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

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

Scot: Wow. Man.

Mitch: Whoa.

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

Scot: Yeah. How about you, Mitch?

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

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

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

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

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

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

Troy: Hey, Scot. Good to be here.

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

Mitch: Hey. Happy to be here.

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

Jonathan: Hey, guys. Good to be here.

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

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

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

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

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

Mitch: Literally?

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

Troy: This is in your 20s?

Jonathan: In my 20s, early 20s.

Troy: Wow. Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

Scot: Yeah, let's get it right.

Troy: A jaunty hobble.

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

Troy: It was a spirited, jaunty hobble.

Jonathan: A spirited hobble, yeah.

Troy: That's right.

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

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

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

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

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

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

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

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

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

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

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

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

Mitch: Oh, interesting.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scot: What is a physiatrist then?

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

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

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

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

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

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

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

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

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

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

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

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

Scot: And what did you do, Jonathan?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scot: Yeah, totally.

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

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

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

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

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

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

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

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

Jonathan: Yeah, I did.

Troy: Nice.

Jonathan: Pulled the thread on that a little bit.

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

Troy: That's great.

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

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

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

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

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

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

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

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

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

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

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

Mitch: "You can hobble."

Scot: Yeah, you can hobble.

Troy: Exactly.

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

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

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

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

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

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

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

Mitch: Yeah, catch a bus.

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

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

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

Thanks for listening, and thanks for caring about men's health.
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Contact: hello@thescoperadio.com
Listener Line: 601-55-SCOPE
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This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Welcome to a very special Valentine's edition of "Who Cares About Men's Health." Did you hear that, Troy? Did you hear what . . .

Troy: That wasn't me. That was Mitch.

Dr. Smith: That was Mitch 100%.

Mitch: All of our very special episodes give me such anxiety. What is the topic today, Scot? Let us hear. What's Valentine's Day going to be about?

Scot: Yeah, you guess what our topic for Valentine's episode is going to be?

Mitch: I don't know. Emotional openness or . . . I don't know. What is it?

Scot: Vasectomies.

Mitch: You know what? I'll give it a solid B-plus. I think this is a good thing. Yeah, love this. Okay, great.

Troy: It works for Valentine's Day.

Scot: Does it? Did you get the tie-in? I was afraid you wouldn't get the tie-in.

Mitch: No, I feel it.

Troy: V-Day has a whole new meaning.

Scot: Actually, a vasectomy could be an amazing gift because women have traditionally borne the responsibility of birth control, right? And sometimes it impacts their hormones, and some of it is uncomfortable, and some of it is a daily grind, it's a responsibility, or all of the above, right? So what if you could take that weight off of your wife and put it on you?

From what I understand, a vasectomy is one of the most effective forms of birth control, and it can remove a lot of stress when you're having sex. But there are some crazy things on the internet about vasectomy side effects, and there are also some legit concerns. And we're going to find out what's legit, what's not, plus also how to figure out if vasectomy is right for you and your partner and what to expect.

This is a Men's Health Essentials episode about vasectomy for the vasectomy curious of "Who Cares About Men's Health," providing information, inspiration, and a different interpretation of men's health.

My name is Scot Singpiel. I bring the BS and I'm on Team V. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. I just want to know did you give your wife a vasectomy for Valentine's Day? Is that how this kind of all came up?

Scot: No, I got it a couple of years ago.

Troy: But not on Valentine's Day.

Scot: But not on Valentine's Day.

Troy: I just wanted to know how many men have actually done that.

Mitch: What do you put in a box or card for that?

Troy: Yeah, exactly.

Scot: Always with his unique perspective, Mitch Sears.

Mitch: Hey. Hello. I'm not concerned about this, but I am curious to learn more about it.

Scot: All right. And the most manly guy on the planet because, get this, he performed his own vasectomy on himself.

Troy: This is amazing. This actually blew my mind when I heard this, so I hope you're going to describe this in detail for us.

Scot: It's urologist Dr. John Smith on the show.

Dr. Smith: Man, I thought my wife was the only person who loved to start conversations with that story.

Troy: That is seriously the manliest thing I've heard.

Scot: I know.

Troy: I have sutured myself up and I tell people that, and they're like, "Whoa, are you serious?" But to tell someone I did my own vasectomy, that would just be next level. I've never heard of that before.

Scot: Yeah, on a scale of one to awesome, how do you feel about that, Mitch? That John did . . .

Mitch: I just can't even imagine. Did you have to? Were you in an emergency vasectomy situation, or what was going on?

Dr. Smith: I mean, all of that is up for interpretation. My wife and I had surprise twins during the beginning of the pandemic, and that was a shocker. And so once we had the twins, she literally looked at me and said, "When are you getting your vasectomy?"

Scot: And going to another provider never was something you considered?

Dr. Smith: I mean, I considered it. I probably should have done it. I mean, probably not the brightest move I've ever made in my life, but it's worked out just fine. I mean, it was one of those where someone no-showed their vasectomy. I wasn't going to throw that stuff away, so I made the executive decision to just do it.

Mitch: You just sat down and did it?

Dr. Smith: Yeah.

Troy: And just to clarify for any listeners who are thinking of doing this, this is a . . .

Dr. Smith: Don't.

Troy: . . . procedure you do on a regular basis.

Dr. Smith: Oh, yeah. I mean, volume-wise, I'm one of the highest-volume vasectomy folks at the University of Utah.

Troy: So this is not an unfamiliar procedure. But you did it on yourself. That's amazing.

Scot: This is a "don't do it at home" sort of . . .

Troy:Yeah, don't do this at home.

Dr. Smith: I would not take what I did and make it something that's the smartest thing I've ever done.

Scot: So, as a guy who had the procedure, I had a misconception. I thought that I was going to show up and there was going to be an operating room full of people, right? I thought there was going to be just a ton of people, but there wasn't. There was one guy. That's one of the things we're going to talk about, one of the misconceptions people have.

But before we get into that, John, what are some of the crazy things that men hear about vasectomy on the internet that they ask you about?

Dr. Smith: I mean, a lot of them will come in and they'll be like, "I'm going to be able to have an erection? I'm going to be able to . . . I'll still ejaculate? This won't impact my testosterone levels? I'll still feel and have testosterone?" Pretty much anything that you can think of when it comes to your genitals being in the crosshairs. There's a lot of misconception out there.

Scot: And it's not true. All those things you said . . . I'm not going to all of a sudden have the desire to start watching Hallmark Channel movies or something, right? My voice isn't going to get higher.

Dr. Smith: No, not at all. And so yeah, a lot of the misconceptions are there. It doesn't change erectile quality. It doesn't even change the amount of ejaculate. The sperm themselves make up about 5% of the ejaculate. And so there's not even a really noticeable decrease in the amount of ejaculation. Your testicles make the testosterone and sperm. They don't stop making testosterone because you got a vasectomy. All those things are all misconceptions.

Scot: Mitch, Troy, have you heard about any kind of crazy things about vasectomy that you've wondered about? I've got one here that I saw on the internet.

Mitch: Yeah. The big one that I've ever heard and when I've talked to people before, they're like, "Ew, no, I'm not going to do that," is the sexual dysfunction stuff. It's the, "I won't be able to ejaculate again," or, "It won't be the same," or, "I won't have . . ."

Scot: Or the pleasure, right? It's going to be less pleasurable.

Mitch: Yeah. And I guess none of that is true.

Dr. Smith: It'll be less pleasurable if you had another kid that was screaming in the background. I'm just kidding. That was terrible of me. But consequence-less intercourse does have its appeal.

Scot: Yeah. And on the other hand, it's really almost freeing. It can make sex better because it's one of the most effective forms of birth control, if I understand correctly, right?

Dr. Smith: Yeah. It's very effective. The pregnancy risk after a vasectomy is 1 in 2,000. And that's not 1 in 2,000 ejaculations, by the way.

Scot: Sure. Okay. I mean, it kind of just makes things freer. And then knowing that I took the responsibility on and my wife doesn't have to go through the stuff she used to have to go through anymore, I think it's cool. I mean, that's my take.

I've seen on the internet that sperm will build up and that could be a problem. Is that true?

Dr. Smith: Very rarely is that a problem. There's a 1% risk of chronic testicular pain after the procedure, which that is one of the possible reasons you could have the chronic testicular pain. But oftentimes, that is not the case. The sperm have a life cycle, they die, and then they're absorbed by the body, so it doesn't really hold true.

But some people do notice chronic testicular pain and they get a vasectomy reversal and the pain goes away. So there is some thought that there may be some truth to that, but it's not a common thing.

Scot: I will admit that was the one potential side effect that I was concerned about, because that could impact your life for the rest of your life. But it's a very, very low chance.

Dr. Smith: You've got a 1% chance of chronic testicular pain is what most of the literature will say. That chronic testicular pain, often there are ways to mitigate that. It sometimes will involve another procedure or another surgical intervention to get rid of that pain. It is a rare occurrence. But when it happens, it's definitely not something that you're going to be like, "Man, I'm so glad that happened to me."

Scot: Troy, any misconceptions you want to clear up?

Troy: I don't know if it's a misconception. I know some people have talked about some of the pain they've experienced after a vasectomy and . . .

Scot: Like just procedural pain? Pain from the procedure itself?

Troy: Yeah, procedural pain. And I know it's a common procedure to have around the Super Bowl. I think some places make a big push then because the idea being that you're going to just sit on the couch all weekend and have an ice pack on your groin to ease the pain.

Scot: Or March Madness, right? You've got an excuse to sit around and do nothing.

Dr. Smith: We've done a Vas Madness a few years.

Troy: Vas madness, yeah.

Dr. Smith: Where you get them in and do it before the tournament.

Troy: And is that common? Are people typically saying, "Hey, I'm just going to have to sit on the couch for two or three days because it hurts too much to walk"? Or is that more of an excuse to watch a lot of basketball?

Dr. Smith: I'm not going to sell anybody out here. Most of the time, we recommend after the procedure to take it easy for a couple of days, about 48 hours after the procedure. Some folks are a little bit more aggressive. Some folks are a little bit more conservative as far as telling you to take it easy for four or five days.

I usually tell my patients ice 20 minutes on, 20 minutes off, for the first couple days and then get back to your routine as it feels okay. No heavy lifting for about five days after the procedure. You can't get in a pool or hot tub or submerge it in water for about 10 to 14 days while the small incision heals. Other than that . . .

I mean, some people will tell you that you can have sex within a couple of days. Some people say wait a week to have sex. It varies between who does your procedure.

Some people will say you can shower the night of the procedure. Some people say to wait to shower a couple of days after the procedure. Again, there's not a huge variety of people that are getting infections or anything from this.

Troy: No running?

Dr. Smith: I usually tell people they can go running when things feel better. I can tell you that I know a couple folks who went golfing the day after they did their vasectomy. Not that they did their own, but after they had their vasectomy done. And they said they were fine. There were no problems.

The big thing that you worry about when you are too active too soon is a small blood clot in the scrotum. Not the kind that goes to your heart or lungs, but a hematoma is what they'll call it. Just a collection of blood in the scrotum. And it makes things a lot more sensitive and painful during the recovery and makes the recovery a little bit more miserable for a couple of weeks.

Scot: Also, I've read that some people are concerned it can cause prostate cancer or it's been linked to cardiovascular disease. Talk about that. That's not true, though, is it?

Dr. Smith: No. A lot of that has been debunked. I mean, there's a lot of literature out there about other things as well that say that. But there's no clear link to getting a vasectomy and then having prostate cancer. There were some articles that came out and most of that has all been debunked, and it's not true.

Scot: And then I didn't know this. There's a no-scalpel vasectomy. Is that kind of the common way now, or what?

Dr. Smith: Well, it's all a gimmick, right? You've got to open up the scrotum to get where you've got to get to start. So it's one of those where you've got to make a hole in the scrotum at some point, whether you poke a hole with a sharp instrument, whether you use a scalpel, you've got to open it up anyway. There's no magic to just the vas deferens just coming out without making some kind of an opening in the skin.

Scot: Do I need to be concerned about, first of all, the way they're making the hole? I mean, is one way any better than the other really?

Dr. Smith: Honestly, no. I mean, the scrotum is very robust as far as its healing capacity it's going to be fine. In three to four weeks, you're not even going to know that somebody was there regardless of how they got in.

Scot: All right. And then as far as how they're actually going to . . . if they're tying or if they're cauterizing the vas deferens, does that make a difference? Should you request one over the other?

Dr. Smith: Well, most people will cauterize and then do something else, or just cauterize. And so the cautery is the one thing that the American Urologic Association says is best practice, is to have mucosal cautery of the lumen of the vas deferens. And so that's something that I'm pretty sure everybody does.

And then on top of that, some people will put clips. Some people will do something called fascial interposition. And that's pretty much where there's an opening in the fascia of the scrotum, and sometimes you'll tuck one end of the vas deferens underneath and put a clip or a stitch over the top of it.

So it's kind of like putting one of them in the basement and one of them in the upstairs so that they can never meet again, is kind of a way to think of it. They call it fascial interposition.

Some people will just tie a ligation stitch around both ends. I mean, there are different variations. You could talk to 50 different urologists and have 50 different ways to do it.

Mitch: What's the thinking behind that? Is it just if the two somehow accidentally meet up again it will heal?

Dr. Smith: Right. So the thought is that you can have someone who's . . . I call them super healers because I don't know of any other way that this happens. But where you can have those mucosal ends grow back together and just recanulate and make a tube again.

I mean, that happens. Very rarely does it happen. I have a friend of mine who actually had it happen where he had a vasectomy done, and he told me he actually had a second vasectomy done. I haven't confirmed that in his medical records, and he still says he has active sperm.

Mitch: Is he Wolverine?

Dr. Smith: He has to be, man. I checked for adamantium, but I did not see any on first glance. I'm not sure.

Troy: Did he know it had reconnected because he had another kid, or what? How did he find out?

Dr. Smith: Usually, we have folks get a semen analysis in 8 to 10 weeks. Some people say six to eight weeks. Again, it varies between folks that are doing this. You get to a semen analysis that looks to see if there are any mobile sperm, how much sperm there are if there are any, and if they're moving. And that gives you a good idea of whether you should lose the protection or not.

Troy: Well, speaking of reconnecting . . . I'm going to put this out there as a misconception, and maybe it's not. But the misconception being that it's very easy to reverse a vasectomy. If you get it done and you want to have it reversed in five years, it's a simple thing to do and you can go on and feel confident you're going to have kids at that point. Is that a misconception?

Dr. Smith: So a lot of it depends on time. The vasectomy reversal can be done. The longer that things are scarred down, the less successful the reversal is. But the reversals are pretty successful. I mean, a high number, we're talking three-quarters or more of them, are able to have sperm there after the reversal procedure. Also, individual doctors have different kinds of success rates that they'll quote you.

The thing that you've got to realize with that, though, is insurance is not going to cover that. So you're going to hit that on your own. It's going to cost you $6,000, $8,000, $10,000, depending on where you get it done, cash to do that.

Obviously, insurance paid for you to get a vasectomy so that they wouldn't have to pay for another kid. And so a lot of that becomes out-of-pocket expense for the person who gets the reversal.

Scot: So I think a lot of guys want to know what the procedure is like. It was almost a non-event. I was a little intimidated going into it. Like I said, I thought it was going to be this big procedure. I think it was done in like 15 minutes. The pain wasn't super bad. I went and bought a couple bags of peas and iced like I was told to and took it easy for two or three days, and everything was great.

I'd read some of the crazy stuff, that it was going to decrease your sexual pleasure, and yadda, yadda, yadda, and none of that happened. And it just feels great not having to worry about it. Is that pretty accurate? Did I describe the procedure pretty well? I mean, just kind of the overview, John?

Dr. Smith: Yeah. I mean, it's a simple procedure that's done in the office. And I don't want to simplify anything because surgery is never a big deal until it's on you. And then obviously, when it's on your genitals, it's an even bigger deal. But it's a very commonly done procedure. It takes 15 to 20 minutes, maybe 30 minutes, in the office. It's minimally invasive. I do mine through a single incision that's about a centimeter to a centimeter and a half long. Numb things up with lidocaine and just take care of it.

Scot: Don't even feel it. Don't even know. It is kind of weird though because you're sitting there in a chair, and you're kind of watching the doctor do it, but you're not seeing what the doctor is doing, because you've got some blankets or something up there. So you know something is going on and you're actually kind of seeing that something is going on, but I didn't feel a thing.

Dr. Smith: Yeah, once you're numb . . . I mean, the worst part is the numbing. When I did mine, that was the worst part, was getting numb. And most men when they're done, they're like, "Oh, the numbing was the worst part. After I realized I was numb, I could just relax and hang out."

Scot: I don't even think the numbing was that bad, really. I don't remember it.

Dr. Smith: Listen to this guy. What a tough guy. "It didn't even bother me, man. My name is Scot."

Scot: I still don't measure up to you, but . . .

Troy: Yeah, I think you're trying to outdo John on this one, Scot.

Dr. Smith: It hurt, man. I did not like numbing it up. I'm not going to lie to you. That was the worst part by far. But again, once it's done, that is the part that people say is the worst.

And then you had a great recovery. Most people do have a good recovery like that. I was very similar to that. I had some minimal discomfort for a few days. Bruising for 7 to 10 days in and around the scrotum.

I did not get a hematoma, thank goodness. I mean, they happen about 1 in 20 to 1 in 30 vasectomies. So they're not super common, but they're the most common "complication" that you have after the procedure. If you do get one of those, your recovery is not quite as fun. I tell you guys it gives you the man flu for a couple of weeks. You're not going to want to do much. But that's kind of what to expect for it.

A lot of guys come in they're like, "Man, I was really worried and scared about this and it wasn't as bad as I thought." I hear that quite a bit.

Troy: And you mentioned insurance coverage earlier too, John. It sounds like this is covered by insurance.

Dr. Smith: So a lot of insurances will consider this preventative care. You need to check, obviously, with your insurance company. But if you think about it, it makes sense for them to pay for a vasectomy. Then you don't have to worry about taking care of another kid on the insurance for 18 years, or 26 years. And so a lot of them will have that.

So we'll have a mad rush at the end of the year where people think that they've met their deductible and they need to go get their vasectomy. But then a lot of times, if you look at your insurance coverage, you could have done it into March, April, May, it didn't matter because it was considered preventative care.

Now, not every insurance is that way, but a lot of them are because it's advantageous for them to obviously have that done to decrease another kid coming on to the policy.

Troy: Yeah, a calculated decision on their part.

Dr. Smith: Yeah, exactly.

Scot: As we get ready to wrap this up, what type of guy would be a good candidate for a vasectomy? Are there some people that are better candidates than others?

Dr. Smith: Almost everybody is a good candidate. Oftentimes, if there is a difficult exam or something where we think it needs to be done in the operating room, it can be. Most everyone is able to be done in the office.

Obviously, a good candidate would be someone who's not interested in fertility any longer and does not want to have any more children. And so those folks would want to come in.

We have them have a consultation to go over all the risks/benefits before they have the actual procedure, and then come back for a second visit for the actual procedure. That way, they have the ability to do that.

Also of note, when we talked about insurances, government insurance makes you wait 30 days from a consultation to have the procedure done so that you have time to think about it.

I was told when I did my training that that was because some places were doing the vasectomies on people who were in mental hospitals, things like that, without consent. And so the government changed it to where they had to have consent and wait 30 days, and yadda, yadda, yadda.

But all of the government insurance does require a 30-day wait period and a form to be filled out. So Medicaid and other government insurance, you have to do that.

Scot: Something I remember, I had my consult and they asked me the same thing. They asked me how many kids I have. Zero. "Are you positive that you don't want to have kids?" Well, I'm to the age and my wife's to the age where that's probably not even a smart thing from a health standpoint, and we've decided that that's the case. And they did ask if I talked to my wife about it. You would recommend that as well? This is a conversation that should be had between both partners. You shouldn't just go out and surprise . . . do the Valentine's Day vasectomy surprise.

Dr. Smith: Right. If you've already had that conversation with your partner, and you guys have decided that's not what you're going to do, then I think you're pretty safe. But I think it is a wise thing to talk to your partner. If you don't have a partner, then obviously it doesn't apply.

Troy: And I have to ask this too, John. Let's say someone out there is thinking they're not married, but they don't want to worry about the issues with possible pregnancy with partners, and so they decide to have a vasectomy. How effective is a vasectomy at preventing STDs?

Dr. Smith: It's not at all.

Troy: So you're still using a condom for those guys.

Dr. Smith: Yeah, absolutely. I mean, that's not going to stop an STD in their tracks at all. That's just going to make it so you're not going to get someone pregnant, but it's not going to stop transmission of any of that stuff.

Scot: By the way, I think Troy knew the answer to that question.

Troy: I had to ask it.

Dr. Smith: Was Troy baiting me in?

Troy: I was baiting you. I had to ask it. I think that maybe potentially that could be a misconception, that you think, "Hey, I had a vasectomy. Great. I don't have to worry about pregnancy."

Scot:Yeah. Woohoo.

Troy:You're right. Not a big concern. Far more effective at preventing pregnancy than condoms or oral contraceptives, but doesn't do anything for STDs.

Dr. Smith:Absolutely.

Scot: Yeah. You might forget that. I could definitely see that.

Well, if you're considering having a vasectomy, of course, if you have any concerns or questions, if you've seen something crazy on the internet that we didn't address today, then definitely talk to a urologist.

If you have other concerns, like what it's like, for some reason other guys that have had them, it's been my experience, love to talk about them. I don't have any qualms about it.

I don't know if there are some people that think it makes you less manly or anything like that, but from my personal experience, I'm really glad that I got one.

I will admit it was a little strange thinking that this is it. I've made the decision that under no circumstance . . .

You do consult men that this is not a reversible procedure, even though there is potential to reverse it if you've got the cash and if you do it soon enough?

Dr. Smith: Correct. I usually tell people that this is reversible, but I don't do it to be reversible.

Scot: Yeah. Right. Your job is to do it so it works and those things don't grow back together. But beyond that, I mean, it's been great. So I would highly recommend it if you are done having children and you don't want to have to worry about birth control anymore.

Dr. Smith: I concur.

Scot: If you have any questions, you can email us. The email address is hello@thescoperadio.com. And we've just given you a Valentine's Day gift idea, so you're welcome. Just don't make it a last-minute gift. Have that conversation.

Troy: Last-minute gift. Yeah, it sounds like maybe the gift would be proposing the idea rather than coming home and showing the incision on your scrotum.

Scot: Yeah, that's a good idea. Thank you for listening, and thank you for caring about men's health.
Relevant Links:

Contact: hello@thescoperadio.com
Listener Line: 601-55-SCOPE
The Scope Radio: https://thescoperadio.com
Who Cares About Men’s Health?: https://whocaresmenshealth.com
Facebook: https://www.facebook.com/whocaresmenshealth

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

Scot: I have a question for you guys. Do you know the best way to make sure you never fail to achieve your goals?

Mitch: Never set them in the first place.

Scot: Yes.

Troy: Just don't set them, yeah.

Scot: Unfortunately, that's probably not the best plan because goals are useful, right? They can help us achieve the things we want to achieve. But sometimes even when you set goals, you don't achieve them. Just like you never set the things in the first place. And today on the podcast, we're going to talk about goal setting, if you've kind of gotten off track, how you can get back on track. That's what the podcast is going to be about.

I'm curious, do you guys have any sort of goals you've been working on that have gotten off track? Let's start with you, Troy. Anything you'd like to bring up?

Troy: Yeah, without question. It's funny. We talked about this, or we were in touch about this beforehand, and I gave it some thought. My first thought was, "Wow, I'm doing really great. Look at all the stuff I'm doing." And then I thought more about the stuff I had wanted to do over the last couple years where I've just failed miserably, and I thought, "Wow, I've really gotten off track." So, absolutely.

Scot: Could you be specific? You got a couple that you'd like to share?

Troy: Yeah. Oh, for sure. A goal I set like two years ago was I wanted to write more, with the goal of actually writing a book. And I have not even gotten started on that, so that is so far out there. And we can talk about specifics of why I have failed miserably at that, but I haven't even started it. So that one is one where I've really failed.

Another one I set where I did pretty well, but have definitely gotten off track, is trying to keep in touch with friends. And I tried to be more specific on this goal of just being in touch with friends on a weekly basis and trying to get out at least once a month to do things with friends. I'm saying this and I'm embarrassed that I'm saying it because it makes me sound like a total recluse, which at this point in my life I probably am. I tried to set a very achievable goal. Again, to some extent, I was successful, but I am definitely off track on that as well.

Scot: Mitch, do you have any goals that you've been working on, you've kind of gotten off track, or you're not making the progress you want?

Mitch: Oh, do I. So over the last couple of months I've tried really hard to . . . I've been going through some mental health struggles, etc. We're trying to work through it, and I know that I will feel a million times better if I get back into a routine, if I have a reasonable bedtime and I get the same amount of sleep, if I wake up, I do my exercises, my physical therapy, etc.

I set time aside every week to do some meal prep. That was really, really effective for me. I know what I need to do. I write down the things I want to do. And what kind of makes it harder was that I did it really well for a week or two, and it just feels like I'm not doing quite everything I want to in all of those areas right now. So I know that feeling very well.

Scot: Okay. I have some goals too. I would like to read more. I don't feel like I read enough. I want to declutter my office and my garage, get rid of some of the stuff here. That's good for your mental health. And I also want to lose some body fat. So those were kind of some of my goals that I feel like I'm not making the progress on.

And today, we're going to talk about all of our goals and we'd like you to even think about what a goal is you'd like to accomplish and maybe you've stalled out on. We're all together going to try to get a framework so we can all get back on track.

This is "Who Cares About Men's Health" with information, inspiration, and a different interpretation of men's health. I'm Scot Singpiel. I bring the BS, and I also bring a lot of experience to this conversation because I've failed to achieve the same goals for the past 10 years.

Troy: Nice.

Scot: Or I guess we could call it I've practiced the same goals for the past 10 years.

Mitch: There we go.

Scot: The MD to my BS, Dr. Troy Madsen. He's the one that suggested this topic, and although he did say he has some that he hasn't met, I don't know that he's ever failed to achieve a goal.

Troy: I wish that were true.

Scot: And always coming with a unique perspective, welcome to the podcast Mitch Sears.

Mitch: Yep. Always unique. That's me.

Scot: So this show, in a way, as I talk about these things, I feel . . . I don't know. It's just like, "Could you whine more about some of the simplest things in the world to accomplish?" I just feel like there are guys out there that can set a goal and they just laser in on it and they just get it done.

And as I joked in the open, I've kept daily pages and I've looked through my pages in the past, and really it's the same stuff over and over again for me. It's just like, "Come on, Scot. Let's get it done. What's so hard about this?"

So I'm really hoping maybe this show gives me some clarity on some of the things I'm not doing right so I can kind of restructure my thinking a little bit and feel less like a loser and a failure.

Troy: Well, you've got to give yourself credit too, Scot, because you have done a lot of things. And to be successful at achieving these other goals, I think we have to at least recognize where we have been successful and what we've done to be successful in those things. So I think there's no question you've been successful in things.

Like I said, as I thought through it, at first I was patting myself on the back saying, "Oh, wow, I've done this and this," but then I thought more thinking, "Wow, these are some big things I wanted to do and I just haven't done them." So I think you kind of have to look at both things.

Scot: Yeah. That's interesting that you had the positive vibe at first, and I had the negative vibe, like, "Oh, I've still got all these things to do." How about you, Mitch? Where'd you fall in on that whole deal?

Mitch: I just am feeling kind of awkward talking about it, but that's where I'm at. I felt kind of negative, but I felt I had a pretty realistic, like, "You know what? This isn't working, and I'm trying really hard not to feel like a failure." But just in saying it aloud, like, "Yeah, I had these goals and they're not quite working" . . . I don't know. I just feel like that thought that you were talking about, about being a loser, being a whatever, it's just like, "Ugh, I don't like admitting aloud to other people that I made a goal and I am not reaching it right now."

Scot: Well, let's dive into figuring out maybe why we're not achieving these particular goals. I think Troy is right. I think we've all probably set out and have accomplished goals, but I don't know, it sounds like Mitch and I are kind of the same. We tend to focus on the negative.

Mitch: Oh, no.

Scot: Yeah, I don't know. But anyway, I think the first thing that you need to ask yourself is "Did you set yourself up for success in the first place when you made your goal?"

One of the frameworks that I found, and probably we've all heard of . . . and actually, after revisiting it today, I thought, "Wow, this is actually a lot more useful than I gave it credit for in the first place" . . . is setting something called SMART goals. Have you guys heard of this?

Troy: I haven't, no.

Scot: Oh, you haven't? Mitch?

Mitch: No, I haven't.

Scot: You haven't either? Really?

Mitch: No.

Scot: Oh, wow.

Troy: Not specifically. I'm sure I've heard of a lot of the concepts involved in this, but I don't know that I'm familiar exactly with SMART goals.

Scot: Yeah. I'm not talking smart like, "I'm bright and I'm dumb." It's an acronym.

Troy: I knew it.

Scot: A SMART goal . . .

Troy: I figured this was going somewhere.

Scot: SMART goals are these things. The S stands for specific. So is your goal specific enough or is it too vague? Run these against the goals that you have or the goal that you came up with.

Troy: Okay. So my writing goal, already I failed on that.

Scot: M is for measurable. What does success look like and how will you know if you've obtained it?

So within measurable, I've heard them talk about two different types of goals, process goals and outcome goals. So a process goal is "I'm going to exercise every day." That's a process goal. "Every day, I'm going to do something." Now, of course, it doesn't meet the specific in SMART goals, but that's beside the point on this one. Or outcome goal is "I'm going to lose five pounds." That would be an outcome goal.

A is for attainable. So is it something you could attain at this point in your life or is it too much too soon? With fitness goals, I think a lot of us set goals that are unattainable.

Is it relevant? Does it tie back into your objectives, the things you want to accomplish? Or I've seen it talked about as "Does it tie back into your values?" What is your why? Why are you trying to do this? And is this goal actually helping you to accomplish your why?

And T in SMART goals is time-bound. So you're supposed to put a time on it and then reevaluate at that time. Maybe the timeframe is unrealistic.

Troy, with your goals, where do you think the problem was based on this SMART goal framework?

Troy: Well, the writing thing, I think for me, I did have a measurable outcome. I wanted to write a book. So I guess that was measurable. If I had actually written a book, I would've said I achieved it. But in everything else, I really kind of failed. It was not very specific. What kind of book did I want to write, first of all? Did I want to write a novel? Did I want to write a medical education book? I had no specifics.

Mitch: Just a book.

Troy: Yeah, just a book. I mean, who knows?

And then in terms of measurables, I tend to do a lot better with process-oriented things where it's not like, "My measurable is I want to write a book." My measurable in the process thing . . . The thing that would've been a lot more helpful for me would've been to say, "Okay, I'm not concerned about the outcome. I just want to sit down and write for an hour every day." And then ideally, something proceeds from that.

So I think in terms of what I at least thought two years ago I was going to try and do, I just wasn't really set up for success from the beginning.

Scot: I want to dig into this a little bit more because I think this could help people formulate their goals. So specific, is it specific or vague? You want to write a book. That's pretty vague, right?

Troy: That's vague. Super vague, yeah.

Scot: So maybe your objective is to write a book. This is the way I kind of started framing it, and I don't know if this is how it's framed elsewhere. But your objective is to write a book, so what are the steps that you would need to do to write that book? And like you said, you don't even know what kind of book.

And measurable, you kind of got towards that, right? You said, "I want to write for an hour a day."

Troy: Well, I just said that now. Yeah, I should have said that at the time.

Scot: But you're getting closer, right? So is writing for an hour a day attainable though in your schedule realistically, or is a half hour a day better, or 15 . . .?

Troy: You're right. Yeah, probably something that's actually attainable and consistent would be 15 minutes. You're exactly right, if I really said, "What is attainable?"

If I set out to do an hour a day, I would not do that. There's no way I could maintain that. So yeah, 15 minutes a day, you're right. I could do that consistently, and then maybe some days I just keep writing because I have more time or I'm kind of in the groove or whatever. So yeah, in terms of something that's actually attainable, that's what I would need to do.

Scot: And then the relevance part, the R and SMART goal, does writing a book tie back into your objectives or values? I mean, what is your why? Because if your why is not strong enough, you're not going to sit down and do that 15 minutes. I mean, that's a pretty deep question to ask yourself. Why do you want to write a book?

Troy: Yeah, it is a deep question. I think it's something I've always wanted to do, and so that's maybe more the relevance, but I think the relevance would have to relate more to actually what I was writing about. Is it something that just the process brought joy to me? If so, that makes it very relevant.

Does it get at a deeper purpose or something else I'm trying to bring attention to, whether that's a medical topic or health topic or something that entirely has nothing to do with health?

So you're right. I think the relevance would have to . . . Just saying, "I'm going to write a book," that in itself maybe there's some relevance, but I think I'd need a lot more relevance to really stick to it.

Scot: Yeah, and then, too, if the relevance is, "I just want to go through the process of writing a book to say I did that," that would then maybe dictate what kind of book you're going to write. Maybe you want to make that process as easy as possible as opposed to learning a whole bunch of new skills, like writing fiction.

And then time-bound. Did you ever put a time on it as far as, "I'm going to get this part done in this amount of time"?

Troy: No, I never did. It was two years ago and I believe it was a New Year's resolution sort of thing, and I think I envisioned within the next year I would be able to do it. But I can't say I ever put any timeframe on it.

Scot: Mitch, do you have a goal you want to run through the SMART thing?

Mitch: Well, it dawned on me as we're kind of talking through it that my goal was . . . I had little micro ideas that were specific, but the idea of "get into a healthy routine" is way too broad. I'm much better these days. I used to be very much outcome-focused when it came to my health, right? How many pounds I wanted to lose or . . . It was a lot of that kind of stuff.

Scot: How many abs you want to see.

Mitch: I want to see eight abs, whatever it is, right? So I'm getting better about process. It's like, "Hey, I want to work out 30 minutes a day so many times a week."

Scot: Which ties back to the overall objective of healthier habits.

Mitch: Yes. But also I think I'm trying to do a whole lot of things. I've got bedtimes and meal preps and I want to reach out to people more and I want to work through this ADHD CBT workbook that my therapist gave me. I put those all together in the same goal, and I think that might be what's screwing me up.

Troy: Just too big, too much.

Scot: I love that insight, because I think this is something I observed as well, very similar. Sometimes we make a statement like, "I want to live a healthier lifestyle," and we don't think how complicated that really is until you start really breaking it down and trying to do something.

Sometimes seemingly simple things are very, very complicated, and then we get mad at ourselves because we can't achieve this seemingly simple thing that actually has a lot of complicated steps. And each step might take learning some new knowledge or might take overcoming who knows what obstacles.

Troy: Well, I think even just the more specific goal, like you said, Scot, "I want to lose five pounds," even that is very non-specific in a way because it doesn't talk at all about exactly what you are doing with your diet, what you are doing with exercise, all those other things.

So even beyond just the general healthy lifestyle, I think even sometimes some of these specific things we want to achieve are just far too . . . We need more specifics there of how we're going to get there.

Mitch: I think that one of the things with this particular issue I'm having is that, yeah, it's complicated, but also change of any sort can be hard and taxing and it takes effort. And I don't necessarily think that this was overly complicated. You said, "Think through it," and everything. I wrote everything down. I got my little panda planner out and I wrote down when I'm going to do certain things, and what time of the day I'm going to do them, what kinds of blah, blah, blah. I wrote it all out.

But I think for this particular one, you look at at attainability and how reasonable the whole thing is and it's just like, "This is a lot of changes all at once." This isn't a small easing into it. I'm trying to get myself to do four or five big changes, and while I might understand what I need to do, that's still a lot to do all at once.

Scot: Yeah, it is. It can overwhelm you and then it's like, "What's the point? I'm never going to achieve all of this."

Mitch: And then they're all linked together in my case where it's like, "Well, I didn't get to bed on time, so I guess I'll eat McDonald's in the afternoon."

Troy: That's right.

Mitch: Why are those connected?

Troy: And that's a really tough thing too, because I think sometimes when we do set goals that are really tough and we don't achieve them or we fall off the wagon, so to speak, we just kind of give up and just say, "Well, so much for that." And that's the hard thing about it.

I like the attainable piece of this as well, of the SMART goals. I think not just attainable, but something that's . . . We want to set hard goals in a way, but at the same time, I think we want to have steps along the way that we can be very consistent with and that aren't overwhelming.

And I think there's so much more value in just being consistent in something rather than just having a huge effort and just putting that forth and saying, "Wow, I did it," whether that's a workout or whatever it might be. But just consistency every day, something that's relatively easy to do, and if we're consistent at it, I think we see big results.

Scot: I'm going to say overcoming an established routine to do something else in a routine is extraordinarily hard. We have routines for a reason. It's to conserve brain energy. If you had to make all the micro decisions you have to make on a daily basis from "How am I going to get to work?" to whatever, that's why routines are helpful, because they allow us to then turn that brain off to do those things we have to do. So just realize that's a tough thing to overcome.

And in my instance, for example, my "declutter my office and my garage," this is another complicated thing, right? I can get very specific and say, "I'm going to take one thing out of my office or my garage and put it in a box for Goodwill every day." But here are some things that I've struggled with. Well, first of all, I'm a "I might need that someday" kind of guy.

Troy: That's totally me. Trust me, since we did the declutter challenge, I have said to myself so many times, "Why did I do that?" because I need that thing now. And then it keeps you from getting rid of stuff.

Scot: Right. Even if that thing is something I could easily go and buy for a dollar at the hardware store, I get mad at myself because I didn't store it for 20 years, right?

Troy: Yeah, you could have saved a buck because you saved it.

Mitch: Yeah, a buck.

Scot: So I have to overcome that aspect of my personality. And some of the things in this office are tied to my identity. They were things I purchased at a time that, for whatever reason, I identified with, or they were part of who I was at the time.

For example, a picture of me on the cover of a radio magazine when I used to be in radio. That was tied to my identity. I don't necessarily care about it anymore, but it's tough to throw that away or get rid of that.

And some things are stuff my mom saved from my past and I don't have a connection to that anymore, but because my mom saved it and it's from my past, I don't want to get rid of it.

Some things are like, "Hey, I could sell that and make some money," and that slows things down.

So just the simple thing of getting rid of one thing a day can really tie into a lot of complicated issues that we have as people that we have to overcome in order to do that, right? So isn't that crazy? I think that's just completely crazy.

Mitch: Yeah.

Troy: Well, it is. But again, I think if you do have that specific goal, and if you just make it very easy and very attainable . . . I like what you said, just getting one item every day that's going to go to Goodwill, or maybe it's even one item every week if you just need a starting point.

But it seems like once you do that and then you get that item, then there are going to be some days where you say, "Well, I can get rid of this too." Then you kind of get on a roll there with it, and then the next week you just may not be in the mood to get rid of anything, but then you think, "Oh, it's just one item."

So making it a low bar that's achievable and you feel like you've achieved that on a weekly basis, I think, is really key to the larger success.

Scot: The next part is kind of the troubleshooting. So let's say you've got what you believe to be a really solid SMART goal, but you're still not quite accomplishing what's going on. So this is a troubleshooting step that I found in the "Harvard Business Review."

And the process is this. The first thing you do is you think about that goal and you imagine achieving it. I mean, you really picture it. You feel the pride or the excitement or the sense of accomplishment or whatever emotions that you have that accompany that goal.

And then you ask yourself, "What's in the way of achieving that goal? What's it going to take to realistically get there?" And that might be more knowledge. It might be putting together an actual plan, how you're going to make that happen.

For example, if your goal is to eat more vegetables every day, do you have vegetables in the house? Maybe the plan is make sure you pick up a couple of bags of frozen beans.

Then going between the future that you want and the obstacles you have to overcome to get there, according to research, will help develop motivation and the clarity to succeed. And they call this mental contrasting.

They've actually done research on this, that people who do this mental contrasting of thinking what they want, really putting themselves in that position and then thinking, "What are the obstacles between me and that?" are more likely to put more effort into achieving their goals. They're more likely to make them happen.

I took two things out of this. The first thing I took out of it is this process of looking at where you want to go, what it is you want to accomplish, and then troubleshooting it. What's in my way? What is it that I have to do? And that helps you come up with that plan. What is it that I need to do to realistically get there?

And then you can evaluate that along the way and go, "Boy, is this really that important to me? If this is what I realistically have to do, maybe it's not that important to me after all."

But it's a process that you can go through to maybe troubleshoot those SMART goals and figure out, "Is this worth it to me? What do I need to do to get there specifically? How can I break this down into smaller things, into smaller SMART goals, perhaps?"

And then I think the other part that they're talking about is this actual mental imaging of the accomplishment. I think the psychiatrists are saying that that helps motivate people. According to their research, people will put more effort into achieving their goals.

Troy: That's interesting. Sometimes I worry too much though that I try to see the end from the beginning, which is kind of part of that process. I don't know. Like I said, for me it just works just to focus on the process and the achievable goals, and then it seems like that end piece eventually comes.

Sometimes I think when I do focus on the end from the beginning, I get a little overwhelmed. I don't know. I'm interested if that's worked for you, just what they recommend, envisioning that end and how you'll feel and everything associated with it.

Mitch: See, and that's what kind of . . . It's like every so often these things come into my life, whether it's you sharing it on this podcast or whatever. It's like, "I didn't know about SMART goals. When was I supposed to learn about SMART goals? There's a process here."

And it's the same with this "Harvard Business Review" thing. I think, in kind of a similar but different way with Troy, that most of my goals, I don't spend a lot of time thinking about the end. I think about all the steps that I have to do to get there, and that can be overwhelming.

But then on top of that, because I don't take the time to be like, "How will I feel if I accomplish this? How good would it be? What would I appreciate? What will I be able to do?" I don't spend any time thinking about that. So it stays nebulous and it doesn't feel like something I actually want. It doesn't feel relevant.

You have to think about it or else it's not going to be in your brain and it's not going to be real. Why is the "Harvard Business Review" coming into my life right now? Ugh, it's so frustrating.

Troy: So maybe in your case, maybe that's helpful. Like I said, for me, maybe I've focused too much on that, on the end, and not so much on the specifics. But like you said, maybe sometimes, in other cases, you focus so much on the specifics that you find them overwhelming without really focusing on what the reward is going to be. So it's probably something . . .

Mitch: If it's worth it.

Troy: Yeah, exactly.

Mitch: And if it's worth it to you, yeah.

Scot: Yeah, and you can discover that along the way, right? Maybe it was never really worth it to you after some deep analysis.

Troy: Right.

Scot: Some other troubleshooting tips that I came across here. So is it the goal you really want? When somebody says, "I want to get healthier," is that what you really want?

Maybe you said, "All right, I want to get healthier. I'm going to go walk 30 minutes a day for a few months," and then you gave it up because you weren't losing weight. Well, that's a little bit of a different goal, right? The true goal reveals itself. So was that a failure? Well, maybe, maybe not.

But is the goal you really want the goal you're working towards? You've kind of got to ask yourself that question. I think being specific can help with that, the SMART goals.

Did you have a plan in place? It's great to have goals, but what's that plan you're going to do to get there? And I think that's the HBR, the "Harvard Business Review." What are the obstacles? What are the things that are in your way? What is it you need to do to make that goal?

Another piece of advice is getting started again as soon as possible. So if you have set a goal and you've noticed that you're not making steps towards it, don't keep putting it off. Get back into it as quickly as you can.

This is another big one we've talked about on the show. Be compassionate. And we talked about it at the very top of the podcast, right? Don't focus on your failures. Focus on your progress made.

So I wanted to have two kettlebell workouts a week, and I did pretty good for a couple of weeks and then I got off track for a week, and I'm like, "Oh, I failed." Well, no, I can start doing it again. And I did it again last night, right?

And not only that, but I've got my sheet of exercises now. So that was something I accomplished. I went and did the research on the exercises I wanted to do, so it wasn't a failure. I'm starting at a different point, right? If we use the mountain analogy, I'm 20 steps further from my beginning point. I'm not back at the beginning.

Troy: You've taken a nap along the way, but you made 20 steps.

Mitch: Got a breather. You got this.

Troy: You got a breather, yeah.

Scot: So it's not a failure.

Troy: But you're higher up the mountain.

Scot: And then accountability partners was something else I came across. So seek out others who share similar goals or at least will be supportive and help you be accountable. So that might be the missing key for some people.

And then this one really spoke to me. I think we want things to go as smoothly as possible, and when they don't, I think sometimes we're like, "Well, that was not a success." But plan for obstacles. They're going to happen. That's part of the process. They're problems to be solved.

Troy: Yeah. And I think the compassion piece of it is huge because I think the biggest challenge for us, like you said, is just recognizing what we've actually done. We set these goals, we want to be perfect in them, we want to do this every day. Whatever it is, we want to achieve it. And then we just find that we're just not getting there or we're not getting there as quickly as we are and we just are like, "Why am I doing this? What's the point?" And so I think that's probably the biggest piece of it and the biggest challenge.

Mitch: Yeah, that's kind of the thing that I come across a lot, is that it's so easy to fall into a shame spiral. It's so easy to be like, "Ugh, no, I'm terrible. This is bad," or whatever, for me at least. I really like that idea of "I've done something."

For my particular goals, I have a plan. It took me some time to sit down and write down the kinds of things that I wanted to do. Was it maybe a little too much? Sure. But that doesn't mean I need to beat myself up about it. I made some progress. And if we keep focusing on that aspect of it and can forgive ourselves for not being Supermen, I think it might be a little easier to get back on the horse.

Troy: Yeah. And I think if you just do absolutely nothing to achieve your goal, you make zero steps, you can still pat yourself on the back for the fact that you actually set a goal. That's worth something. You envisioned it. You set it. That's a step.

Scot: All right. Are we at a point where we can wrap this up? I think we kind of covered some stuff. Do we want to do some takeaways?

Mitch: Oh, sure.

Troy: Sure.

Scot: Boy, Troy sounds a lot more excited about doing takeaways than Mitch, but that's okay. What's yours, Troy?

Troy: My takeaway is SMART goals. Again, I've heard of certainly pieces of this, but I like the way it breaks it down. I'm not a big fan of acronyms, but in this one I kind of like the acronym.

And then for me, I think getting back to the goal where I've obviously failed, the piece of the SMART goal I need to find . . . there are lots of other pieces, but the big piece I need to find is the relevance. So that's the thing I'm going to take from this. If I'm going to write a book, what is the relevance to me? And maybe rethink this goal and potentially move forward on it if I can find that relevance.

Scot: Maybe a short story would be . . .

Troy: Maybe a short story. Maybe a haiku. Keep it simple. I'm going to start small.

Scot: I do want to throw one thing in. So as I was working through SMART goals, it can be easy to take these acronyms and think that everything has to happen in the order that it is in. I found that that's not the case. I found that I got midway through and then that changed actually what the first thing was. Attainable, that's halfway through. Well, when I started thinking about that realistically, that changed the specificness of the SMART goal, right?

Mitch: Sure.

Scot: So I don't think you necessarily . . . They all are interactive and I think one answer could change previous answers before that, and that's okay.

I think it's a great way to set a goal, and I think it's also a great way then, if you do have a breakdown and it's not working, to analyze your goal a few days later or whenever that breakdown is to see, "Well, maybe where wasn't I quite what I needed to do here?"

Cool. Mitch, your takeaway?

Mitch: I think I'm like Troy, where it's like, "An acronym? That's not going to help me. A listicle? That's not going to . . ." But at the same time, just having a process or a method for being intentional about anything in your life can be really helpful.

And so the two things for me that I really kind of appreciated was the "Harvard Business Review" talking about focusing on the goal, and I think that ties into the relevancy for me. A lot of times, it's really easy for me to let goals come and go. Whether that means I'm afraid of not reaching them or whatever it is, I don't do that step.

Because I don't think about where I'd like to be or what it would feel like to be at that point, it never becomes relevant, and so it's easy to let go of.

And then on top of that, the attainability part, I think that's huge, and being honest with oneself and really understanding, "Where are you at, and what can you actually do in this moment in time?" and not defaulting to, "I am a failure if I am not achieving at 100% effectiveness as an idealized super person would be."

Scot: What is your goal? Did you have a goal that you kind of started out with the first of the year, or a goal like Troy that's a couple years old, and you just really haven't made much progress on it, or not the progress that's making you happy? Think about what that goal is, run it through the SMART goal tenets, use some of the troubleshooting steps, and get back on track. You weren't a failure. You just took a nap, like me.

Troy: You just took a little nap.

Mitch: Just a little nap.

Troy: But you're higher up the mountain.

Scot: That's right.

Troy: It may be later in the day than you thought it would be, but you're doing all right.

Mitch: And you're well rested. You're ready. You're ready to go.

Scot: If you want to share any of your experiences, if you have a different take on any of the things we talked about today, or just need accountability partners, we would love to hear from you. You can send us an email hello@thescoperadio.com.

Thank you very much. Good luck with your goals. Thank you very much for listening, and thank you for caring about men's health.
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Scot: When you get to a place where you're ready to care about your health, sometimes it can be really, really overwhelming. Where should you start? There are a lot of different messages out there in the world, but if you could only do one thing . . . Because let's face it, we're not going to become a completely different person. We can only do one thing at a time. What should that one thing be? What's that first step?

So today, on the podcast, we're going to help you figure out that first step, whether you're just starting out, or maybe you've made some progress and you're wondering what is next. This is "Who Cares About Men's Health." We give you information, inspiration, and a different interpretation of men's health. We're just some guys trying to figure it out on our own as well, so we have these conversations about health hoping that they will be valuable to you as well.

So my name is Scot Singpiel. I bring the BS. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. I'm here and I'm ready to talk about that one thing.

Scot: All right. We're calling it "The Hierarchy of Health." And also always sharing his experience, Mitch Sears. Welcome.

Mitch: Hey. Yeah, one thing? That's what we . . .? All right. Okay, I'm here.

Troy: One thing. Starting point.

Mitch: All right. Starting point, okay.

Scot: Probably is not going to be your only thing, but it's going to be your first thing, right?

Mitch: Sure. Okay.

Scot: All right. So I want to kind of be clear on this, and we want to be clear as we're talking about it, because one of the things we really try to do here is talk about stuff we know, like evidence-based. This is based on research. This is information we know. But then also we talk about our own experiences and how that manifests in the real world. So we're going to try to be sure that we're indicating what is what when Dr. Madsen goes through this hierarchy of health with us.

And another thing that I think is important to point out too that we've discovered through the process of this podcast is when we talk about health on this show, we're talking about it in terms of reducing a chance of disease, living a longer and more satisfying life, and just generally feeling better.

It's not becoming more athletic, or more ripped, or building muscle, or losing fat for aesthetic purposes, although that could be a side effect. But it's more about just being healthier.

So, Dr. Madsen, I'm going to throw out the things that we're going to talk about today and I want you to rank these in the most important order, and then we're going to talk about that a little bit.

So, first of all, one of the things we talk about is the Core Four. If you kind of focus on these things, it can go a long way. And that's your emotional health, your nutrition, your activity, and your sleep.

And then we haven't talked about this a lot, but really we should: other things that men tend to do that might not be healthy that you might want to evaluate, such as smoking, alcohol use, nagging health issues, and genetics.

So we're going to rank those. Do you have any to add to that list, Dr. Madsen?

Troy: I do.

Scot: You do?

Troy: Yes.

Scot: Oh, so there's another one, okay.

Troy: There's another one. Yep.

Scot: And where does it fall in the hierarchy? Is it towards the top?

Troy: It's about halfway down.

Scot: About halfway in.

Troy: Yes.

Scot: Any idea what that might be, Mitch?

Mitch: No, I have no idea. I'm just sitting here, I'm like, "That's it, right? Those are the eight things I need to be worried about." And now there's . . .

Troy: This list is so comprehensive, I know.

Mitch: . . . a ninth one.

Troy: Yeah, I'm going to make it nine. We're going to make it nine.

Scot: Well, what's awesome about this list is it really does kind of help narrow down what is the first thing you should do. So, without any further ado, Dr. Madsen, our hierarchy of health. If you want to take that first step to a healthier lifestyle and you're at square zero, what's the first thing? What would be the biggest impact for your dollar?

Troy: I know what you think it's going to be, and it's not going to be that.

Scot: Smoking.

Troy: Nope, it's not smoking. I'm going to say the number one thing. So let's say you're a total couch potato, you don't do anything, your diet is horrible. Let's say you smoke, you drink a lot alcohol, you know nothing about your genetics, and you have all kinds of nagging health issues. The number one thing I would say that will have the biggest impact on your health that is the most practical thing to do is activity.

Scot: Really?

Troy: That's where I would start, and I'll tell you why, Scot. There was a study that came out recently, evidence-based. This looked at exactly those people, and it compared people who did nothing to people who had minimal activity, short bursts of energy, two minutes long, maybe three times a day, just taking the stairs instead of the elevator, shoveling snow, things like this. Not big activity. They found that people who engaged in these short bursts of activity had a 50% reduction in heart disease and cancer risk over about seven years.

Mitch: Wow.

Troy: Fascinating, I know. Major impact.

Mitch: Because we're not even talking the 30 minutes three times a week of activity.

Troy: No.

Mitch: We're talking just 10 minutes? What are you saying?

Troy: We're talking just take the stairs. That's all it was. So that's why I say that's your starting point. If you do nothing else, take the stairs, shovel the snow, do something to get your heart rate up for two minutes three times a day. That alone will have a dramatic impact. Fascinating study, really well-done study.

Scot: And just to be clear, more impact than quitting smoking, if everything else is equal?

Troy: I'm going to say yes. Quitting smoking is absolutely going to reduce your cancer risk. I can't say for sure that, in seven years, it will reduce your cancer risk by 50%. Maybe we'll find something out there that suggests that.

I'm looking at seven years. They were seeing this impact seven years, not a long time down the road, major impacts on health. And again, you're starting super low, and just adding something to it. But just adding that little bit makes a huge difference. So that's why I'm going to say activity over smoking because of the shorter-term benefits they saw in a lot of this risk reduction.

Mitch: Wow.

Scot:All right. And of course, we know activity has so many other impacts on the rest of our health, right? That activity . . .

Troy: Exactly.

Scot: . . . can help us feel emotionally better too. It can help us sleep better. I don't know if you're like me, but for me, if I get my activity in, I tend to find, and this is just me, that I will eat better. I don't know why, but I'm more likely to make better choices when I eat.

Troy: And that's why I put activity at the top, because I think a lot of these things follow when you get more active. Then you're going to be more motivated to quit smoking because then you can be more active. So I think it then kind of feeds into itself. So if I said start anywhere, just start with activity. And with the activity, start incredibly small. Just take the stairs. That's it.

Scot: Just start moving a little bit more.

Troy: Move a little bit more, yep.

Scot: Try to walk around the block.

Troy: That's right. Walk around the block.

Scot: All right.

Troy: Small amounts of activity.

Scot: All right. Well, already I'm surprised, Mitch.

Troy: That's what we do. We aim to surprise.

Mitch: You were so sure.

Troy: We aim to surprise on this podcast.

Scot: All right. Hierarchy of health, first thing is activity, and that's just adding in a limited amount of activity. What's the second thing then you might want to consider doing?

Troy: I've got to have smoking here, because you're exactly right. Yeah, smoking, huge health impact. If you can drop smoking, your risk of cancer is going to drop, your risk of lung disease, all kinds of health issues.

And again, if you're starting to get active, I think it makes it easier to quit smoking just because it gives you a little extra motivation, probably improves your mental health, maybe makes moving away from smoking a little bit easier. But that would be next on the list.

Scot: Mitch, I don't want to speak for you, but maybe . . .

Mitch:Oh.

Scot:. . . you can jump in. "No, please, Scot, speak for me." Maybe you could jump in here. So, to me, one of the things I love about the fact that activity was the first thing suggested and that some research showing that just even a small amount of activity, if you were getting none, can make such a huge difference in your health, that sounds a lot more achievable than quitting smoking.

Mitch: Oh, yeah.

Scot: Smoking, that's a major thing.

Troy: That's why I started with activity too. Sorry, Mitch.

Mitch: Sure. No, go ahead.

Troy: That's why I kind of put activity first, because I think it's a win, like, "I got that. I did it. I'm more active. Let's tackle smoking."

Scot: So part of it is mental. You get those little small wins.

Troy: Yeah.

Mitch:Having, I guess, both quit smoking and starting to do my activity on this podcast with both of them, training for the Who Cares 5k was . . . it was work and it was a big shift in my life. But we're not talking an addictive substance that I needed patches on my body and sucking down chocolate cinnamon bears, etc.

I think for me, at least, smoking was the kind of keystone. Once I was able to pull that out, it was easier for me to get exercise because my lungs didn't hurt. And it was easier to feel better, and my sleep went better. It was something that was really kind of holding me back with a lot.

But at the same time, if the activity really does give you that much more benefit, it was a whole lot easier for me to start being more active in my day-to-day than it was to quit smoking. Not to say it's impossible. I don't want to sound like whatever. It's just hard. It's really hard, especially if you've tried it before.

Scot: And let's take this moment to celebrate, Mitch. How long have you been cigarette free?

Mitch: Oh, the math . . . I think we're three.

Scot: That's so incredible.

Mitch: Three years now.

Scot: Yeah, that's so awesome.

Troy: All you have to do is just think how long has the pandemic been going on and then you just add about four months to that.

Mitch: I made it through.

Troy:Right before the pandemic, yeah.

Scot: Mitch, another question about smoking and activity for you. Did you find when you were trying to quit smoking that doing something like getting out and walking helped manage any of the addiction at all, took your mind off it for like a couple seconds? I can only imagine you're constantly thinking, "I want a cigarette," and you're constantly playing this game of "How can I distract myself for another five minutes to not want a cigarette?"

Mitch: So, in my case, one of the things that I did try doing is . . . not only did I do the cessation aids, which I highly recommend. If you've tried quitting smoking before and it didn't quite work, talk with your doctor, get the patches, get the gum. Not that it's easy, but it made it for me, someone who had to do it seven, eight times to actually stick to it, man, that stuff really, really helped.

But yeah, there was something about . . . During that time period, I started taking walks. For me, when we talk about nicotine addiction, it is not just the cigarette. We know the cigarette is bad. We know it's bad for our health. But it was also a time to take a break from everything and go outside and sit for 5, 10 minutes, and then come back inside and just kind of reset.

And when you suddenly lose that cigarette, you've got to make sure you're still doing those types of things. So if that break from the every day, and if that getting outside, walking around a little bit is a part of why it's so hard to quit, I just started walking around the block.

This was before I started jogging. This was before I whatever. But I would go out the front door, I would just do one lap, come back in, and it helped a lot actually, surprisingly.

Scot: Incidentally, it should be mentioned, people trying to quit and not being successful multiple times is the norm. If you're in that situation, if it's been six times, try seven times.

All right. The health hierarchy, Dr. Madsen. We've hit starting with some activity. Then we've moved to smoking, quitting it, or at least reducing maybe as a first step so it's not quite overwhelming, if you can just even reduce it. What's number three?

Troy: So number three is going to be nutrition. And here, we're just going to keep it really simple. Ideally, in terms of science, you're going to switch to where you're eating the Mediterranean diet. Lots of great science there. But let's just keep it really simple and let's just say you look at your diet, and you say, "My diet is not good at all." Start with just stopping drinking soda. That would be my number one recommendation on diet.

And in terms of evidence, tons of evidence showing you reduce that sugar intake, just so much sugar in sodas, you're going to see big benefits very shortly in terms of weight loss, and certainly in the long term, in terms of cancer, risk of heart disease, those things.

Scot: Also, a lot of sugar in your body is not good for your organs, from what I understand.

Troy: Yeah, exactly.

Scot: It's just really hard on them. It's like this sugar bath, which isn't a great thing for your organs.

Troy: Yeah, exactly. And again, if you're looking to go all in on that in terms of really switching your diet, then work toward the Mediterranean diet. Increase your fruits, vegetable intake, legumes, nuts, whole grains, those sorts of things. That's the ideal, but again, we're starting just saying, "Hey, I've got to start somewhere." I would say start with sodas. Try and reduce, and that's a quick way to get your sugar intake down a lot.

Scot: And if sodas aren't the issue, I think . . . So there's been some debate on the show, I remember. But one of my takeaways about nutrition is this debate of "Do you deny yourself or do you add? Do you subtract or do you add?" Do you try to eliminate the stuff that you think is bad, or is it better just to go, "You know what? Every meal, I'm going to try to eat a serving of vegetables. I'm not going to change anything else. I'm just going to add a serving of vegetables"?

I mean, I don't know. Some people might do better at subtracting. Some people might do better at adding. But that would be another maybe next step. How can you add in some of those healthy things Dr. Madsen talked about just even once a day? Again, don't overwhelm yourself.

All right. The hierarchy of health. We started with activity, we moved to smoking, and then working on your nutrition, especially if you're drinking soda to get rid of that, or add in something healthy. What's the next one?

Troy: So I would say the next one is something we've talked a lot about this past year, and that is emotional health. I think you're going to get benefits to your emotional health as you do these other things, but the more you are able to improve your emotional health, that will then feed back into these other things you've already been working on and, I think, make you a lot more successful.

And of course, there are the health benefits simply to improving your emotional health, reducing symptoms of depression. But that then feeds into more activity, better diet, and you're getting all the health benefits from those things as well.

Scot: I want to try to nail down what does that even mean then, improving your emotional health? What's a concrete thing a listener can do?

Troy: Well, certainly if you are suffering from severe depression or anxiety, I think it's worth talking to your primary care provider, being referred to a mental health professional. If you feel like maybe you're not at that point, there are certainly online resources. We've talked a lot on our show about mindfulness and resilience and working on those sorts of things as well.

So I think it's looking at your outlook on life, looking at your general mood throughout the day, those sorts of things, and just saying, "Hey, where am I right now? Do I feel like things can be better? Okay, great. Do I need to get some additional help for this from outside individuals, or is this something where we can engage in practices like we've talked about, like gratitude journaling or . . ."

Scot: Box breathing.

Troy: Box breathing, yeah, exactly. Those kinds of strategies where maybe you don't feel like you're at the point where you need to go see a mental health professional.

Scot: Mitch, do you have some thoughts on this? As I look at this list, you've overcome most of these.

Troy: I know. It's remarkable.

Mitch: Overcome. It is all a process, and I'm still working on it all.

Scot: I know you are.

Mitch: So emotional health. See, that's just kind of it too. I don't know if I am the everyman with that particular situation. We have found some stuff with . . . We'll talk about it more this season, a recent ADHD diagnosis that I got in adulthood, a generalized anxiety disorder, etc. I was at a much different place than I think the average person, just kind of not feeling super great, or wishing they had a more positive outlook, etc.

But I can tell you that the first step, the very first step is always either talking to someone you really trust about what's going on in your mind, or talking to a doctor. That's what started my whole line down it. I was at a physical checkup getting my yearly physical, and I'm just like, "I'm not feeling right. My thoughts are not what I want them to be. I'm tired all the time, etc." And they at least were able to give me resources and a direction to start.

I really think that's where you need to start, is talking to at least someone in your life, get some perspective, whatever, someone you trust. Or number two, talk to a doctor and the doctor should be able to help you in the right direction.

Scot: And on the podcast, we do talk about all of these things we discussed, the Core Four, and even stuff like smoking or alcohol use. They're all interrelated, right? They all point back to emotional health in one way, shape, or form. For example, too much alcohol will make me anxious the next day.

So I think when you start improving some of these other things, some of that emotional health might start to improve. I have not found myself quite in the same situation as you, Mitch, where things such as just taking a 10-minute break during the day and just not consuming any media . . . That maybe can be another one, right? Try to eliminate social media. That made a huge difference for me. I limit it a lot more than I used to. Or just taking a break and just being there with your thoughts and just being in the quiet can reset you for a little bit later.

Troy, do you have anything you'd like to add to that? Are we ready to move on to the next in the health hierarchy?

Troy: Well, I'm so excited for the next one. I don't know. This is the wildcard. We're at the halfway point. This is the one you didn't suggest that I'm just going to throw in. And this is one we just had an episode on: health screenings. So this is one where this is definitely going to make a difference on your health.

We talked about colonoscopies. Certainly, if you're a woman listening to this show, mammograms. Prostate cancer screening, something to discuss with your primary care provider. There has been a little bit of controversy in terms of prostate cancer screening and we have talked about that on the show as well. But I would say health screenings.

And one of my wake-up calls was a cholesterol screen. To see my numbers in my 20s really was a wake-up call, and then led me to make a lot of these other changes we've made.

So it can certainly help to prevent disease, it can identify early disease in terms of cancer risk, and it can also potentially prompt you to make additional changes to avoid future disease.

Scot: Motivate you, which is another big part of this equation. A lot of us know the things we need to do, but sometimes we're just not motivated to do them until we get that little wake-up call, like you did with your cholesterol. I did with my fasting glucose.

Mitch: Sure. And that's one of the big things for me that really kind of changed the game, is not just talking on the podcast. I think that was a huge part for me. Just talking about my health was a big first step for me. But actually calling the number and being like, "Hey, what do I need to do to get a PCP? What do I need to do to get a primary care person?"

And just being able to have my primary contact with my health not be the instacare or the emergency room, to have it be someone who I see on a regular basis, who checks in, who I have enough of a relationship with that I can ask those "oh, one more thing that I'm curious about or I wonder about." They're the people that have the know-how and the specialty to help you, right?

And if you're just kind of struggling on your own, getting that first set of screenings and starting that relationship with a PCP can really help with a lot of these.

Troy: Exactly. And that's a big part of that, too. It's the screenings and then it's having a primary care provider who you can go to with those questions and go to with emotional health issues. Certainly, they can have resources to quit smoking, all those things as well.

Scot: The health hierarchy on "Who Cares About Men's Health." What is the next one if you could only work on one thing? We're getting pretty deep now.

Troy: I know. This is getting tough here at the end. I feel like it's getting a little bit tougher to kind of slice these and rank them. But I'm going to say reducing alcohol use.

So if you're at a moderate or high-risk range in terms of alcohol use, reducing that. Alcohol use increases your future risk of cancer. It becomes a little tricky because, certainly, you've heard of studies where alcohol use at . . . A low range of alcohol use can reduce your risk of heart disease.

That being said, multiple societies have stated if you don't drink, don't start drinking alcohol to reduce your risk of heart disease. More and more of these studies are saying, "Well, it reduces your heart disease risk, but even at a low level increases your risk of cancer."

But bottom line is if you're drinking at a moderate to heavy range, work on reducing that at least down to a low level.

Scot: That surprises me alcohol is so low. I thought it would be right up there with smoking. Why is it so mid to low pack?

Troy: Great question, Scot. It became tough to rank these and that's probably why.

Scot: So the difference between these at this point might be just really negligible.

Troy: I don't know. It's tough. Clearly, smoking is a no-brainer. I feel activity is a no-brainer because so much follows. I feel emotional health, once you address that, is going to help all those other things. So we kind of hit the big guns there.

I put alcohol down a little bit lower on the list. There certainly is cancer risk associated with alcohol. There's no question there are long-term risks associated with moderate to heavy use.

Scot: Yeah, like liver disease. What are some of the other diseases alcohol moderate to high use can cause? Potentially ending up in the ER with you because of trauma?

Troy: Yeah, exactly. That's probably the number one thing I see, is just the trauma associated with alcohol use.

Scot: It can really impact somebody's emotional health.

Troy: Yeah, exactly. And that again becomes a challenge because there's so much interplay here, and a big piece of emotional health may be alcohol use. It may be as you address your emotional health that your alcohol use reduces.

And we had one guest on the show who talked specifically about that, who talked about his alcohol use and how he then was able to address a lot of the underlying issues with anxiety and PTSD, a lot of what he experienced working for the fire department. And then he found that his alcohol use reduction followed.

So maybe that's why I put it a little bit lower, because I feel like if you're addressing some of these issues, sometimes the alcohol use is used to cope with anxiety or frustrations with your health. And as these other things improve, I think in many cases, not all, but in many cases, the alcohol use, the reduction may follow.

Scot: I do know if I'm more active and I'm watching my nutrition, I tend to use less because I'm full and I don't want to. And I'm also like, "Hey, I'm engaged in some activity doing some healthy things, so I'm going to just kind of . . ." Not quit, but I'm just a little bit more moderate in my usage, I would say.

Troy: Yeah, exactly. I mean, you talked about how you go out on your back porch and you drink your tea now instead of drinking a beer, and you're engaging mindfulness there.

Scot: I also always had a rule . . . well, I didn't always have a rule. I developed a rule that I cannot have that after-work drink or whatever until I've eaten a meal. Eat first. And a lot of times, then when I'm done, I don't feel like the beer, which is what I tend to want to drink.

Troy: Exactly.

Scot: One more thing I think that's worth bringing up. Even though we're building this hierarchy, I think it can be adjustable depending on what your main issue is that you need to deal with. Maybe nutrition moves up higher because you have a lot of body weight that you need to lose that is threatening your health. That and activity would be the two things.

So I think keep in mind that maybe this is flexible depending on the person's situation. And that's where a conversation with your doctor might occur.

Troy: Exactly.

Scot: All right, Troy. What's next on the hierarchy?

Troy: I put this low on the list because it's something I just am so bad at, so I just wanted to make it so it's not a high priority. It's sleep.

Scot: To make yourself feel better.

Troy: Yeah, it makes me feel better. It's not that important because I put it low on the list, so it couldn't matter that much.

Scot: But it is important.

Troy: It is important. There's no question it's important. And again, I put it a little bit lower on the list because we're talking about priorities in terms of hierarchy and things to tackle before trying to tackle other things. But I feel like if you're addressing a lot of these other things, hopefully, this sleep improvement follows. Not always the case.

Mitch, we've talked about your struggles with sleep and addressing all of these other things and just seeing the sleep not improve. But I think the hope would be if you're exercising more, you're eating better, mental health is improving, that your sleep is going to improve as well. That's why I would just say don't try and tackle that right off the bat.

Mitch: Do I want to disagree? No. It's accurate. He's right.

Troy: Please, disagree.

Scot: You want to disagree with the doctor?

Mitch: That's where I'm at. It's like, "Let me just tell you."

Troy:I'm just the ER doctor.

Scot: That was a test, Mitch. You absolutely can disagree.

Troy: Please do. I'm open to feedback.

Mitch: No, but it is true. Sleep was something I was concerned about, but it was lower on the list. And it has improved with getting some things figured out. But it was a lot worse when I was still smoking, when I was drinking every single night, when I was not getting any activity. I had full-blown insomnia. Could not fall asleep, stayed up until like 4 or 5 in the morning, and just kept going.

And once I got those other things figured out, I could at least fall asleep. Now the quality of the sleep, that's what I'm kind of working on now with my shaky legs, etc. But I went from not being able to fall asleep, feeling tired all the time, to being able to fall asleep by increasing and improving some of those other aspects.

Troy: I guess it's a good question, though. If you had started from the start and gone to see a sleep expert and had addressed the underlying sleep issues, do you think it would have been easier to quit smoking and easier to address mental health issues just because you were more well-rested? I don't know.

Mitch: I don't know. That is a hard question.

Scot: It is. And there's no research on that, Troy?

Troy: I don't know. There's probably something out there somewhere, but it is tough. Again, in my mind, I feel like if you can address these other things, hopefully the sleep falls into place. I just think it's hard to just say, "I'm going to sleep, and I'm going to sleep better, and I'm going to improve my sleep hygiene, yet I'm smoking, and I'm anxious, and my diet is horrible, and I'm drinking a lot." It's hard to start with sleep. That's the way I thought about it.

Scot: Yeah. So you're pointing something out. This is a hierarchy, what you should focus on first, but that does not discount how important sleep is.

Troy: Exactly.

Scot: We know good sleep definitely can reduce the chance of disease and has a lot of other health benefits. Just simply saying to try to take care of some of these other things first, and hopefully sleep will take care of itself. If it doesn't, like with Mitch, then you need to kind of investigate, "Why am I still not sleeping? I tend to be doing these other things right. So what can I do to improve that sleep?"

Troy: Exactly. I look at this as a hierarchy not in terms of what is the most important thing on this list to your health, but if you are just not doing . . . You just feel like, "I've got to start somewhere," where do you start?

Mitch: I like that.

Scot:All right. We're getting close to the end here. What's after sleeping?

Troy: We're getting there. Nagging health issues is next. So once you've gotten through all these things . . . And again, you could argue, "Well, if I address that nagging health issue, I could exercise more." But I feel like you've started exercising, you're at least moving, you've got that short burst of activity, and then maybe you increase to 30 minutes three times a week.

And then as you address those nagging health issues, maybe they're orthopedic issues or just other things that have been on your mind that you've just wanted to get checked out, then I think it helps you get to the next level in terms of that activity, or whatever these things may be holding back on the list in terms of what we've already talked about.

Scot: Yeah. So the activity, you would start doing some limited activity. But then if you find, "Wow, if I try to do 15, 20 minutes, my knee starts killing me and I just can't walk," then to go to that next level of activity, you'd want to take a look at whatever nagging health issue you have.

Troy: Exactly. I think it's rare that those nagging health issues would limit us so much that we can't just take the stairs. But then I think as you get more active, then you may need to address those just to be able to get to that 30 minutes three times a week, or even beyond that.

Scot: But if it is getting in the way of activity, we know that activity is that one big thing, so maybe you might want to start addressing that health issue, which would probably involve some physical therapy, which is activity anyway, right?

Troy: Exactly.

Scot: All right. We're to the last one now, aren't we?

Troy: We're to the last one. What's left?

Mitch: Genetics.

Troy: Genetics is left. I just put it at the bottom because I think genetics is more interesting, and that's how I found it. I found it more just fascinating. When I learned my family history of migraines . . . And this was after our episode on migraines that my cousin contacted me.

Mitch: Oh, really?

Troy: Yeah, we did our episode on migraines. My cousin just happened upon the podcast and heard that episode and texted me and said, "Our grandmother had migraines, and she would refer to them as her sick headaches."

Scot: I love that.

Troy: And her mother had her headaches and referred to them as her sick headaches. And they would just have to go in a dark room and seclude themselves for a while, and then they would come out. Back in the early 1900s, migraines were not . . . It was funny to hear, or interesting to hear that history.

So I find genetics more . . . it can be certainly informative. It can affect some of those health screenings we talked about if you have a strong family history of heart disease or cancer. So it plays into that as well, and it will probably come up as you're looking into those health screenings.

But if it hasn't come up at that point, I think beyond that, again, it becomes interesting and it helps you understand maybe a little bit better some of the challenges you're facing or have faced as you've addressed these other issues. But it's certainly not something I would start with . . .

Scot: Start with.

Troy: . . . on this hierarchy. Yeah.

Mitch: All right. I am going to disagree with the doctor here.

Troy: Go for it. Please do it.

Mitch: For me, this list, I literally worked top to bottom with what you were talking about. I started with getting a little more activity and realizing I couldn't breathe right, and so I got rid of smoking. So I went down the list.

But it's that last bit of genetics that has unlocked a lot of stuff in this last year, right? The chronically low testosterone in my family, the ADHD diagnosis, which apparently is very much part of my family history, etc. There were a lot of pieces for me that not only fell in, but butterfly-effected through everything else but I didn't have that information.

And it's not necessarily something that came up in everyday routine screenings. I had to go to specialists. I had to whatever. To be fair, I checked everything off and then figured those out.

But there is a part of it that if you know you have a history of something, maybe go check that out. Man, not a day goes by these days that I'm like, "I wish I knew this before. I wish I knew this first." Man, oh man, I went through a lot of struggle and spent a lot of time that if I had known that this was a possibility in my genetics, if I had known, had a better family history, etc., I could have skipped a lot of these steps.

Troy: Interesting. So do you wish you had known that from the start, and that would have helped guide your journey a little bit more?

Mitch: Yes. So we'll talk more when we do the ADHD episode. But one of the things I'm finding, and when I talked to my new psych specialist and everything who's working on it with me, one of the first things they said was, "So how many times have you tried quitting smoking?" And I'm like, "What?" I didn't even bring that up, right? I thought we were here to talk about how I'm scatterbrained, whatever.

And the response was, "Well, actually, there is evidence and research that smoking and nicotine can be used as a self-medication for undiagnosed ADHD people with dopamine deficiencies." And so it's just like, "So you're telling me because my brain is wired differently it's harder for me to quit?" "Oh, yeah. I would have told you to take Chantix from the start." And it's just like, "Oh."

I had so many emotional breakdowns and everything, and it was all because . . . And I'm reading these very nice messages online about people sharing their own strategies. But I'm like, "It's not that easy, y'all." And come to find out it was actually because there's something wired up there differently. So that's kind of the look-back.

You're right when we're talking about order of operations, biggest bang for your buck. But if you know that you have a family history of something, I would just advocate for maybe checking that out, too. I didn't know. I did not know, so it was the last thing on the list to check off and it's been the most impactful in my health in the last year.

Troy: That's interesting. So, yeah, maybe that's a good starting point then of understanding your genetics more.

Scot: I don't know. That might also speak to . . . We're making this list just as a general rule, right?

Troy: Yes.

Scot: Some of the things you've been finding . . . For many people, and we don't know the numbers, obviously. This is one of those things I'm speculating on. For many people, going through this in this order very well might get them to the point they want to be. But a small percentage of people, you included, fortunately or unfortunately, however you want to look at it, there were some other things going on that you weren't aware of.

Troy: And again, that's kind of how I looked at it. It maybe then helps you fine-tune that focus. You've already focused on some aspects of your mental health, and then you feel like you've made some progress, and then you understand your genetics more and you're like, "Oh, wow. Okay, now I understand better the challenges I faced in addressing that issue," which is kind of what you experienced. But that being said, I totally get it if you understood from the start . . .

Scot: Yeah, I do too.

Troy: . . . the challenges with addiction or whatever in your family. I think it helps you in terms of being more patient with yourself as you were then trying to tackle those challenges for sure.

Mitch: Well, I'm going to blow up this whole idea and say the number one thing you should probably start doing is talking to one another about your health.

Troy: There we go.

Mitch: There we go, right? Just talking about what's going on, talking to other guys, talking to your family. I don't know. I think that that could be a really great first step.

Troy: That is a great first step. That's not on the list. We should have put that. Just start talking about your health first and then you can start with some action after that.

Scot: Troy, thanks for The Hierarchy of Health. I think this is a good roadmap for somebody to kind of go down regardless of the place they are in their journey. If they've already implemented some activity, but they're smoking, that would be a good next step. Have you reduced those sodas? Can you introduce some perhaps healthier choices into your diet? Are you looking at that emotional health? Are you getting the health screenings, watching the alcohol use, sleep, nagging health issues, and genetics?

So I think that's a very useful tool. Again, I'm going to iterate maybe that might change for you. But it's a starting point, right? And at least outlines some things as opposed to having it be all the choices. Now you have a small list of choices, and your instance might be a little bit different and you might start somewhere else.

This was this really good. Any takeaways, Troy? I mean, you kind of walked us through it, so I don't know that you have any takeaways. But sometimes when you talk about this kind of stuff with other people, you develop some new knowledge. So did you get anything out of this, or not really?

Troy: Yeah, my takeaway is it was fun to think through it and fun to prioritize this. But I'm guessing if you had 10 different doctors do it, they'd all have different orders on this list.

Mitch: Oh, really?

Troy: I can't pretend to be an expert on this. And I think anyone is going to look at this list and, depending on their specialty and even their personal life and personal interests, would maybe . . . Maybe someone else puts emotional health number one. I'm sure we've had guests who would do that.

So that's my takeaway. You may disagree. Please disagree. But I think it's a nice summary of so many things we've talked about on the show. And again, I think the takeaway is to decide where you want to start, go for it, start small, work your way through these things, and then revisit them and then continue to revisit them to improve in each area.

Scot: Mitch, jump in with yours.

Mitch: I kind of tried to do all these at once last year, or the last couple years, and you guys have on multiple occasions been like, "Hey, maybe that's too much. Are you not feeling overwhelmed? Etc." And I was, looking back.

Prioritizing, taking small steps, improving one thing or another, I think just take it from this one person who tried to fix all their health at one time, it was a lot. It was a lot and very, very overwhelming. Find out what is the biggest impact on you and focus on that first, and then go from there.

Scot: In trying to make it simple, sometimes it can make it complicated again, right? Because we had a list of nine different things. So I think my last thing, and what's worked for me, is just try to find maybe one of those things that you can sustain and then make it part of your daily routine. And then try to move on to the next thing when you're feeling better.

And if, for whatever reason, you're having difficulty trying to get that one thing, maybe try something else or figure out, "Well, why am I having a hard time trying this one thing?" And then that will lead to another problem you can solve.

Just solve one of them at a time. You don't have to make perfect progress on that one thing. Just make some progress and then maybe try something else. And like Mitch said earlier, it's all a work in progress, isn't it?

Mitch: Yeah.

Scot: Yep. It's not just something you can take for granted. It's not just something that happens unless you're actually paying attention to it, doing things actively, or talking about it, unfortunately.

So, gentlemen, thank you very much for getting together for our weekly conversation. If you are listening, what's the one thing you're going to do? Pick one, try it, and if you want to let us know how it goes for you, you can reach out to us at hello@thescoperadio.com. Thanks for listening, and thanks for caring about men's health.
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Interviewer: You've likely heard of postpartum depression in regards to the mother of a new baby. But did you know as many as 10% of fathers face their own sort of postpartum depression? And it can happen before or after their child is born. But unfortunately, men are unlikely to discuss it or get support. And untreated, it can impact the emotional health of the father and his ability to be available for his baby and the mother.

Jamie Lea Hales is a licensed clinical social worker, and she specializes in helping couples with their mental health during and after pregnancy. I didn't know postpartum depression was a thing that men could have. Does it have a particular name when men have it, or is it just male postpartum depression?

Jamie: Actually, it really doesn't have its own special name. You would think that it might, but the reality is we just refer to it as perinatal mood and anxiety disorders because it can hit moms, dads, partners, grandparents, and caregivers really just in general. So it's much more broad than I think we initially realized.

Interviewer: And what causes it?

Jamie: I think it comes from a combination of life stressors, changes, loss of identity, and also the fact that your brain can change as you become a parent.

Interviewer: Wow, that's really interesting. So is it all in the brain? Is it all chemical related or are there other factors that can contribute to male postpartum depression?

Jamie: Outside of the changes to the brain, realistically when you have a new baby enter your life, whether it's your first or your fifth, there are going to be some compounding psychosocial stressors that come along with that. It is one of the biggest changes that you can go through.

Interviewer: And what kind of stressors are the most common to contributing to perinatal mood disorders or postpartum depression in men?

Jamie: First and foremost, lack of sleep. I cannot hit that one enough because it is the thing that I see over and over again. If you are not taking care of yourself, if you're not getting enough rest . . . And when I mean enough rest, I mean four- to five-hour chunks at a time. For both parents, this is probably the key to keeping yourself well.

Interviewer: Are there other types of stress guys talk about that can lead to male postpartum depression?

Jamie: When we look at some of our male patients, the pressure to provide financially can actually increase stress quite a bit because there are dueling priorities between being home, helping out, and being more involved, which we are seeing a lot more men being more actively involved in their child's caregiving, but also the dual pressure of having to be at work as well.

I mean, I don't want to completely gender that because that can 100% be the reverse as well. But it's just a lot.

Interviewer: And I've heard another major form of stress for men can be these expectations about what it's like to be a father or the kind of father they want to be. Can you tell me more about that?

Jamie: We all have this idea maybe in our heads of what parenting is supposed to be or should be. And when you actually get into the thick of it, a lot of the time, it doesn't line up with exactly what you thought it would be. And so there can be kind of an interesting grief reaction.

If you had a difficult relationship with your parent, you may have a lot of pressure on yourself to do better than they did. Or if you feel like you had the ideal parenting situation and it's not . . . And some people do. I mean, some people really do feel like, "My dad was the best. He was the best that I could possibly hope for." And then when they feel like they're not living up to what those expectations might be, that can be really, really difficult for people to accept.

And it takes some time I think, especially if you're not going to therapy or talking with somebody openly about this, to be able to resolve and say, "Okay, but I get to decide what type of parent I am going to be," and whatever that is, is okay.

Interviewer: Right. It doesn't have to be what you see on TV or in the magazines or what the guy down the street is doing.

Jamie: Absolutely.

Interviewer: We create those own realities ourselves.

How do most men experience this when they describe to you how they're feeling? What are the words they use?

Jamie: A lot of the time, it's just "I'm not feeling like myself." There's a loss of identity, I think, coming into being a parent.

And some of the symptoms that we see more frequently with men is irritability. Lots of "I've been really snappy with my partner a little bit more, just quick to anger in general."

We also see an uptick in use of substances. So more frequent use of whether it's prescribed to things that they've been given to help with sleep or anxiety, or even just increase in alcohol use because there is that stress and trying to figure out how to kind of mellow out. That's something that we see pretty frequently.

Interviewer: Are some fathers more likely to be impacted by male postpartum depression than others? Are there some things we know?

Jamie: Definite risk factors are preexisting mental health conditions. You are far more at risk for experiencing a PMAD if you are already struggling with mental health conditions.

Now, that being said, it does not mean that it will necessarily get worse. It's just something to be very much aware of, which is why we talk about a lot of this from a preventative standpoint.

Also, if you are somebody that has struggled with depression or anxiety prior to having kids, staying on your medication and continuing to work with that is going to be pretty key.

Another risk factor that I would definitely want to touch on is when a pregnancy is unplanned or unwanted and you haven't had adequate time to truly process through that and kind of wrap your head around it, that can be a risk factor as well.

So I highly encourage people who are in maybe a situation that they're not 100% sure about to talk with their partners about it well in advance during the pregnancy so that you can work on communication and really just work on trying to set yourselves up for a healthy plan for self-care once baby actually gets here. It's important for both people, and I always like to include both partners as much as I can in our process.

Interviewer: At what point, if a guy recognizes some of the symptoms you talked about, should he be concerned and seek some additional help to get some tools to help get through this time?

Jamie: If you notice it at all, if it's really impacting your day-to-day life, it's impacting your relationships, impacting your work, that's a great time to reach out and get some help. I think that there is benefit potentially to getting on the internet and looking at some just online resources, just trying to understand it better and get some education.

Interviewer: And of course, make sure that the resources you're reading are reputable from medical institutions, that sort of thing. Are there other resources online you like?

Jamie: The online resources I do really enjoy because I think it's a good way for dads to find a community of people who are struggling with the same things and are being open about it without having to search too hard or run the risk of feeling like the person in their life is just going to say, "Well, suck it up."

If it looks like it is getting worse or you just don't quite know how to wrap your head around it, I think that speaking with somebody who is in the mental health field could be very warranted.

This is a really common thing. We see this. Statistically, it could be 10%, but I think it's much higher than that. So please reach out for help if that's something that you feel like you could be struggling with or even if you're just unsure. There is no shame in that.

Interviewer: For men that aren't quite to the point where they feel they need to see a professional, you've talked about an acronym called SUNSHINE that can help with postpartum depression. Does this apply to both women and men?

Jamie: Absolutely.

Interviewer: All right. Let's go through this, because this is a tool right now that our listeners could take away and start implementing right now and see if it helps. So let's talk about SUNSHINE.

Jamie: One of the wellness acronyms that we use quite frequently in our work is actually SUNSHINE. So what it is, is a series of different things that you should be thinking about when it comes to your mental and physical well-being during pregnancy and the postpartum period.

So it stands for sleep, understanding, nutrition, support, humor, information, nurture, and exercise. So those are all points that I think would be helpful in the preparation phase for having a kid, to think about, "How am I going to still try to get some of these things?"

And it's going to vary depending on where you are in that process. During the early stages, your focus may be on one of those things. And throughout the process, it might be able to expand into something else.

So I always advise my patients not to think about it as if you're not doing each and every one of these things, you're failing at your postpartum experience or you're failing at therapy. But just make sure that you are keeping them somewhere in the back of your mind because you are still an important person and your relationships are still important, whether you've got a baby in the picture or not.

Interviewer: So just give us one sentence for each one of the items in SUNSHINE. So sleep.

Jamie: Four to five hours as often as possible. Uninterrupted.

Interviewer: Uninterrupted. And try to get the standard eight to nine, otherwise?

Jamie: Absolutely, if you're able to. What that will likely look like, however, is especially in the early days taking turns potentially with your spouse, because they also need that time.

Interviewer: What about understanding? Expand on what that means.

Jamie: Understanding can mean a couple of things. You could again reach out and try to get a better idea of what other people's experiences have been like. Or you could also just get some education around what perinatal mood and anxiety disorders actually are.

Interviewer: And then what about nutrition?

Jamie: Nutrition, that's a tricky one. So this is not a great time to start a brand new diet plan. It's probably not going to be the top of your list of things. What we do want to make sure is that you are making sure you're actually eating and fueling your body. It's really, really easy to put your focus all on everybody else and sort of forget that you have needs also.

Interviewer: All right. So make sure you're eating and try to get as much nutrition as possible, knowing that maybe you might have to use some convenience foods.

Jamie: Absolutely. And preparation going into this can be really helpful for that, making sure that you do have some healthy things around the house. But I'm certainly not going to judge you if the thing you ate for lunch was a bag of M&Ms. Just get something in your system if you can.

Interviewer: Support.

Jamie: Support is something that we should start generating right from the get go, whether it's our family, improving our communication with our spouse, whatever that looks like. It's good to try and bring your support system in as long as that's a safe thing for you to do.

Interviewer: All right. And humor. Crack lots of jokes?

Jamie: Definitely. Hey, dads are known for their dad jokes, right? That's a thing for a reason. But being able to laugh at the situation sometimes really can help. Not only does it increase your endorphins and just make you feel better in general, but sometimes being able to find humor in the absurdity that can come along with parenting is not a bad thing to do.

Interviewer: Good tension release a lot of the times, yeah. Information.

Jamie: Information. Get good information about these things. Get good information about your mental health. When I say go to online resources, I think finding ones that are specific to dads' mental health through Postpartum Support International are great. I would suggest don't go down the social media rabbit hole of things that will probably make you feel worse about your parenting.

Interviewer: Does information also include just learning more about what it is to raise a child?

Jamie: Absolutely.

Interviewer: Because to me, that would be a major stress point. I have a friend that I don't know how many books he read before his child arrived, and he said it just made him feel so much better.

Jamie: Yeah, I think it can be a real help to people just having a better idea of what that could look like. The caution I will put on that is that there is a perspective for pretty much anything you can find out there. So maybe get some guidance from your pediatrician before you just delve into something.

Interviewer: Yeah, make sure you're getting some of the good books. Nurture.

Jamie: Nurture comes back to the self-nurturing piece of this. It is okay to talk about how you are feeling.

Interviewer: And feel. It's okay to feel. A lot of guys struggle with just even doing that or identifying what the emotion is.

Jamie: Yeah, absolutely. Or feeling like a dad in general. It's a big shift and we want to make sure you're taking care of yourself.

Interviewer: And it's okay to say, "Hey, I'm doing okay. I'm an okay dad." I mean, if you can't say, "I'm a great dad," go with, "I'm an okay dad," I suppose.

Jamie: Being a good enough dad is good enough. It's different for everybody. And people always balk a little bit about that idea, but there is a whole theory around the good enough mother, and so we do actually talk about that quite a bit. Dads fall into that category too.

Interviewer: And finally, in SUNSHINE, you have exercise.

Jamie: Again, I'm not saying go out and start a whole brand new plan and get a gym membership and do all the things that you've been trying to accomplish, but get some movement. That movement can just be going out for a walk once a day just to get some vitamin D and stretch your legs.

Interviewer: It's good for the body and the mind.

Jamie: It is.

Interviewer: Exercise, like you said, releases all those endorphins and makes you feel good, helps reduce that stress.

If those things aren't working, what's the next step that you would recommend a man take?

Jamie: I would recommend reaching out to even if it's just your primary care physician to say, "I'm struggling with this. This is hard." If you are actively involved in child's doctor's appointments, you could even talk to your kid's pediatrician about how you're feeling. They have a lot of really great resources.

Interviewer: Jamie, this has been a very informative, great conversation. I know it's going to help a lot of dads-to-be. Any kind of final thoughts as we wrap up this conversation that you would really want somebody to take away after listening?

Jamie: There are times when you're in the early stages where it just feels like everything is falling apart, but you're definitely not by yourself. You're not the only one that has struggled with becoming a parent or feeling like it's going to be like this forever. It's truly not. Get some support, and at the end of the day, it will get better and you're not by yourself.

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

Scot: All right. Do you have any questions before we start, Neil? Anything that you want to know? Anything that'll help you feel more comfortable?

Neil: No. I mean, just thanks for having me. I didn't contact you guys for that. I just wanted to know how to treat sleep apnea, but it's great to be a part of the show, so thanks. Yeah.

Scot: Well, that's the danger of reaching out to us, is we might have you on the show. No, we really appreciate you being on the show. This is something we'd like to do more of, but it can be really challenging getting listeners to interact. There's not a lot of interaction. We like that because it's about men talking about health, and we like as many perspectives as we can get.

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

Troy: Hey, Scot. Good to be here.

Scot: Mitch Sears, as always, in the mix. We always love having his perspective on the show.

Mitch: I'm happy to be here.

Scot: And we are so excited. Our guest of honor this episode, guys. We have an actual listener joining us.

Troy: Yeah, it's exciting.

Scot: His name is Neil. Neil, welcome to the show.

Neil: Hey, thanks for having me. I'm super excited to be here. Big fan.

Scot: We're super excited. Oh, did you hear that? He's a big fan.

Mitch: I know. What the heck?

Troy: Do we have competition for a number one fan now?

Scot: I don't know. I thought we just had one fan.

Neil: I'm it.

Scot: "Who Cares About Men's Health," changing one Neil's life at a time.

We talk about health turning points on this show, that moment when you knew something wasn't right, and as a result, things needed to change. And listener Neil contacted us about a couple of other questions he had, but as he was doing that, he told us a little bit about his health transformation. We were so intrigued by it, we wanted to find out more.

So this is what Neil had told us in an email. He's 50 years old. He's in better than average shape for a 50-year-old. Works out five to six times a week, runs mud races, takes deliberate walks every day, eats healthy, drinks alcohol only occasionally.

Raised his testosterone from 300 to 450, which puts you right in the zone there, man. That's awesome. And that was done by changing his exercise. He said that he ended workouts that thrashed him, like CrossFit, and instead is doing more lifting. And then started eating healthier based off the show as well.

So we wanted to find out about your story. Before, what was it that molded kind of your opinion or your ideas of health, exercise, nutrition, and sleep that caused you to live the life that was the life before, this kind of extreme life it almost sounds like?

Neil: Yeah, I think that's exactly right, Scot. I was doing way too much. I was doing CrossFit in the morning. It would be nothing for me to get up, do CrossFit 5:00 a.m., 6:00 a.m. in the morning, finish that at 2:00, 3:00, go for a four- or five-mile run, and then maybe even do something at night. That happened as well in preparing for different mud races and things of that nature.

And as I age, which is one of the things I learned from you all, I wasn't losing weight, I wasn't gaining muscle. In fact, I was gaining weight and I was gaining it around my belly, which I knew was bad for my heart. So I kind of knew a change needed to occur.

Troy: So it sounds like your change was really kind of the opposite of a lot of changes we hear about. Your change was definitely not ramping up the exercise, but reassessing the exercise you were doing and just saying, "Maybe I'm doing too much or I'm doing the wrong things."

Neil: Exactly. So what I noticed was, and I think I wrote this to you guys, I felt like I was living the bad commercial that I think all men hate. Your testosterone is low, you're gaining belly fat, you're agitated, and you can't concentrate.

Scot: Don't want to be that guy, do you?

Neil: No. None of us want to be that guy. And as I approached 50, I thought to myself, "I've got to do something different. I'm pushing myself so hard." And so I started doing research, and what I realized is that the stress workouts that I was doing were causing what I believe to be a major increase in cortisol.

And so I learned from one of your previous guests that the only way to naturally raise testosterone was to lift weights. And I had stopped lifting weights because I was taught lifting weights makes you gain weight, and I wanted to lose weight. So I had the completely wrong concepts on what I was trying to accomplish.

Scot: Yeah. You wanted to lose body fat. So what was your diet like? Was your diet kind of the same?

Neil: Yeah. My diet was pretty rigid. It was paleo and I ate a lot of meat, which I don't do anymore. I feel so much healthier eating the way I'm eating.

I want to explore the Mediterranean diet that you guys recommend. But I eat really high quality carbs, split grain bread, quinoa, those types of things, vegetables, and I eat small portions of meat. And I feel way healthier than I used to feel eating paleo, which was high meat, high fat, that type of diet.

Troy: And a couple of things you mentioned I'm curious about. You said you weren't doing any weightlifting. Were you doing any resistance training at all, like push-ups, pull-ups, sit-ups?

Neil: I was doing some push-ups, pull-ups, sit-ups, but not enough. Those were add-ons, if that makes sense.

Troy: Okay. But you were doing quite a bit of CrossFit though, you said, so I imagine you were getting some resistance training there.

Neil: Yes, some there. What I learned from CrossFit is you would do the resistance training and then you would go and do the AMRAP or the EMOM or whatever the next part of it was. And for me, I don't know, maybe I pushed too hard, but I would be completely thrashed by the time it was over. And I would feel awful. I'd crash on the ground.

Then what I noticed is I was falling into the trend of overeating afterwards. That's when I started realizing I need to make a change.

Troy: And was there one thing specifically? You mentioned you noticed increased belly fat, increased weight rather than losing weight. Was there one specific moment? Was it your testosterone check that really triggered this reassessment, or was it more of a process as you just noticed things were going the wrong direction?

Neil: I think it was more of a process. And actually, I was talking to my doctor, who's my best friend, but I don't go and see him, and we were just BSing at a bar having a beer and dinner together.

Scot: That's my kind of doctor visit. That's good.

Neil: Right? And I said to him, "Man, I'm doing all these events." And I told him what was going on. And he said, "There's a lot of evidence that that can actually do the reverse."

And so I didn't really follow up with him, but I decided to do some research on my own, and that's when the cortisol discovery came up. And I kept reading, "Take Ashwagandha. It fights cortisol." And then I realized cortisol is caused by stress. And so I thought, "Maybe I should stop stressing my body to this extreme." That was the process that I went through.

Troy: And it sounds like realistically you were doing, at least just from what I heard, two to three hours of pretty high intensity exercise every day.

Neil: Yes.

Mitch: Wow.

Troy: Yeah, that's a lot.

Scot: Yeah. It could be super frustrating too, I bet. You're exercising, you're eating what you think is healthy, and you're putting on body fat. That must have been really super frustrating.

Neil: It was super frustrating.

Troy: Were you monitoring your body fat percent during that time, or was it more just you noticed the increased body fat around your waist and on your belly?

Neil: No, I was not. I don't have percentages, but yes, my pants were getting tight. The usual.

Troy: Yeah, that's incredibly frustrating.

Neil: Yeah.

Scot: So where did you get your ideas about fitness? What brought you to be doing three hours of exercise a day and eating paleo? Where did these ideas come from?

Neil: Yeah, that's a good question. I'm not totally sure. I played sports in high school and in college, and I think it just came from media. I just thought that's what you're supposed to do.

And the American way is . . . which I love America, I don't mean to sound negative, but it's "push harder," right? Everything is "push harder, push harder, push harder." So that's what I did.

And I've taken more of a . . . Well, I've adopted your four pillars of health or whatever, four foundations of health. And I meditate now and just do some things quite a bit different.

Troy: But I think it's not at all uncommon. We always think if we're not getting results, you've got to do more of it. It makes sense, I think, for most of us to say, "Well, if I'm not losing weight exercising two hours a day, I should probably exercise three hours a day."

Mitch: And not just that. I mean, I'm really empathetic and resonating with the story, even though I think I come from a very different background. It's just this idea that whenever I was struggling with either my weight or feeling healthy enough or liking how I looked in the mirror or whatever, the thing that I tried to do was work harder, right? I'm not lifting heavy enough or I'm not doing the right program or whatever.

And I'd find something on Reddit and I'd commit to it for a week or two. I'd choke down 12 giant chicken breasts every couple of days or whatever, and I just felt like garbage. I felt tired. I didn't see any real results.

It's so interesting to hear that someone who was very active and who was doing these other things was kind of experiencing the same thing. If you are pushing yourself far too much, it's not going to get . . . I mean, it's not sustainable. It's not good for your body.

Scot: It's counterproductive.

Mitch: Yeah.

Scot: I'd like to share my experience. I wanted to put on some muscle, so at one point, as more of an adult closer to my age now than my age a while ago, I was lifting really, really heavy and doing heavy squats and that sort of stuff.

And I'm sure I was not doing them in good form. I'm sure I was trying to put too much weight on too fast because I had a bit of an ego going and I had this goal that I wanted to lift more weight, so you just put more weight on, right? You don't think about those things.

And then I'd come home and the next day, not from muscle soreness, but just . . . I don't know. It was just muscle fatigue. I could barely squat down and pick something off the floor. And I'm like, "What good is this kind of exercise routine if I can't live my daily life?"

The other thing that would happen is when I would start exercising, even where I wouldn't consider it pushing myself super far . . . it's almost embarrassing the little amount of weight I would do . . . I would notice I would start getting sick every time I started exercising again.

And I think possibly what I was doing is I was just doing too much for what my body could handle at that moment. You've got this built-in recovery system, and if you stress it too much, not great things start to happen. You start to get sick. You start to experience some of the things that Neil experiences.

Neil was going a lot harder than I was, which I'm a little nervous to say. I mean, that's been my observation. So that's really changed my opinion on what is fitness. It's about getting that dosage to be healthy, to have a healthy heart, to have healthy lungs, to have healthy bones and muscles, and to do the things I want, not to take over my life or make it so I can't do the things that I want. So that was a big reframing for me.

Neil, do you have any thoughts on that? Any additional thoughts?

Neil: Yeah, it's been great for me because I actually have more time to do other things that I want to do, like spend time with my family. So that's been great.

And I'll tell you, I probably will do another mud run because I'm curious to see if I can still go as fast as I used to. I have a feeling I can. In fact, I think I can go even faster because I think I'm a lot healthier, and that's what's exciting to me.

So I get up, I lift, I go for at least a one-mile walk every day, and that's about it. And I lift for about a half hour. Then about every fourth day, I do some type of HIIT workout that's about 20 minutes. And then about the 10th day of my routine, I do a big stressor, but I take the next day off. I feel way better. I'm actually excited to give it another shot at that.

Troy: So you said you're now doing 30 minutes of weights a day, a one-mile walk. How much cardio are you getting? Are you getting a decent amount just with the weightlifting or how's that looking?

Neil: Yeah, the cardio . . . so I get the HIIT. I think I get enough with the walking. My resting heart rate is about 57. So I feel really good about my cardio. My run times have all been . . . I run at 5,000-feet elevation, and my run times have all been sub-9-minute miles, which is good for me. I feel like my cardio is doing great. I mean, if you have another suggestion, Troy, I'd love to hear from you.

Troy: No, I think you just find what works for you. I was curious just how you perceive the cardio and if you feel like it's dropped off too much, because it sounds like before you were doing a lot of cardio. So I'm curious if you feel like you found a good balance there and exactly where things are.

But just the fact that you're getting your heart rate up and you're doing it every day, that sounds like that's what you need and it's working well for you.

Neil: Yeah, I think it is. Thank you.

Mitch: And one of the things that kind of . . . a thought that just kind of entered my head is that's the same approach that a former guest and listener Robb experienced. His approach to fitness and his own health was work out 30 minutes a day, run a couple of times a week, whatever.

But that's not what we hear when we talk about health and fitness, right? We hear, "You've got to push yourself harder. Oh, you've got to do whatever." It's not just a consistent, livable, reasonable kind of approach to your health. That's not what we hear.

Scot: Hey, Neil, it sounded like a lot of your thought of health . . . We do talk about the Core Four, exercise, nutrition, sleep, and emotional health. It sounded like before it kind of really focused around exercise and nutrition more and sleep and emotional health weren't quite at the forefront, and you've kind of brought those to the forefront. Is that accurate?

Neil: Absolutely.

Scot: Yeah. Tell us about that.

Neil: Well, if you remember, Scot, I originally emailed you about sleep apnea. I was diagnosed with moderate sleep apnea. My doctor friend recommended a CPAP. I don't really want to do that, so I'm still working on it. But I do know that I've lost about 16, 18 pounds doing what I'm doing. I have been sleeping way better, and my girlfriend says I do not seem to have the apnea like I did when I was heavier. So that's good.

I meditate every day in the morning, and I do a gratitude/grateful journal every night. And it's funny because I started the grateful journal literally the same week you guys did your show. I was like, "Oh, these guys. I'm their number one fan."

Scot: It didn’t freak you out a little bit, like, "Where's the camera, guys?"

Neil: It did freak me out actually. And actually, some of Mitch's stories freaked me out too because I was like, "Man, yeah, I know what he's talking about there."

Troy: Wow.

Neil: So anyway, that's really helped. I really feel very healthy. I feel better now at 50 than I did at 45 when I was doing all that stuff.

Troy: And it sounds like a lot of . . . The theme of this is just more balance. And it sounds like you're finding a lot more balance. Scot mentioned you were very focused on diet, but it sounds like it was not so much a balanced diet. It was just more of an extreme paleo diet where, again, that theme of balance has come more into your diet approach while also focusing on these other things as well.

Scot: Did the Neil before think the paleo diet was considered eating healthy? And what does the Neil of today think of the paleo diet?

Neil: Yes, to answer your question. Yes, I thought it was healthy and I was . . . When you go to the supermarket, you see all the magazines and everything else, "Eat paleo." So that's what I did.

And yeah, I did think it was healthy. The Neil now says no way. I just feel way too good or way too well to ever eat that way again. I actually like carbs. I have avocado toast every morning and I love it.

Troy: Nice.

Scot: All humans love carbs. That's what has sustained humanity.

Neil: Yeah.

Scot: It's interesting how the media and how popular culture can take things that aren't healthy and make them seem healthy? There was a period of time you believed the paleo diet was a healthy diet. And if somebody is on paleo . . . I might get pushback for this, but I think, Troy, you could speak that that's kind of an extreme diet and probably not the healthiest choice.

Troy: Yeah, it is. I absolutely believe it's an extreme diet. And the big thing I look at are the long-term outcomes. Cardiac outcomes. What's it doing to your cardiac health? What's it doing to your risk of colon cancers and other cancers? If you're eating that much red meat, those risks are all going to increase.

And again, we always come back to the Mediterranean diet. And the big reason I come back to it is because there's great research on it looking at those same outcomes of health in terms of just your . . . You're going to feel better, but just health in terms of your heart health, your cancer risk. All those things have been shown to improve with the Mediterranean diet.

The Mediterranean diet to me is pretty simple. It's just whole grains, nuts, legumes, vegetables, fruits. It's pretty simple, and it's very balanced. Any extreme diet, I think, may show some short-term results. Paleo, obviously, you're not eating carbs.

Scot: Short-term results, and this is interesting, I think, in weight loss. So much of our idea of health revolves around, "What is our weight? What do we physically look like?" We don't even consider "What's this doing inside of me?"

Mitch: "How do you feel?"

Troy: Yeah, exactly. "What is this doing inside of me? What's this doing to my heart health, to future risk 10, 15 years down the road? What's it doing to my cancer risk?" and those kinds of things. So, yeah, we do often focus very much on the short-term. Paleo, I have no doubt people can see some short-term results in terms of weight loss.

Again, Neil, it sounds like that wasn't so much your case. Maybe you did. Maybe initially you did see some results in terms of some weight loss, but I think it eventually catches up with you where your body equilibrates and you're not having that water weight loss that initially you get with all that ketone production from just not taking in carbs.

But yeah, again, long-term outcomes, I think it's that balanced diet. And I think, really, the Mediterranean diet is the one that again and again shows the benefits.

Neil: Yeah, I did have initial weight loss and I thought, "Oh, this is the greatest thing in the world." And that didn't stick.

Troy: Interesting. Yeah. That's my experience in terms of what I've heard from other people and just based on the physiology. Again, Thunder could speak to that a whole lot better than I could. But yeah, it's interesting that was your experience.

Scot: As you started focusing more on your emotional health, how have things in your life changed? How has that aspect of your health changed?

Neil: I definitely have the ability to stay in the moment better. With modern society and phones buzzing every second and computers beeping every other second, the ability to kind of just stay in the moment and concentrate has definitely improved through the meditation. I really enjoy that.

I also feel more at peace. I did share with you guys I'm working on being agitated. My job is somewhat of an agitating job, being a lawyer. But I still feel a little bit better at it. So I'm working on it.

But I do feel definitely more at peace. For me, it's a better connection with my family, because when I'm with them, I'm present, which is nice.

Scot: And then just even from an emotional or mental health standpoint, what would happen at work, Neil, before meditation and gratitude versus now? What might be something that would happen? Did you express anger? Was it frustration? Was it just overwhelm? What was it that's kind of gotten better?

Neil: Frustration. Frustration and allowing things that are out of my control to control me. You guys know this, and I think you guys just were talking about this, but when you meditate, you have the ability to realize what's in and out of your control.

And that's been a big asset, especially in my job, because as lawyers, we constantly or oftentimes have conflict with others. So you can control what you can control. You can't control what the other guy is doing. And so that makes life a lot better, a lot healthier.

Troy: Yeah, I couldn't agree more with you, Neil. I think that's just such a huge, huge thing to be able to meditate on and certainly to approach things with just accepting what we can control and accepting we can control our response, but we cannot control what others do. So, yeah, that's great to hear that's been a big part of this as well.

Neil: I know we're probably going to wrap up here soon. I want to thank you guys because you've really led me down this path. I found you on accident. And the University of Utah, thanks that they keep you guys on. I think it's fantastic what you do.

Men hate talking about this stuff. And when I got asked to do it, I've got to be honest, I was a little nervous. I really appreciate everything you guys have taught me and you guys are super open.

Mitch has shared so many different things, as you, Scot, and Troy have as well, but Mitch I know has led us on quite a path over the last few episodes. And then Troy had his dad episode, and I just listened to it all. I mean, I have two grown kids and I still listened to the episode about being a new dad.

There's always something to learn, and it's entertaining. You're very funny and I get a chuckle out of it, so it's good. Mitch, are you laughing at me?

Mitch: I'm so delighted because this is . . .

Neil: It was like a giggle of delight.

Mitch: Oh my god.

Troy: It was like he's on a merry-go-round.

Mitch: No, it's just that's part of it, is there are times that I think, "I am sharing a lot. I am giving a lot out there." And the hope was that . . . In the same way that just being able to talk to other guys about their health has completely changed my life, if I could just talk about my own health that way, maybe someone out there could hear it and do the same, or have at least even an ounce of the same sort of change I've had.

And so I'm just tickled pink to hear that there's someone else out in the world who is like, "No, we don't have to be super intense, and if guys just start talking to one another, we can help figure this out together."

Scot: You mentioned that you were a little nervous coming on the podcast, right? You listen to the podcast "Who Cares About Men's Health." We talk about guys don't talk about their health. We try to model behavior where you do talk about it because it can make a difference as we're seeing, but yet you were still a little nervous to come on. Where do you think that came from?

Neil: Ego. In a word, just ego. I mean, you can embarrass yourself, right? So I'm sure somebody I know listens and they haven't told me yet and they're going to hear this and they're going to be like, "Dude, I heard you on that show."

Scot: Well, hopefully it goes, "Dude, I heard you on that show and I've struggled with something like that too."

Mitch: Yeah, that's what we need, right?

Neil: Yeah, I hope so. That's why I was willing to do it. If you guys were willing to do it and you need other people to help out, why not?

Scot: So would you have a conversation with any of your men friends, other than this doctor friend that you get your doctor appointments at the bar? I've still got to figure out how to do that, which I think would get guys more interested in health and going and getting their checkups.

Troy: Yeah, sporting events. Let's take this to the arena. I agree.

Scot: Anyway, would you now be more likely to talk to another person in your life, doctor friend aside, about health? Is that something you do, or are you still a little close to the vest? I mean, I'll admit I'm still a little close to the vest.

Neil: I have a core four of friends, let's just say, that I would. And then outside of that, unless I'm asked, I probably wouldn't to be honest.

Scot: Sure. Got it.

Neil: Yeah, I wish I could. It's just not . . .

Troy: Yeah, it's tough. It is. It's tough. I think this podcast definitely gives me more of a forum where I feel like I can be more open about my health. But you're right, I think beyond that. I think it's helped me in a lot of ways to talk to some of my friends about mental health stuff and they've opened up to me, which I think has been really good. But it is. It's still tough stuff that most guys just kind of don't want to talk about, so I get it.

Scot: Wrapping up here, what have you learned from this journey that you have gone on this transformation? What have you learned from this experience?

Neil: If I can steal from Troy, I think balance. I was way out of balance. I was over-fit to the . . . Actually, I didn't even share this with you guys, but to the point where I had an EKG that was kind of wonky and they said, "Oh, you've got a runner's heart." It was really . . .

Scot: Wow.

Neil: Yeah, it was really odd circumstance. Anyway, what I've learned is just balance. My eating is better. I have some discipline as part of my eating. I have some discipline as part of my working out. I have some discipline as part of my meditation and my sleep. But I'm not over-the-top disciplined like I was before, where if I ate a piece of pizza and fell off my paleo diet, I needed to go run 10 miles. So I just I feel great. It's all about balance. That's what I learned.

Scot: And enjoying life, right? A piece of pizza has never derailed somebody's health, right?

Mitch: Right.

Scot: It's when that piece of pizza gets together with 18 of its friends every week. Then you've got a problem.

Neil: Right.

Troy: That's right.

Neil: Yes. Well, I've reintroduced pasta into my life and I love it. I just don't do it a lot. That's all.

Scot: Right? And I would contend that's just as much of a mental health thing as anything else. You've got to enjoy life. Why are we doing all these health things to these extremes at the expense of enjoying our lives?

Neil: Absolutely.

Scot: Well, Neil, thank you so much for coming on the show, sharing your story. I'm just so excited that you are finding success in what you're doing. A little of an unusual story, as Troy pointed out. Most of us are coming at it we need to exercise more maybe as opposed to less. But I think it's fascinating to know that you can take things too far, and when you dial that back, good things happen.

I bet you will run that mud race faster, because I've heard stories of runners that end up hurting themselves or getting sick and they take three or four weeks off, and those first runs back, they do better because they were just over-training.

It comes back to what Mitch says. You think, "If I want to get better, I've got to do more," but you've got to remember that recovery and all that other stuff as well.

Troy: And I've got to say this, Scot. I always say I'm not going to talk about running, but since we're doing this, I've got to say one of the big things that really hit me.

Several years ago, I talked to a runner who had broken the three-hour barrier in marathons, which is kind of a big deal when you can get sub-three hours.

And I said, "Well, how did you do it?" And he said, "Well, I just started running slower. I just didn't run as fast on my long runs. I just slowed down on my long runs and I saw the results."

So he went from kind of the same thing where he was just pushing himself way too hard. He said, "I just slowed down on my long runs and my races got faster."

So it's kind of cool to hear that. And it sounds, again, Neil, like you're kind of seeing the same things, where you've taken a step back from the really high intensity stuff. Again, you may see results as you start to do more mud races. It'd be interesting to see what happens.

Scot: And I think if there's another lesson to take away, it's what we believe, what society might have us believe, what the media, what advertisements might have us believe might not necessarily always be the right way, right? The paleo diet or you've got to push yourself if you want to be super healthy.

That's why, Neil, I love that you did some research and you're looking at science and you're looking, "Well, what does that actually say? What is the truth versus what truth are we kind of being fed about health?" So that's one of the lessons I'm going to take away.

Mitch, do you have a lesson?

Mitch: Just talking about it. Willing to be a little bit vulnerable and saying what you are concerned about with your health or whatever, how much it can help one another, right? Talk to your other guy friends. Just talk about health, please.

Scot: Neil, great story. Thank you for being on the podcast, and thank you for caring about men's health.
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Scot: Surviving the holidays. What is your game plan? It seems like when people talk about the holidays and health, it always kind of goes back to, "How do you watch what you eat? How do you keep exercising?" But there are other factors too that we consider.

We talk about the Core Four, which is exercise, nutrition, but it's also sleep and emotional health. Are there some things that the members of the "Who Cares About Health" crew do during the holidays to try to make them a little bit more enjoyable? Whether it is managing the physical aspects of health or emotional aspects of health.

And today on "Who Cares About Men's Health," each of us is going to share our holiday game plans to maintain our health during this holiday season. Just little tweaks we've made, things we've learned, maybe even major changes, how we celebrate the holidays.

This is "Who Cares About Men's health," providing information, inspiration, and a different interpretation of men's health. And on the show today, you've got me. I'm ready to jingle my bells and bring the BS to this holiday season. My name is Scot Singpiel. The MD to my BS and looking sharp in his Santa hat is Dr. Troy Madsen.

Troy: Yeah. I'm here, Scot. Can you say jingle your bells on a podcast? I don't know.

Scot: And standing under the mistletoe by himself as always is . . .

Mitch: Ah, no. But I do appreciate that more than being a Santa's helper elf or something. Good.

Scot: Ladies and gentlemen, Mitch Sears is on the podcast as always, and it's great having you here today.

Mitch: Hello. I'm glad to be here.

Scot: Today, we are going to talk about our little holiday game plans. Are there some things that you have done that have changed your enjoyment of the holidays or that have helped you get through the holidays? And that could include physical stuff or emotional health.

Now, most of mine revolve around emotional health. One of mine is physical health. How about you, Troy? Just in general, your three, how would you categorize them?

Troy: I think emotional health is a big one.

Scot: Okay. And how about you, Mitch?

Mitch: So mine is really focused on nutrition and emotional health.

Scot: Oh, it is? Okay. I feel like sometimes that's all you see, is, "How do you keep your diet through the holidays?" I mean, do you really need to? I don't know. Maybe we'll discuss some of those things.

But one of the things I don't think people think about, and maybe I'm not giving us enough credit, is kind of the mental health aspect. I don't know. What's your guys' perspective on that?

Troy: Yeah, I think the mental health aspect of the holidays is absolutely huge. Some of the worst shifts I've had in the ER have been when I have to work Christmas Day. It's just so depressing because you just see so many people there who are just so sad and miserable. And it may be just they're stressed out or maybe they're just super lonely or whatever it is, but it's a tough day to work in the ER, honestly.

So I think that really drives home to me the emotional health impact of the holidays. It can be great, it can be amazing, or it can really kind of go the other direction.

Scot: Yeah. How about you, Mitch?

Mitch: I guess for me it's kind of interesting because it seems like . . . We talk about how to keep thin during Thanksgiving or whatever the particular holiday is, but very seldom do we talk about the potential an emotional minefield that goes from reconnecting with family that you haven't seen for a while, or the pressures to get the perfect gift, or have the right events, or whatever it is.

There's a lot of self-inflicted stress that happens. You're put into a bunch of situations that are stressful. Travel is terrible, whatever.

But yeah, personally, I've spent some time the last few years really trying to figure out how can I make sure that I get through these holidays and actually enjoy them?

Scot: Yeah. I think that's key, right? And that's the other thing you see in popular media. The mental health things of . . . It's terrible and you should definitely get help for it, but dealing with depression and dealing with this and dealing with that. But the holidays are supposed to be a joyous time of the year where you do enjoy reconnecting with friends and family. And if we're doing things during the holidays that is impeding that, that's not necessarily a good thing. So how can we optimize maybe even?

I don't know. I'm really curious to hear what you guys have to say. I'm going to go ahead and kick mine off with Christmas gifts. Is Christmas gifts on anybody else's list?

Mitch: No. I love gift-giving more than anything in the whole wide world.

Scot: All right. So for you, that works.

Mitch: I love it.

Scot: My experience, especially after I got married, was the in-law gifts, a father, a brother, a mother-in-law, and then my wife. You had to get gifts for all of them. And then their family also did Christmas stockings, which was fun, but it was also stressful to buy all that small stuff. It was a lot of stress thinking about, "What do these people want? What can I get for them?"

And then I have this personal conflict where I don't want to just get something for the point of getting something that a couple years later is going to be a burden and then they're just going to be taking it to Goodwill and I've just wasted resources on the planet. That stresses me out a lot. I want to get something I know somebody is going to use, and it can be hard to get something that somebody is going to use that they're also going to love, right?

But a couple years later, we decided to just get gifts for the kids. So it was just the two kids, and then the rest of us, we didn't get gifts for each other. I truly don't miss it and it makes it so much more enjoyable not to have that stress. So it kind of got us out of the gift rat race, which I really appreciated.

And then there are a lot of different versions of this, I think. I mean, some people draw a name and put a price limit on it. That would be a good way to kind of get out of that rat race.

I know some people give gifts of things that they have that they no longer found useful, but maybe somebody else might find useful. Or they might give a gift that they made for somebody else, or they give something that they personally like so then that other person can share in that. Or maybe you limit it to books.

But that gift rat race for me was just a miserable part of the season. And now that we're kind of out of that, it has made all the difference.

Troy: No, I agree. I think it can really escalate to where it just becomes so stressful for everyone. We used to have extended family events and everyone was bringing gifts for everyone else there. And you could tell there may have been some people who enjoyed it, but I think for the most part people just found it stressful, and someone finally called a truce, just said, "Let's not do this." It was like, "Okay, good."

Scot: Or just even knowing what the expectation is for gifts. Those extended families, you're going to go to that, "Is cousin Ellie going to bring something? Do I need to get something for cousin Ellie? I better have something for cousin Ellie in case cousin Ellie gives me something."

Maybe there's even something to be said for appreciating this notion that you don't have to get somebody else a gift, and if they give you one, you don't have to feel guilty about it. If somebody gives you a gift, you can just say, "Thank you."

Troy: That's a great point.

Scot: "I really appreciate that." And if that other person is expecting something in return, then they did it for the wrong reasons. But if they truly just wanted to give the gift, you don't have to feel guilty that you didn't get them something.

Troy: That's a great point. Yeah. I think just accept it, be grateful, express your gratitude. Don't feel like you have to reciprocate.

Scot: Yeah. And if you do and something strikes your fancy, then you can, but you don't have to.

Troy: Yeah. You don't have to. And you can be grateful knowing that they feel . . . I think we've talked about it before. I've seen some studies. People giving the gift often experience greater joy than the person receiving the gift. There's actually been research on that. So you can just feel good that you gave them that gift.

Mitch: And as an avid gift giver who loves this stuff, I love being able to find a unique whatever gift for people. I have running lists of every person that I know. As I see things, I keep it. I love this type of stuff.

At the same time, in my last relationship, I was invited to Christmases where basically the in-laws would shower us in gifts. And there were stockings and there had to be 10 boxes. Everyone has to have so many gifts and whatever. That stressed me out.

And so it was very much the situation where it's like, "I'm not going to play this game. I am confident enough in my own skin that I am going to get thoughtful gifts. One thoughtful gift for each person because that's all I can financially afford." The concept of showering one another in gifts and whatever, it was just not for me, not my thing. So I swore off of all of that.

Scot: And that's just a difference of the way that people celebrate Christmas. So maybe even just having that conversation, just saying that this is . . . "I so appreciate it, but this just really is overwhelming to me. Maybe we could downgrade this a little bit."

Mitch: Sure.

Scot: All right. Troy, what's something that you do at Christmastime or during the holidays to . . . What's your holiday game plan?

Troy: My holiday game plan is to keep it simple. And I think that kind of goes along with what you talked about, Scot. I think you can feel obligated, like, "Okay, I've got to have a bunch of lights on our house," or, "I have to send out Christmas cards to family and extended family and friends and all these other things," or I need to reciprocate, like, "Oh, we got cookies from the neighbor. We've got to get them something." Whatever it may be.

I really try not to kind of go down the rabbit hole with a lot of those things and just keep it simple and just say, "Hey, what we're doing, is it something that's bringing me joy, that I'm having fun with, that's making this whole experience this season more enjoyable? Or is it just creating more stress?"

And if it's creating more stress, it's not worth it. And if people think less of you for it, so be it. It's a time I hope we can just enjoy, and I don't want it to be something that just becomes a stressful experience.

Scot: And I love getting homemade cookies and stuff like that. That's simple, right? From anybody. It doesn't matter who. I like those little treats that somebody made. That's fun.

I don't know what that has to do with anything other than maybe telling you it doesn't have to be an extravagant gift. It could be the salsa that you made from the stuff in your garden. My wife does that a lot. She'll give out salsa or jalapeno jam and people look forward to that. And it's a simple thing. Took a little bit of work, but not a lot. Doesn't cost a lot of money. I love it.

Mitch, jump on in with your holiday game plan.

Mitch: All right. The big thing that I'm going to try this year is that I end up putting on significant weight over the holidays. And it has to do with I go to a bunch of events, I host a bunch of events, I do a lot of baking of my own. There's leftovers and I just find myself eating more than . . . I'm not a big eater, I don't come from a family of big eaters, but here we are, holiday time, I get caught up in the lights. I don't know if we've covered this before. I get real gross around the holidays. I get super sappy. I have a big tree. It's bad.

Scot: Sounds great to me. But go ahead.

Mitch: I know, but it's just like . . . I don't know. I'm wearing my leather jacket and singing carols with the people down at the Temple Square. That's the kind of weirdness that I run into.

But suddenly, I'm accidentally eating tons and tons and tons, and then I'm usually pretty upset with myself. I've kind of ruined most of the goals that I've been working on.

So this year I am going to commit to making all of my own food as part of it. That way, I know exactly what is going into it. I know it's not just buying a bunch of sweets or candies from the store. It is something that I have made, so I know exactly what's in it. So I can kind of know, "Hey, this is a lot of sugar or not."

And number two, I'm going to keep up the meal prep stuff that I've been doing. I buy some groceries. I make myself some food beforehand so I can make sure that I eat it. Through the day, I always know I have a healthy meal. I'm going to keep that up, right? I'm not going to just rely on leftovers for the next few weeks. I'm going to keep that habit up.

I'm going to eat the good food when it's the day, when it's the time. But this fancy food creep is what I'm going to be trying to kind of fight against this year.

Scot: You're still going to enjoy the good stuff, but you're just going to try to not allow it to creep into every meal.

Mitch: Yes, because that's what happens. You go and it's like, "Hey, you should take some pie home and some of this home and some of this home." And then for the next five or six days, breakfast is pumpkin pie. It's just what happens.

Troy: And here's something too I've had to learn to do, because I grew up learning you don't waste food, you eat food. You've got to feel comfortable throwing stuff away. Graciously accept it when they're like, "Please take this extra pie home." "Oh, no, I really shouldn't." "Yes, please take it." "Okay." Don't be afraid to throw it away.

Scot: Where it almost gets aggressive.

Troy: I know. It's like, "Okay. I'll take it."

Scot: You've said no six times, and eventually you just have to yes because you know you're not going to win.

Troy: Yeah. Exactly. But don't be afraid to throw it away. It's like, "Okay, maybe I'll have a little bit of it. I'm not going to eat this whole pie." You've got to toss it.

Scot: All right. What is your holiday game plan to get through the holidays and maintain the Core Four, maintain your mental health? I've got another one for you. This is going home for Christmas.

Now, this isn't going to work out for everybody, but I was talking with my friend Jay about how going home for Christmas for him was something he didn't enjoy. It was a long distance he had to travel. Then when they'd get there, it was too cold to do anything anyway. So all they did was sit around and eat and that was it. He wasn't enjoying it. He wasn't enjoying time with his family.

And I know, Troy, you're thinking at this point, "Just sit around and eat? What's so bad about that?"

Troy: It sounds awesome.

Scot: Yeah. But he said he just wasn't enjoying that time. He was like, "I'd rather go back during the summer, take that week, go during the summer when we can go out and do things. And also when it's removed from all this stress of holiday meals and just the gifts and all of that." So I'm like, "Well, why can't you do that?"

What is Christmas other than just a day we associate with spending time with family? Why can't we associate that time whenever we want?

Now, again, that might not necessarily work for everybody because sometimes people do have built-in time off around the holidays, and this is such a built-in tradition that . . . In his case, he has brothers and sisters that you've got to kind of convince. But he did convince most of his family members to do that. So now he goes back in the summertime.

My wife and I have decided we're going to adopt that for a lot of the same reasons. We just spend Christmas at home just with us. The time we have off for Christmas, most of it is in our pajamas. Most of it is doing stuff together and it's just a quiet, nice relaxing time.

I mean, that was a game changer for my friend Jay. It's become a game changer for us. And then we can go back and we can enjoy our time with our families at a slower pace, at a time of year where we can actually go out and do some stuff where it's not so hectic.

And then the other thing that we used to do is . . . We used to be so busy because our friends were back home at the same time we'd go visit our family. So it was family day, friends at night. During the pandemic, though, we started Zooming. So then that's kind of filled that need.

Mitch: Interesting.

Scot: So I mean, if you can kind of change up . . . If going home for Christmas is not working out for you, if that's the situation you're in, it might be time to think about if there is an alternative thing you can do that's going to be more enjoyable and get back to the whole spirit of Christmas, which is being with friends and family and spending good quality time with them.

Mitch: I cannot. I guess, for me, I always kind of rolled my eyes at people who were like, "Oh, I have to go back home for Christmas." But it kind of dawned on me that I was very privileged because I live in the same state as my family. I don't need to go through all the hassle of travel.

But again, in that last relationship, I had to drive up to Wyoming multiple . . . to and from, just before the worst storm of the year. I had to worry about, "Will my little Toyota Avalon make it past the Pass? How long am I going to be stuck there? Will I have to take extra PTO?" And then when we get there, there's just a lot of sitting around and it's like, "Why are we here for five days?"

There's this kind of being able to will yourself to be like, "You get space to . . . you get to decide your own emotional wellness, so you get to say, 'Hey, what can we do? This particular part is not working for me.'" And that's really good. I really appreciate the approach that you're taking to it.

Troy: Yeah. And it makes me think too, hearing all of this, I wonder if there's value, if you're just finding the holidays are stressful, in doing essentially just a holiday detox, just telling people, "Hey, we're not doing anything this year."

Scot: Well, that's what me and my wife have essentially done. You get the pushback. Or just take an inventory. What are all the things we're doing? Are they adding value or are they not adding value? Can we maybe just have the things that add value? I think you brought up that concept a little bit earlier, Troy.

Troy: Yeah. And I think there's that idea too . . . Again, I'm kind of going with this holiday detox. Just don't do anything. Don't plan anything, don't put up a Christmas tree, and then just ask yourself, "What do I miss? Is there stuff I miss? Okay, I miss this. I miss this. These are the things I want to do."

Scot: I like that. That's good.

Troy: Yeah. Kind of start from the ground up again if you're just finding it's just too stressful.

Scot: Troy, do you have another game plan for the holidays?

Troy: The thing I want to talk about, Scot, and again, I feel like a broken record when I talk about it, but I always have to remind myself as I approach holidays or whatever events that are . . . I don't want to call it distracting, but just something where it's out of your routine. Just keep the routine going, the stuff you want to keep going. And so for me, it's running. I want to keep running, I want to keep doing what I'm doing. Stay consistent with it.

Mitch talked about diet and trying to stay consistent with what he's doing. I want to do that as much as possible. I know there's going to be lots of sweets. Avoid those as much as I can.

So it's more just a reminder to myself just to keep doing what I've been doing and try not to let those things slip up too much over the holidays.

Scot: Yeah. But on the other hand, I don't think you should beat yourself up around the holidays. So here's another one that I have. It's about eating. I take about a quarter serving of each thing that I think I can eat. So I take a look at what I think I can eat and then I take a quarter of that, right? My eyes are always bigger than my stomach.

And it does have a little something to do with weight, but more it has to do with how I feel after, right? And it also has to do with the other things that I like to do. I like to give myself a little bit more grace this time of year because treats are around and it's fun and it's a nice little reward.

So if I can watch what I'm eating and not completely go overboard there, like one tends to do at the holidays, then I feel a little less guilty about having the treat. And part of it is weight, but part of it is just I hate that stuffed feeling that I perpetually feel.

Especially, again, when we used to go home, it was a humongous meal after a humongous meal. All we do is eat, and I just don't feel good. I just feel miserable and don't want to do anything.

So quarter serving of each thing. Try to maybe just not have eyes as big as your stomach. That's my little piece of advice.

Mitch, do you have something you want to throw in?

Mitch: I do. I'm very pro holidays. They're very exciting for me. I really, really get into them. But one of the things that is really easy for me to do is to kind of allow the holidays and the pressure and this idea that I've got to get these events done, whatever, to kind of let my anxiety and let my negative feelings in where they should not be, especially at a time where they should not be.

So to help with emotional stability, or resiliency in particular, one of the things that I've started doing the last few years is at Thanksgiving, I pass out a whole bunch of little strips of colored paper, holiday colored paper. And I have everyone and myself write down a whole bunch of things that they are grateful for. We just did an episode about gratitude. So I kind of get everyone involved and we all write down things that we are grateful for.

And the day after Thanksgiving, I turn those strips of paper into a paper chain, a countdown to Christmas, because that's what I celebrate. And so every single day I open that up and I find out something that either I am grateful for, and I'm reminded of it to start the day with my morning cup of coffee and one thing that I'm grateful for, or something that my friends, my family, someone else is grateful for.

And it's really interesting because it's like, "Hey, I'll send a picture." It's like, "Oh, I drew yours today. Ha-ha-ha, you were grateful for shoes," whatever.

It creates this reminder every day of why I appreciate the holidays and why I am grateful to be able to be a part of it and in a place where I can have people over and have them in my life, when it can sometimes get real easy to be hard on yourself, to let the stress take over, to try to keep up with the Joneses, every single day.

Build that into the holidays. Make gratitude a part of the holidays. And it's worked really well for me.

Troy: That's a cool idea. I've never heard of that before.

Mitch: Yeah. My mom used to do it when we were kids, and these days I thought I'd bring it back.

Troy: That's fun. Yeah, I've made chains at various points. I made a chain counting down to when our baby was born, but it was the chains of my ER shifts and I just felt so much gratitude every time I tore one of those links off the chain.

Mitch: So you make the ritual. You make it something you're doing.

Troy: Yeah. That's kind of fun, though. That's cool. I like that it has the gratitude statements on it and you can kind of look at those every day. That's cool.

Scot: I don't know. That stresses me out.

Mitch: Why?

Scot: All of that sounds like a lot of work. But you know what? We've talked about this on the podcast before. We'll talk about it again. It works for you. It might not work for me. That's cool, right? We pick the things that work for us. Although I do like the gratitude thing.

One of the things I was thinking about doing this year, and I probably never will because I can kind of be lazy, but I take a lot of photographs. I want to start sending Christmas cards to people that have made a difference in my life over the course of the year. Maybe even go through my gratitude journal and look at the people that I've mentioned and just have a photo that I took as the card and then just let them know how I feel about them.

Mitch: I love that. That's great.

Troy: Yeah. That's really cool. Very personal touch and . . .

Scot: I'd like to test it out on you, Troy. So I'm going to get down on my knee and look up into your eyes and I'm going to tell you what . . .

Troy: Get down on your knee.

Mitch: Send it in the mail.

Troy: You can just send a photo.

Mitch: Yeah, send it in the mail.

Troy: The US Postal Service will be perfectly fine for that, Scot.

Scot: I just don't know if other people would . . . if that would be awkward for other people or other guys.

Troy: I don't know if it would be . . . No, I think it'd be kind of cool. And you don't have to make it super over the top or anything. Just say, "Hey, this holiday season, there's a lot I'm grateful for. I'm really grateful to have you as a friend." Something like that. And it'd be really cool, the personal touch. I love that idea of sharing some of the photos you've taken.

Mitch: Yeah. Well, one of the tests that I've started doing with some of my anxiety issues is if I worry, "Will this be too much? Are they going to like it? Are they going to care about it?" I just think, "How would I feel if I were to receive something like this?" If I'm like, "That would probably feel pretty good," then just do it.

Scot: And if it makes Troy feel awkward when he gets my card, then that's his problem.

Troy: Yeah. If we never speak after that, then so be it.

Scot: Oh, wow.

Mitch: Oh, man.

Troy: I'm just kidding, Scot. I think it's really cool. Like I said, I . . .

Scot: You would enjoy getting a Christmas card?

Troy: I would love to see your photography. I know you do lots of dark sky photography. I would love to see it. I think that's really cool, and it would actually mean a lot to think you're sharing some of your talent and what you've done there and just to have a card like that. Yeah, I've never gotten that before, so it would be cool.

Scot: Cool. All right. Well, maybe you've encouraged me to do it. Have we hit all of our holiday game plans?

Mitch: I think so.

Scot: We good?

Mitch: Yeah.

Troy: :I think so.

Scot: All right. We're in the huddle now. We're ready to break and go out there and play the holiday game.

Troy: Let's see what it brings.

Scot: Okay.

Mitch: Survive.

Scot: Three, two, one, break.

Troy: Break. That's right.

Scot: Guys, as always, thank you so much for being on the show. If you're listening, I hope one of these ideas can help you. We encourage you to try one of these ideas, even if it's just to take a quarter serving of everything you want to eat instead of the serving size you think. Or if it's making a gratitude chain like Mitch likes to do. Or if it's just telling yourself, "I'm going to try to keep as much of my routine that I have going as I can throughout the holidays."

And maybe be kind to yourself if you don't quite do it. But just set that goal, like Troy. Although Troy is going to nail it 100%. He always does. But we don't have to live up to Troy's standards. That's the other thing we learned on this podcast.

Troy: It's always a challenge.

Scot: Guys, thanks for listening and thanks for caring about men's health.
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Scot: Hey, Troy. What was one of the things that everybody said about being a new dad, and you're like, "Eh, really?" and it turns out it's true? What was the one thing? Do you have something?

Troy: I think the anxiety that comes with it, that's probably the one thing. I heard people say, "You will lie there at night, and you will just listen to her breathe. And you will just make sure you are hearing her breathe." And I was like, "No way. I would never even do that." I have absolutely done that. So, yeah, that's definitely true.

Scot: Oh, man. Transitioning into fatherhood, like any chapter, can be really, really challenging and it can have an impact on your health. I mean, how many times have you heard guys say they stopped exercising or eating right after they've had kids, or their sleep is just constantly impacted after that? Or just even emotional health issues. It's a big change in your life. And we have a guy that has just become a new daddy, Dr. Troy Dadsen.

Troy: Dadsen, with a D.

Mitch: Dr. Troy Dadsen.

Scot: With a D.

Troy: There we go.

Scot: And this is a Sideshow episode of "Who Cares About Men's Health," where we're going to get a new daddy update, where Troy is going to tell us some of his experience as it relates to his life, and back to the Core Four that might be able to help other new dads.

"Who Cares About Men's Health" provides information, inspiration, and a different interpretation of men's health. My job, I bring the BS. I'm Scot Singpiel, and I chose not to have kids because I was afraid I'd screw them up. So that's why I don't have kids.

Troy: Scot, I was deathly afraid I would screw them up too. But I have a kid now, and hopefully I don't screw her up.

Scot: Now that is the MD to my BS, new daddy, Troy Madsen.

Troy: Yeah, that's me, bringing the baby to the show.

Scot: And nieces and nephews are enough for now, says Mitch Sears. He's on the show as well.

Mitch: Yeah. I'm good for a bit. Yeah, I'm good.

Scot: Okay. Because I just made that up to be clever in the intro, and then I asked myself, "I wonder if that's true. I wonder if he actually wants to have kids at this point."

Mitch: I don't know. No.

Scot: No?

Mitch: No. We'll see. I mean, we'll figure it out at one point or another.

Scot: Okay. All right. Troy, it's great to have you back on the show for a new daddy update. So I've got one question for this episode of the podcast. Tell us all about being a new dad.

Troy: So I'm just going to go into a 20-minute monologue now.

Scot: Actually, just give us an update to start off with. How's it going so far? How long's it been and how's it going?

Troy: So things are going incredibly well. It's been two months. She just turned 2 months old. Her name is Adeline. We call her Addie. That's her nickname. So she goes by Addie. She was born just over two months ago.

And I will say the delivery experience itself went incredibly smoothly. It was funny. It was just about . . . Well, it was one week before she was due. And Laura, my wife, was at the vet with one of our foster dogs, Arthur, who, Scot, you know well. You saw pictures of him at least. Very cute little guy. And Laura calls me and says, "Well, Arthur is doing well, and I think my water just broke."

Mitch: She buried the lede? Ugh.

Troy: Yeah, she totally buried the lede. She started with, "Well, Arthur is doing well. Everything is good. And I think my water just broke."

Scot: Well, from a comedic standpoint, that is the delivery. So good for her.

Troy: Yeah, exactly. From a comedic standpoint, yeah. So she came home. We went in to the hospital. So we got in there about noon. Addie was born about 2 in the morning. Came out with her eyes wide open and just the most beautiful little girl I've ever seen. Obviously, I'm very biased.

Scot: Of course you are.

Troy: And then I had about an hour with her alone because they just had to watch her over just in the pediatric . . . just the neonatal care unit. So I had about an hour in there with her alone, just sitting there with her, and just looking at her and just thought, "Wow, this is absolutely remarkable."

And every day since then, I've felt the same way. Every day it is just . . . Just to see her grow, and develop, and her mental development as she's become more attentive and more focused on our faces. Just in the last two weeks, she'll smile. I'll look at her and she'll see me and she'll smile, and look at Laura and smile and laugh. We'll laugh and she'll laugh, and it's just the cutest thing in the world.

And she's just my little best buddy. We walk around during the day. She loves to ride around in this pack. I've got this little pack that sits on my chest, and she's facing me and she just loves that. She'll ride around all day.

Some days, after a long run, my legs are tired and I'm like, "I don't know if I can be on my feet for another three hours carrying this kid around." But she loves it, and she'll fall asleep. And she'll look around, look outside at the squirrels and birds and whatever else.

It's like I've got this new little best friend at home now. And quite honestly, just really enjoying it.

And I think probably the biggest surprise in all this has just been how smoothly everything has gone. Again, me being kind of the pessimist, where I see so many things that go wrong in pregnancy just throughout my medical career, and just being aware of those things. And so I think just every day I'm so grateful that everything has gone as well as it has, and everything continues to go well, and just really enjoying the time I have with her.

Scot: You know what? As you were talking and as we're having this conversation, Troy, it just dawned on me talking about the new baby and going into depth about details about the new baby is something that we tend to think that women do, right? That's my perception.

Mitch: Yeah.

Scot: But then as you're talking about this, and I'm sitting here and I'm listening, I'm like, "I don't know if guys talk about . . ." Do you get asked by other guys about how it's going, and are they expecting an in-depth update? Are they just expecting, "Eh, it's great"? What's your experience with that?

Troy: Yeah, I think it is definitely less of a guy thing. I have had one friend in particular who has seemed genuinely interested, who has texted me. And we really haven't talked. It's been more just text. But he's always like, "Oh, send me pictures." I don't know if he's just being nice. I think most guys it's kind of like, "Hey, how are things going?" And you're like, "Oh, things are good. She's great." But he has seemed a little more interested.

But I think it is not a conversation I would say I've had a lot beyond having the same sort of conversation with my parents or siblings. Kind of telling them about things. And even then, when I say siblings, I'm talking about my sisters.

So, yeah, I don't know that guys have that sort of conversation a lot, but we'll see.

Scot: Yeah. I want to jump in and ask, this friend of yours that has shown some interest, does that make you feel different? Do you like that? Do you like talking about her? I guess what I'm trying to get at here is maybe we should do this more often for our friends that have become new dads, because they would enjoy talking about it. It would make them happy.

Troy: I think it would make them happy. But I also kind of feel like I don't want to be the guy who is always saying everything about his cute little girl and showing everyone pictures because I'm kind of like, "Do they really care? Am I over-sharing? Is this too much? Do they really want to know all this?" So there is that sort of guy thing in me too, where it's kind of like, "Do they really want to hear me say all this stuff?"

Scot: If the shoe was on another foot, if it was not you with the new baby, but a friend of yours that you would consider a close friend, would you want to hear about it?

Troy: That's a good question. Probably at this point I would a lot more than I would have a year ago. I think as you're going through it, and you're having those experiences, and then others share that with you . . .

I think six months down the road, if I have a friend who has a new baby and they're sharing their experiences with me, I think then there's a certain amount of nostalgia and reminiscing that you would experience as you hear their experiences.

But let's say a year ago, I don't know that I would've been that interested. And that's just simple reality, just because it wasn't really part of my life. I didn't really have a lot to relate to there.

So that's kind of where I'm sometimes hesitant to say too much and feel like I'm over-sharing, or being that kind of irritating person who's showing them 100 pictures of my new baby and they just don't care.

Scot: I mean, I am actually genuinely interested. Even though we're doing this for a podcast episode, I'm genuinely interested in hearing about your experience and hearing about it in depth. Although there are other people in my life that I would not be, but I consider you a much closer friend.

So I think I want to flag this as a little takeaway. At least my observation is if you have really close friends and you're not having these discussions, maybe open up because it's really going to make that other person feel really good. They want to talk about it, I would imagine.

Troy: They do. Yeah, I think so.

Scot: You say you want to talk about it.

Troy: I do. I love talking about her. I really do.

Scot: Don't just peg this as this is something that women do. Men can do this too.

Troy: Yeah. There are so many cool experiences just on a daily basis, just little tiny things. Again, like I said, when she started to just focus on us more, and you could tell her eyesight was improving and focusing on our smile, just the laughs, and the little sound she makes. And talking to her, her looking at me and then her moving her mouth and making little noises like she's trying to talk too.

It's just silly little things like that, but it's just like, "Wow, this is so cool." Every day she entertains me. I'm not bored at all. Every moment I spend with her I find interesting and entertaining in some way.

Scot: So you said what's been surprising for you, and definitely it sounds like you've been blessed how well things have gone, because that doesn't necessarily happen in all cases. But what's been kind of challenging?

Mitch: Sure.

Scot: What do you deal with there?

Troy: Yeah, I think some of the challenges . . . Fortunately, I think I did have some preparation for them. I will say this, and I don't want to say this in a negative way at all, but leading up to this, I received more unsolicited advice than I have ever received at any point in my life.

I can only think of a couple cases where I might have asked for some advice, but the amount of advice I have received was astounding, as people found out we had a baby on the way. But that's a good thing. I think it helped me out a lot.

But I will say one of the things that has been a big adjustment is just expecting everything is going to take a whole lot longer. If we're getting ready to go out anywhere, you just expect it's going to take a lot longer to do that.

There were some unexpected medical issues very early on. Not major issues, but just some things that came up where it was, in that first week, multiple visits to the pediatrics clinic. The first couple days, we were just down there every day. It was a little stressful. No question about it.

Scot: Yeah, I didn't know about that.

Troy: Yeah. It wasn't big stuff. I mean, it was just stuff that comes up.

Scot: But at the time, it probably was, right?

Troy: It wasn't. I mean, that's the thing. Again, I knew of so many things that could possibly go wrong that I felt very grateful that that was all that we were dealing with. It wasn't big stuff. It was just like, "Okay, I've seen this in the ER. I've dealt with this. This is what we do." But it was an added level of just a little more complexity.

Scot: Yeah, it makes your life even more busy because you've got all these appointments and more traveling and stuff.

Troy: Yeah, exactly. So that's why it was a relief to just kind of get through that first week. And then at the end of the week, the pediatrician was like, "Hey, everything is good. We'll see you back here in a couple weeks." So I was like, "Great. We have two weeks where we don't have to come and see a doctor." So that was nice.

But yeah, I think in terms of just unexpected things that have come up, I think it helps having . . . Working in the medical field definitely helps to at least kind of know a lot of what you could deal with.

I will say, though, maybe one of the most unexpected things I have dealt with is how you truly as a medical professional lose all objectivity when you're talking about your own child. It's very different.

I may see a rash in the ER and be like, "Oh, that's what it is. No big deal." I see a rash on her, I'm like, "Oh, wow. It could be this, this, this, this, and this, and I'm really concerned." I'm a little different because I'm overthinking it.

But I will say, I think every parent runs that risk of turning to Dr. Google. You Google stuff and you see every awful thing that it could possibly be. And that's kind of where my mind has gone at times, like, "Oh, it could be this, this, this."

Yeah, I think we all face those anxieties as this little person who we just are so involved in, and care so much about, and don't want to mess things up on, that we might overthink certain things. So I think that happens to everyone, regardless of whether you're in the medical profession or not.

Mitch: So one of the things that I'm finding really interesting hearing about this kind of dialogue is being someone who has not really thought about kids much. When I was younger, there were some medical things going on. I was told I might not be able to have them, etc. If you were to have talked to me a couple years ago about any of this, I probably would not have been interested. I just would've been like, "Uh-huh. Babies."

Scot: Even with Troy?

Mitch: Even with Troy. I would've . . .

Troy: No offense, Mitch. I would've felt the same way.

Mitch: I would've been appreciative of his excitement. But me, myself, I'd be like, "Cool. Let's see what else we can talk about."

But in the last few years . . . We made the joke about nieces and nephews, and I have some, and I've interacted with them. I was the youngest of my family. I didn't have babies to hold, and there was no real child interaction until just recently in my life. And there's kind of an excitement about it, right? They're new. They're trying new things out.

And so it's so exciting to hear Troy, someone I've worked with, someone that I care about, my friend, having these things for his own baby, and his own experience. So it's different and I appreciate it.

Troy: Well, thanks, Mitch. I will say that, too, in terms of what other people have said . . . and I've heard it for forever. Everyone has always said, "When you have kids, it completely changes your life." I never heard anyone say it changes your life for the better. They always just said it changes your life. I feel like my life is a lot better. I love it.

Scot: Oh, that's awesome.

Troy: This has been good. I will say this has been great. It has absolutely been a huge change.

And it's so funny because that weekend she was born . . . She wasn't due for another week. We had planned out at least five different activities we were going to do that weekend. We were going to go to the symphony. There was a Gorillaz concert that Monday. We were going to go to that. We didn't buy any tickets. We were just like, "We're going to wait until an hour before." So obviously we canceled all . . . we didn't do any of those things.

We haven't gone to any concerts, no shows, nothing like that since then. It completely changes your life. There's no question. But those are minor things.

Scot: The trade-off is worth it.

Troy: It's well worth it. I'm absolutely enjoying it.

Scot: All right. Well, let's jump to the Core Four check-in, because fatherhood does change a lot of things, right? Your life is flipped, turned upside down. And sometimes it can be hard to maintain some of those things, and a lot of stuff changes. So, Troy, how are you doing with the Core Four? Let's go ahead and start with eating. Has the eating changed at all?

Troy: No, it hasn't, and I feel fortunate there. The one big change I will say early on is that I wasn't eating as much. And it's funny, I actually lost a few pounds in the first month. I think I just wasn't eating as much. Just busy. And then with kind of sleep patterns being off, for me personally, I wasn't eating at night.

So in terms of the time-restricted eating, intermittent fasting, whatever you want to call it, usually I'm doing 12 hours. So then I was actually having nights where I was going 15, 16 hours.

Scot: Without eating? Okay.

Troy: Without eating. So I think that may have been part of it. But it's been good. I have tried to focus on that, on making sure I'm not eating a lot of sweets, or stress eating, or snacking in the middle of the night if I'm up, things like that.

Scot: So you have had to make a conscientious kind of effort?

Troy: Oh, for sure. Yeah, there's no question. And I knew that was potentially going to be an issue with snacking in the middle of the night if I'm up with her, or, like I said, kind of stress eating, turning more to sweets, that kind of stuff. So I have tried to make a conscious effort to say, "Stick with what you're doing." And it's been going well, so that's good.

Scot: How about activity? I think I already know the answer to this. You've been such a dedicated runner, and you've had such a running habit that I'd imagine that it's been pretty easy. Or no?

Troy: I would not say easy, but fortunately, it has been consistent. And I'm still fortunately . . . Again, this had to be a conscious effort, and I feel like we're in a good spot now where I feel like I'm good with keeping going with this. But I really wanted to say, "I'm going to keep doing this and I don't want this to be something that I just give up."

I think it was John Smith . . . He said a couple things that stuck with me. Number one, he said, "With every child, pick one of your hobbies and forget about it. You're going to lose it." So I was like, "I don't want it to be running."

But then he also said . . . He offered to go to Buffalo Wild Wings with me or something. And he said, "You just need to do stuff just so you feel like yourself."

And so kind of tying those two things together, I just thought, "I want to keep running," because when I run, that's how I really feel like myself. I just love that time. I enjoy it. I'm out there with my dog. And so I've been able to keep that going and be consistent.

It's been something with Laura where it's like, "Hey . . ." We both say we want to support each other to do these things we enjoy. She loves going to classes, like exercise classes, fitness classes, so I'm here to help her do that. She helps me to make sure I have the time that I'm going out going running.

Scot: That's awesome.

Troy: So that's been a conscious thing to make sure we're doing that. That's been good.

Scot: Yeah, communicating with your spouse and just planning out how that is going to be possible.

Troy: Yeah, exactly. It is so much more complex when you've got a little one at home, and you're trying to balance childcare and all that. It's a whole lot different than when you're just kind of doing your thing and like, "Hey, maybe I'll go running at 6 this morning. Eh, maybe I'll go running at 7. Maybe 8." It's much different when you're making sure you . . .

So, anyway, so it's just been a matter of organization, and making sure we're communicating, and sticking with what we like to do.

Scot: It takes more work, man.

Troy: Yeah, it does.

Scot: Not only are you bringing more work home with that kid, but it just takes more work doing the things you did before the kid. How about your emotional health? How's that doing?

Troy: It's been good. There certainly has been an element of anxiety. There's no question about it. Anxiety of making sure I'm not doing anything that would ever put her in harm's way, doing anything stupid, anything that . . . I don't know. You just read so much, like, "Put the baby back to sleep. They have to lie on their back. They can't lie on their stomach. Nothing in there that could suffocate them." I can't have any blankets in there, no toys. Stuff like that. I don't want to do anything like that, and I want to know everything I need to do to make sure there's nothing that could potentially harm her.

And these are just little tiny things. I'm not talking about dropping the baby. I'm talking about making sure there's not a blanket that she could somehow bunch up in her face and suffocate. So there's definitely that element of anxiety, and I think every parent experiences that.

So, yeah, from an emotional health standpoint, I think a little more anxiety. But at the same time, I think there have been so many positive things from an emotional health standpoint too. Just the reward and joy in being able to interact with her.

You asked about running and fitness. I think this kind of thing brings so much more meaning to just health and diet and all those things, just because I want to be a healthy dad for her. I want to be healthy. I want to be here for her in the long-term. I want to stay healthy. It's not just about me running marathons or trying to qualify. I want to keep running because I want to stay healthy.

A lot of things we talked about on the podcast have had a lot more meaning as I've thought about those in terms of just healthy lifestyle, and being healthy, and doing that for her too.

Scot: So there's a lot of extra overhead you have to deal with. If you think of the mind . . . And this is just an analogy, right? It's flawed like all analogies. But if you think of the mind as a computer, everything you have to keep track of is just another processing unit, right? You've added so much more, all the things you talk about that you're just trying to pay attention to make sure that your child is safe. So that kind of fills the cup.

Are you doing anything additional to help with your mental health or help bring a little bit of relaxation from that kind of anxiety or that stress?

Troy: I've been watching a ton of sports.

Scot: That's what you do, huh?

Troy: Watch so many sports. And it's been a great time to have a baby. The month of October and November, it's just like sports heaven. There was the World Series. NBA starts up. College football and NFL are in full swing. That's kind of my release in a lot of ways, watching sports. It's distracting.

Scot: It helps turn your brain off for a little bit.

Troy: Yeah, it turns the brain off. Yeah. And it's fun too, because it's time we're kind spending together. I'm carrying her around, have the TV on, walking around with her with the little pack on, and she really enjoys that. And so, yeah, that's probably been my thing.

But you're right, I think you do need that sort of release where you just be . . . And not to go down on the dark side, but you have to be aware that some people, it just becomes so overwhelming. And the sad part is, again, as a healthcare practitioner, I've seen the cases where it's become completely overwhelming and you see the shaken babies and you see those who have been abused, and it is just absolutely horrible. And you just ask what led to that? How did people get to that point? I don't know all the dynamics there.

And then there's postpartum depression. We've talked about it in men, as well as in women. So that's something. And I worried about that going into this. I wondered, "Is Laura going to experience this? Am I going to experience this?" I've had many patients in the ER, women in particular, who have experienced postpartum depression.

So, again, I think you do have to have that release. You do have to have those other things where it's a distraction. And we've tried to have other activities, like planning activities every week with her where we're going out on walks. We're planning this week to go do this little drive-through Christmas light thing where you drive through and see Christmas lights. Just little things like that that you can look forward to, activities you can do together.

And as I'm saying this, I kind of feel like a jerk. I'm sounding like I know what I'm doing. I have absolutely no idea what I'm doing. Let me just say that up front.

Scot: Fair enough.

Troy: I have no idea what I'm doing. We're just trying to figure this out. But this seems to be working. And again, two months into it, so far, so good.

Scot: Yeah. And I think the important message is I think sometimes people feel guilty if they're not 100% with the new child all the time. But you still do have to take time for yourself, whether that's something you enjoy doing, or just even some downtime where you can just turn the brain off for a little bit.

And if you're having struggles with that, that's an important thing to talk to a professional about and get some tools to help work through that.

Troy: That's it. And I've had to tell myself that a few times. I've had to just say to myself, "If I'm not in a good place emotionally, I cannot be emotionally available to help her out." I've got to be in a good place. Laura needs to be in a good place. I think every parent needs that.

Yeah, you've got to be able to . . . whatever that means. Like you said, if you need professional help, if you're just turning to family members, whatever, friends, to get some help, being able to . . .

Scot: No shame in it.

Troy: Yeah, no shame at all. You've got to be the best parent you can, and that's how you do it. You've got to be in a good place emotionally.

Scot: All right. Core Four check-in, the last one. I think I know what the answer to this one is going to be. That's why I saved it until last. Sleep.

Troy: Sleep. Again, this whole process has been so pleasantly surprising. I dreaded the sleep piece of this just because I've struggled so much with sleep. I really just thought, "This is going to be awful. We're not going to sleep."

So what we did very early on in the first couple days is we decided we're going to split up the night shift. So Laura took the 9:30 p.m. to 3:30 a.m. shift, and I took the 3:30 a.m. to 9:30 a.m. shift. And I set my alarm. Every night at 3:30, I got up, took over for her. I was then able to bottle-feed her. Laura had dedicated sleep time. At that point, she was feeding like every hour or two. She wanted to eat, and she needed to eat. She's growing a ton. So that's how we did it.

We did that for six weeks. And then at that point, she got to a point where she's sleeping more consistently and much longer stretches. So we haven't done that since then.

And Laura . . . thank you, Laura . . . has been the one who gets up with her at night now, which some nights it may be once or twice, fortunately.

But it was interesting doing that regular sleep schedule. So I was falling asleep at like 9:30, sometimes 9:00 before Laura's shift started. Doing that consistently, it actually worked out pretty well.

And I thought a lot about what Kelly Barron talked about, about sleep hunger. If I've ever had trouble falling asleep before, I now know if I get up every morning at 3:30, I will not have trouble falling asleep because I had no trouble falling asleep.

So it actually worked out pretty well, where just having that regular sleep schedule . . . It was kind of nice in a way. It was always tough to get up that early, but . . .

Scot: But it's consistent, which is . . .

Troy: It's consistent.

Scot: . . . not a thing you've ever really had before.

Troy: Yeah. I mean, in stretches I . . .

Scot: You're taking the male paternity.

Troy: Yeah, exactly.

Scot: Do you get crap for that from the other guys?

Troy: I sure do.

Scot: Do you?

Troy: Sometimes it's very subtle, like, "Wow, they didn't have that when I had my baby."

Scot: "Well, yeah, how lucky am I?"

Troy: I'm like, "I'm so glad I have it." So I'm very fortunate. Yeah, I have been on paternity leave. That's something the university offers, and I am so grateful for that. This would've been much different trying to do crazy shifts along with this for the last two months.

Scot: And it's something that not everybody has, so it's just one of those great things.

Troy: I know. I mean, that being said, I think most people, at least you can . . . Yeah, you take FMLA time, but . . .

Scot: It's whether you get paid.

Troy: I mean, I get paid. Yeah. For me, it's like eight weeks. Well, it's really six weeks paid, and then two weeks of just leave. That's technically how it works out.

Scot: You highly recommend it if it's available to people and they can make it work.

Troy: I will say that. I will tell anyone if you have that option, take it with no shame whatsoever. Do not feel ashamed. Do not feel you have an obligation as a man, because you're a man, to say, "Well, I'm not going to take it because I'm a man. I'm going to keep showing up at work. I'm not going to take paternity leave." Absolutely take it.

And I think it's a number of reasons. Number one, I feel like it's really helped me to be available to kind of do that shift schedule and help Laura out. It's been great for just being there with Addie, with my baby, to bond with her.

But then also, we've kind of been a little bit isolated. We're not really going out. And this is something our pediatrician told us, like, "Keep your circle tight. Don't be going out and doing a lot of things out in public. There's a lot of flu. There's a lot of RSV. There's COVID."

So it's been, I think, a good thing for her health too, where her immune system is very susceptible, where we've just got kind of our tight little circle here and we're not out in public a lot.

I think, again, don't be ashamed to take that time off for a number of reasons.

Scot: All right. As we wrap up this episode, what would you like to learn from our experts? Do you have any experts you'd like to have on the show to talk about dad issues?

Troy: We need pediatricians on here. I think every episode we have going forward should be pediatricians. What do I expect three months, four months? I know that's not practical.

I would love to have Kirtly on here more. I think she's so insightful. I thought so much back to what she talked about with pregnancy, and what to expect, and how to be emotionally available. And I think that's a really important thing going forward. How do you continue to do that as a husband and a parent?

Beyond that, I think diet and exercise are always going to be a challenge, because there are going to be different challenges at every phase of her life in terms of just her needs and the time investment. So I think anything we can continue to talk about there. It's just a great reminder and motivation to keep focusing on those things.

Scot: Yeah, reminder to keep focusing on maybe ways to make it simpler, or easier, or less time consuming, which isn't always possible. I mean, you can only shave it down so far. But those are good insights.

Troy: Yeah.

Scot: Well, Troy, congratulations.

Mitch: Yeah.

Troy: Yeah, thank you.

Scot: I'm so excited and happy for you, and every time your wife posts pictures on Facebook, I love it.

Troy: So many pictures. So many.

Scot: That's all right. It's a well-documented growing up she'll have.

Troy: There's no question about that. Yeah, no doubt.

Scot: All right. Well, Troy, thanks for sharing your insights about being a new dad. I hope that that is helpful to you if you're a new dad, and maybe you can take one of the things Troy talked about and apply that when you are expecting your child, whether that's, "Listen, I've got to make a conscientious effort to make sure that I still exercise, or that I find something that I can do that gives me a little break with my brain for a few minutes a day."

What were some of the other things you talked about? Don't have those stress foods in the house if you think you're going to eat them. But on the other hand, if you need some stress food sometimes, then go for it.

Troy: Yeah, go get those Oreos.

Scot: Everything is just kind of in the middle, in balance and moderation.

Troy, congratulations on being a new dad. Thanks for sharing your experience, and thanks for caring about men's health.

Troy: Thank you, and thanks for talking to me about it. Like you said, it's fun to talk about it. And this is the most I have talked about it since she was born and it's really fun to talk about it. So I appreciate you listening to me and letting me chat about it.
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