hold on. This is in your chart? What medical purpose does this description serve, Troy?

Mitch: It's at the top, right?

Troy: It's so funny. Yeah. I never use adjectives like that to describe anyone because it's just . . .

Scot: In the ER, do you have to describe people?

Troy: I never use that. No, some people just do that. It's just habit, I think, just because the average person who is nice, who comes in, who they enjoy talking to, they will describe as, "This is a pleasant 30-year-old male who comes in with a chief complaint of," whatever. It's just habit for them.

It is not code for anything. It doesn't mean they think you're weird or something. Yeah, it's funny when it's in there because when I see that, I always think, "What are they going to say about the person who's not pleasant? Are they going to say, 'This very unpleasant, 40-year-old man'?"

Mitch: And that means something.

Troy: Yeah. Exactly.

Scot: I love how they use the word "generally." Mitch, does that concern you that in that short interaction that there was possibly a moment where you were not pleasant?

Troy: That is the one piece that jumped out to me. Typically, they'll say, "This is a very pleasant 30-year-old man." The fact that they said generally, yeah, that's a little bit of a red flag, Mitch.

Mitch: Oh my god. It was an ENT too. I'm like, "What did I do?"

Troy: Yeah. "What did I do wrong? What do I have to do to get very pleasant?" Ask them that the next visit, like, "What does it take to get a very pleasant description?"

Mitch: "What do I have to do?"

Scot: Yeah, "What can I do to just have you drop generally, just so it says a pleasant?"

Troy: Yeah, just need "a pleasant." "This is a pleasant."

Scot: Oh my gosh, that's fantastic.

Troy: Oh, yeah. It just cracks me up when I see that. It's kind of like this old-school thing. Yeah, like I said, I never use adjectives like that, but it's just funny.

Scot: But some doctors do and there's no purpose to it, Troy?

Troy: Yeah, there's really no purpose to it. It's not like I look at that and say, "Oh, good. I'm so glad I'm going to see him now, because if he hadn't said pleasant, I would not want to see this patient in my clinic." So it's not some code between doctors. Don't worry.

Mitch: Well, it's almost embarrassing, because I'm trying to read all their instructions, but I can't. In that first line, I'm like, "What did they mean? What did they mean by generally pleasant?"

Troy: You're trying to decode it.

Scot: You don't actually make it to the important stuff about your health.

"Just Going To Leave This Here." It could be a random thought, it could be something to do with health, or it might just be something that really couldn't find its place elsewhere on the show that we wanted to share.

So, on Instagram, I follow some health accounts. They're not your typical health accounts. This one is @letstalk.mentalhealth, and they have this little graphic that I love because I think it sums up the things that we're never taught that we should have learned at some point in our life that are so crucial.

This says, "What I learned in school: How to multiply eight times seven, and what H2O stands for. What I wish I learned in school: The importance of mental health, mindfulness, self-esteem, reframing negative thoughts, self-care, emotional regulation, personal finance, and the importance of sleep." And that's why we talk about some of those things on this podcast and some of those other things that we don't talk about. It's never too late to learn something new about any of those areas. They will pay dividends.

Troy: I'm going to add two more to that list: home maintenance and car maintenance. I wish they taught those things.

Scot, I'm just going leave this here. I'm just going to let you guess. What is the top-ranked diet of 2021?

Scot: Well, if you're bringing it up, I know you're a fan of the Mediterranean diet, and you probably want to give it some props. So that's my guess, Mediterranean diet.

Troy: No, it's the see-food diet. I see it and I eat it. Just kidding. It is the Mediterranean diet. We always come back to the Mediterranean diet. It's come up many times as we've talked about different diets. It is the number one ranked diet of 2021 by "US News and World Report."

The thing I love about the Mediterranean diet is it's such a straightforward diet. It makes sense. And then there's good research to back it up looking at heart benefits, weight loss, general health, all those sorts of things. Really good research to back it up.

So, if you're looking for a diet for 2021, and trying to switch things up a little bit, look into the Mediterranean diet. Again, we've talked a lot about it. But it's a very straightforward, great diet.

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

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

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

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: All right. Is this thing on? Check one, check two, check three. Troy, are you there?

Troy: I'm here. Can you hear me?

Scot: Yeah.

Troy: You hear me good. Okay. Made me nervous there.

Scot: Caleb. Check-in, Caleb. Are you there?

Caleb: Hey, I'm here.

Scot: All right. I guess I'm the one that makes a bigger deal out of the check. You guys just like Troy is like, yeah.

Troy: Here, here. Exactly.

Scot: "Who Cares About Men's Health?" The podcast that provides 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'm the manager of thescoperadio.com, and I care about men's health.

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

Caleb: My name is Caleb. I'm a certified strength and conditioning coach. I work at PEAK Health and Fitness in the College of Health here at the University of Utah, and boy, howdy, do I care about men's health?

Scot: And it's great to have you on today, Caleb. I'm going to clap for you. Troy's probably not. He's a little harder to win over than I am. I tend to give it up to the guests right away. So we'll find out at the end of the podcast how you did if Troy gives you a clap so.

Troy: Yeah. Here we go. Yeah, we'll see if you're earning the clap. You got to earn the clap.

Caleb: I respect that. I respect that.

Troy: Thank you.

Scot: Getting back into our fitness routine, so I talked to Caleb last week at PEAK Fitness. I went in, Troy, Caleb saw me in compression shorts last week because I went in for one of those bod pods. You know, those are those tests. You sit in that little like canister and it checks your body fat, right?

Troy: I thought you were going to say that's like your usual workout gear. You just walk around in compression shorts.

Scot: Oh, man. I wish. No.

Troy: I was going to say I'm glad I have not spent more time in the gym with you, but yeah.

Scot: I was chatting with Caleb though when we were at PEAK Fitness, and he had an interesting story, I thought, that it would be really worth sharing with everybody because I think with COVID, our routines have been flipped upside down. A lot of us, that means . . . me especially, that means that my fitness routine, like I haven't strength-trained since March, I'm pretty inconsistent with exercise, and I want to get back into that fitness routine.

Troy: Because that was really a big thing for you too, I remember. You were doing strength training several times a week, and you had your walking routine. It sounds like it's . . . I mean, it's got to be tough to have that drop off like that.

Scot: Yeah. Well, it is and it's not. That's one of the things I liked about Caleb's story is I could kind of relate to what he went through.

Troy: Yeah.

Scot: So Caleb, let's get to your story. So I asked Caleb the question, how has COVID disrupted your fitness routine? And your answer was . . .

Caleb: Entirely.

Scot: Yeah. So first of all, give us a little background of like what you used to do for fitness and staying in shape and some of the activities that you did.

Caleb: I actually used to play professional rugby, and I was playing professional rugby until literally COVID hit and canceled our season. You know, I was working at 24 Hour Fitness as a personal trainer, I was teaching fitness classes for seniors through the county, Salt Lake County, and then I would go to practice and we would train and we would bang some weights, we'd bang some bodies on the field online and, you know, late into the evening and then it was, you know, back home and it was rinse repeat for the next day. So yeah, I went from having a serious purpose, having a serious goal specifically in the realm of fitness, I went from having a very serious accountability process to having nothing.

It was actually really nice for a hot second there. For a while it was like, man, I'm being able to sit down and relax for a second here, this is kind of great. But you know, as that spring wore on, I was like, you know, if I'm going to play rugby again next season, if this is going to go, I can't do this for too much longer. I got to take advantage of this time, you know. This is a good time for me to be in the gym to be working out. And so the gyms opened up again, oh, I don't know what was that? Late June, something like that and one day I was getting ready to go back into the gym and the general manager for the team that I was playing for called and he said, you know, he's like, "Hey, well, so we as a club, we're actually going to go a different direction. We're not going to resign you, but you can, you know, you're a free agent now. You can sign . . . you're free to talk with whoever or field any emails or phone calls from any other club," and that was kind of the point where I was like, "Well, you know, I wonder if this isn't just kind of the right time to hang it up."

I was getting ready to start school here at the U, a fully funded and paid graduate assistantship program, you know, get my masters. Basically, get paid to get my master's degree and I was like, you know, I don't know if I can . . . I don't know if I can turn down a free master's degree for a few couple of more years of rugby. So I decided to officially retire, and it was kind of funny because right after that, I was on the way, I was getting ready to go to the gym that day and my, you know, the general manager calls and I have that conversation with him and I thought about it for about, about eight seconds and I, you know, I was like maybe this is the time to hang it up. And I just slid my shoes right back off and I slid right back into the couch. And then all of a sudden now any accountability I had for getting back into the gym was completely gone. And so from late June until, you know, early August, mid-August, I didn't do anything, and that was an active choice at that point. That was just like, that was me just deciding like I don't want to . . . I don't have anything to do here.

Scot: I was shocked when we were talking before, Caleb, a little bit because, you know, you were doing so much in the realm of health and fitness, and then COVID came along and it just all kind of came to a screeching halt and you said it was even a decision like I'm not going to exercise for a while. And you said you just really need to have that thing to drive you. Otherwise you just tend to sit around, which I can relate to because that's me. Like I think by nature, I'm lazy. I'm not saying that you are, but by nature, I think I'm lazy unless I have a reason to go exercise. I just won't. I would just as soon sit around, I think, and not do anything. Is that kind of your case as well?

Caleb: Yeah, I definitely identify with that. I mean, you know, as you can tell by . . . You know, you don't just start working 17-hour days just like for the fun of it. You know, that's kind of a process that you grow. And so, I mean, I had been doing that, you know, working tons of hours every day, every day of the week for, you know, I was in the Marine Corps for five years and that was a whole nother . . . That was, you know, 14 hours a day of whatever. So, you know, that's just kind of the lifestyle that I led, and I realized that I kind of . . . I like living like that to a certain extent, but the problem is that because I live like that, I don't know how to like keep myself accountable because I'm so used to having everything else in my life keeping me accountable. Does that make any sense?

Scot: Total sense.

Caleb: Like, you know. So yeah, so I'm kind of in that same boat. If I don't have something telling me what to do or if I don't have an accountability process, then yeah, I'm very much . . . I enjoy being lazy if I can for sure.

Troy: I don't think that's anything really unusual. I think it's just our nature as humans. Like it's what leads to innovation. It's what leads to, you know, technology so much advancement is because we're lazy and we want to make our lives easier.

Scot: That path of least resistance, right?

Troy: It really is. Yeah. It's just how we are, and you're right. It's a struggle, there's no doubt.

Scot: So, Caleb, now you're looking at actually trying to make a change. Like there was a turning point now that's happened. What was that turning point that made you decide, "Maybe I need to start exercising again"?

Caleb: Well, I mean, it's hard to call yourself a strength and conditioning coach and then be neither strong nor conditioned. So, you know, finally at a certain point I was like, you know, like I don't have to do it the way I was doing it, and that was kind of exciting, a little bit like there's an opportunity for change here, there's an opportunity for growth, there's maybe an opportunity to do things differently than I've done them in the past and see if they can get me to where I want to go. And I, you know, at a certain point, I think I went and I played in like a fourfold rugby tournament up in Pocatello or something a couple of . . . like a month ago.

Scot: Oh, ringer. Nice. Yeah.

Caleb: Well, yeah, you can call it a ringer if he's able to like cross the field once without, you know, passing out from asphyxiation. And so, yeah, that was an eye-opening . . . that was an eye-opening moment for sure. I was like, "Man, I am out of shape. This is who I am now?" You know, "I got to get this turned around." So yeah. So I just finally came to that conclusion that look, I know I need certain things in my life in order to make things happen. So I started arranging those things, you know, finding a workout partner, finding a program that I wanted to do, finding a goal, finding a new methodology, you know, whatever, removing certain barriers, adding in certain accountabilities, and really just get myself going.

Scot: Up until this point, rugby, I would imagine, was a lot of the driving kind of, you know, why you were engaging in fitness. What's the driving thing now? Like what is your, why? What's your purpose?

Caleb: There's a few different reasons. The first one being I want to set a good example for my son. I want him to see that, you know, like taking care of your body is a good thing and, you know, being strong isn't a bad thing. And, you know, I've always wanted to be the dad that is capable of still doing things with his kids. So I didn't want to let those days get away from me and that's where they were going. I could feel it in my back there for a little while, you know, you start to feel old.

And so there was that, but then there's also just the . . . I just think human beings were never meant to get old in the way that we get old in today's world, you know. We get old these days because essentially, our bodies get forgotten about and we stop using them and what you don't use, you lose, right? If you don't use it, you lose it. And we don't use our bodies, so we lose them.

And I think, you know, that time that's a fairly recent development in human history and human physiology. It used to be your body broke down from overuse. Eventually, you just used it so much and it just got worn out and it got tired and it just broke down. And that's kind of how I'd rather go. I want to be strong as long as I can. I want to be capable as long as I can. I want to work as long as I can. And I don't want to let anything pass me by. I don't want opportunities to get away from me simply because I didn't keep my body in a position to do anything with them.

Scot: One of the things we talk about on this show is the importance of getting some activity, right. And that does not have to be going into the gym and lifting heavy weights. It could be good getting out and doing a hike. Dr. Madsen likes to quote, who was that? That actor that said, "Get out and sweat a little bit."

Troy: It's the Matthew McConaughey rule. I heard him call . . . I heard, yeah, it's, you know, he's not someone I often quote, but I did read an interview once where he said his goal is every day to do something that makes him sweat. So it's not about getting in the gym. Maybe it's just about working in the yard, you know, maybe you're digging something or, you know, you're climbing or you're running or you're hiking or biking or whatever it is, something that makes you sweat. And so that's his rule and that's kind of his way he stays fit.

Caleb: Yeah, definitely. And that's a great methodology because it really takes the pressure off, right. It's like I don't have to go home and change clothes. I don't have to put on a special set of shoes for this. I don't have to go to a special location. I don't have to drive anywhere necessarily special. You know what, if I just get out and like take my kid to the park and he . . .

Scot: And play Frisbee.

Caleb: Exactly. Just go . . .

Scot: Right, or chase him around.

Caleb: Exactly. Go chase him around in the jungle gym whatever for a hot second, you know. Now you're being a parent and you're being active, you know. It's like it really does take the pressure off.

Scot: Hey, Caleb, I want to . . . Let's break it down for somebody who is struggling. Your story was a story of struggle. It was a story of you are very much engaged in your fitness and activity. And then the reasons went away and you had to kind of reevaluate. And a lot of people, myself included, have probably gone through that and you had to find a new way forward. So if COVID has disrupted somebody's fitness routine, how can they get back into it? Give us some solid steps based on what you know as a trainer and what you've learned through your personal experience.

Caleb: Well, I guess, number one, I'd find a reason. So that's the big thing. What do you want to do? It can be tough too because sometimes people will say, "Well, I don't want to do anything. That's why I'm sitting here."

Scot: I want to Netflix, that's what I want to do.

Caleb: Exactly. So find something, you know, find a reason, find a goal, find a reason to get off of that couch, find a reason to get outside, find a reason to do something. And then once you've found that reason, I think step number two, and this is kind of an all-encompassing term here is schedule. So find that time in your schedule and then write it in there. I actually . . . I'm not one for scheduling. In previous lives of mine, I've never really kept any kind of timeline of my day or anything. It was just kind of, well, when I finished one thing, I'll just get to the next one and, you know, just kind of went with it. But I specifically set aside two hours of my day, every single day for fitness. My time personally is 6:30 p.m. to 8:30 p.m. I schedule in time for travel and like that's my time frame, two hours right there. And I know that like when that notification hits, there's no . . . like I'm doing it. That's what's happening here.

Scot: And I should say you do a lot more than what they kind of advise for the average person. You don't have to get in and do two hours.

Caleb: Oh, no. Not at all.

Scot: Thirty minutes of sweating a day has been proven to be enough so.

Caleb: Sure, 100%. Yeah, absolutely. But then I guess along with that scheduling is like that's, you know, keeping that commitment, finding ways to remove those barriers that would keep you from that schedule, finding accountability. So not only taking away things that are going to get you out of the gym, but also adding things that are going to get you into the gym, right. And then number three, don't be afraid to reset the little bit. Reset the foundation, right. You got to be . . . you're on a journey here. You've got to find your new, or maybe you're finding it for the first time, you got to find your level, your ability, your whatever.

For me, man, you know, doing a couple of squats was enough to get me breathing pretty hard when I got back in for the first time, and so I knew I needed that body weight. I knew I wanted to reset that foundation and get myself back into it. Again, in a kind of no pressure situation, right, once you start stacking plates on bars and doing all kinds of stuff, now you're competing with your old self and you're ticked off because well, you know, I used to be able to do this and now I can't do. It's like, well, that's just . . . so don't even do it. Right. That's my thing. I just put it down, put the weights down, let me just move my body again, let me just find a way to move.

And so that's what I would say is focus or find the goal, find the reason, and then up that level of focus so you can keep that commitment to that reason and then find the best way to get to that reason, right. For me, it was going back to body weight, right? For some people it may be a national park's pass, right? Somewhere they can hike with somebody else. It may be, you know, a membership at a climbing gym, you know. Whatever it is, find your reset button, get back to what you want to do.

Troy: And Caleb, I think what you said about just being realistic about where you are, I think that's huge, you know, because I think sometimes we do feel like we've got to go out, okay, I've got to start exercising. It's got to be this heroic effort. You go to the gym that first day and you just do tons of whatever, and you come home and you're just dead the next day. And it's just like in my mind, you know, I just always feel like make it realistic, make it sustainable, keep it consistent. And yeah, in doing that, just say this is where I am right now and this is what I'm going to do, and I'm going to be consistent with it and then reevaluate in a month.

Caleb: Yeah. I love that. I love that. Keeping it consistent is also . . . that's so big. One day I kind of had this revelation. It was after like a good workout and I had been very fickle. It had been like a week in the gym, and we got to the gym, two weeks back, you know, half a week off, you know, I had no routine, I had no plan. And then I had a particularly good workout one day, and I finished that workout and I was like, "Man, imagine if I did this every day for one year. I feel good right now. What if I did this 300 times and check back in a year? What would that . . . That would be incredible." And so that is a huge piece of that puzzle is like you with your running, right Troy, like having that consistency and that kind of stick-to-itiveness, right? Like some days it's going to be hard. It's going to be hard. But imagine what happens when you fight off enough of those days and you string together enough days that all of a sudden now we start to see some real fun.

Scot: Yeah. You know, I probably wasted your time, Troy, because finding motivation or getting back into routine is not a problem you have. I don't know how you do it, but Troy has run now for how many days straight without missing a day?

Troy: Well, Scot, I looked back and I tried to figure when I started running every day, and it was about five and a half years ago. So I figure it was about a week ago, maybe a week and a half ago, I hit my 2000th day in a row. So I was proud of that, I was proud to get to that point. But it's funny though. We talk about this, and this is something I have absolutely struggled with. I mean it's, you know, through COVID, through a lot of other things that have happened, I have continually had to kind of reset that motivation and refine that motivation.

So I think that's a process where, you know, maybe there are people listening who are saying, "Well, yeah, when COVID hit, I didn't completely drop my routine. But at the same time, it just doesn't mean what it used to mean to me, or I'm not putting the effort into it that I was before." And I think I've gone through that process where there have been many times in the last six months I've asked myself, "Why do I do this?" Like all the races were canceled, so there was that extrinsic motivation. You know, my wife and I were running races, running marathons and traveling, and, you know, making trips out of it. All of it was canceled. I had qualified for the Boston Marathon. The Boston Marathon was first rescheduled for September and then canceled. It was made a virtual marathon, where we just went out and run a marathon and say, "Well, that's the Boston Marathon." So it's like this big thing you work for is gone. So it's been a challenge for me too.

So I think a lot of it is this process you've talked through as well, Caleb, of finding what do I just get out of this? What is the intrinsic value in this activity for me that I do every day and is it worth it? And, you know, the conclusion I came to is, yeah, it is worth it. I enjoy this. It means a lot to me. This is worth doing. And I even, you know, I even tried to say I'm going to up my game a bit. I tried to up my mileage. I've upped my mileage in the last three or four months to get more miles in just to try and find that more and, you know, obviously stick with it, but even try and build on that a bit.

Caleb: Yeah. That's incredible.

Troy: Yeah. But it's a challenge though. I think no matter where you are in this process, I think you always face those times where you question why you're doing it and you just have to just reset and continually go through that and find why exactly you're doing it.

Caleb: Yeah. Totally agree, totally. And I think that's the thing for people is they think that, you know, they look at somebody like you, Troy, and if sometimes, I mean, I wouldn't even look at somebody like you and be like, man, you got it all figured out, you know, your life, you got like the social media life, right? Like everything hunky-dory, there's a smiling family, couple of kids, it's beautiful, you know. But like that's the thing is everyone's fighting their own battle here, and there's always going to be reasons not to do something, right, like running or just physical fitness in general, right. It's like why is this even a conversation? We know it's good. Everyone knows it's good for you. Why are we even talking about this? We shouldn't have a problem with this, but we do, right, because there's always reasons. There's always a reason to not do something.

And so it's important to focus on those things, those reasons why you should and why I want to and why can't I? Right. Like it's such a huge thing finding that positivity and focusing on that and allowing that to be the driving force behind your motivation rather than it being, well, I don't want to get fat, so I should run, you know, or like, I don't, you know, finding those negative aspects of motivation are just as bad as having no motivation at all. So we want to find ways to get yourself there and be kind to yourself in the process, right.

People are always like, well, there's always tomorrow. I can get my health in line tomorrow. It's like, well, but then if you start . . . but if you started today, then tomorrow would be day one and not day zero, you know? And then that would make day 365 come a lot sooner. And so if you just keep putting things off, it'll never happen, but you know, the journey of 1,000 miles takes a single step, right? So that's, I think, a huge piece of that puzzle is finding the reason to make today the day. That's a huge . . . and once you figured out, "Hey, today's the day," and then that makes every day, every day, man, now you're making some serious strides and now you can start to see some changes.

Troy: Yeah. And I think too, I think a big thing, and sometimes we've talked about on here is congratulating yourself for what you've done. Like sometimes you think, "Oh, I've got to do more and more and more." But that's been part of this process for me too, is just saying, "Hey, I'm really happy with where I am." Like I got my . . . I went to my doctor back in August. I got my cholesterol checked, and it wasn't really time to get it checked again. And he's like, "Oh, we'll do some blood work because I couldn't get my lipid panel." He goes, "Okay, we'll do it." And I was so excited to see my numbers because I have struggled with that, and so just seeing my HDL is high, my LDL is low, stuff like that it's just like . . . I think it's good to have that just to say, "Hey, this is worth it," you know. Pat yourself on the back a little bit, recognize what you're doing, and then keep building on it.

Scot: Couple of the takeaways that I got that I really enjoyed here, try to find the positive reason. Don't just look while I'm doing this because I don't want to get fat. I think I look at it that way. So I'm going to start looking for positive reasons. But I'm going to really also look for just that intrinsic thing. What is it intrinsically beyond the health and fitness is it that I get out of these things? And I'm kind of excited about trying something new with COVID. So I got some kettlebells and in a future episode . . . have you done kettlebells before, Caleb?

Caleb: Oh, yeah.

Scot: Okay. I need . . .

Troy: I haven't. So this is going to be good for me. I've never done kettlebells.

Scot: Yeah. I've done a little research into kettlebells, I'm intrigued by them, but I need some professional advice. So on a future episode, will you talk me through how to get started with kettlebells so I don't do something stupid?

Caleb: Yeah, let's do it.

Scot: Troy, is there any takeaways you'd like to hit up?

Troy: My takeaway from this is, Scot, it's a song, and Caleb kind of mentioned this and it's a song I often think about. It is on my run playlist that I listened to Baz Luhrmann, "Everybody's free to wear sunscreen."

Scot: Oh, that's a great song. Love it. Yeah.

Troy: Great song. It was for the class of '99. That's the year I graduated from college, so it's on my playlist. But one thing he says in there I often remember is the race is long, and in the end, it's only with yourself. And Caleb, there's something you said there too. It's not about competing with others. It's about just saying, "Hey, where am I today?" You know, it's a long race, so let's just try and, you know, move forward. Let's try and build on where I am today and not look at what others are doing, and, you know, not try and beat someone else out. So that kind of stuck with me what you mentioned there, Caleb.

Caleb: Yeah. Hey, I'm glad to have inspired you back to the '90s, that's great.

Troy: Absolutely. Anything to quote songs from the '90s.

Scot: Caleb, thank you so much for taking time to share your story, and thank you for caring about men's health.

Caleb: Yeah. Thanks for having me, I really appreciate it.

Scot: All right. Time for Odds and Ends on "Who Cares About Men's Health?" And Troy, do you have your party hat and party horn ready?

Troy: I am so excited for this moment. I have missed producer Mitch so deeply, and we get to hear from him now. I'm so excited.

Scot: We're on Skype with producer Mitch, and we have him on the show because we want to say congratulations for being one year smoke free. Now we're going to see if that gets a clap out of Troy. It definitely gets claps.

Troy: Oh, absolutely. Congratulations, Mitch, for one year. That's awesome.

Scot: That is amazing. One year smoke free. So for real, you've gone a year without smoking a cigarette. You didn't even have a moment where you had one in a moment of weakness.

Mitch: No. No cigarette, no JUULpod. No, no nothing.

Scot: All right. I mean, be honest after the earthquake you must have.

Mitch: Oh no. No, no, no. I just grumpily drank coffee and looked at all the other people smoking.

Troy: Come on, Mitch. You after COVID you must have.

Scot: Yeah. After COVID you must have.

Troy: Come on, after the wildfires, you must have.

Scot: And after the wind storms.

Troy: After the wind storm, you must have.

Scot: Hundred-year-old trees here in Salt Lake City, you must have had a cigarette.

Mitch: I didn't. Nope, not a single one.

Scot: That's amazing.

Troy: Talk about a year to quit smoking. I mean, you really made it tough, man. You really set yourself up, but you did it all through the joys of 2020. You've made it.

Scot: Do you feel better after a year of not smoking, physically better?

Mitch: I do. I do. I sleep better. But I guess the more part of it is that like craving still happens. I mean, I still . . . if someone were to offer me, it would still be a challenge. But at the same time, I don't have a shortness of breath, you know. When I do choose to go running these days, I can. I can go out and I can run and I'm not heaving and feeling like I'm going to die, you know. I don't have these random chest pains that I'm terrified or a heart . . . or like a cancer or a heart attack or something like that. That fear is gone and just having that little anxiety not there, that's what it really is. That's really the change so.

Scot: It's interesting though, you said you still have the cravings. I wonder, have you talked to others who say that goes away at some point, or do they say that's always there? I'm not sure. I don't know.

Mitch: So to answer that, like, I don't know. It seems like every person I've met who's smoked for a long time, they all say that they still to this day, it doesn't matter how long they've quit, they've had those cravings. So I don't know. Maybe they'll go away, maybe they won't, but at the same time I at least know that it will feel . . . that I appreciate not having the anxiety. I appreciate not being nervous every day that I'm going to just suddenly die of a heart attack or find cancer the next day. And I think it's that relief that keeps me from dipping back into it so.

Troy: Congratulations, Mitch, just incredible that you've done this. It's great to hear your voice too. We haven't had a chance to talk to in a couple of weeks, but so glad you've been successful and happy one year anniversary on quitting smoking.

Scot: Congratulations. Thank you for sharing your story. And like we say to all our guests, thanks for caring about men's health.

Mitch: No, thank you.

Scot: Time for just going to leave this here. That's where we might have something to do with health that's on our mind, or it might just be something completely random. Just going to leave this here. Troy, have you ever gotten toothpaste in your eye before?

Troy: I kind of have. Like, I have an electric toothbrush, and when I first started using it, sometimes I forgot to like completely turn it off when I pulled it out of my mouth and I'd have to say I do remember getting some toothpaste in my eye, but I'm guessing there's more to this than just a little bit of toothpaste.

Scot: No. I got toothpaste in my eye. So you got kind of diluted toothpaste. You got the toothpaste after it'd been in your mouth for a while. I don't know what happened, but I put toothpaste on my electric toothbrush, I turn it on, and then I had this tremendous stinging in my left eye. And it's got to . . . it had to be, it had to be toothpaste, you know. I went and rinsed my eye out. Was that the right thing to do?

Troy: Oh, yeah. Yeah. Rinse your eye out.

Scot: That's okay?

Troy: Yeah, just run it under cold, yeah, just kind of lukewarm water, and yeah. That's the best thing. Anytime you get anything in your eye, if you can just tolerate, just tilting your head to the side, let that water run in there and wash it out.

Scot: Oh, should I have gone to the ER?

Troy: Yes, please. I wish you had come in during my night shift. It would have just given me so much joy to see you there because you had toothpaste in your eye. Well, Scot, I'm just going to leave this here. You know, I have to give a shout out to my crew for my virtual Boston Marathon. I know I've talked about this before, but they canceled the Boston Marathon. They did this thing where they said, basically go out, run a marathon, and then we will count it as your Boston Marathon. This was the 124th Boston Marathon. They've never missed a year so . . .

Scot: That would have been your first Boston Marathon.

Troy: Yeah. It would have been my first. Yeah. So basically, what I did . . . So Laura, my wife, she drove me up to the top of the Mirror Lake Highway, 10,777 feet at the Bald Mountain trailhead, and that's where I ran my virtual marathon. I ran down the Mirror Lake highway. Charlotte, my dog, she ran with me the first half, and then Laura and Sally and Itty Bit, Itty Bit is our other dog. We have those three that were in the car the second half, and she was there obviously the first half as well leapfrogging me, giving me water, encouraging me. She even had a trophy for me at the end for the COVID Marathon. Did you see it?

Scot: I saw that trophy, yeah, I did.

Troy: First place.

Scot: Was that a surprise? Did you not expect the trophy?

Troy: I didn't expect it, but my favorite part of the trophy was she had it engraved so it said first place COVID Marathon, but she didn't have my name engraved on it because as I thought about it afterward, there must have been a chance that maybe someone else could have gotten first place in the COVID Marathon. I do remember passing someone at one point on the road, so maybe they were in this as well, but I beat them. I got first place. So anyway, it was, you know, it was kind of a bummer with Boston getting canceled, made it a fun experience so.

Scot: Well, congratulations. So now it's done, like if they run the Boston Marathon next year, your qualification, even because of COVID is no longer valid?

Troy: It's kind of weird. You can use your qualifying time for this year and resubmit it for next year, but it's really a bummer like if your qualifying time maybe didn't beat the time by a lot, by more than maybe a minute or two, it's possible that you would not qualify for the 125th Boston Marathon. So you just have to resubmit it with everyone else submitting stuff so.

Scot: You're going to do that.

Troy: Oh, yeah, yeah. I'll submit it, but it's funny. Normally, that would be happening right now where you submit your time and you see if he got in, but they're delaying it because you know, because of COVID. They don't even want to start to make plans for next year, which would typically be mid-April. So we'll see what happens. I wouldn't be surprised if they can't run it. I don't know. We'll see.

Scot: All right. Time to say the things that you say at the end of podcasts. I'm going to start that over. All right. Time to say the things that people say at the end of podcasts, because these people, Troy and I, are at the end of our podcast. So thank you very much for listening. Subscribe, whatever podcatcher you like would be great and if it has the ability to rate and review, that'd be much appreciated as well because it does help other people that would enjoy this find it.

Troy: You know, you can reach out to us. Reach out to us. You can find us on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. You can email us, we'd love to hear from you, hello@thescoperadio.com. We even have our call-in number. Scot, can you give them the number?

Scot: 601-55SCOPE. Go ahead and write that down, Troy, and write that down, everybody else. 601-55SCOPE. If you have any questions, comments, you just leave your message right there. Is that it? Did we cover everything, Troy?

Troy: I think that covers it. And if you call that number, you can hear Mitch's very encouraging voice to encourage you to leave a message for us. So call in, let us know what's on your mind. Let us know what you'd like to hear us talk about. And thanks for listening and thanks for caring about men's health.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

With the end of the season upon us Scot, Troy, and Mitch take a look back at the past six months, discussing their favorite episodes of the season, their accomplishments, and the big realizations they've come to about their health and life in general.

• EP44: The 4 Rules of Rest with Dr. Kelly Baron
• EP55: Surprise! It's Hidden Sugar with Thunder Jalili, PhD
• EP50: Putting Runner Controversies to Rest with Shane Thoreson and Laura Lamarche

• EP48: Get to Know Your Macros - Protein with Thunder Jalili, PhD
• EP33: New Year Resolutions Suck with listener Jay
• Ep51: Do I Need an Antidepressant? with Dr. Kyle Bradford Jones

• EP41: At Home Genetic Test - Listen Before You Spit with Karin Dent
• EP45: Three Tools for Your Mental Health Toolbox with Listener Ben and Kevin Curtis
• EP52: Carbs Aren't Bad with Thunder Jalili, PhD

Troy is coming to the realization that there is no "magic bullet" or "secret sauce" to health. After speaking with guests over the past two seasons, he's learning it's all about holding to a core set of simple principles and keeping consistent to the health behaviors where you can.

Scot has learned how to eat again. He used to weigh food and scheduled eating times every day with a very strict macronutrient breakdown By speaking with Thunder about nutrition, he's letting go of a lot of the "baggage" he's gained over years of not so practical diet advice.

For Mitch, the shelter in place has forced a lot more self-reflection in his day to day, especially taking stock of his mental health. This has led to an improvement in communication and relationship with his partner that he works alongside all day since the shelter-in-place.

Troy has seen the impacts of COVID-19 first-hand in the ER. The only real defense against the disease right now is being generally healthy. While this podcast often speaks about health and the benefits that will pay off in 30 years, the pandemic is making the immediate importance of health very apparent.

Keeping consistent with your health can be just as hard as making big changes. Despite the stresses that come from being an ER physician during COVID-19, Troy has stuck to his daily running routine and is celebrating 5 years of running every single day.

Sometimes accomplishments aren't obvious until you take a look back at where you've come from. While Scot originally felt he had nothing to celebrate, after looking back and reflecting, he realized he has done quite a bit in the past 6 months. Whether it be completing another class towards his Master's Degree, converting his classes online, learning to speak in front of a camera, or just getting out and working on his photography with his wife.

A special thank you to all the friends and listeners of the show that participated in the 5k last weekend. It was a long journey for producer Mitch. Even with the setback of a major injury, he reached his goal of going from couch to running a 5k. He shares his experience and what the event meant to him.

See more photos of the event and the listeners who participated on our Facebook page.

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.