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Scot: It is the "Who Cares About Men's Health?" sideshow. Today's episode, "How Will Smith is going to get you back into the gym." Also, lessons we can learn from a very unfit at this particular moment in time, Will Smith. My name is Scot Singpiel. With me Dr. Troy Madsen, he brings the MD, I bring the BS.

Troy: I like that.

Scot: You like that?

Troy: I do like it. That's good.

Scot: So on Instagram and Facebook, I just happen to stumble across a post that Will Smith put up. And he posted a picture of him . . . the first one that I saw was a picture of him and he's in kind of these tight black shorts, and he's got this kind of zipper up sweatshirt unzipped. And he doesn't look like the Will Smith that we've seen "I Am Legend" or the other movies, right? And he goes, "I'm going to be real with y'all. I'm in the worst shape of my life."

So then I stumbled across another post from Will Smith where again, he's standing there and he's kind of pushing his belly out this time. And again, not the Will Smith we're used to seeing, right? And he said, "This is the body that carried me through an entire pandemic and countless days of grazing through the pantry. I love this body. But I want to FEEL better. No more midnight muffins. This is dead. Imma get in the best shape of my life. Teaming up with YouTube to get my health and wellness back on track. Hope it works."

So I saw that and I thought that that was pretty cool because there's got to be a lot of ego involved when your Will Smith, right? So to post these pictures of you not in the best shape of your life, I think it was really inspiring. And it made me think wow, that's kind of like me minus the movie star career, the perfect family life, and all that.

Troy: Did you actually tell what kind of shape he was in though? Or is he just like in a baggy sweatshirt? What did he have going on there?

Scot: I emailed the pictures to you so you could look and see for yourself. Yeah, check that out. And then we'll wait.

Troy: Is there an attachment? Oh, here's the attachment. What is going on with this email here? Yeah, he's definitely showing off his bod there. Yeah, he's put on a little weight, you know? Yeah. And this is a guy . . . I've always thought about Will Smith being in an incredible shape. So this is good. This is good. I mean, this is good for all of us. Like, yeah, this happens so.

Scot: And I could totally relate to that because, unlike you Troy who upped your physical activity and your output during the pandemic, I kind of went the way of Will Smith, like I just really went south.

Troy: So we've all been in this position though, Scot. This is how I felt a few years ago. Like, I feel good right now. But we've all been in this position, or we're in this position right now, where maybe you felt like you were in good shape and things just went downhill.

Mitch: For a 52-year-old, I mean, it's not a pooch. It's a ponch he's got going on.

Troy: Yeah. And he's 52.

Scot: And what's the difference between a pooch and a ponch? I didn't realize there were . . .

Mitch: I think I have a pooch. It's small. It's like a little fanny pack. Right. And then he's got like a full backpack.

Scot: Wow. The other picture that was really inspiring that I kind of came across at the same time. And this is how I was inspired back into the gym was a picture of him sitting on a shoulder press bench with what looks to be maybe 10-pound weights, dumbbells that he's pushing above head. And it says, "Crazy that this photo was taken right before I picked up the big ones, dang."

So he's joking around. But we've got a great lesson to learn from him here because if you do go back into the gym, and this is kind of what I want to talk about that. He kind of offers us some good lessons about getting back into a fitness routine. So I will say I've been back to the gym, and I've gone . . . I had to go out of town. But while I've been in town, I've gone every other day. And I've done some exercises and it feels great. So thank you Will Smith for inspiring me. If you want to come on the show, I'd love to thank you in person. So see if that happens.

Troy: Yeah, you're welcome to join us on the show, Will Smith, too. If you can . . .

Scot: And then, he also joked about weights here in another Instagram video.

Will: This guy says let's just get the movements. Let's just get your body back into making the movements, so we avoid injury, right? But what that means is he'll just give me the bar with no weights on it to do a bench press. And I'm like, we're not shooting that. Nobody's going to have a video of me bench pressing with just the bar with no weights on it.

Scot: All right, just so you know, afterwards, then they cut to a clip of him squatting a bar with no weights on it. So once again, totally willing to just let it all be out there that Will Smith, who we think of is in great shape is starting slow, starting light. He's easing his way back into it. And I think that was another inspirational thing.

And we've talked about that before on the podcast that you don't want to rush right back into it, because if you do, you can hurt yourself first of all, but it could also kill your momentum after a couple weeks. It just might be too exhausting, so you just might quit. It makes it non-sustainable. And then there's a danger you might not continue.

So I really appreciate Will Smith not only posting that picture, admitting that the pandemic has impacted him, put him in some pretty bad shape. And that you know what you don't go back in and lift weights like you were Will Smith in "I Am Legend" when you're Will Smith after the pandemic. So those are some good lessons for me about getting back into a fitness routine from Will Smith. Any thoughts either one of you guys?

Mitch: One of the things I was thinking is that I really appreciate this, this idea of I love this body, him posting it, non-edited, etc. because the other photo that has been circulating on the internet right now about getting, "back into shape" was Chris Hemsworth getting in shape for "Thor" and he just has the biggest, giantess bicep you've ever seen. And it's just, that doesn't inspire me, right? That kind of gets me in this "I'm not Chris Hemsworth," you know?

Scot: Yeah, or I'll never attain because, I mean, when we talk to Rashago, excuse me, who is our bodybuilder that we talked to, we learned that that takes a lot of work that's not sustainable for the average guy.

Mitch: Right. So seeing this, it's cool. I really, really appreciate this because I've been trying to get back into fitness. And just this idea of I love this body, right? This idea that it's not like a shame. It's not like, no, this is bad. He wants to feel better. It's not all about looking your best. It's about feeling your best.

Troy: Yeah, I mean, just seeing him looking like that. And it's not like it's airbrushed or anything like that, like some of the celebrities they want to present an image. And he's just very real about and says, yeah, I was in great shape. I'm not in great shape now. But I'm working to get back into good shape again. And again, I think we've all gone through cycles similar to that. So it is inspiring to see someone basically saying, yeah, this is not where I want to be, but it is who I am. And I'll keep working to get back to where I was before or somewhere at least kind of close to where I was.

Scot: The other thing that I love about this Will Smith thing is just being humble enough to post, Will Smith doing 10-pound dumbbells. Because for me, I did go back to the gym, and I did go back to doing weights because that's something I've done off and on my whole life. And I just needed something easy. It was something that felt comfortable to me.

But what doesn't feel comfortable when you go back in there, especially here at University of Utah, where you've got all those young students in there is they're moving massive amounts of weights. And then I go and I have to put it on the light stack, right? But reframing why I'm doing it and just going, "You know what, it doesn't matter. I'm doing this for me, I'm doing it for this reason," really helps. And you just kind of got to go, "You know what, nobody's going to see it, nobody's going to care."

And one of the things that I really try to concentrate too on is form, because over my years, I've noticed muscle imbalances start to develop. So instead of just making it about how can I move this weight in any way, shape, or form possible, just to say I've moved a lot of weight. How can I move this weight in a way that is achieving my goals of giving me better mobility and flexibility and balanced strength? So I really watch my posture when I do my back pull downs because, as we've talked about, in a previous episode, I've got this dowagers hump. So I'm trying to get those muscles strengthened and stretching so that will kind of start to straighten out. So those are my priorities now. So that's what's helped me.

Let's move on to the next segment of the sideshow. I guess I should also say a couple other episodes to check out. So we've got the one with Ernie Rimer about the basics of strength training. That's Episode 24. That'd be a good one if you're interested in just starting out. It's good for beginner. Episode 54 getting active again, we talked to Caleb Meyer, he's a strength and conditioning coach who went through kind of a similar thing. So he talked about getting back into it. And then we also talked to Caleb in Episode 58 about kettlebells, which is some exercises that you could do at home learning how to exercise with kettlebells so.

All right, Troy, get out that stack of articles what might we hear about today? Troy's going to go ahead and give us some titles of some articles and we're going to pick which one we want to hear.

Troy: Yeah, Scot, you know, I always love searching through the medical literature, see what's out there. Some of these are articles that have appeared also just in general science magazines, things like that. But I will give you some ideas here, some topics. You pick what you like. So to start us off, we have a randomized trial of oxycodone and acetaminophen versus acetaminophen for musculoskeletal pain. So opioids versus just plain old Tylenol, is there a difference?

Scot: Oh, that's a good one, okay.

Troy: Could there be a dramatic hidden impact of not having a regular bedtime? We've talked about that before. Characterization of scooter injuries over 27 months. It is scooter season now if you've been downtown. We've been almost hit by scooters many times. Extreme exercises carries metabolic consequences. All right . . .

Scot: So I think that's enough choices. I think . . .

Troy: Scot, I can keep going. The flimsy evidence for flossing. How could you pass that one up?

Scot: Next time let's just limit it to three. And then we'll choose from that because I don't even remember what the first three were at this point. Mitch, did you hear one that intrigued you?

Mitch: I'm always interested in scooter injuries because Jonathan broke both his arms.

Scot: Oh, really?

Mitch: Yes.

Scot: Over sleep, over sleep? I would think the sleep one would be better.

Mitch: Yes.

Troy: Jonathan broke both of his arms on a scooter?

Mitch: Yeah, at the same time. He like fell off the scooter with a heavy backpack and he broke both of his arms. And so he was like a mummy all wrapped up for two months.

Troy: People don't talk about it a lot. But yeah, the logistics of breaking both your arms with scooters are awful. We don't get into the specifics. But it really limits you. And when I see people will come will break both their arms, I'm just I'm so sorry about this, like, "Yeah, this is a bad situation to be in. And you're going to be in this for six weeks." So scooters. You want that one, scooters?

Scot: All right. We'll hold on to the sleep ones later. I know that some of the sleep interviews are our most popular ones. So I do want to do those sleep ones for sure. But scooters hits home, so to speak, for Mitch.

Troy: It hits home. Yeah, it does hit home for Mitch, and it is scooter season. And I'll tell you scooters kind of . . . The reason I kind of include this article is I hoped you would pick it because I've done a lot of work with the scooter research and published on that. And it's one of these things that really hit the news where we had articles in "The Washington Post" and "The New York Times" about some of the stuff we did at the University of Utah. And we were one of the . . . not one, I think we were the first site to really look at this and say what happened here. What kind of injuries did we see after people started using rental scooters in Salt Lake? They rolled out. Everyone's using them. What kind of injuries are we seeing? And it wasn't just that we saw people with bumps and bruises, we were seeing people come to the ER who were major traumas, who had very serious injuries, major head injuries.

So this article actually appeared in the "American Journal of Emergency Medicine." It is slated to be published in July of 2021. So it will be published very shortly, but it's appeared online. And this article, they looked at patients at a level one trauma center over it's about a three-year period since November 2017. And had 442 patients who came in there who were injured on electronic scooters. And basically they said, "Okay, how serious were these injuries?" They said that hospital admission for those who came there was 40%. So these aren't patients coming in who were just saying, oh, I bumped and I got a laceration or even just a broken bone. These are 40% of their patients were admitted to the hospital, and 3% of these patients went to the intensive care unit. So these were serious head injuries, very, very serious injuries. They found that people who are more likely to admit it were those who were older than 40, who had alcohol use or other substances, who lost consciousness, or who came in by an ambulance. So kind of some obvious stuff.

But one of the most surprising things for me, both in this article and in the research we did, is the fact that no one uses a helmet. I mean, it's not surprising when you're out there seeing people. But when scooters are going 15 miles an hour, it's a pretty fast rate of speed you're moving on that. We found that in our study that no one reported helmet use. In their study, it was 2.5% of people. The other surprising thing is just that we found a lot of people were intoxicated. I think a lot of people are using scooters to bar hop, things like that. It's dark out, you're riding a scooter, you're . . . at least had a couple drinks. And that's going to increase your likelihood of getting injured. They found that people who had used alcohol or were intoxicated in some way were much more likely to have a serious injury.

So takeaway from this for me is it's a lot of stuff we already know. But it was interesting to see this now in a larger study. Bottom line is electronic scooters I think they're a great way to get around and quick way to get around. But if you're using it while you're intoxicated, that's an issue. It would be great if you had a helmet. I know no one does. But we see a lot of serious head injuries from this, so just be aware. It's summertime. Great time to get out. Great way to get around short distances on scooters. But be aware of the potential for injury, as you're well aware, Mitch.

Mitch: Yeah, and that's what's interesting is hearing that study because when we were in . . . we went to the hospital like 6:00, 7:00 at night. Jonathan had both of his arms broken. And the nurse there was saying, "Oh, well, you're the least severe e-scooter injury I've had today." And that was the most telling thing, where like I'm sitting there and I'm like, "What do you mean?" And she's like, "Well, I can't go into specifics or whatever. But that's all I can say." And it was just he has two broken arms, like how is it . . . And the idea of today. Just how many people are getting hurt with these e-scooters? So it's just really interesting to hear that.

Troy: Yes, and we've looked at that too. Yeah, I mean, the numbers have increased over time that we're seeing which makes sense as more people are using e-scooters, you're going to have more injuries, but yeah, we are seeing more and more.

Scot: Usually within the first two or three times you use it that you're going to get injured. Isn't it? Isn't that kind of the average.

Troy: It's correct. I wouldn't say usually within those times, but your likelihood of getting injured within the first two or three times is much higher. So it doesn't mean that all the injuries or most of them happen then. It just means that people who use it, like, it's their first or second time on the scooter, they're more likely to get injured than someone who's used 10 times so . . .

Scot: Which makes sense because I think it's a whole new way for some people to travel, right? And you've mentioned before they go a lot faster than you might think.

Troy: You go fast. Yeah.

Scot: And you hit something in the sidewalk. And if you got to bail on that, I mean, running 15 miles an hour recover, you're probably going to go down.

Troy: Your legs can't keep up. You're going to fall.

Scot: So I think one of the takeaways for me on the scooter thing too, was if it's your first couple of times, play it conservative till you kind of get used to how that thing works.

Troy: Yeah, take it slow.

Scot: How it's going to react on the sidewalk, how the brakes work, that sort of thing. Don't just get on it and start scooting.

Mitch: And the big thing for Utah, especially with Jonathan yeah, don't drink and ride these scooters. But these-scooters were developed in warm, sunny places. Jonathan fell because there was a little bit of ice on the ground, like the smallest amount of ice and the scooter just . . . whoop. So it's be careful when it gets colder out there because these scooters are still out there. They don't bring them all home so . . .

Troy: Yeah, and it's not just the ice. It's just slick sidewalks after a little bit of rain, something like that. These wheels are so small, and they don't even . . . they're nothing even like a mountain bike. They are not studded at all. They're not going to hold you on any sort of uneven ground or any slick surface. So yeah, I think that's the takeaway. You see people on them all the time. You think, "Oh, so easy to jump on. Great way to get around." But again, it's surprising to me not that we're seeing injuries. That doesn't surprise me. The surprising thing to me is how serious these injuries are. We have seen people who have died because of scooter injuries because of massive head injuries. This is something we have seen, other sites have seen too, so . . .

Scot: And then, any of the-scooter injuries that have come in, have you gleaned anything from any of those patients? They say anything to you that stuck with you?

Troy: The biggest things for me if I had three takeaways it would be if it's your first time on a scooter, like you said, Scot, take your time, make sure you know what you're doing. A lot of people were like, "It was my first time on it. I was going way too fast. I didn't know what to expect." Second thing, carry a helmet. I mean, if I could tell you one thing, like if you're going out just carry a helmet, maybe people will think you look stupid with a helmet on on a scooter, but cite this study if people give you a hard time. I've got some research. Come on, guys. Third thing, don't ride while intoxicated. Those would be the three simple things. And that's what the research drives home too. Again, it doesn't eliminate all potential for getting injured. But I think those are the big things where we see people getting serious injuries where they hit their head. And that's what puts you in the intensive care unit. So not nearly as fun as the green urine article. I was hoping you were going to pick that one. But probably more informative.

Scot: There's always next time.

Troy: I'll save it. It'll continue to reappear so . . .

Scot: All right, thanks for listening to "Who Cares About Men's Health?" the sideshow. We have numerous different shows. So if you're interested in nutrition, activity, sleep emotional health, that's called the core four, be sure to check out our core four episodes. If you're interested in men's health essentials. These are conditions that affect men, be sure to check out our men's health essentials section. And of course, this was the sideshow where it's a little looser, but we still do try to talk about health and tie it back in.

If you did like this podcast and you found it entertaining, informational, useful, inspirational, any of that kind of stuff, do us a favor and just tell one other person, share it with one other person that you think might dig it. That would really help us a lot try to find more listeners and more men who care about their health. Of course, you can also check us out on Facebook facebook.com/whocaresmenshealth. And you can reach out by calling us at 501 . . . And you can reach out by calling us at 601-55-SCOPE and leave a voicemail message or send us an email at hello@thescoperadio.com. Thanks for listening. And thanks for caring about men's health.

Dr. Miller: Diagnostic ultrasound. We're going to talk about that next on Scope radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm Dr. Tom Miller and I'm here with Dr. Daniel Cushman. He's a sports medicine physician in the Department of Orthopedics at the Orthopedic Center here at the University of Utah. Daniel, welcome. Tell me a little bit about ultrasound-guided diagnosis of musculoskeletal disorders. I know this is a new technique, relatively new. It's been around for a long time but it's finding more applications these days.

Dr. Cushman: Definitely. Ultrasound is kind of a non-invasive way of looking at structures underneath the skin. It doesn't do a great job for things like bones which we have X-rays for, but if you're talking about something above the bone like a tendon or a muscle or those kinds of things, we can see those very well with ultrasound.

Dr. Miller: Does it assist you in your clinical diagnosis?

Dr. Cushman: All the time. For example, somebody hurts their shoulder, we can get a good look at those tendons, the rotator cuff tendons with ultrasound or if somebody's wrist is hurting we can look at the tendons there. Sometimes we can look at nerves particularly to see if they're being pinched somewhere.

Dr. Miller: It would help you, let's say, looking at a shoulder with an ultrasound, that might help you determine whether there was a full thickness tear or partial tear or even no tear.

Dr. Cushman: Exactly, and that's something that on exam when we're examining patients it's not something that's as obvious as it seems it should be. A lot of the time we can have patients who have completely torn their rotator cuff and they don't really have too many problems and then the opposite is true where somebody has done almost no damage to rotator cuff but they're in severe pain.

Dr. Miller: This would also help you decide on the guidance of treatment, right? Whether they go to physical therapy or whether you rest the shoulder for time.

Dr. Cushman: Exactly.

Dr. Miller: It just gives you a better sense of your diagnosis I suppose.

Dr. Cushman: All the time.

Dr. Miller: The other thing that's interesting is you're doing this right at the clinic visit, so this sort of obviates the need for having an MRI.

Dr. Cushman: Yeah. Definitely. A lot of the time I'll just simply grab the ultrasound machine with my patient in the room and it just takes a little bit of gel and that's pretty much it.

Dr. Miller: So this also maybe has a lower cost than the standard sort of other imaging techniques that we have.

Dr. Cushman: It's significantly lower and I don't know the exact numbers but probably somewhere in the range of a tenth the price of an MRI if you're looking at a shoulder for example.

Dr. Miller: Is it as good as good as an MRI for looking at, let's say again, a shoulder?

Dr. Cushman: Yes. That's really dependent more on the person doing the exam. If somebody has had a lot of experience with ultrasound, studies show they're about as good as an MRI. If somebody is not as experienced, then it's really only as good as the person who's doing the exam.

Dr. Miller: What other areas of the musculoskeletal system do you use this on? How about Achilles tendons or . . .?

Dr. Cushman: A lot of the time we can tell without having to use the ultrasound machine what the problem is but other times it's very helpful and so Achilles tendons, we do use it on occasion. There are there are some times where we think we know the diagnosis and this really either confirms it or shows us that something else is causing the problem and so it's helpful in that regard.

Dr. Miller: How about in the hip?

Dr. Cushman: In the hip joint there's a couple of uses for that pretty commonly. People who have had hip replacements where they can't really do an MRI afterwards and they still have some pain, a lot of times some of the hip replacement surgeons will have us take a look at the tendons that are going over the the prosthesis.

Dr. Miller: Sometimes patients will come in with pain and you've told me previously that you can use the ultrasound to sort of find out where that pain arises from or is there a structure along the nerve that is actually causing the pain. So for instance you might think it's . . . the patient may tell you that they have pain at the wrist or the end of the arm but actually the generation of that pain is higher up and you've learned that from the ultrasound.

Dr. Cushman: Yes, exactly. One of the one of the disadvantages of something like an MRI is you can really only do one segment at a time so you can only look at the neck or you can only look at the shoulder. You can't really do both at the same time. With an ultrasound, if you're thinking maybe a nerve is causing this, you can trace it all the way from the finger, all the way up the arm to the shoulder, to the neck and get a pretty full view of the entire nerve or whatever structure you're really looking for.

Dr. Miller: How many specialists like yourself are versed in using ultrasound as a diagnostic tool nowadays?

Dr. Cushman: Here at the U, there's probably about four or five of us at least in our department and it's getting more and more popular because it's such an easy test for patients. Patients generally love it by comparison to having to do an MRI or going back and additionally it's so much cheaper for the patient.

Dr. Miller: It also gives you real time feedback so that you don't have to wait for test results coming back from radiology.

Dr. Cushman: Definitely. A lot of the time, one other thing I was going to mention was that when patients say, "It hurts when I do this," and they move their arm or they move their leg, we can actually look at it while it's moving as opposed to an MRI or an X-ray, which only shows a static picture.

Dr. Miller: Do you think in the future that more orthopedic surgeons and sports specialists will be trained in this technique so that it's pretty common throughout the specialty?

Dr. Cushman: I think so. I think it's becoming kind of a second set of eyes for people to look under the skin.

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