Search for tag: "medicine"

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Scot: All right. So we're out here at the pickleball courts. We've got Dr. Chris Gee, sports medicine. Have you ever played pickleball?

Dr. Gee: Not really.

Scot: Not really. Okay. We've also got Dr. Dwayne D'Souza, and you're our expert. He's the guy that brought the paddles, and in the email, he said, "I have enough balls." That was his words, not ours.

Dr. D'Souza: That's true.

Scot: Got Producer Mitch. Troy couldn't make it. And I'm Scot. So let's talk about pickleball briefly. Fastest growing sport. Might be a great way to get some physical activity for young and old. It's kind of getting stereotyped as old people play it, but that's not true, is it, Dwayne?

Dr. D'Souza: Yeah, I think when pickleball started it was originally that because it was a way for people to transition from tennis to kind of a less running, moving sport that's less hard on your body.

But I think because of the pandemic specifically, and just before that, people started playing a lot more because it was an easy way to get outdoors. There'd be more and more courts built on the West Coast moving towards the east. And I only started playing, I guess, last September. That's because my housemate's dad, who's 75, plays twice a day.

Scot: Wow.

Dr. D'Souza: He takes a little nap in the afternoon and goes back. And so he's like, "You have to come play." And I played one day and I got addicted. And I've been watching YouTube videos and trying to learn. I mean, when you go to Fairmont, especially post-work time, like 4:00 p.m. to 5:00 p.m., it's all younger 20s, 30s, 40-year-olds playing.

Scot: Got it.

Dr. D'Souza: And it's pretty fun.

Scot: Cool.

Mitch: What makes it more fun than, say, tennis?

Dr. D'Souza: I think it's because you can pick it up very quickly and it's a very inclusive sport, so anyone can play basically starting right away. Within one game, you can learn the rules very simply. And since there's less movement from side to side or court coverage, it includes a lot more people. So I'll be playing against 80-year-olds, like 20-year-olds versus 80-year-olds, and it's an even game.

Scot: It's a little less harsh, but I mean, you can still get hurt, right? I've been reading . . . See, I don't want to get hurt. I've never played court sports, so I know there are going to be some movements my body is not used to, like lateral movements, stopping, starting, that sort of stuff. But in my brain, I'm like, "Well, old people play it. It's cool." But you've still got to be careful.

Chris, could you maybe tell us a little bit about what your take is on injuries or what we want to watch out for since I haven't played court sports before?

Dr. Gee: Yeah. I mean, I tend to see . . . I'm sure Dwayne's seen similar stuff, but I tend to see a lot of calf injuries and things like that from pickleball kind of stuff. And it is some of that . . .

Scot: Is that from quick starting and quick stopping?

Dr. Gee: Yeah, stop/start kind of things.

Scot: We're just not used to it. I mean, that's not something that a lot of it of us have ever done.

Dr. Gee: Exactly. Yeah. It's an easier sport because it's smaller court, but you're still going to do some movement. And I think some people maybe aren't ready for that and get injured a little bit.

Scot: So start out kind of slow. I don't plan on being a pickleball hero today. There's not going to be lunges or dives for me.

All right. Dwayne, you mentioned that you knew somebody whose older dad played it, and plays it a couple times a day. That's another injury I read about too, is you get older people that haven't really ever done a ton of activity, even if they have done activity. Now all of a sudden, there are overuse problems, right? Because he's playing a lot. Tell me a little bit about an overuse injury.

Dr. D'Souza: Yeah. I mean, I tend to see, at least so far, a lot of planter fasciitis, Achilles tendinopathy/tendinitis type stuff where you're constantly cutting or pivoting and you're just not used to that. So there's no warm-up or gradual buildup that you've done to get used to playing that frequently.

And then because it's a paddle sport, you're using your arm a lot. We see a lot of classically tennis elbow, which is a lateral epicondylitis. We see, especially in some older people or people who quickly ramp up to the sport, a lot of shoulder-related, rotator cuff, swinging through the ball, going all out, trying to hit it as hard as they can. They start pulling things. They start having these shoulder-related issues.

But it mainly seems to be kind of shoulder, elbow, and then lower extremity, knee down type of stuff. Don't see a ton of hip-related issues, core-related issues. And every once in a while, if people have not played and they are running back and they're not used to that, they'll . . . Older people will trip and fall as well, which is unfortunate.

Scot: Yeah. I've read some broken bones. Is that kind of a less thing that happens, or a lot, or what?

Dr. D'Souza: I would say the broken stuff happens much less frequently than the overuse and not properly taking care of your body, allowing yourself to recover type of thing.

Scot: Okay. All right. So, as we play here today, what advice do you have for me? Do I need to warm up? Do I need to stretch? Is my headband positioned correctly? My wrist sweatbands? Does everything look good here?

Mitch: There's a guy in khakis here. I think we're okay.

Dr. D'Souza: Yeah, I think you'll just see how it goes. Most people kind of warm up by just hitting the ball back and forth a few times and don't do any of the movement. I, in general, just try to move everything just to keep it going. But there probably is a specific way to warm up, and I'm not a pro, so I don't do that.

Scot: All right.

Mitch: Which one should I grab?

Dr. D'Souza: Yeah, that one is fine.

Scot: Let's grab that paddle. All right. So tell us, what are the rules here?

Dr. D'Souza: So you can play singles or doubles. We have four of us. We'll play doubles today. Basically two on each side of the court. Essentially, the goal is to . . . You can only score a point on your service. So if you're on defense and you don't score or you don't . . . If you don't fault and you don't cause any issues, essentially . . .

Scot: So it's like tennis or volleyball.

Dr. D'Souza: Yeah. I would say it's basically Ping-Pong, but you're standing on a court, if that makes sense. And you serve cross-court. So, from that baseline, the green area over there, you have to serve across. This area is called the kitchen.

Scot: And that's the area closest to the net, to the first set of white lines.

Dr. D'Souza: Yeah, seven feet on either side. And essentially, you can't volley the ball, so you can't take the ball out of the air from within this area. It has to bounce before you can hit it or come into here.

So most people will stand essentially right here and try to do everything, unless the ball bounces in. Then they'll come in and hit it from here.

The only other big rule is you serve it, it has to bounce on the other team's opposite square.

Scot: So not in the kitchen, the other square.

Dr. D'Souza: Other square.

Scot: What are those called?

Dr. D'Souza: I don't actually . . .

Mitch: The other squares.

Scot: The other squares.

Dr. D'Souza: Yeah, I don't actually . . . I don't know.

Scot: Okay. Well, I mean, I'm looking at this . . .

Dr. D'Souza: This is the kitchen. This is the . . .

Scot: I'm looking at this $200 paddle. I figured you'd at least know . . . I mean, you're kind of all-in.

Dr. D'Souza: That's true. Yeah, I got a great deal on this paddle. The only other rule is when you return the serve, the serving team has to let it bounce before they can hit it. After that, it's a free for all. No longer do you have to wait for it to bounce. And that gives the defensive team a chance to move forward. Otherwise the serving team could just run up and just smash everything.

Scot: Okay. Got you. Well, you guys, you think you know what's going on?

Mitch: Sure.

Scot: I say let's just try it.

Dr. D'Souza: I think the best way is just hit the ball.

Dr. Gee: That's what everybody does, right?

Scot: All right. Dwayne is on my team.

Mitch: Sure.

Scot: No, it doesn't matter.

Dr. D'Souza: We can also warm up if you guys want to get used to hitting the ball.

Scot: Yeah, let's do that.

Mitch: So then a bounce and then a . . . Oh, sorry.

Dr. D'Souza: No, you're good.

Scot: Do we need to know how to hold the paddle?

Dr. D'Souza: Oh, good question. Yeah. I mean, you can hold it whatever is most comfortable for you. The most common way is kind of this grip where you have a V.

Scot: Yeah. I can see how tennis elbow and wrist stuff would . . . On a day-to-day, I don't do any of this. My forearm is already starting to burn.

Mitch: Already?

Dr. Gee: And it's just an underhand serve?

Dr. D'Souza: Oh, yeah. All serves have to be underhand.

Mitch: You can't smash them?

Dr. D'Souza: You can't smash them, yeah. And it's got to be an upward motion below the navel.

Scot: Gosh, that just doesn't move very fast.

Dr. Gee: It's different, right?

Mitch: Oh my god. It doesn't have nearly as much give as a tennis racket.

Dr. D'Souza: Yeah, you guys also have wooden paddles, so . . .

Mitch: Oh, okay.

Dr. D'Souza: I don't want to judge, but . . .

Scot: Whoa.

Dr. Gee: That's way out there.

Scot: That's how you get your exercise.

Dr. D'Souza: Yeah, and the ball doesn't travel as fast or . . .

Mitch: At all.

Dr. D'Souza: . . . as far because it's basically a fancy whiffle ball.

Mitch: I wasn't good or anything, but I played a bit of tennis in high school PE, and this does not feel anything like it.

Dr. D'Souza: Yeah. The ball just doesn't do that thing.

Scot: Geez.

Dr. Gee: I guess I'm breaking the rule.

Scot: I didn't know what to do there. If it hits the line, is it out?

Dr. D'Souza: Good question. So lines are in except this kitchen line on a serve. This line counts as in. All the lines count as in.

Scot: Man, it doesn't fly super straight.

Mitch: Sorry, man.

Dr. Gee: Yeah, it kind of catches the wind a bit.

Scot: It kind of hovers a little bit.

Dr. D'Souza: Yeah, it's all about your paddle face when you make contact with the ball.

Scot: Oh, it's all about the paddle face?

Dr. D'Souza: All about the paddle face.

Scot: Let me see your paddle face, Mitch.

Mitch: I got none.

Dr. D'Souza: It's true. I mean, so many people think of pickleball as a sport that is very easy just because of the type of people that play. It takes a lot to get used to.

Dr. Gee: Right?

Dr. D'Souza: I mean, within one game you can learn the rules very simply.

Scot: Apparently, I've turned into a pickleball hero, Mitch. Are you going to jump in and play at some point? Oh, you've got flip-flops on.

Female: I didn't really . . .

Scot: Actually, yeah, that's a good question. So I read that shoes are kind of important, and shoes can cause injuries. And you're supposed to have court shoes?

Dr. D'Souza: I would recommend court shoes. A lot of people play with tennis shoes or whatever, but something comfortable that is supportive. Court shoes are the best option.

Scot: I've got running shoes. Is that a bad call?

Dr. D'Souza: I think he'd be fine for a couple days, but if you did it every day for a couple weeks, you might regret it.

Mitch: What would he regret?

Dr. D'Souza: I think you're just going set yourself up . . . If you're not used to the cutting and pivoting and they're not built for side-to-side movement, you're going to get some issues with sore feet, blisters even, and sometimes you can even start developing some of those plantar fasciitis-type injuries where the sole of your foot is all irritated and inflamed with some pain in the morning.

Scot: Okay. So shoes do matter.

Dr. D'Souza: I think if you're playing seriously and playing more than a couple times a week, it probably matters.

Scot: So just casual, regular shoes is fine. If you start getting into it a little bit more, maybe that's the first thing you would want to look into, is some decent shoes, some court shoes.

Dr. D'Souza: Yeah, because the startup costs for pickleball . . . I mean, you can get paddles for $30. You can get kits for your family for $40 or $30 with the balls, and that's all you really need. And if you want to keep going further in it, it gets exponentially more expensive.

Scot: Sure. Like anything, right? All right. Do we want to try playing?

Mitch: Okay.

Scot: Mitch is not sure. Does Mitch have proper pickleball hair? He's been working growing out his hair.

Mitch: I was about to say.

Dr. D'Souza: Good flow today. I'll serve first

Scot: And I can stand anywhere in here then? Except for I can't go into the kitchen.

Dr. D'Souza: You can't go in the kitchen. My advice on the serve is if you are the receiving team, you have to let it bounce. So if they hit it to here, you have to wait. So most people on the serving team are always back.

Scot: It's easier to move forward than backwards.

Dr. D'Souza: Definitely. You're not going to fall. You're not going to get injured that way. And then Chris, because I'm serving to you and you have to let it bounce, you should be all the way in the baseline. And then Mitch, you should be up because it's not coming to you. And you win this game by being here. You take away so many angles. So if you can already start at the line, then it helps your partner because Chris should be trying to get up essentially.

All right. 0, 0, on the 2.

Scot: Oh, look at that. We're playing pickleball, folks.

Mitch: Paddle face, paddle face, paddle face.

Scot: Well, then you have to switch.

Dr. D'Souza: So then you and I switch. Yeah.

Scot: Oh, and then you serve from that side.

Dr. D'Souza: I'm serving towards Mitch.

Scot: So you keep serving. We just switch.

Dr. D'Souza: Yeah. Until they break our serve.

Scot: And then they would serve and then when we break theirs, then I serve.

Dr. D'Souza: Then it would be coming to you, yeah.

Scot: Okay.

Dr. D'Souza: All right. So 1, 0, on the second serve.

Mitch: And I've got to let it bounce.

Scot: Just keep giving it to Mitch.

Mitch: Okay. All right. But I always serve to Chris, right?

Scot: The only difference is we started serving. Otherwise it'd be like, "Keep giving it to Scot."

Dr. D'Souza: 2, 0, 2.

Scot: Oh, boy. Okay. All right. I totally whiffed it. My first big pickleball opportunity, I didn't even hit the ball.

Dr. D'Souza: And that was Mitch's serve coming to you, because Chris just . . . we broke Chris's serve.

Mitch: I'm not following the serving thing, but that's okay.

Dr. D'Souza: So Chris served.

Mitch: And he was one.

Dr. D'Souza: He was the one. So you're the second serve and you serve . . .

Scot: Oh, so unlike volleyball where if you break the serve or whatever . . . Gosh, I'm quoting games I don't know the rules.

Mitch: So it's like golf.

Scot: So when somebody's serve is broken, then their partner gets to serve. So each team gets two opportunities to serve.

Dr. D'Souza: Correct. Except for the . . .

Scot: Except for the first.

Dr. D'Souza: Also the first one, yeah.

Scot: Okay. I got it.

Dr. D'Souza: Chris, You are going to want to back because you have to let it bounce. Otherwise we'll just hit it right at you and you'll just be like . . .

Dr. Gee: Oh, got you. Okay.

Dr. D'Souza: You could stay there.

Mitch: All right. So 0, 2, on the 2.

Dr. D'Souza: Correct. That's perfect.

Mitch: Nailed it. Basically a pickleball master.

Scot: The talking part Mitch is really good at.

Mitch: Announcing?

Scot: So was that a fair serve?

Dr. D'Souza: It was not because . . .

Scot: It's in the kitchen.

Dr. D'Souza: . . . it landed in the kitchen. All right. 2, 0, on the one.

Dr. Gee: Oh, got it.

Mitch: Got it.

Dr. Gee: Oh, sorry. Sorry, Mitch. He was frightening me up there. I thought he was going to . . .

Dr. D'Souza: Intimidation.

Dr. Gee: How long did it take you to kind of get the hang of the rules and stuff?

Dr. D'Souza: Oh, probably one game.

Dr. Gee: All right.

Mitch: Oh, okay.

Dr. Gee: So I'm slow.

Dr. D'Souza: I think you can get it within your first time playing, because it's 11 points in the first three games or so. You kind of make sense who you serve to. I think the scoring thing might take a couple reminders usually for most people. Go for it.

Scot: But it was in the kitchen, so . . .

Dr. D'Souza: No.

Mitch: Not on the return.

Dr. D'Souza: On the return, it doesn't matter because the court is opened.

Scot: So I blew it.

Dr. D'Souza: Eh, that's all right.

Mitch: You didn't blow it. We're learning.

Scot: All right. So what are we? 7, 0 . . .

Dr. D'Souza: 7, 0, 2. You're the second server now.

Scot: I'm 7,0 on the 2. And when you serve, you serve underhand?

Dr. D'Souza: Underhand, and you can't . . . So basically underhand with the paddle angle below your navel. You have to make contact below your belly button.

Scot: Oh, is that a rule?

Dr. D'Souza: It's a rule.

Scot: So I can do it underhand like . . . Oh, that's not below my navel, though.

Dr. D'Souza: So the most angle you can have is like that, because this has to be below your . . .

Scot: The top of the paddle below the navel. So I'm going to be more like this.

Dr. D'Souza: Yeah, as long as it's an underhand motion. So you can let it go and drop like that, or you can drop serve it where you can't push it down, but you can let it go because the ball will never bounce above your belly button just based off how they're built, and then hit it like that. So different ways to serve. You just can't do it overhand or completely side arm.

Scot: All right. So tell me if this would be a legal serve. This is just practice, guys.

Mitch: Unless I make it.

Dr. D'Souza: That's perfect.

Scot: That's okay? Okay.

Dr. D'Souza: You should have kept it.

Scot: All right. Here it comes for real, guys.

Dr. D'Souza: All right. 10, 0, 1.

Scot: Oh, wow.

Mitch: He's done playing around. And that's game, right?

How are you feeling, Scot? You got a sweat? What's going on?

Scot: Yeah, I'm sweating a little bit. I'm glistening. It's a hot day. It's a beautiful day here in Salt Lake City. This is a beautiful set of courts . . .

Dr. D'Souza: It is.

Scot: . . . up on the side of the foothills. You can see the whole valley.

Mitch: How do you think Troy would be doing?

Scot: He'd be doing great. He doesn't do anything wrong.

Dr. Gee: You get all practiced up and then you bring him out and crush him.

Scot: That's brilliant.

Mitch: Oh, Part 2.

Dr. D'Souza: All right. 5, 0, on the one.

Dr. Gee: Ideally, you want to play more up here if you can, right?

Dr. D'Souza: Yeah. So the way to win the game is . . .

Mitch: Now you share that?

Dr. D'Souza: . . . you kind of . . . if both your teammates are up here, there's only so much that they can do because if they hit it above the net, you can basically smash the ball.

Scot: Because it just doesn't go that high generally.

Dr. D'Souza: Correct. So if you're up here, they have to essentially hit it short. And so you just wait for them to make a mistake. You guys are at the point of the game where you're kind of just learning the rules, but it gets much more advanced. The rallies last 50, 60 shots.

Dr. Gee: Really?

Dr. D'Souza: And people are super patient because they're just hitting these things called dinks, which is a very light shot over the net that kind of doesn't bounce very high, and it forces them to always hit up on the ball. And anything that's elevated above the net, someone is going to attack it.

Mitch: So you keep it low.

Dr. D'Souza: So if you keep it low, that's how you win. And you do that by being up here and forcing the shots like that. You just do that back and forth.

Dr. Gee: But I hit that one too high.

Dr. D'Souza: Yeah, I would've . . .

Dr. Gee: You would've smashed it. Yeah.

Dr. D'Souza: Right? And so you hit at people's feet. The rule is red light for attacking is here to knees. Yellow light, if you're pretty good, is knees to hips. Anything above your hips is attackable. It's a green light. And so that's for attacking the ball. And it gets pretty advanced from there.

Mitch: My personal goal is to be able to hit the ball back.

Dr. D'Souza: Yeah, exactly.

Mitch: Seventy-five percent of the time.

Dr. D'Souza: There's a reason I didn't go into that detail.

Scot: I mean, we're just having fun right now.

Dr. D'Souza: I was like, "There's a lot more." And these rallies are ending pretty quickly because you guys are getting used to the ball, but they'll go for 10, 20 shots a rally once you guys get there.

Scot: Mitch, it's like anything else, right? Play the pickleball you want to play. It's what we talk about on the podcast all the time. You don't have to play super competitive if you don't want to. If you get a group of people, you just want to hit the ball around a little bit and move, that's great.

Dr. D'Souza: Anyone can play. People show up with music, they show up with their dogs, they put them in the corner. People bring a beer.

Scot: I heard people talking as they were paddling back and forth. I mean, you choose how you want to play.

Mitch: Well, that's just it. I think with the ball being as slow as it is, the couple of times I've played tennis, I am completely beat by the end of the first round. I'm feeling active right now. I don't feel like I'm killing myself.

Dr. D'Souza: You can play for a couple hours without any issues usually. Well, once you build up to that, but . . .

Scot: Guys, huddle.

Mitch: Are you huddling up?

Scot: Actually, yeah, before we started this next game, I wanted to point out a couple things. One, I don't know if you've noticed this, but the guy in the khakis is now playing against two people.

Mitch: Is he killing it?

Scot: So he's a sleeper.

Dr. Gee: I think he's got long sleeves and . . .

Mitch: He's a shark.

Dr. Gee: He looks like he'd be at the office.

Dr. D'Souza: I don't think I would be playing in that. That is not appropriate pickleball attire.

Scot: But it works for him.

Mitch: It is.

Scot: Okay. So we've played a couple games here. From a "how you're feeling standpoint," Mitch?

Mitch: My heart rate is up. I don't feel like my joints are dying.

Scot: Okay. That's good.

Mitch: And I'm having a good time.

Scot: Is there anything, as you were playing, you were like, "Oh, I could see how maybe I might hurt myself trying that"?

Mitch: There was a time that I went to swing back and my foot stopped, but my body kept going, and I had flashbacks to my ankle injury.

Scot: You were going backwards?

Mitch: Yes.

Scot: Okay. So is that backwards we . . .

Dr. D'Souza: Yeah. So the key is when someone lobs the ball like that, a lot of people are used to just backpedaling. That is not what you want to do because you're backpedaling and trying to hit it. That's how you fall. So the thing that everyone should do so they don't have an injury is rotate and slide, because that way you're hitting it straight without leaning back and falling.

Scot: So turn side and . . .

Dr. D'Souza: You need to pivot and get there versus backpedal and fall and hit it.

Scot: Okay. That's good advice.

Dr. D'Souza: I see a lot of people a little bit older get hurt.

Mitch: Hey, young people can get hurt.

Dr. D'Souza: That's what I'm trying to say, is anyone can do that, but you kind of have these balance issues as you get older.

Mitch: I don't want to end up back in Chris Gee's office. Luckily, he's here this time.

Scot: That was good thinking. I don't know if this is a deal or not, but I think maybe as a younger person, the perception could be, "Oh, a lot of older people play this, so it's going to be fine for me." But everybody can get hurt the same way, especially if you haven't done a lot of activity, court sports, that sort of thing.

Dr. Gee: Yeah, I agree. I'm feeling good, enjoying kind of moving around. There are definitely times where I'm reaching for a ball and I'm like, "Oh, that's a new movement that I haven't done for a while." But yeah, I think as long as, like Dwayne said, I'm getting my body in the right position, I think that'll help.

Scot: Oh, interesting. Body in the right position. Anything at one point where you're like, "Oh, I could have hurt myself there, or I could see how that could be a problem"?

Dr. Gee: Yeah. I've been running a lot more lately, and so this whole cutting, pivoting, twisting is new on my ankles. I feel a little like, "Oh, yeah, I could see I've got to strengthen some things there."

Scot: Yeah. But it's good, right? Because you're getting more of that functional movement.

Dr. Gee: For sure.

Scot: We tend to stay in that . . . What is that plane? The back and forth plane? The sagittal or linear?

Dr. Gee: Yeah, a linear plane.

Scot: Running, biking, all those things. This moves you around. Anything for you?

Dr. D'Souza: From this game?

Scot: Yeah.

Dr. D'Souza: I mean, I played three hours last night and three hours the night before, so . . .

Mitch: Oh, no big.

Dr. D'Souza: I'm sore in general just from playing that much, but not really. Not right now.

Scot: Yeah. For me, I think it's the sudden stopping and starting, and then maybe trying to do . . . When you kind of try to lunge and you've got your . . . that's not a movement I'm normally used to doing. All right. Break.

Dr. D'Souza: The thing I'm impressed is everyone now knows the scoring pretty . . . You guys pick that up within like two games.

Scot: All right. Dwayne, I want to know . . . This has been a lot of fun, but one of the reasons I was able to show up in confidence today is because I knew you have played before, you understand the etiquette. It could be intimidating, right? There are some barriers to playing this game. Where do you play? Does it have to be a dedicated pickleball court or can you play at a tennis court? Are they the same thing?

Dr. D'Souza: It should be a dedicated pickleball court. The only reason is that, as you can see just looking here, you can fit two pickleball courts on each tennis court. Sometimes four if they map it out. You can actually put four on there.

The nets are different heights. So tennis nets, I think, are 36 in the middle and a little higher on the sides, 40 on the sides. And pickleball, I think, is 34 and 36. So it's a smaller court, different net. But tons of people will still go and practice on a tennis net and can still use the facility if they wanted to.

Scot: Sure, as long as they're abiding with the rules. Probably if a tennis player shows up, you've got to yield it if you're a pickleball practicer.

Dr. D'Souza: Probably, yeah.

Scot: Yeah, they are definitely different. We're here at a pickleball court/tennis court. You can definitely tell the difference.

Dr. D'Souza: And now, a lot of courts are being converted from tennis to pickleball, and there are a lot more courts in Salt Lake. There are lots of apps online that can show you where there are courts, where they're free, where they are for fee. And there are even Facebook groups for, "Hey, I'm going to go play here at this time. Come." And so it's pretty inclusive in that sense.

Scot: All right. So some, you probably could reserve. These courts, you could not reserve. You just have to show up. What if you show up and the courts are full? How can you confidently know it's your turn?

Dr. D'Souza: Yeah. So every court has a different kind of waiting system. The rules are actually posted right on the door and they'll usually say . . . Here, it basically is an hour play per court. And the way you wait is you just put your paddle up in a line. And so the first court that's available, the next group with their paddles up gets to jump on it.

At Fairmont, the way it works is they have six of these paddle holders. And so every game to 11, you saw how quick those were, less than 5, 10 minutes. Basically, as soon as you're done with your game, you rotate off and the next group . . . There's an arrow that tells you who's next. That group goes on your court and you put your paddles up on the paddle holder, and it just rotates super quick.

It's nice because you can show up with a group of four and you can play with your foursome, or you can just show up solo and jump on with a group that needs one, and just put your paddle up and just jump in.

I'm here by myself, and so most of the time at Fairmont, just show up by myself, put my paddle up, jump in with the group, and you kind of go from there.

Scot: Cool. Chris, did you have any questions? I asked your question. I shouldn't have.

Dr. Gee: No, that's what I was going to ask. If you're alone and you want to go play . . .

Dr. D'Souza: Yeah, it's pretty easy. There are a bunch of groups online and you can also . . . I literally just show up after work or if I have a random morning off, I'll just go and there are people playing. And if it's just solo or three people, you can just hit the ball back and forth or come up with . . . There are varieties of games you can play with less than four people. And then if not, you just put your paddle on the thing and wait and you're good to go.

Scot: Are there other barriers anybody can think of? Anything else that would've stopped you from coming today had we not all kind of group planned this?

Dr. D'Souza: I mean, you can play indoors or outdoors, right? So indoors are usually you have to pay for those, but outdoors is kind of weather dependent. You really don't want to play in the wind. But in the winter, my housemate's dad rides his bike, brings a shovel, and shovels off the snow, and we play with a different ball that doesn't break as easily in the cold. I mean, people play in the 20s and 30 degrees all the time.

Mitch: Well, I'm glad that I came here because one of my constant barriers is I'm always a little anxious I'm not good enough, or I'll come and I will be the awkward guy on the field, whatever. But just to have actually come here and seen there are so many different types of people here. There are men, there are women, all ages, they're all playing together. Yeah, it really took the intimidation factor of and it's been good.

Dr. D'Souza: Yeah, as soon as you play once, you'll be like, "Oh, I know what to do."

Mitch: Kind of.

Dr. D'Souza: So there's this whole ranking in pickleball of . . . Like, 5, 0 is the best in pro level. And there are all these rules for it. But if you know the rules, you're already at the 2.5, 2 level. And so that's just knowing the score system. And so you already can say that essentially.

Mitch: I will never say that.

Scot: A barrier for me might be . . . So if I showed up with a couple people, you'd be playing against a couple other people maybe. I mean, I guess you just end up on the court you end up. But what if the people you're playing against are super serious? Or for the most part, is everybody kind of chill and play to the lowest level?

Dr. D'Souza: Everyone is usually pretty chill. You can find some people that are very competitive and they tend to stick around in their group because they only want to play highly competitive games. But for the most part, because it's so inviting, you'll frequently play against generation differences, skill differences, and everyone is just encouraging and trying to get you better.

So I think you'll quickly learn. Like, you're at a game and you're like, "Oh, wow, I can't do that shot," and you'll learn. And maybe the next game you might rotate to a different group.

Scot: Got it.

Dr. D'Souza: Things like that. You can even sometimes tell by their paddle.

Scot: How do you know?

Dr. D'Souza: If you have all wooden paddles, you're probably a beginner and you're probably going to be playing with some beginners. I mean, you can just kind of . . .

Scot: As a group of people, though, for the most part, pretty friendly?

Dr. D'Souza: Oh, yeah. I think it's the most welcoming because you can play with anybody, any time, and just show up and be like, "Hey, do you guys want to play?" A lot of times, two people will show up, they'll be playing singles, another group of two will show up, and they'll be like, "Hey, you want to play fours?" And then you just play. It's super fun. People let you borrow paddles, balls, like, "Bring it back next week. I'll see you next week." You just kind of use their stuff. It's pretty welcoming.

Scot: It's been a lot of fun. Dwayne, thank you so much.

Dr. D'Souza: Yeah, of course.

Scot: Dr. Gee. Thank you so much, Chris. Mitch . . .

Mitch: Thank you.

Scot: . . . thank you. Don't know what else to say.

Mitch: Thank you for caring about men's health.

Scot: Do we have time to play a couple more deals or . . .? Where are we at?

Dr. Gee: Yeah, let's do it.

Mitch: Sure. I'll play a little bit.

Dr. D'Souza: I'm good.

Interviewer: We know here in the United States, the opioid crisis and the addiction to those drugs is a real concern. But when it comes to the medical side of things, what is opioid addiction?

Joining us today is Dr. Elizabeth Howell. She is an Associate Professor of Psychiatry and the Director of Addiction Psychiatry and Addiction Medicine Fellowship at University of Utah Health and Huntsman Mental Health Institute. Now, Dr. Howell, just to kind of start out, like, when it comes to your perspective, what is opioid addiction?

Dr. Howell: Well, everybody has their own thoughts about it. But if you want to look at the official definition, we would look at something called the DSM, the "Diagnostic and Statistical Manual 5th Edition" of the American Psychiatric Association, and they have 11 criteria. And if you have two or more of those criteria, you have either mild, moderate, or severe opioid use disorder or other use disorders. But I think a simpler way to think about it, because I don't think the general public goes around memorizing the DSM-5, is to think of it as loss of consistent control over use of a substance, continued use in the face of adverse consequences, compulsivity or craving. And then the other part can be denial, and it doesn't mean that you don't know there's a problem, but you're not in touch with how many ways the use of the drug is affecting your life.

Interviewer: So those are behavioral things that we're looking for.

Dr. Howell: Right.

Interviewer: But when it comes to, say, biologically, physiologically, I guess, what is going on when we get into this? Because I've heard that it's not actually the drugs that are causing the addiction.

Dr. Howell: Right. The addiction is actually in the brain. And, you know, there is no addiction without a brain, so we don't know in the field if there's something different about people who get addicted before they ever use or if the drugs cause the brain to change or both. And that's a big mystery. There's actually a really neat study that we're part of at HMHI, called the ABCD Study, that may shed some light on that. But for now, we don't have the answer to that. So what we do know, though, is once people have started using regularly is that the brain is different and it doesn't react the way that the brain of someone who doesn't use drugs reacts.

So, for example, people tell me all the time, "I don't understand why they don't just quit using because I can have a drink and then stop." But the point is that that person's brain is very different than the person's brain who is unable to stop when they start. And there are a lot of different brain changes that happen, and it's interesting because you can actually track some of these brain changes to specific behaviors. So, for example, you know, being out of touch with the consequences of your actions, or not having strong feelings about anything except drugs, those can all be traced to different parts of the brain. So it is behavioral, but behavior comes from the brain and addiction and drug use change how the brain reacts to normal things in our lives.

Interviewer: When we say that the brain is different, I guess, does that mean that there are certain people that are more susceptible to addiction? Does that mean that, you know, is it nature? Is it nurture? Or are certain people just born that way? Do people, you know, grow up leading towards addiction?

Dr. Howell: It's really both. About 40% to 60% of the risk is genetic. That's only 40% to 60%. Some of the other risk comes from life experiences or, you know, where you grow up. If you grow up in a family where everybody else is drinking, of course some of that is genetic, but it is also environment and you are exposed to that. But also, trauma is a huge risk factor for addiction. Trauma, traumatic experiences in childhood, especially, can change the brain in a way that you're much more susceptible to either wanting to use, or when you do use, losing control over your use.

Interviewer: Thinking of those patients, you know, or maybe a loved one is listening right now and they have someone in mind, what kind of treatments are available? Because, I guess, one of the things I want to ask first before you get fully into the treatments is, is there a cure for opioid addiction?

Dr. Howell: There's no cure, as I think of a cure. There is treatment. And this is very similar to other illnesses that we treat in medicine. So, for example, if you have high blood pressure, there's probably no cure. You can definitely treat it. You can do things. You can lose weight. You can exercise. But even people who are very thin and very athletic can have high blood pressure. It's a medical condition. You can do everything you possibly can with your life and you could still be suffering from addiction. You might try everything. You still have, for whatever reason, a very high risk of continuing to be unable to control your use, having craving, etc.

But the treatment that we have tries to at least arrest the process. So for opioid use disorder, one of the most effective treatments we have is medication for opioid use disorder, and this can be kind of controversial for some people, but methadone, buprenorphine, naltrexone, are all different medications that they work in different ways a little bit, but they do help people stabilize so that then they can get their lives back together, and then the behavioral treatments can work a lot better when your life is more stable.

So, really, treatment has to be a combination of things, and it doesn't happen overnight. There isn't a magic medicine, a magic bullet as people call it, to treat any kind of addiction, especially opioid addiction. And the medications only work when you're taking them. Once you stop taking them, your brain is still different and you can start having craving years after you ever used an opioid. And that's the disease if we want to call it a disease, or that's the difference in the brain is that the brain is always going to be seeking the drug even when the other parts of the brain know that it's destroying someone's life.

And I hear this from patients all the time. "I know this is killing me. I don't want to use, but I can't stop." And that's the terrible conundrum that people have when they're in the middle of their addiction and they want to stop. So our treatments are really to help them be able to stop safely and then try to get their lives back together and hopefully heal up some of the brain changes that have happened over the course of their addiction so that they can live a life without being addicted.

Interviewer: So now that we know a little bit more about opioid use disorder and how some of the physiological things that actually comes with this type of addiction, if there is a listener that either themselves or someone in their lives, you know, might be going through this kind of struggle, where do they start to get this treatment, to get this kind of, you know, get on the road to recovery or, I guess, remission if this is a disease?

Dr. Howell: You know, sometimes you can go to your primary care doc or provider and get some help. There are more and more primary care providers who are prescribing medication for opioid use disorder. But then there are others who don't or they don't feel comfortable with it, or they don't know that much about it. And so, then, you would go preferably to an addiction specialist of some kind. The fellowships that I run, the Addiction Medicine and Addiction Psychiatry Fellowships train physicians who finished a residency in a primary specialty to be addiction specialists and to be able to treat regular opioid use disorder and other addictions, but also how to be specialists for people who have really complicated problems, because often we see the patients who've been through many different kinds of treatment and nothing has really taken hold for them and we need to get a little bit more sophisticated or refined about how we're treating their specific addiction. And the medication is only part of it. By no means is it the only thing that you have to do. You can't just throw a medicine at somebody and expect that their opioid use disorder is going to be just fine. It doesn't work that way.

So what you would do is if you, you know, you could start with your primary care provider. If they are not knowledgeable or comfortable, then, you know, one of the things that you can do is you can call, actually, our University HMHI crisis line and they can often help people get connected to treatment because you may need to go in the hospital. It may be that severe. And yet you may just need outpatient treatment, and they can help people sort that out and figure out what's needed.

We also have a recovery clinic over at HMHI, and it's staffed by addiction psychiatrists and addiction medicine specialists and therapists and other staff. And our trainees also work there, and they can help with evaluations and recommendations for treatment. And if you can get treatment at HMHI, fine. If not, if your insurance doesn't cover it there, then we can help send, you know, refer you out to wherever you can get the treatment with your insurance coverage.

Interviewer: And for a listener who might not be in the state of Utah, I assume that there are similar crisis lines in other places of the world?

Dr. Howell: Right. Yeah. So if you're not in Utah, it varies drastically around the country, but there's generally a community crisis line. And the other thing is that there is a 1-800 number through the Substance Abuse and Mental Health Services Administration. But there is a website, and I think it's called "Find Treatment Now" that you can look up and find all kinds of treatment options within your ZIP code and within a certain range from your home.

Interviewer: And for listeners who might be interested in, say, those different resources, they'll be linked in the episode description, if you want to click on your app or on the website. Now, Dr. Howell, I guess the one last thing I kind of want to ask to kind of wrap this up is, what kind of hope do family members and people suffering from this disorder, you know, have when they get into treatment?

Dr. Howell: You know, most people come in to treatment and their families are pretty hopeless feeling. And I'm not trying to sugarcoat addiction. It is a disease that can be fatal, but it's not uniformly fatal. Even without treatment, a lot of people get better over time. But especially with treatment, it can accelerate that process.

There's two things that, I think, are important for opioid use disorder. One is if you are someone with opioid use disorder or you care about somebody who has opioid use disorder, you should definitely get a naloxone overdose reversal kit because the one thing I can't do is help somebody who's dead. And if you die of an opioid overdose when we could have prevented that with naloxone, it's really tragic and unnecessary. So once again, this depends on your community. In Utah, we have utahnaloxone.org and they can facilitate you finding a place that you can get a free naloxone kit to have on hand. And clearly, if you're the person overdosing, you're not going to be able to give yourself naloxone, so it's helpful to have it and for everybody in the family to know how to use it, where it is, etc. I have one in my bathroom. I have a sticker on my door at the house that says, "I have naloxone." And pretty much any addiction provider I know carries some of it around because we never know we could just be walking down the street and come upon somebody who needs to have an overdose reversal. So I would look into that and that's the first thing.

But the second thing is that there is hope for recovery, and I'm always meeting people who are in recovery, who've had severe addictions. I was in another part of the state recently and I was working with a guy on a community event, and he said, "I'm so-and-so and I used to be a heroin addict and, you know, I was . . ." and he told me all about the things in his life that were tragically going wrong. And he made a big change in his life and got into recovery. And I don't know all the specifics, but it's five years later, he's not been using for a while. He's taking care of his children. He's got his own business and he's really successful and he's very happy. So that's what I see can happen. And if you only see the tragic part, you see people in the emergency room or in the hospital with all their complications or you see people who are destroying things in their lives, you feel hopeless. But you never really get to see all the people that do well. And that's one of the nice things about our addiction care system that we have is that we get to see people on both sides, and we're not trying to sugarcoat the tragedies that can happen, but we definitely know people can get better and live productive lives.

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Scot: Not only does body fat impact how we look and feel about ourselves, excess body fat has been associated with a lot of diseases that can significantly impact our health. And one of the organs, I didn't even know this, that's particularly susceptible to becoming damaged by excess body fat is the liver. And today on "Who Cares About Men's Health, what to know and what to do if you've been diagnosed with fatty liver disease.

Got a big crew here today. This is going to be a lot of fun. The MD to my BS, it's emergency room physician Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: All right. And we also have Dr. Susan Pohl, who is in family medicine. And she's also very passionate about wellness for disease prevention. So you're in the exact right place. Welcome, Dr. Pohl.

Dr. Pohl: Thank you. Good to be here.

Scot: And the star of this week's show . . . What do you think of that, Listener Brett? You're the star. You're the reason we're all here today.

Brett: Oh, I'm so excited. Thank you.

Scot: Yeah. So Brett wrote an email to us that I'll get to here in a second. But essentially, he was diagnosed with fatty liver disease during his last physical. So first thing, Brett, when your provider told you that, what was your reaction, being told that you had a fat liver? That kind of doesn't sound like a fun thing to be told.

Brett: It was a little scary because, "Do I need a liver transplant? Am I going to die soon? Or is this just because I am overweight?" That's the question.

Scot: We talk about the core four on this podcast, which is to be healthy today and in the future, you should watch your activity, your nutrition, your sleep, your emotional health, and then you've also got to know that plus one more, which is your genetics. I have a feeling we're going to be delving into a lot of those today.

So here is the email. "I've been listening for a while and thought I'd ask a question after my last physical. Diagnosed with fatty liver disease, but my physician didn't explain it too well. And I've been searching for more answers on what it is, why I should worry about it, and what I should do to treat it. I've Googled a lot of stuff, but I'm unsure what to do. My doctor recommended I avoid fatty, greasy, fried foods. But I wasn't sure if I should consult a dietitian or do anything else."

So that is Brett's condition. I want to ask you, when you searched on the web, what did you find about fatty liver disease? I'm kind of curious what's out there.

Brett: I found actually a couple of previous interviews that The Scope did for fatty liver disease. And I found pretty much the . . . Healthline, I think there was an article for it, and basically it said, "Take it seriously and lose weight," is the main thing, which is good, but easier said than done also.

Scot: So is the concern, actually, how to accomplish what it suggested to do? Or did you really truly find that you didn't find a lot of information that explained what this condition was, why you should be concerned, that sort of thing?

Brett: A bit of both. I wasn't really sure how I got it. Am I drinking too much soda? Am I eating the wrong foods? And then should I be exercising differently? These are things . . . Then what's the long-term prognosis? I was really scared that, "Am I going to need a liver transplant in 10,15 years? Or is this more like something that will eventually kill me when I'm 90 and that's okay?"

Troy: I'm curious, Brett, how did your healthcare provider diagnose you with fatty liver disease?

Brett: Well, there were a couple of ways. First, the blood work said that that indicated it. But then there . . . he sent me downstairs in his clinic. They had this thing called a FibroScan. It was essentially an ultrasound that looked at my liver and found the tissue was consistent with that diagnosis.

Troy: Okay, interesting. Obviously, we're all kind of spread out everywhere recording, so I haven't met you in person. But if you wouldn't mind sharing with us a little bit more about your health. Do you consider yourself overweight? Do you exercise, or did this come as a surprise to you to hear, "Wow, I've got a fatty liver and this doesn't make any sense"? I'm just a little curious about kind of where things came from there.

Brett: Effects of weight gain were definitely not a surprise to me. I've been a stay-at-home dad for the past three years, and it's been a more sedentary lifestyle than it was when I was working. I do work out, especially in the past year and a half, four to six days a week. Mostly a lot of cardio, but also weightlifting and things like that. I do it at night because as a stay-at-home dad, I don't have a lot of time in the day to run to the gym, and there's no daycare there.

So I've gained probably 25 to 30 pounds over these past three years. I've not been happy with it, but I've also thought that some of that could be from not just diet but also exercise. My body mass index is about 32 right now. So it's in the obese range, but it's on the lower range.

Going back to the episode a few weeks ago, when you had Scott on, the listener, I believe that was his name, I'm bit more average in my eating and exercise, average American, than he is. So growing up liking the normal food groups, which includes some of the fattier and sweeter foods. But also, I like to cook. I like to make meals that are healthy. I also have kids who are picky eaters, so sometimes I have to sacrifice good food for what they will actually eat. So it's a balancing act always.

Troy: Yeah, for sure. Like you said, though, you are exercising regularly. You have put on some weight just in the last few years. But again, it sounds like this kind of blindsided you to hear this, like, "I've got fatty liver disease." Like you said, you're searching all over trying to get answers. What does this mean? What are the implications of this?

Brett: Yeah. I mean, I expected things like higher cholesterol and things like that. Those things I've actually seen over the past few years of physicals. But this was kind of more surprising. Moving from heart to liver was more surprising.

Scot: Dr. Pohl, let's have you jump in right here. I want to ask a question, but I also just kind of want to let you go with what it is you would want to know at this point. I think Brett's main concern is, "Is this something he needs to worry about? And what can he do about it?" That's what he wants to ultimately walk away from. But we could also learn more about this condition. So, Dr. Pohl, where do we go from here?

Dr. Pohl: Thank you so much for having me on the show. Just as a clarification, I am a family physician. So I work at University of Utah, and I'm board certified in family medicine. I'm also board certified in obesity medicine, so I treat people who are having complications from weight. I'm not a hepatologist. A hepatologist would be someone that just specializes in liver disease.

Scot: So let me jump in for a second. Is that ultimately who Brett should go see at this point, or . . .

Dr. Pohl: So one of the things to think about . . . I'm just going to start from a big 10,000-foot informational view, and I think Brett can then get some more information from his doctor.

First of all, when we think about the liver, the liver has hundreds of functions, including clotting and digestion and regulating your blood sugar. The liver itself also stores fat, and everybody has fat in their liver. So fat in the liver is normal, but when the amount goes up, that's considered abnormal.

Again, from a 10,000-foot view, the liver can become diseased. The two main classifications of liver disease are related to alcohol or non-alcoholic liver disease.

So the first thing I would want to know is how much alcohol you drink, because that in and of itself can be a toxin and is one of the most common causes that can progress liver disease. Brett, do you mind if I ask how much alcohol you drink?

Brett: I don't drink at all. The most I do is I throw some wine or something into a recipe for . . . But I don't drink any alcohol.

Dr. Pohl: Okay, so that makes it easy. We can classify this as non-alcoholic liver disease. So as we branch into the non-alcoholic liver disease, there are some interesting terms. I don't want to get too much into the weeds, but the term non-alcoholic fatty liver disease, or NAFLD, actually means that you just have more fat than is generally considered "normal."

Normal fat content would be somewhere around 5% to 10% of the liver content is fat. And so you've been diagnosed with a little bit more than that, and I don't know what your level is.

Now, excess fat in the liver, actually the body can tolerate that in a lot of people. And NAFLD, or non-alcoholic fatty liver disease, is actually incredibly common. One out of every four adults in the US is considered to have some level of NAFLD, or higher than what we consider normal fat in the liver. But only some of those patients will then progress to some level of fibrosis.

So fibrosis is where the fat is actually more inflammatory and there's starting to be a little bit of scarring in the liver. Scarring in the liver is fibrosis, and we can pick that up on scans, like the FibroScan that you talked about or MRI.

What we want to avoid is this becoming very progressive and it leading to cirrhosis and liver failure. And I think that's what you were concerned about, Brett.

So it's important that you had the FibroScan and that they did look for some fibrosis. Now, if we're starting to see some fibrosis, then we're talking about NASH, which is non-alcoholic steatohepatitis. Only a few people with fatty liver are starting to get some inflammation and fibrosis in their liver.

But the good news is that the liver is incredibly resilient. The liver is an organ that is just an incredibly resilient organ. So the fact that you've been found to have this, this is one of those things that you are in control of, and you can be the captain of your ship and help your liver recover and heal from this.

Troy: So hearing all that, Dr. Pohl, where do you think Brett falls on that? I know it's probably hard to tell without actually seeing results, but you think he kind of falls maybe in that fibrosis phase or maybe just a little bit more fat than the average person in the liver?

Dr. Pohl: Well, I would have to see the result of his FibroScan. I mean, verbally, that story that he's telling me . . . the fact that your doctor was concerned about it makes me think . . . I'm playing Sherlock here. But from that story, there was enough fibrosis that the doctor was concerned and would classify you more in the NASH.

Now, I'm not sure if that's true, so I would contact your doctor and say, "What level of fibrosis . . ." We score that with numbers. "What level of fibrosis do I have? And do I have NASH?" And so just ask your doctor, "Do I have NASH, non-alcoholic steatohepatitis?"

Brett: Non-alcoholic steatohepatitis.

Brett: Yeah, or N-A-S-H. You can do a lot with this. And that's the good news, is that lifestyle medicine is the way, really, to approach this. It's the best way to improve the fat distribution that you have. Everyone needs fat, but the way your body is distributing its fat is causing some issues for you.

So I'm just going to segue into some lifestyle things you can do. You mentioned things like soda and sugar. Your doctor had mentioned things like fat, and obviously excess fried foods are going to be calorically rich, and so that can lead to weight gain in general. But tell me about the sugar that you eat regularly, including sugary sodas and drinks.

Scot: They always go after the good stuff, don't they, Brett?

Brett: Yeah. Well, it's true. I think I'm a little better than average in terms of soda intake. I probably have one or two a week, maybe. My post-workout drink, because it's at night, is a cup of chocolate milk. I looked online and it says eat chicken breasts and things like that. But when I get home from the gym at 11:00, that's not exactly appetizing. So that's my main sugar intake.

I feel like I'm pretty normal on things like candy and things like that. Not a lot, but like I said, I'm also around kids, so sometimes they make me eat. "Make me." Yeah.

Troy: Dr. Pohl, do you think that for Brett it's just flat out you've got to get your BMI down and this is all going to reverse? Or maybe he continues on at a BMI of 32 but drops the sugar, and then that's the key to reversing this.

Dr. Pohl: Most people with a BMI of 32 that have fatty liver or NASH will benefit most easily from weight loss. So unless there's a profound transformation of fat to muscle, most people need weight loss.

Scot: It sounds like really it's just a matter you're decreasing your total body fat and, in turn, you're decreasing the fat in the liver, and that's really what you're trying to do here.

Dr. Pohl: Yes, exactly. And sugar does tend to be very toxic to the liver. When we get big spikes of sugar, that's very inflammatory and actually produces inflammation in the liver.

I never say no to . . . I like chocolate cake, and I never say no to those things, and an occasional soda. I mean, all those things are part of my diet. But just realize that those should be kind of the peak of your pyramid. So if you really need that piece of pumpkin pie around Thanksgiving, have that piece of pumpkin pie. I mean, that's important to you. Have that piece of pumpkin pie. But don't have rolls and pasta and pumpkin pie and a Coke and chocolate milk after your workout. That is five servings of carbohydrates that your body is going to turn into sugar.

So think about what's important to you. Just don't waste those calories on things that . . . waste those sugar grams. If you want to get really technical, talk to your doctor about monitoring the sugar and actual grams of sugar in your diet. Most people do well by keeping it under 50. A lot of people do really well if they keep it . . . Getting it under 25 would be awesome, but that's hard to do, because it hides in so many things like ketchup and salad dressing and those kind of things. So decreasing your sugar is really important.

And then there is some data that shows that increasing the good foods in your diet will also help. So the nice thing about this is it's the same diet that we talk about for heart health. So we're not talking about a different liver diet than heart health. The Mediterranean diet is what tends to promote weight loss. It tends to decrease inflammation.

I'm sure you've talked about the Mediterranean diet before, but that's a diet that's high in foods like salmon and cod and fatty fish, and then high in dark vegetables like greens and kale, and adding some nuts.

Now, the key with nuts is measure those nuts because they're very calorically dense, but nuts are a good part of your diet. And by decreasing the empty carbs and adding some of these good nutritious foods to your diet usually you can heal that liver.

Brett: I do think that's something that I haven't done too much, is doing a detailed monitoring of the food that I've eaten, looking at the . . . That's good to know the level for the sugar content to have in a day, because I haven't really tried to measure that. And I think that's a good idea to get started.

I've really struggled about how to start approaching this, whether to start cutting out 20% of my portion size of my meal or whether to just cut out certain foods entirely or whether to do certain things.

One of the questions I had to my doctor, and he was kind of saying, "Yeah, maybe, but you could try these other things," is should I look at going to a dietician to help me get started on this? Or should I start with some more basic steps?

Dr. Pohl: I think consulting with a dietitian is fine. And I think you can talk to your insurance about whether they'd pay for it. I think if you've got inflammation in the liver, they likely will, but sometimes that becomes a barrier. Sometimes insurance doesn't want to pay for that. But investing in that or accessing your insurance for that is a great tool.

One of the things to start with, though, is to start with just the easy things. I'm not getting paid by MyFitnessPal, I promise, but I'm a big fan and I recommend it all the time. Just for three days, if you enter in all the foods that you eat, it'll actually show you how many sugar grams you're eating. Just for three days, enter in all your foods and see at the end of the . . . Don't modify anything. Just enter it in and see how many sugar grams you end up with at the end of the day.

Then you can start thinking about, "Oh, goodness, maybe some of those empty calories that . . . Do I really need the barbecue sauce with the sugar or can I substitute some Tabasco sauce or something else?" So there are some easy substitutes, if you start looking at that.

My suggestion for most people is start monitoring with one of those easy online apps, and MyFitnessPal is pretty easy to use. Just put your information in. You can take that information to your dietician, and then they can help you with some easy substitutions as well.

Scot: Dr. Pohl, it sounds like really the place that you recommend Brett to start is just those added sugars. That's what we're talking about, right? So monitor what you're eating for three or four days and find out what those added sugars are and see if you can get rid of some of those with something else. Is that accurate?

Dr. Pohl: Yes. Get rid of those easy, added sugars. Yes, that's a good summary.

Scot: Yeah. And I will tell you a soda, I think, has like 50 grams of added sugar. And you said you want to try to keep it at 50 grams a day?

Dr. Pohl: Yeah, exactly. So even that one soda is a lot for your day. Now, I don't like to tell people you can never have a soda, but just realize that you're spending those grams of sugar on a drink. Do you really want to do that? If we talk about it as a cost, it's an expensive cost to have all of your sugar in one can of soda.

Scot: We had an episode called "Hidden Sugar." It's really shocking where sugar hides. Like Dr. Pohl said, in barbecue sauce, in salad dressings. We talked about you think you're eating a fruit-flavored yogurt and that's healthy, but there's a lot of added sugar in that. The little packets of instant oatmeal that you get, half of that is added sugar. So it really kind of hides in very insidious ways.

You might be surprised after looking at packages and monitoring just how much added sugar you're actually getting. Even I used MyFitnessPal and I eat pretty clean, and my added sugar was higher than I ever would have expected. So I think that is good advice.

Dr. Pohl: I want to admit that I had been advising people about diet and exercise, and then I looked at my low-fat yogurt and found the exact same thing. It was 24 grams of sugar. So it was a day's supply of sugar in my low-fat, healthy yogurt.

These things that are sold to you in packages, make sure you look at those packages, because a lot of the things in the health food aisle like granola and low-fat yogurt and things that have the word "fruit" on it, fruit snacks, fruit juice, all those things, they're in the health food aisle, so we feel like, "Oh, these must be great." But check those sugar grams because they hide in these "healthy foods."

Scot: Especially low-fat food, because when you take the fat out, you've got to add something back in to make it taste good. And sugar is what they do. They add sugar back in.

Troy: Yeah, I saw something about a junior high that has their healthy foods vending machine, and they would sell applesauce in there. And the applesauce was just selling out like crazy, and they're so excited, like, "The kids are eating applesauce. Yay." Each little thing of applesauce has like 15 grams of added sugar or something ridiculous. It's amazing.

But I went through that same process with yogurt as well. I was thinking I was eating healthy. We had Thunder on here, Thunder Jalili, who talked about hidden sugars. I looked at the yogurt I was eating, same thing, just tons of added sugar. It's just amazing.

Brett: Yeah, I do try and monitor some of that, and I try and not do as many processed meals and things like that, try to make meals from scratch. Even things like pancakes and waffles, I make from scratch so I can see what exactly I'm putting in there, and not relying on a box mix or something like that. I like to make even macaroni and cheese from scratch, but sometimes my kids aren't fooled by the difference between the colors.

But that's the thing. I do like to try and control those hidden sugars after . . . I did listen to that episode, and that's one of the things I tried to control through the recipes that I've gotten. But I'm absolutely not perfect in that way, and I'm eating plenty of things I know are sugary, too, though.

Scot: I'm really trying to make this simple for any guy that's listening, and sometimes it can get really complex and it can get confusing as to "What should I really, really do?"

So I think we've established to really critically look at those sugars. You might think you're doing well, but after a three- or four-day examination, you might discover, "Not doing as well as I thought." So if you can maybe replace some of those calories with healthier choices, limited seeds and nuts and some vegetables, that's another strategy to try.

I think a lot of people don't realize how many calories are in the foods they eat. I think it's really easy to eat way too many calories. So perhaps monitoring those through MyFitnessPal will give you some insight into that.

And maybe really having two or three meetings with a nutritionist also have just a separate set of eyes on what's going on might be advantageous too.

Dr. Pohl, what do you think of that advice? Brett, do you think that's . . . is that a little bit more straightforward of a plan that you think you could follow?

Dr. Pohl: I love that summary. I think it's a great, actionable summary. Brett, what do you think you could do?

Brett: Yeah, that sounds like a very good idea to start monitoring, start there. It's the easiest thing to do for me personally, and it gives me some data to go to the nutritionist and see what to move forward from there.

Dr. Pohl: And the biggest thing is also just talk to your doctor about it and just find out what your level of fibrosis is and what kind of weight loss plan you should be on.

The caution I want to give you at the very end is that dramatic weight loss, which would be something more in the line of two to four pounds a week, we would recommend . . . If you're going for dramatic weight loss quickly, that can actually worsen fatty liver because of the stress that you're putting your body under. So slow and steady weight loss, something in about the range of one to two pounds per week, is kind of that sweet spot of sort of detoxifying your body.

Troy: And how long do you think Brett should give it before he really goes back to his doctor and says, "Hey, I'd really like you to take a look at my liver again and see where things are"? I mean, are we talking a few months, six months, a year?

Dr. Pohl: Well, talk to your doctor about what level of fibrosis you have. And then the goal would be if you're starting to see some changes on the scale, and you've made some changes consistently for at least three months, then go talk to your doctor about whether you should be rescanned and see whether that level of fibrosis is less. Three to six months.

It's interesting to see . . . the studies show that even small amounts of weight loss, like 5 to 10 pounds, which is only a couple of percentage points, can actually make big changes on the inflammatory properties of the liver.

So set a goal of a certain amount of weight loss. But if you've had some success with 5 or 10 pounds, definitely talk to your doctor about if it's time to look.

Scot: I hear Troy's voice in my head right now, Brett. So I'm going to share some additional thoughts here. And I'd like to get both Troy and Dr. Pohl's thoughts on this.

So it doesn't have to be all at once. Don't expect you're going to change overnight what you eat, or you're going to go from one person to another. It doesn't have to be radical changes. You don't have to all of a sudden go to eating chicken breasts and a plateful of vegetables. The nutrition can still be good. Just start making some minor changes.

Is there one thing that you could do in the first week? Maybe that's to eliminate one soda, or maybe that's to eat an extra serving of vegetables. Give yourself a little bit of time, I think, to go through this process.

I think a lot of times we think, "Oh, I've got to eat healthy now." And then that comes with a lot of baggage of what it is you're going to eat, and sometimes then you get miserable and it's not sustainable.

Troy always says just make those little, small changes one at a time.

Troy: Yeah, that's the key too. I think you have to give yourself credit for what you're doing as well. You're exercising a lot. I think that's great. You're doing more exercise, far more, than the average person does. So you really need to give yourself credit there.

Dr. Pohl has given some great advice just in terms of maybe dropping some sugars here and there. I'm sure you'll start to see that weight loss. Again, one pound a week sounds like that's the goal. And as you see that, again, give yourself credit for it. Say, "Hey, I'm making progress. This is where I need to go." It's not a dramatic change. It's going to be something over several weeks and months.

Scot: And that weight fluctuates from week to week, right? So if all of a sudden you gain a pound, don't worry about that. Sometimes it's just the time of day you've weighed yourself on that scale. Dr. Pohl, a half-pound would be fine, right? This is a long-term game right now. He's got time.

Dr. Pohl: Oh, yeah. In fact, if there's no weight loss, but you're making those dietary changes . . . Like I said, if you're exercising and making dietary changes and you're weight-neutral, that's fine. But I just don't want you to go for dramatic weight loss because that can be harmful as well.

Brett: Well, thank you so much. I really appreciate you doing this and for giving me all the congratulations for actually caring about my health. I'll take all the praise I can get, and hopefully I don't die from this soon. No, just kidding. This was very reassuring. Thank you.

Scot: Brett, thank you very much. Appreciate having you on the show. Hope you have a great rest of your day.

Brett: Thank you.

Scot: Awesome. Dr. Pohl, thank you as always. I appreciate your time.

Dr. Pohl: Thank you for inviting me. It's so much fun to talk about health and helping people become more healthy and reach their fitness goals and their health goals.

Scot: Hey, it's me, Scot. You made it to the end. Good for you. That must make you a super fan. Just wanted to throw this out there. If you found this podcast helpful, or if you've enjoyed "Who Cares About Men's Health" episodes, and you know somebody else that could get benefit out of it, please let them know. That's the way we can grow the show.

We'd also love to hear from you at any time. Listener Brett reached out to us so we could answer his question. You can email us at hello@thescoperadio.com. You can also go to our Facebook page. It's facebook.com/whocaresmenshealth. And you can also call and leave a message on our listener line at 601-55SCOPE.

Would love to hear from you. Love it if you'd recommend the show to somebody. Thanks for listening, and thanks for caring about men's health.

Interviewer: So during the summer months, temperatures are rising, people are getting out more, and you might be getting a little concerned about heat exposure and how it might be impacting your health.

We're here with emergency room physician, Dr. Troy Madsen. And Dr. Madsen, when it comes to heat exposure, what do people need to be concerned about?

Dr. Madsen: Well, the biggest thing with heat exposure is just your body overheating. That's where you really start to see issues not just with feeling uncomfortable, but potentially having even a life-threatening situation. Some people . . . you know, you may be familiar with just being out in the heat, you've been hiking or on your bike, or you know, whatever you might be doing, and you're probably familiar with that feeling of just feeling thirsty and tired and maybe a little bit nauseous and maybe a little bit of a headache. Well, at that point, you may be experiencing what we call heat exhaustion. But the big risk becomes when you move beyond that, and your body temperature continues to rise. And then you can experience what's called heatstroke. And that becomes a much more serious thing.

In those situations, your body temperature is often very high. You can have damage to the organs in your body, meaning damage to the kidneys, even potentially the heart, the brain. And in some of those situations, when you hear about these stories of people in places where there is just extreme heat and people are dying of the heat, it is often because of heat stroke that that's happening.

Interviewer: Yeah, we hear about these deadly heat waves and things on the news. And it's, you know, what does that even mean? We're talking like organ damage. Like the heat is getting so high that . . . are you talking brain? Are you talking heart? Who is at risk, and what is it actually doing to the body?

Dr. Madsen: It's exactly that. The body is getting so hot that it is leading to damage and breakdown of the tissues in the brain, the heart, the kidneys. Sometimes part of that is dehydration that's contributing to that as well where that's affecting your kidney function. But in terms of risk, there are a few groups who are really at risk of this. Number one is people who are experiencing homelessness, who may be out in the heat, aren't in a cool place. Other people who are out doing outdoor activities. And maybe you find yourself in a situation where you're out, you're exposed, you know, there's no way to really cool down, maybe you didn't bring enough water along on your hike or your bike ride.

But then there are also certain groups that are really at risk. And these are the very young and the very old. So young babies, infants, and then older people have a tougher time regulating their body temperature. So you might be out, and let's say you take your baby, you know, in a stroller, you're out on a walk, or you go to the zoo or something and you're feeling okay, or maybe you're feeling just a little bit of a headache or a little bit hot. Your baby could be experiencing very severe symptoms in that situation. So if you live with the very young or the very old, just be aware that if you're not feeling great, they're probably experiencing a whole lot more of the heat and much worse effects than you are.

Interviewer: So it sounds like heat exposure affects basically anyone and everyone if you don't, you know, take the right steps. What are some of the ways that a person can, say, prevent heat exhaustion and then later heat stroke?

Dr. Madsen: Well, the biggest thing, you know, is to try and be in a situation where you can cool down. If you're out on a hike or you're out somewhere in the outdoors, try to go in shaded areas, ideally areas that have a water source, something where you can cool down if you need to. Carry plenty of water, you want to make sure you have lots of water with you. The general rule of thumb is 16 ounces of water per hour. I tell people start with at least eight ounces if you're just doing moderate activities. Sixteen ounces can be a lot to carry if you're out on several hours, but try and do that if you can, or at least know where you can get some water.

The big thing I would suggest too is if you have elderly parents, relatives, friends, neighbors, check in on them. One of the sad things that sometimes happens is older people, especially right now, may not have checked their air conditioner, may not know if it's working, or it may work and then it stops working. And sometimes a very sad thing we see is people in this situation then are either embarrassed to reach out for help or don't know who to call for help. And the house temperature gets very hot, and they experience severe symptoms with heatstroke or even death. So check on those people. If you have babies as well, just be aware that they can experience these heat symptoms much more than you may be experiencing at that same time.

Interviewer: So heatstroke, something to keep in mind, something that could be very, very dangerous. ER-worthy if it gets bad enough?

Dr. Madsen: Absolutely, yep. If it's bad enough, if you have a family member or yourself who's just confused, not feeling well, absolutely, get to the ER. Try to get cooled down quickly. Call 911 if you need immediate help.

Interviewer: So a little bit of elbow pain if you're a pitcher in baseball is okay, but if it starts to get pretty severe, you're going to want to do something about that.

Dr. Chalmers, how much elbow pain for a pitcher is acceptable? And what's kind of the threshold that you maybe want to have somebody look at what's causing that pain?

Dr. Chalmers: Yeah, we've done some studies that have helped to inform of us of that. And I think one thing to understand that it's not a normal human motion to pitch a baseball. There's nothing we're evolved to that makes us good at pitching a baseball. And there's a lot of adaptations pitchers undergo, as they pitch through adolescence, that help them to become better at it for sure.

But we've done two studies that I think help and inform our thinking about this. We did a large study of youth baseball players, kind of youth and adolescent baseball players, where we asked them whether or not they have pain. And about 30% of kind of normal, uninjured players will say they have regular pain with play. Now this study we did, though, I think is even more informative is we took pitchers and we had them throw through a simulative game. So they threw 90 pitches kind of in simulated 15 pitch innings. And what happened is that . . . and we collected pain scores and fatigues scores, and what we found is that as pitchers get towards that sixth inning, pain scores start to creep up to somewhere around 1 or 2 out of 10, which just kind of still qualifies as minimal to mild amount of pain but not zero pain.

So I usually tell pitchers, if you're throwing and you're getting above a 2 or a 3 out of 10, that that's not normal, it's not expected, it's not something that can be just swept under the rug with the classic saying of, "There's no crying in baseball," and that it's something that probably you should look into. But if you're having a little bit of soreness, 1 or 2 out of 10 with heavy use six innings of pitching, that's probably very normal and something that you could expect with this particular sport.

Interviewer: How do you, when you do the 1 to 10 ranking, help somebody understanding like what a 1 what might be? Because somebody's 1 might be somebody else's 6.

Dr. Chalmers: Well, no, I think you're right. I mean, I think this is always the issue with pain is there's no objective measure of pain. We have no way to measure that in a way that can be comparable between patients. We have the subjective scale. Usually, the ways that we qualify that are, you know, the number, which can be hard, the words which to say mild, moderate, severe, mild being kind of a 0 to 3, moderate being 4 to 6, and severe being 7 to 10. And then the other way we use this is the scale called the Wong-Baker Scale. It has this . . . you know, starts with a smiley face at zero and like a very unhappy face at 10. I usually think of 2 out of 10 as being a place where there's still maybe a little bit of a smile if you have a really good game, but definitely there's some grimacing if things get bad. And if you start to get to the place where there's no longer a smile on your face, then probably it's too much.

Interviewer: And that's during. What about pain afterward? How long until that pain would go away for kind of the average player?

Dr. Chalmers: Well, usually what I tell people is that you should be able to do what you're doing in a reproducible way every other day. So if you feel like I could pitch like this every other day, then that's a right amount. If you feel like, "Ah, I need four days to recover from this pitching outing because it was so painful or took that much recovery," then what you're doing is too much.

Interviewer: And you said, you know, the saying is, "There's no crying in baseball," and sometimes pitchers tend to be a little tougher than the rest. If somebody is having elbow pain above the threshold you described, what are some of the downsides to not having that looked at?

Dr. Chalmers: Yeah, there are definitely downsides to just pitching through significant pain. The significant pain can be a sign of a substantial injury to the elbow. So, for instance, if you do have ligament tear and you're trying to just work through it, I've definitely seen players that years later have developed arthritis in their elbow or they have bones spurs that have worked to kind of help the elbow to stabilize even though the ligament is not functioning properly. So there's definitely a downside to thinking, "I'm just going to push through this."

Interviewer: And then, what about the repair? Some of these elbow surgeries can take a long time for patients to recover. Do you think that plays into why perhaps sometimes pitchers choose to play through it, because they don't want to be out of the game for any period of time?

Dr. Chalmers: Yeah, I think that's definitely part of it, is that pitchers think, "Oh, I can't afford to take 12 to 18 months off." So, if you know that there's a solution that can get you back in six months, that's the length of the offseason, and I don't think you need to worry so much about, "Oh, I'm going to lose next season." So it's definitely worth if you're having pain thinking, the very least get it looked at the end of the season, to see maybe if there is something that can be done that could still you get back in time for next year.

Interviewer: Yeah, and new procedures are coming along all the time that have shorter recovery periods. So even if you are of the opinion or if you've heard, "Well, if I get this done, I'm going to be out for 24 months," that might not be the case anymore.

Dr. Chalmers: Oh absolutely. And not only that but if you're listening to this and it's two years from now, let me tell you, it's going to be even better, because we've got all sorts of things coming down the line that will help to bring down recovery periods for pitchers in the future.

Interviewer: Yeah. So, if you have some elbow pain while you're pitching, there is something you can do about it and actually something you should do about it. And there's a new procedure that might be the thing that you need.

Dr. Peter Chalmers is an orthopedic surgeon. He's an elbow specialist. He's also the current team physician for University of Utah baseball and Salt Lake City Bees Triple-A baseball. So if somebody does have elbow pain while they're pitching, where do you start with that diagnosis, Dr. Chalmers?

Dr. Chalmers: Yeah. Absolutely. So elbow pain during pitching, it's not normal to have really, really a sore elbow with pitching. And there can be a couple of different causes, and some of them can be problematic for the future for a pitcher. So, definitely, I think it's worth, after a period of rest, if the pain doesn't go away, seeing someone to be fully evaluated with, you know, having someone take a look at the elbow, and then potentially getting an MRI to take a look at the cartilage and the ligaments within the elbow.

Interviewer: All right. And if the condition happens to be something called an ulnar collateral ligament injury, then there's a procedure that's been used for a long time called Tommy John surgery. Tell me a little bit about that, and then we're going to talk about the alternative, which could be better for some patients.

Dr. Chalmers: Yeah. Absolutely. So, for a long period of time, if you tore your ulnar collateral ligament, the ligament on the inside of the elbow that basically holds the upper arm and the lower bones together when you pitch a baseball, if you don't have that ligament, those bones try and fall apart, and it's basically not possible to pitch a baseball. If you tore that ligament, historically, then your career was just over.

And there was a pitcher named Tommy John, who had that injury, and he went to a surgeon who said, "Well, there's got to be something we can do," and they invented this procedure to reconstruct or rebuild the ligament using a tendon graft. And that actually works pretty well, but it has a very long recovery. It takes about a year to get back to play because the new tendon has to become a ligament over the top of the old ligament. And that process is very slow.

So that was the historic way that we would treat ulnar collateral ligament injuries, and the pitcher that first underwent it, his name was Tommy John. So they're commonly referred to as the Tommy John ligament or Tommy John surgery.

Interviewer: And now there's a new procedure. So I've heard that considered called reconstruction, and now there's a new procedure that actually just repairs the ligament and has some better outcomes. So tell me a little bit about that.

Dr. Chalmers: The good thing about many of these ligament tears is often the ligament is torn right off of either the upper arm bone or lower arm bone side. And the ligament itself is still good quality tissue. So, historically, we would replace that whole ligament with a new tendon graft.

The new procedure is to repair the patient's own ligament and allow their own ligament to serve as their ligament going forward. That has a much quicker recovery and can get pitchers back to play in six months. So that's been a huge advance in our treatment for this injury and has certainly, for a lot of our players, granted them ability to get back to another season or even sometimes to get two seasons in depending on the timing.

Interviewer: So, when you're working with a pitcher, how do you determine which one of these two that you're going to use?

Dr. Chalmers: So there's a number of factors that go into that. Certainly, the appearance of the ligament on the MRI and the location of the tear play a role, but often during surgery, we'll also assess the quality of the tissue. And if the tissue is robust enough, then we can use the patient's own tissue to do the repair.

Interviewer: If it is an option, then is it just as good as the Tommy John surgery? You said, definitely, you could get back to playing faster. Is it as a robust of a repair?

Dr. Chalmers: It may be better.

Interviewer: Oh.

Dr. Chalmers: Some of our early data suggests that the rates of return to play may be higher after repair than they are after reconstruction.

Interviewer: And I understand another advantage of the ligament repair is if you have a younger athlete, that this would be an option where Tommy John surgery would not be an option. Tell me about that.

Dr. Chalmers: Yeah. Definitely, younger athletes have the highest capacity for healing. And so, in a younger athlete, this surgery can work very, very well, and that's who it's been performed in mostly to date. But in someone who's really young, if they have open growth plates, you may be concerned about performing a surgery with a ligament graft, where we may have to drill tunnels in the bone that may disrupt the growth in the future. So this is a nice option for that patient population.

Interviewer: And what does the recovery look like then? You said that the recovery is faster. You know, Tommy John surgery could take up to a year. How fast is this recovery, and what's the rehabilitation process like?

Dr. Chalmers: So as early as two weeks out from surgery, the patient begins moving their elbow. About a month from surgery, they begin strengthening. And the whole goal here is that you have to start strengthening early because as early as three months out from surgery, the pitchers will start throwing again.

Interviewer: Wow.

Dr. Chalmers: And the goal then is to get back to full play with full velocity, pitching full games by six months.

Interviewer: That sounds pretty amazing. Is that pretty amazing from your perspective as an orthopedic surgeon?

Dr. Chalmers: It's a huge advance. It's a huge change over the year, sometimes 18-month recovery we saw historically with reconstruction surgery.

Interviewer: Are there downsides to this type of repair?

Dr. Chalmers: Well, it's a relatively new option, and so we don't have 5 or 10-year outcomes with it so far. But so far, it appears to have few downsides as compared to the reconstruction. There had been some concern that if you do this surgery, it may make another surgery in the future more difficult. And so far, those have not appeared to be true, but there have been very few of those performed because it works so well.

Interviewer: And it sounds like this is a very specialized procedure still at this point. What advice would you have for somebody choosing an orthopedic surgeon to do this type of procedure?

Dr. Chalmers: Well, I think that one of the most important things patients need to understand is that surgery itself is a technical skill, and it's important to find a surgeon that you feel like performs enough of those procedures to feel competent at it. So, as a result, I think when you look for a procedure that's less common like this, you need to find a surgeon that feels comfortable and performs enough of them, that they'll have already worked through the kinks and make sure that they're not going to have any problems performing this procedure for you.

That's one of the benefits of coming to a place like the University of Utah, where you have specialists in a large variety of areas. It allows each of us doctors to find a smaller niche and then, as a result, to be better at what we do.

Interviewer: I want to talk a little bit about this procedure. So what is, in your mind, the youngest patient that you would do this type of a procedure on?

Dr. Chalmers: One of the things that is unique about this area of the elbow is that right above the ligament is a growth plate. So for people who are skeletally immature, it's very rare to have the ligament be injured. And the vast majority of those that are skeletally immature, the growth plate itself sees most of the injury, if there is an injury. As a result, we very rarely perform this procedure for anyone under the age of 14 really.

Interviewer: Is there anything else about this procedure that you feel that a patient or a patient's parents would be interested in hearing that I missed?

Dr. Chalmers: One of the things that I think is really interesting about this procedure and really important for people to understand is that we've talked historically about the reconstruction and the tissue within the reconstruction as though we can make you a new ligament. But I will tell you that the tissue that we bring in from somewhere else is not the same as what you were born with. It doesn't have the same nerve fibers. It doesn't have the same pressure fibers.

And we demonstrated that actually pretty elegantly recently in a study we did with the Angels, where we looked at the changes in reconstructed ligaments as compared to non-reconstructed ligaments over the course of a single season or off-season on ultrasound, and found actually that the ligaments that had undergone a prior reconstruction respond differently to stress than native ligaments. And I think that's probably because they don't have all of their normal sensors within them.

So one of the big benefits of this procedure is that it preserves all that. It preserves all the normal pressure sensors and nerve fibers within your own ligament and allows it to respond normally to stress in the future. So that's a real benefit of this procedure over the reconstruction, and one reason why I think we're probably going to head more and more in this direction in probably a lot of areas of our field in the future.