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Scot: Welcome to the "Who Cares About Men's Health" Sideshow. This is a fun little episode we're excited about. Survival tips, fact or fiction. You've heard these before. Don't eat snow, because if you do, it'll make you more dehydrated. To prevent hypothermia, you've got to get in a sleeping bag with somebody else naked. And then this is a good one. After an avalanche, what you should do if you get covered by snow is spit so you know which way to dig to escape. We're going to find out if those are true or not.

My name is Scot Singpiel. On "Who Cares About Men's Health," I bring the BS to the show. And the MD to my BS is Dr. Troy Madsen.

Troy: Hey, Scot. I am so excited for this because I've heard these myths and I want answers.

Scot: And Producer Mitch is in the mix.

Mitch: Hey. I also want to know if I should butter my burns at some point. That's what I keep hearing.

Scot: Oh, okay. Well, our guest, Graham BZ. Is that your last name? BZ? That's what we're calling you.

Dr. BZ: My last name is Brant-Zawadzki, but it's long and terrible, so BZ is much more . . .

Scot: Yeah, it's cool.

Troy: I have to say this, too. Scot has this fear, like this deep fear of mispronouncing people's last names. I was so excited for him to pronounce your last name. And then he just totally glossed over it. So I'm disappointed.

Scot: Well, I didn't even know what it was. Even his email says Graham BZ, so I didn't know what his last name was. I thought, "I don't know." So here we are.

Troy: Made it too easy for you, Scot.

Scot: Anyway, he is an interesting doctor that practices mountain medicine, and that's actually a thing. What exactly is mountain medicine?

Dr. BZ: So mountain medicine is a subset under wilderness medicine, which is a larger umbrella term, and it all refers to medicine in an austere environment. I'm part of the Wilderness Medical Society, and you'd be surprised how hard it is to come up with a good definition for what wilderness medicine really is. But it's basically when we're providing medical care beyond the scope of your typical medical system and infrastructure.

Scot: All right. And I actually went to the WMS, the Wilderness Medical Society website, because I was trying to figure out exactly what it was you did. They have a definition there. "Wilderness medicine, also known as expedition medicine, is a practice of medicine where definitive care is more than one hour away and often days to weeks away. Defined by difficult patient access, limited equipment, environmental extremes. Decision-making, creative thinking, and improvising are required." So does that sound fair?

Dr. BZ: That is fair. I will tell you that I'm part of a committee to currently update that definition. But I think that that pretty much sums it up adequately for now.

Mitch: Graham, when it comes to expedition medicine, all these cool terms, what's some of the cool stuff that you get to do?

Dr. BZ: I think the best teaching case or one of the most influential cases for me was actually we were training some Peruvian mountain guides down in Peru. It's kind of a train-the-trainer model where we go and train the mountain guys and then they go on and train these other folks within their own country.

And the course that I went to, we basically hike into the base of this 18,000-foot peak, and the base camp is at about 15,000, so it's pretty high altitude. And some of these folks flew straight up from Lima, which is sea level, into Cusco and didn't really take the proper precautions in terms of acclimatizing before coming up.

And so one of our cohorts developed pretty severe HAPE, which is high altitude acute pulmonary edema, and required more than just oxygen. So we actually had to deploy what's called a Gamow bag, which is a positive-pressure, kind of an inflatable, almost like a sleeping bag that you kind of crawl into and then pressurize.

We learn about that a lot as students, especially in wilderness medicine, but what we don't learn about is just how much effort it takes to maintain pressure in this bag. Basically, think about using a bike pump, or even a foot pump. You can use both. And you're continuously pumping nonstop for hours to maintain this pressure.

Scot: To keep a person alive?

Dr. BZ: To keep a person alive and to keep this person . . .

Scot: Wow.

Dr. BZ: Yeah. To keep their oxygen saturation up, you're just continuously pumping and pressurizing this bag. And the idea is that you do that to temporize them to a helicopter evacuation, or at least just improve them enough so that they can then get down on their own.

So for about four hours at 2:00 in the morning, we're all just sitting there pumping and keeping this bag pressurized so this person could oxygenate themselves and improve a bit enough to get walked out.

The whole experience was definitely a humbling one. And then trying to get this poor person hiked out to . . . I think it was about a four- or five-mile hike down to where we could actually access a vehicle and then get him out from there.

Scot: And all of that happened because this individual went from sea level to 15,000 feet too fast without actually taking intermediate steps to get their body used to it.

Dr. BZ: Exactly.

Scot: Wow. And how long would that normally take to get used to something like that?

Dr. BZ: So there are different . . . It kind of depends on your strategy. There are different strategies for acclimatization. For the course we were doing, we would recommend up to two weeks to really properly acclimatize. I think taking up to four to six days for that level of transition is kind of the minimum that you'd recommend.

Scot: All right. Let's get to it. Let's get to these myths here, these questions. We're going to throw these out here and I thought maybe we could all just kind of play along. Now, I don't know, Troy, if you know some of these answers since you've got the MD here. Don't participate. But Mitch . . .

Troy: I don't. That's why I want to know the answers. Yeah, these are questions we've talked about and I've heard these, and some of these, I'm really curious.

Scot: All right. So the first one, don't eat snow if you're out in the wilderness and you don't have any water because it'll actually make you more dehydrated. So this is one of those situations maybe you're out, it's wintertime, you've run out of water, you're not near a water source, you're not near your car, and you need to survive. Should you eat snow or not? This says you should not. I think that sounds silly. That's my take. Mitch, what do you think?

Mitch: I guess I don't understand how it would make you more dehydrated. For me, that's the thing. It's water. It's just super cold water, right? What on earth is in the snow that's going to make you more dehydrated?

It's like when coconut water came out. Does anyone remember when the coconut water craze was going? I was doing some volunteer work up at Sundance, and the lady I was working with, she's like, "Oh, coconut water hydrates you better than water." And I'm like, "That doesn't make any sense." So on the flip side, we now have snow and I'm like, "How does it dehydrate you if it's water?"

Troy: Well, this is what I've heard, though, Mitch. The rationale is that the water content of snow is so low, especially here in Utah where it's super dry, that it takes more effort and uses more energy to produce than water, just like putting snow in your mouth, than it really produces water. So that's the rationale I've heard. I don't know if that's true, but that's what I've heard.

Scot: All right. We heard Graham chuckling a couple of times, so we'll see if that's his tell or not. Is that true? True or not?

Troy: Yeah, what's the word?

Dr. BZ: I don't think anyone has ever looked at drinking snow in the Sierras versus Utah and wondered if they're . . .

Mitch: "Is it dryer?"

Dr. BZ: Yeah, exactly. But I think Troy is pretty spot on. So the problem with . . . Snow is mostly air, especially again here in Utah. So you'd need to eat about, I think, 8 to 10 quarts of snow to meet the same amount of just liquid water.

Again, it's much colder the body temperature, so every time you're putting that snow in your mouth, your body is spending energy to melt that snow so that you can drink it, and that burns calories. In the end, it does consume more total body volume water than you actually are receiving for it. So point to Troy. That is right.

Troy: So this is true. I'm going to say I can't take credit for this because I never would've believed it, and then I saw it in a Sundance film. And in this Sundance film, these guys were lost out in the snow, and one guy said to the other guy . . . This guy was super dehydrated. He was like, "You can't eat the snow. It's going to make you more dehydrated. It just takes up too much energy. You can't do it." And I was like, "That's stupid."

Then I thought about it more and I was like, "Maybe it makes sense." It's true. You just don't get a lot of water out of snow. The water content is really low.

Scot: And to make the connection, burning energy requires, in that chemical process, water is what we're saying, right? That's why it uses more water.

Dr. BZ: Correct. That's exactly right.

Scot: Okay. Yeah. Got to go back to my cellular biology class that I never took. So what should you do instead?

Dr. BZ: So what you want to do is you want to find another way to melt the snow that's not using your own body's energy. So if you can heat the snow up in any way, even just leaving it in the sun in a spot where it can be melted, then you can drink the liquid melted snow and that's going to be the best way you can hydrate.

Troy: I'm going to ask this because I know Scot is thinking it. What if you had a container and you filled it with snow and then you peed on the snow?

Scot: What?

Mitch: What?

Troy: And then the warmth from the urine . . . You're going to have some urine in there. Is that just going to be useless? Is it going to be just too . . .

Scot: You pee on the container if you've got the container, and then hopefully the heat transmits.

Troy: I don't know. Do you think it would?

Dr. BZ: That is an excellent question. So it would depend on how dehydrated your urine was to begin with, I think, because dilute urine is . . . You're still going to be able to pull . . . We always get asked this. "Can you drink your urine if you're dehydrated?" And the answer is if you're coming from a hydrated status . . . Well, an answer, I should say. If you're hydrated, you can kind of drink your urine over a couple of cycles before it really starts ruining your kidneys and other things as you're getting more and more distillate.

So if you're pretty hydrated to begin with, that's already urine that you've heated up and you've used those calories already. You might as well put it in the snow and dilute that urine a bit. And if you're in dire straits, I think that's an ingenious way to potentially temporarily hydrate yourself.

Troy: So maybe it would work then.

Dr. BZ: Yeah, I'd say.

Troy: It's better than drinking your urine, it sounds like. At least if you have a big old thing of snow and you can pee in it or . . . I don't know. Again, hypothetical here. I'm not recommending it.

Dr. BZ: I think last resort Hail Mary kind of stuff.

Troy: Yeah, don't do this every time you're out skiing.

Scot: Try to use the sun's energy first, I think, would be a good . . .

Dr. BZ: I was going to say, if you're going to use a container to try to melt snow, you want the back half of that container to be . . . Use dark clothing or something that's reflective so that that energy isn't just passing through the snow. You're kind of trapping heat energy in that container as well.

Scot: Oh, okay. Yeah, that makes sense.

Troy: Kind of dark container or something there. Okay. That makes sense. Yeah.

Scot: All right. Myth number two. To prevent hypothermia, you need to get the person who has hypothermia naked into a sleeping bag, and that body temperature helps warm them up, as opposed to just getting in clothed because you wouldn't be transmitting enough heat. So the question is, is that just a clever pickup line, or is that a legitimate survival strategy, Graham?

Dr. BZ: I don't want to discourage anyone from crawling into a sleeping bag naked with another person, if that's what seems like the right thing to do. But it will help. It'll definitely help warm someone up faster than just putting them in a sleeping bag and clothes by themselves because you're going to help transmit . . . Again, you're going to help heat that sleeping bag and help raise the temperature of that environment faster. So getting into that sleeping bag with that person will definitely help.

The reason we say get in naked is because the way a sleeping bag works is it radiates heat back at you. And if you're wearing a lot of clothes together, then you're kind of trapping heat under your clothes and it's not radiating to that person as effectively.

So technically, yes, that would be the fastest way to warm someone up. Do you need to do that? Probably not. There are, again, other ways to do it. I think putting someone in a sleeping bag with a heated bottle of water or another heat source can act in the same way.

Really, the best thing to do to warm someone up if they're not comatose, if they're still awake and alert, is to use their own body's thermodynamics. So get them active. Get them doing jumping jacks. Get them moving. If they are in the sleeping bag, have them moving up and down and doing kind of snow angels in that sleeping bag as much as possible to help burn calories as well from the inside.

So I hate to say it, but if you're going to be in a sleeping bag with someone, you also want to be active in that sleeping bag.

Troy: There's just so much more to this. This is one of the things I heard too. This is one they teach in Boy Scouts. It's like, "If this ever happens, you have to . . ." It's just like, "Huh, okay."

But it sounds like there are other alternatives and maybe better alternatives, like you said, like a heated water bottle or something like that to really get the job done. But it sounds like it makes sense if you're in that situation and you have to do it.

Dr. BZ: And again, totally naked is probably a bit dramatic. You don't want to be both in a sleeping bag but also covered in all your winter gear. If you're in long johns and underwear, that will be equally as effective.

Scot: All right. Question number three. After an avalanche, if you get trapped in an avalanche, in order to know which way to dig to escape, you should spit because then the spit is going to go down, because that's what gravity does. It pulls things down. Mitch, what do you think? Yes or no?

Mitch: When we were doing our pre-production, it was the first time I've ever heard of this. And I guess I never would have thought to . . . I guess you would get all turned around, but spitting is the last thing I would think of doing to try to figure out which way was up or down. I guess that's my first question. When trapped in an avalanche, do you get tossed around enough that you don't know which way to dig?

Scot: Yeah, hold on that answer, Graham. Let's go to Troy.

Troy: This is one I have heard for years. I don't know if it's also one of those things people just say, but it does make sense. If you're tossed around in an avalanche, you may not know which way is up. And I've heard that if you want to know which way is up, spit, because then if the spit just falls back on your face, you know your face is facing up, and if it falls to one side, you know the other way is up. If it falls straight down, you know that up is back behind your head.

Obviously, there are certain logistical issues if you are trapped in an avalanche, so that's probably the bigger question. But I'm curious, Graham. Is this something you've heard or something you've ever recommended?

Dr. BZ: So I think the bigger question . . . The first question is, can you get tumbled around enough to not know which way is up or down? I've never been in an avalanche, but talking to those who have, the answer is absolutely yes. I mean, if you've ever been just even in a whiteout, you can kind of get vertigo and lose your sense of your body in space. So you can definitely be disoriented like that.

The bigger question is what can you actually do about it. So we talked a bit about how snow is roughly one-tenth the density of water. And that, again, varies by the type of snow and where you are and how dry it is, etc.

But when you think about an avalanche . . . So snow just sitting on the ground is maybe, let's say, one-tenth the density of water. Once that avalanche is set off and all that snow is sliding down the hill and then sets at the bottom, all that snow is now compacted and the density has increased. It's at least doubled. There are some studies that show that it can go significantly more than that. And so that snow is no longer that nice, fluffy Utah powder we like to play in. That is now basically, for all intents and purposes, concrete.

And so even if you knew which way was up or down, the ability to dig yourself out is more or less impossible. Just being under a foot of cubic snow can translate into hundreds of pounds that are on your body.

And so I think a better way to know which way to dig out is if you can move any part of your body, it's probably under the least amount of snow. Or if it's even sticking out of the snow, that's the direction you'd want to go if you can move anything.

But what unfortunately kills a lot of avalanche victims, even those that are only partially buried, meaning that a part of their body is still sticking out of the snow or just very shallow, a shallow burial, is even in a shallow burial, people just can't dig themselves out. They don't have the ability.

Troy: That's an interesting thing too. Graham, I think we often have this image that people get covered in avalanches and they get tossed around and hit trees and rocks and they die from that. I think you kind of alluded to it a little bit there. What percent of people actually die from that versus just die because they're stuck there and they just can't get out?

Dr. BZ: Yeah, that's a great question, Troy. We looked at this locally here in Utah. And what happens is we actually compare a lot of our avalanche data in the U.S. and North America to European data and we see a stark difference in the rates of trauma for that exact reason.

A lot of avalanches in backcountry terrain and the Alps and other parts of Europe happen well above treeline, and so there are a lot fewer obstacles to strike, such as trees, boulders, things like that. And so we see a lot more deaths that are due to purely asphyxiation from suffocation under the snow versus patients here in the U.S. where maybe the rescuers get to them in time but they've suffered severe traumatic injuries, which have led to their decline.

So it's a great question. We see a much higher incidence of trauma with avalanche here in North America than in some other parts of the world.

Troy: Interesting. It sounds like, bottom line, you can spit if you want to spit. Maybe that will let you know which way is up. But it sounds like the more . . .

Scot: Just end up having a wet face.

Troy: Going to have a wet face. Yeah, it's probably not going to help a whole lot. But yeah, I like what you said there about if there's a body part that moves, it's probably by the surface or it's not covered, and if you can move any direction, that's the direction you want to go.

Dr. BZ: Exactly. If you are in that phase where maybe the slide is slowing but hasn't fully set up yet and you can still move any part of your body . . . You've probably heard of this idea of swimming with the avalanche, and that actually has a lot of credence.

We know that larger particles float to the top. If you think of an avalanche, it's kind of laminar flow of particles.

So the same way we call it the Brazil nut effect, that in a bag of nuts the bigger nuts always float to the top, or in granola, the bigger clumps are always at the top. And by the time you're at the end of the bag, it's all the crumbs at the bottom.

The same thing happens in an avalanche. So you want to make yourself as big as possible and you want to try to push all those particles, as many as you can, below you so you can float on top. So if you can do that to stay shallow in the pack, that's great.

And then another thing to do is, as a last resort, try to make as much space around your head to make a pocket of air that you can use to survive longer than you might otherwise.

So one of the things we look for in avalanche rescue to determine if a patient has a better chance of survival is if they have an air pocket around their face or if there's any snow impacted in their mouth. Because if there's snow in the mouth, or what we call an ice mask, where the snow in front of the face is kind of melted and then refrozen and sealed off, then that patient has a lot lower chance of survival because they've had less air to breathe while waiting for rescue.

Troy: So it sounds like just keep moving if you can move.

Dr. BZ: Yeah. Move as much as you can, as long as you can.

Troy: As long as you can, yeah. Hopefully, none of us are ever in that situation.

Scot: It sounds terrifying.

Troy: Absolutely horrible. Yeah, it just sounds awful.

Dr. BZ: I will say that the more I've learned about avalanche safety and snow science, I thought I would be able to use that to go further in the backcountry and do cooler things, and it's had the exact opposite effect. I'm much more conservative than I ever was before I recognized the danger.

Scot: Now that you know.

Troy: I can imagine.

Scot: The danger is more than what the average layperson realizes, then, is what I'm getting from you.

Dr. BZ: Yeah. I think we've made a lot of strides in avalanche science and snow safety, and we have these decision rules people use and what we call obvious clues where people look at terrain features and try to determine what the risk of an avalanche is. And those are all fantastic things.

But I think they also sometimes give people a false sense of security in terms of thinking that they can't be in an avalanche if those rules say that it's safe, but the opposite is true. An avalanche can happen anywhere at any time. I think a lot of us get very lucky when we're recreating in the backcountry, and we think that translates into good choices when it's just the luck that nature provided us that day.

Scot: Graham, thank you so much for coming on the show and using some of your mountain medicine experience to talk us through these rumors, and some good tips there too for any of our listeners that might happen to like to go out and recreate in the backcountry. We sure appreciate you being on the show. Thanks for listening and thanks for caring about men's health.

Dr. BZ: Thank you so much. Thanks for having me.

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: It's a Sideshow episode of "Who Cares About Men's Health," and it's a very festive Sideshow episode. It's our Christmas episode where all three of us pick out three gifts each that you can give to somebody in your life that would help them be healthier. Not like the hardcore healthier, but the kind of health that we talk about on the show. So it might impact the core four or it might impact something else.

My name is Scot. I bring the BS to the "Who Cares About Men's Health Podcast." And to counter that, the MD to my BS is Dr. Troy Madsen.

Troy: I'm here and I've got my gifts with me. I'm so excited.

Scot: And Mitch Sears, Producer Mitch in the mix.

Mitch: I'm ready for today.

Scot: Who wants to start?

Troy: Oh, so much pressure. Who's it going to be?

Scot: All right, Troy. Why don't you go ahead and start since you've probably put more thought in this than the rest of us?

Troy: I've put a little bit of thought into this, but I have based my gifts on gifts that have been inspired by our guests this past year. So each gift relates to one of our guests.

So my first gift I'm going to give, Scot, is a wellness coach appointment. And we kind of said at the start we were going to try and keep these gifts under $40 each. So I looked at Peak Fitness through the University and you can get a 30-minute appointment with a wellness coach for $35. And that's as a member of the general public, not a university employee.

This is a tribute to listener Scott who set up an appointment with a dietician, but I think also was looking kind of for a wellness coach. So that would be my gift. You give this to someone and say, "Hey, it's free. I paid for it. Just do it. Just get whatever you can out of it." It's 30 minutes, and it might be something that helps point them a certain direction in terms of their general health and maybe gives them some ideas.

Mitch: Now, I actually did one of these a while ago. I think we mentioned it on a previous episode about Mitch's personal health journey, and they're great. I mean, in those 30 minutes . . . I ended up doing additional ones with this person, but they were able to take baselines, they were able to give me some directions on where to go, they were able to give me resources on types of workouts that might work best for me, numbers of dieticians to call, etc. And it was really nice. In that 30 minutes, I was able to get at least started in the right direction to improve my physical health and my nutrition. What a great idea.

Troy: That's cool.

Scot: Awesome gift.

Troy: Yeah, I remember you mentioning that now that you said that. That's cool that it wasn't just 30 minutes, like, "Okay, let's get some info." But they really gave you something to work with. So that would be my idea. You give that to someone, they can take out of it what they want, and hopefully come away with something useful.

Scot: One of the challenges can be just getting started or knowing what direction to get started in or getting some resources to get started, because it can be a little overwhelming at first, as we've learned when we've talked to our couple of listeners.

I'm not saying that they were overwhelmed, but I'm saying as we went through the thought process of what kind of advice to give, it's kind of a challenge if somebody has never really ever actively engaged in what they eat or actively engaged in types of exercises. So good call.

Troy: It's a starting point, yeah.

Scot: All right, Mitch. Gift number one from you.

Mitch: In the same vein, I was looking up online . . . One of the things that we talk about a lot is kind of this idea of getting social connections. It's good for your mental health, but I also wanted to mix in how do we make sure that we're doing nutrition and things.

A cooking class. I found some group rates on cooking classes that we can come in under that $50 range, get a couple people, and go learn how to cook something new. It doesn't have to be 100% the healthiest food ever, but just the practice of learning to cook.

I think about the series that we did this year with Theresa Dvorak, TD. And just those recipes that I learned how to do, I'm doing them. And so by getting out, by going and learning how to do another dish, what a great way to start cooking for yourself again.

Troy: Yeah, that's a great way. I was the person in this who had no idea what he was doing, and I think for someone who has maybe no experience with cooking, a cooking class would be intimidating, but I'd be like, "Hey, it's a gift. It's free. I'm not paying for it. I'm just going to go there and enjoy it and then probably walk away feeling more comfortable in the kitchen." So that's a great idea.

Mitch: Well, go with them. If they're nervous, get yourself a ticket too. The two of you can go and cook together.

Troy: Go together, yeah.

Scot: Yeah, that takes care of that emotional health because you're getting some good relationships in there, and then maybe you might learn some skills in the kitchen, what some of those confusing words mean in recipes, some knife skills, that sort of thing. So that's a great idea.

My first one is also about cooking, and it was inspired by our series with Theresa Dvorak, the healthy man meals that you can make in bulk that are easy. I thought maybe some sort of a healthy cookbook with quick and easy recipes.

So we learned that preparing good food not only can help your emotional health, but it helps your physical health as well. For me, it was kind of a meditative state almost when I was in the kitchen and it feels good to make food for somebody else.

And I know Troy's spouse was really excited, and so was mine in a way that I haven't really seen her excited about other things that I've done around the house. I mean, that was really gratifying from an emotional standpoint.

I just Googled "healthy cookbook quick and easy recipes," and started kind of going through some.

Now, if you're not sure what type of cookbook to get, maybe go back to our healthy man meals series, go through those, and you might be able to have a better idea of what to look for.

I found one called "Easy 5-Ingredient Healthy Cookbook: Simple Recipes to Make Healthy Eating Delicious." It looked like she had a spaghetti squash recipe like we made. It looked like she had some sort of a Thai Curry thing like we made. That's $19.

And I'm going to take it another step further. Maybe do what we do. Find a friend and then make them . . . Say, "On Saturdays, we're going to both make the recipes and then talk to each other and compare notes."

It gives you something to talk about. It's good motivation. We know that when you do something with somebody else, you're more likely to do it as opposed to just going, "Eh, that's not a big deal."

And one last option that could be free. Maybe you put together a few recipes, there are a lot of free recipes online, and make up your own little cookbook for a friend, somebody maybe who wants to eat out less or wants to eat better.

I don't know how to package that as a present, though. I don't know if you put it in a physical binder or something like that, but if money is an issue or you have some favorite easy recipes you like, you could go back and use the ones that we offered in our series as a starting point, because we posted those online.

That's my idea.

Troy: Yeah, I like it. And even with that, Scot, maybe you give them those recipes you found online and say, "Hey, I'll come over and we'll make one of these together," or something like that. Make it more, again, that social thing, like Mitch was talking about. Also a great idea.

Scot: Yep. And I'll tell you if you listen to that series, having recipes you can make and then having recipes that you have food in the fridge makes all the difference because then when you're hungry, it's there. You don't have to make a choice. You don't have to go for the poorer options.

Mitch: So one of the things I want to say is being someone who got way into cooking for a while and got a bunch of cookbooks, and my partner is way into cookbooks, if you're looking for a cookbook and you're looking and you're trying to find one for someone who isn't the biggest cook already, stay away from some of the more complicated ones. They look really nice, they look really fancy, but if you get some of these really technical cookbooks, they are so overwhelming even for the more experienced cook.

If you're trying to give the gift to someone who is just starting out, be sure to find to cookbook that's on that level.

Troy: And didn't you mention one on the show? I thought you mentioned one that starts off super easy, like making eggs.

Mitch: "America's Test Kitchen." They have a cookbook series that's 101 recipes, and it really does. It starts out, "Here is an egg. Here is how you cook an egg. Here's what makes an egg delicious." And you kind of roll your eyes at it, but suddenly your scrambled eggs are the most delicious scrambled eggs you've ever had.

It's not just what you made in college, and it's like, "All right. Let's see what I can do next," rather than . . . I don't know. There's a Gordon Ramsay book that I've been handed before and it's like, "I can't even pronounce half the ingredients or know where they are in the store. No, thank you, Gordon Ramsay. I appreciate it, but . . ."

Troy: I'm liking the idea of the "America's Test Kitchen" 101 Recipes. That's a good way to go.

Scot: One last thought I have on that that you maybe think about. The best scrambled eggs ever, it's food that then maybe you will look forward to eating that's just as good as some of that fast food. We all know that the fast-food restaurants have labs and they chemically engineer that food to be addictive. I mean, in order to battle that, you've got to make some decent food. So I like that. That's good.

Troy, circling it back around to you for number two.

Troy: Okay, gift number two. This is inspired by Chris Gee when he talked about "nerd neck." So this is a laptop stand. As I'm sitting here at my desk right now, I'm thinking, "I wish I had one of these," because I hunch over my laptop. A lot of us are working from home in areas that are just not at all ergonomically suited for us, and we hunch over our laptops and now we're spending hours and hours doing this every day.

So these laptop stands lift the laptop up and tilt it towards you to create a more ergonomically suitable environment where the laptop screen is at your eye level and the keyboard is up higher. So it's more comfortable just for your back, your neck, your hands, everything.

You can find these for $20, $30 online, and just a nice gift, something to hopefully prevent the "nerd neck" or help someone treat it if they're already experiencing it.

Scot: Love it, especially because we know that when you have poor posture, not only does it not look right, but we know those muscles get tightened. And in a state of tightened, they start to get weakened, and then you could be more likely to hurt yourself when you do exercise and do those sorts of things. So preventing that is super crucial.

Mitch, gift number two.

Mitch: All right. So gift number two is now thinking a little outside the box. Thinking about sleep hygiene and some of the stuff that Kelly Baron has talked about, one of the original gag gifts, which has significantly changed my life, is a toilet light. Do you guys have toilet lights? Do you know what toilet lights are?

Troy: No. This is a light on the toilet to help you at night so you're . . .

Mitch: Yes.

Troy: Interesting.

Mitch: They're like $10. You can get them on whatever online source. And it seems so ridiculous. They come in different colors. They perch on the side of your toilet. But what happens is in the middle of the night, if you need to go to the bathroom, rather than turning on a light, it has a blue-light-blocking, non-sleep-disturbing light so you can see exactly where the toilet is and you don't have to turn any lights on.

And I cannot tell you . . . It started out as a "ha-ha" funny gift, "thanks for the white elephant gift." That thing has broken and I have replaced it twice now. It is such a vital thing in our environment. We have the bidet. We could go into the bidet. A good bidet is expensive. But just that idea of waking up, not having your sleep being disturbed, go right back to bed. No need to turn on the light.

Scot: You don't have to turn on the big bright lights.

Mitch: Nope. It's wonderful. It's beyond wonderful. Toilet light. Look them up.

Troy: I am looking it up. I'm already intrigued because this sounds great. You stumble in the bathroom at like 2:00 in the morning. Number one, your partner is going to appreciate it because it's probably going to help a little bit with the aim. But number two, it probably makes it that much easier, like you said, to go back to sleep because you're not flipping on lights. And if your bathroom is right next to your bedroom, it's not disturbing your partner or whatever. So it sounds like that's a gift for the whole family.

Mitch: Absolutely.

Scot:All right. That was a good one. My number two is not necessarily inspired by anybody, but it's going to help with sleep as well. I'm completely copying Mitch, it sounds like, because every category he has put out there, I come in with something after that.

Mitch: Did you also get a toilet light?

Scot: No. A white noise machine for sleep. So these things, you plug in. They're $20 to $30, and you can get just the white noise, which is that noise or fans or they make the . . . These things you can change the noise. You could have a brook or sea waves or birds or bonfire or train. I don't know who uses trains, but whatever. I like the sea waves and the rain myself.

I started using it more and more when we got our new dog because our new dog is a little bit of a heavy breather when he sleeps. So it covers that really well, and it helps me get to sleep.

In the summertime, we have fans in our windows that run, so that drowns out noise. And then at the end of that summer season, it's so deathly quiet in the house it's almost disturbing.

They're cool, too, because you can take them along with you. They're very portable. They just use a little USB cord. So if you go to a hotel or something and you need a little help sleeping, they're $20 to $30. So just a little white noise machine for sleep.

Troy: Yeah, I love having white noise. I have an app I use on my phone, but I use it with headphones. I actually have these headphones I can sleep with. I started doing that several years ago. I had white noise before, but doing this, I'm just like, "I don't care. We're traveling, dogs are barking, I'm trying to sleep during the day, I don't care. I can't hear it." I have noise-blocking headphones and I use white noise. Yeah, a white machine, anything like that, I agree, I think it helps sleep for sure.

Scot: All right. Gift number three and the final gift. Troy saved the best for last. This better be good.

Troy: It better be good? So the theme here, it seems we all keep talking about TD, about Theresa Dvorak, and the amazing series she did with us on cooking. This gift would make her proud.

So my final gift is a windowsill herb garden. You can buy these little things. It's like a little herb garden. Just imagine how proud Theresa would be if we emailed her in a couple months and told her we made our recipes again with mint we grew ourselves, parsley, basil, oregano.

I had a hard time finding these things in the store, but it would be so cool to grow it and then use it in your recipe and just be like, "Not only did I make this, I also grew some of the ingredients."

So just a fun little gift, I think, for if you know someone who cooks or even maybe someone who doesn't cook a lot. Maybe even combine that with Scot's gift of the cooking book, or Mitch's gift of the cooking class, something fun like that. It'd be kind of cool to do.

Scot: I don't know if you guys have ever had plants before. Again, we come back to mental and emotional health. I find pleasure taking care of plants and watching them grow. That's just kind of neat. So not only would it help maybe make your recipes pop a little bit more, it might help your emotional health.

Troy: Agreed. Yeah, a little something for the winter months to bring a little life into your home and then make a nice meal in February.

Scot: Yeah. All right. Number three for me is something called YogaToes. I've sent you guys a picture of what they look like, and I'm going to try to describe them. Help me with this. So these are things you put over each one of your toes, but what they do is they kind of spread your toes out.

So I don't know if you ever did this when you were a kid? Put marbles between your toes.

Mitch: No.

Troy: Yeah. And walk around with them? Yeah.

Scot: I mean, I was a weird kid I guess.

Troy: I did it too.

Scot: Oh, you did? Okay.

Troy: Oh, yeah.

Scot: Imagine putting marbles between your toes. What YogaToes are is they spread your toes out in the same sort of way, except it's not marbles. It's a silicone/rubbery sort of thing, and you put those things on.

I'll tell you, when I was training for my marathon or if I had days where . . . I'd take them on trips with me, like when I went to New York one time and I got in 20,000 or 25,000 steps. My feet were just sore.

You put these on, it stretches out your toes, it helps your calves feel better, it helps your toes feel better, the bottoms of your feet.

And I just put them on when I'm watching TV. You put them on 10 or 15 minutes a day and it's amazing what a difference it makes.

I think feet are really ignored a lot of times, and I noticed as I was getting older, my toes were starting to kind of get into weird shapes and I couldn't even physically move my toes separately anymore, which I think could be a problem. I started using these YogaToes and started kind of wiggling my toes and doing toe exercises, and it makes a huge difference in how my feet feel at the end of the day. So that's my gift number three.

They've got various kinds and they're various prices. My only tip is if you use them, use them for only five minutes a day at first. You've got to get used to them. Otherwise, you can hurt yourself, like with any muscle thing that you do. I mean, it's crazy.

Troy: Yeah, I'm looking at that. I want to try those. That looks really cool. Yeah, I think it's that gel kind of stuff, it looks like, and that feel having that between your toes. Like you said, there's nothing . . . I don't know. I'm a huge believer, too, in taking care of your feet, and I think this could go a long way toward helping, like you said, your intrinsic muscles of your feet feel better and really working out some of that soreness there. So I'm thinking if I don't get this for Christmas, I'm buying it for myself.

Mitch: "I would like that."

Scot: Dropping a little hint. All right, Mitch. Gift number three from you.

Mitch: Okay. So being just a touch off-color again, this is inspired by a gift I got years ago from my parents, who are listeners. Hi, Mom. Hi, Dad.

Troy: Hey, Mitch's mom. Hey, Mitch's dad.

Mitch: Hey. Just awkward question, how much have you paid for the pair of underwear you are wearing right now?

Troy: How much have you paid?

Mitch: Yes. Is it a six-pack that you get from Smith's? Is that what you are wearing right now?

Troy: I will say it is not expensive. I will tell you that.

Scot: No. And I will also tell you it's time to be replaced.

Troy: I think this is just a guy thing. Underwear, you're just like, "Who's going to see it? I don't care."

Mitch: Exactly.

Troy: I don't know when I bought this underwear. It's been around a long time. I couldn't put a year on it, but yeah.

Scot: All right, Mitch. You've got us intrigued. Are we going to splurge? We're going to splurge on something?

Mitch: Yes. This is the year that you buy the $30 pair of underwear. I cannot tell you . . .

Scot: I don't know.

Mitch: No, I know you are like . . . I don't know if I've brought this up before, but this is the way that a lot of people respond to it. I was the same way until my sweet parents got me a pair. And they're like, "This has been life-changing. Your father loves them. Try them."

They got me and Jonathan a pair. They're amazing. I cannot tell you, when I started running, there's no rubbing. There are no problems with sweating down there. There's no anything. They're amazing. Everything stays where it's supposed to be, they wash up really good, they last forever, and that's kind of it.

We spend our whole lives doing these cheapo pair of underwear that we just throw away and we don't even look at the options. I'm just going to tell you I've tried a bunch of different brands. I'm not going go too far into them, but SAXX, Separatec, there's a whole bunch of different ones. Some that are more geared towards runners, different activities, but they all are about $30 and everyone just gasps and it's like, "Ugh, $30 for underwear? Why?"

Scot: I don't even pay $30 for dress pants or jeans.

Mitch: I know.

Troy: My shirts are around $20.

Mitch: That's why I'm saying just one. Just one to try it out.

Troy: And are these boxers or boxer briefs?

Mitch: Whatever you need. They come in briefs. They come in boxer brief, loose-fit boxer, long-leg, trunk. I'm a big trunk guy. I love the trunks.

Troy: See, I just feel like if you had that, though, you would wear it once and then obviously you're not going to wear it multiple days, and then you would just be . . . Are you washing these every day, or do you just feel like, "Now I've got to buy 10 pairs of these so I can just have them and have them every day"?

Mitch: I mean, you will eventually find yourself spending a whole lot of money on underwear, but I'm just going to tell you it's night and day. I have never gone back. There's been a time or two when you're on Week 2 of not doing laundry and you're back to the old underwear, and it's like, "What am I doing to myself?"

Scot: "What am I doing with my life?"

Mitch: Right. And that's why I'm saying go out and just get one. Just try it out.

Troy: Yeah. Obviously, women are a whole lot better about this than we are as guys. They clearly will buy nice underwear, and it doesn't have to be like anyone is seeing it or anything. It's just like, "I just want to feel good." And us, as guys, we're just like, "Hey, I don't care. I've got my $2 pair of underwear," or whatever it is from the multipack. But yeah, it's a great idea. Something that you're comfortable in.

Too, like you said, I think if you're participating in any kind of athletic thing, if you're running, whatever, it does make a difference. If you're wearing cotton underwear while you're running, forget it. You're going to be so chafed up. It's just miserable.

Mitch: Exactly.

Troy: And maybe that's it too. Maybe's it's a nice pair, like you said, that you're wearing on a daily basis. And maybe if you know someone who's an athlete who would just like a nice pair underwear, you get them a nice pair of whatever. Nike, Under Armour, they all make some more expensive, nice underwear for working out.

Scot: Well, there you go. Three guys, nine Christmas presents for people that are perhaps interested in becoming a little bit more healthy. So if you get any of these, be sure to let us know. There are lots of ways to reach out to us, which Troy will tell you about now.

Troy: Oh, man. We have not done this in months. You have your little tag on the end, you do, so I've forgotten everything, but I know you can . . .

Scot: All right. I'll go ahead and take care of it.

Troy: I'll try. You can contact . . . we're on Facebook at facebook.com/whocaresmenshealth. On the web, whocaresmenshealth.com. You can email us at hello@thescoperadio.com. Or you can call our listener line. We would love to hear from you. It is 601-55SCOPE. Did I get that right?

Mitch: Yes.

Scot: You got it right. You did it all.

Troy: Sweet.

Scot: Nice work. All right. And if you do any of these Christmas presents, let us know how it works out for you. Thanks for listening, and thanks for caring about men's health. "Jingle Bells" me out.

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: It's the "Who Cares About Men's Health" Sideshow. My name is Scot Singpiel. I am the guy that brings the BS to the show. Also co-host Dr. Troy Madsen, the MD to my BS.

Troy: Scot, I'm happy to be here with you.

Scot: And Producer Mitch is in the mix.

Mitch: Hey, there. I'm back. Haven't had roller food in over two weeks.

Scot: Oh, nice.

Troy: Well done.

Scot: Nice. Yeah. Awesome. All right. On the Sideshow, we get an opportunity to talk about some things that will have to do with health, but it's not necessarily health issues that face men or it doesn't necessarily always tie back to the core four, but a lot of times it does.

Today, we're going to celebrate another success. We celebrated Mitch's two-year quit-iversary, but Troy also has had a goal, an objective, and achieved something pretty cool as well. Troy, go ahead and tell us what happened.

Troy: Well, Scot, we talked about this a little while ago. I mean, it's been about a year since we talked about it, but I ran the Boston Marathon. It happened. It happened a couple of weeks ago. It was one of those things that was out there and I'd qualified for the Boston marathon about . . . it's been about three years ago that I qualified for it. And then as you know, COVID happened and there was all that disappointment because COVID hit about a month before I was going to run the Boston Marathon in 2020, and the marathon was essentially canceled.

They did this virtual marathon where you just go out and run and they send you a medal. And then it was rescheduled . . .

Scot: Eh.

Troy: I know. It was kind of like, "Eh, well, I ran the Boston marathon." But it was about 15 miles from my house, so it wasn't actually in Boston. So it wasn't that cool.

And then they had rescheduled and we were looking at April 2021, and then they pushed it back to October 11, 2021, and it actually happened. And it was wonderful for it to actually happen and to be part of it and to be there and to run the Boston Marathon.

Scot: Well, congratulations. And you finished?

Troy: Finished. Yeah, I did finish. Yeah, it was . . .

Scot: How did it go?

Troy: It was great. I enjoyed it. Everyone was like, "Well, how did you do? How did you run?" Well, I ran 3 hours and 16 minutes. I was really happy with that. The fastest time I've ever run in a marathon is 3:07, so it wasn't that far off of it. And that time would qualify me for a future Boston Marathon, which is always an achievement. Any time you can qualify for the Boston Marathon, that's a big deal.

So I was excited about that, to qualify for a future marathon in 2023. I think it would count for 2022 as well just with that race. So in that sense, it was great, but the best part for me was I just enjoyed it. I did not wear a watch. I did not know my time. I just ran. I enjoyed it. It was a cool experience. And then at the end of the day, it was like, "Oh, cool. It was a good time too." So I was happy with it.

Scot: Were you kind of let down then after you crossed the finish line? I mean, was there a point of like, "Wow, this thing is something I've wanted to accomplish, something I qualified for, it's been two years, and well, that's that. It's done"?

Troy: It's funny. It was kind of a relief to be done. And the reason why it was a relief is because most marathons I run, I just don't tell anyone. And beforehand, I was getting some texts from people who were like, "Hey, good luck tomorrow. We're going to be watching how you're doing," and stuff. And I'm like, "Guys, don't watch. Please, don't watch." I don't want this kind of pressure. Come on.

Scot: By the way, I downloaded the app and followed your progress.

Troy: I know. And I'm so glad I did not know you were doing that because I was just like, "I don't want people to be watching what I'm doing. I just want to go out and run."

And it's funny, leading up to it, it was a little bit stressful. I had this great plan where Laura was just going to drop me off at the start line. We stayed five miles from the start line in Hopkinton, Massachusetts. And we get up that morning and she starts to drive me to the start line. We get one block from our hotel and the road is blocked, and I'm like, "What am I going to do?" They're forcing people off the road onto the highway. So I just jump out of the car. I'm like, "See you later. I am running to the start line."

I am not joking. I just started running up the road because I'm like, "I don't know how else I'm going to get there." Fortunately, some guy is driving up, just one of the locals in Hopkinton, and he's like, "Hey, you need a ride?" So he's like, "I can get you two miles up." So he drove me two miles. So I ended up running a couple miles just to get to the start line. So it was a little bit stressful getting there.

Scot: Wow. That seems strange that they didn't plan that better.

Troy: Well, it's probably that I didn't plan that better.

Scot: Oh, okay.

Troy: I should have known the road would be blocked off, but I just didn't find anything that said it would be.

And then the race itself was kind of weird. I liked the way it was, but it was different than usual just because of COVID and all the health precautions. They did not have a start time. There was no gun firing and everyone starting. I was in wave number two. They had several waves based on your qualifying time. And so, for my wave, you basically started somewhere between 8:20 in the morning and 8:40 in the morning.

And so you just kind of walked up to the start line, and I look around and there are people kind of looking around at each other, all nervous, like, "Do I start this?" And I just was like, "Okay, here we go." I just started running and just crossed the start line, and then it starts your chip timing. Just started running.

So it was kind of weird in that way, but I mean, it was a cool experience just because it was . . . everyone was spread out. I wasn't packed in with a ton of people.

And the crowds along the race, that's what they always talk about. The crowds were amazing. So many people were out. It was just a really cool feeling because you could tell the community support for Boston is just huge. And that's what really makes it special, to have all these people out there all along the race route just cheering. You could tell they were just celebrating having this race back, and it was really an amazing experience to be part of that.

I will say, though, my favorite part of the race if people ask, and I'm hesitant to admit this, but my favorite part of the race was about Mile 13. And I'm just starting to come up this hill and I just hear all this screaming. I'm like, "What is it?" I had headphones and listening to music. I'm like, "Oh, what is that?" I didn't know exactly what happened where along the route.

I take my headphones out and just loud, loud screaming. I come up there. This is Wellesley College. This is an all-girls college, and all these college girls, hundreds of girls -- and as this happened, I remembered I heard about this -- are on the route just screaming their heads off.

They're holding their hands out to give people fives as they're coming by and people aren't doing it. And I'm like, "I am giving fives to every one of these girls who's going to give me five." So I'm just going down the line and girls have their phones out just recording and stuff, and I'm just giving fives. It is the closest I will ever come to feeling like a rock star. That is the closest I'll ever come. It was awesome.

I admitted it to Laura afterwards. I'm like, "Laura, I gave fives to all the Wellesley girls." She's like, "Go ahead. You do that." So it was funny. It was just one of those things.

And again, afterwards, I remembered I'd heard about out that, just all these college girls out there just screaming their heads off. But again, it was cool. The crowds were amazing.

As you get closer to town, it's just incredible. These crowds are like 10 people deep. Even early in the race, I thought, "I don't deserve this. Come on, guys. It's Mile 3. You can't be cheering now. I haven't done anything." But you get closer to the end, just huge, huge crowds as you're coming in the city. Yeah, it is a really cool feeling.

So it was an amazing experience, but like I said, getting done, it was a little bit of a relief because it was like, "Hey, I had a good race." I felt good. I enjoyed it. Great experience to think back on. You always worry you're going to go out there and just feel awful, like have some stomach issue or something, but everything went great. So it was a fun experience.

Scot: Oh, that's awesome. Well, congratulations.

Troy: Thanks. Yeah, I was happy about it. It was cool. It was definitely one of the . . . Yeah, people talk about it as the pinnacle of . . . That's what you try to achieve as a marathon runner. People want to run Boston. It's like, "I want to qualify for Boston. I want to run Boston." There are a lot of other great races out there, but that's kind of the big thing. So it was a cool thing to experience. And not just to be there, but just to have a fun experience with the whole thing.

Scot: And what a great story too, like how you got there. And in case somebody is listening that doesn't know that story, Troy, tell how you got started running.

Troy: Well, a big part of running for me . . . We talked a little about it before. There was the vegetarian diet, and that had a lot to do with just getting my cholesterol checked many years ago. I mean, it's been 15 years ago now, and seeing just some really bad numbers and saying, "I've got to do something about this."

So that's when I started a vegetarian diet, but I didn't really start running consistently until . . . it's been almost seven years ago. So in March, seven years ago, I got to a point and I said, "I'm just going to try and run every day." And I said, "I'm going to do two miles a day. I don't care how fast I go. That's all I'm going to do, and I'm just going to do it."

Prior to that, I'd put on a decent amount of weight. And again, I'd had my cholesterol numbers checked and they had improved, but still not super great. So I started out just doing two miles a day.

And then after about six months of that, Laura, my wife, she was running a lot of marathons, like a ton of marathons, and she got me interested and basically got me to commit to running a marathon.

So anyway, I committed to that. And so at that point, I started to kind of increase the mileage and mix in some longer runs. It's sort of evolved from there, but it really just started saying, "I'm just going to try and do it every day, two miles," and then it just built from there.

Scot: And I love that because that's what's kind of known as a process goal. It wasn't an end goal. You never had the goal of running the Boston Marathon or running marathons or getting a particular time.

Troy: I didn't.

Scot: You just recognized a health issue that you realized that a little bit more activity could help, and you just said, "I'm just going to do this every day for a certain number of minutes or a certain number of miles," and you did it, and then it led to this. So I think that's such just a great story.

Troy: Thanks. I think that's the big advice I would give anyone too. It's not about the end point. For me, it was not about Boston. At no point did I say to myself, "I want to run the Boston Marathon." I just said, "I want to run." And it started out just little bits and then it became, "Well, I want to run a little more." And then it became, "Well, I've got this marathon out there. I've committed to do it, going to get through it." And so I ended up doing that and then enjoyed it.

So I think the biggest thing is just enjoying the process. And that's what I've found. As I started doing it on a regular basis, I just enjoyed the process, and that's what it's fortunately been for me. Sometimes the process is challenging, but I've enjoyed it, and I think, for me, that's what's helped me to stay consistent.

Scot: Yeah, it went from an extrinsic reason to an intrinsic reason, that you just enjoyed it. You just liked doing it. And I think for anybody listening, when you try to get into any sort of activity, because we know that you need to get about 30 minutes, a little bit of sweat in every day, you might stumble into something like Troy did that you then ultimately enjoy.

I don't know. It's kind of a chicken and the egg thing. Did you enjoy it because you were kind of destined to enjoy it, or did you enjoy it just because you did it long enough and you liked how you felt physically? I mean, who knows?

And I've actually even learned from you as well. I used to have these goals when I'd go into the gym to lift weights that I want to be able to bench press this much or squat that much. And as soon as I kind of let that go after we had these conversations, I enjoyed doing it a lot more. I don't hurt. I don't hurt myself and I feel better and I feel healthier.

So sometimes just promising that you're going to be part of the process is 90% of the battle. And you don't have to be a superstar at it. Just go out and engage it and sweat. Find that thing that you like. If it's not the first thing you do, maybe it'll be the second or the third thing.

Mitch: Along that same line, Scot, is that when I was doing my little 5k a little while ago, it was the same sort of idea. When Troy said that he ran the Boston Marathon and didn't even wear a watch, my kneejerk reaction was, "What do you mean you didn't wear a watch? How did you run it without knowing how fast you were going?"

But that's just it, is just enjoying the activity. When I was doing the 5k training, it's like, "Don't look at the distance you're running. Don't look at the time that you're doing. Just get in the habit. Just do it and find a way to enjoy it."

And that's been a big change and shift for me as I've kind of matured over the last couple years about my feelings about health, and I really think there is something to it.

Troy: I agree, Mitch. And it's funny because before I ran the race, I kind of thought, "Oh, I'll wear a watch just to see what I'm doing." Then I thought, "I don't want to." And I thought back because, again, I think it's so much about just enjoying the process and just enjoying the experience. And then as you do that and you really embrace it, I think the results follow.

Scot: So Boston is done. Does that mean you're done running then?

Troy: I'm done.

Mitch: Yeah, what's next?

Scot: Yeah, what's next? Because from a goal standpoint, a lot of times we make these goals, whether it's "I want to lose five pounds" or "I want to be able to do this one thing," and then you've reached the goal and then it's like, "Well, now what?"

Troy: I know. I've had that thought. It's funny. I have had that thought and it's funny because leading up to it as I talked to some people . . . and I can't remember how it came up. I mean, when I say that, it sounds disingenuous because runners always have a way of bringing up the fact that they run marathons. So maybe that's how it came up. But I have met people who have run Boston and who said, "Oh, yeah, I ran Boston," and then they've stopped running. They don't run.

And I have not wanted that to happen to me, so I'm still running. I'm still going. The thing that I've come back to is I really do just enjoy the process. I've always told myself I don't want this to be about a time, a certain time that I'm running, like a certain speed. I don't want it to be about Boston, about qualifying, and then once I had qualified, about running the Boston Marathon. I never want it to be about that.

I've told myself I want to be doing the same thing when I'm 80 years old. I love running these races and seeing these old people out there. And they're not running super-fast, but they're just scooting along.

Scot: They're there.

Troy: They're there. They're doing it. That, to me, is the pinnacle right there. I find that just remarkable. I hope that's me honestly, and that's kind of how I look at it.

Mitch: I love that because it seems like . . . I don't know. Maybe it's just how guys are. When I was growing up in high school and stuff, it's like, "I want to be the model on the front of the runners' magazine. I want to be the big beefy dude." And it's so cool to hear, "I just want to be the 80-year-old who's scooting and still doing what I love." That's so different that I like it. I like it a lot.

Troy: Just keep on trucking.

Scot: What I'm taking away from it, though . . . It might be the same. It might be a little different. It seems like what you're talking about is it's like more of a journey, and Boston was just kind of a stop on that journey. It's not an end point. It's not the destination. Any of these things we do, how can you make it into a journey and how can you have destinations you look forward to getting to?

Troy: Yeah, you're right. And to switch your analogy up a little bit, maybe it's more like a really long trail run and some of these things are some of the peaks on the trail run, and you take in the view and you're like, "Ah, it's amazing." But you know there's another peak. You're going to keep going. You're going to drop down a bit, you've got some climbs, and then there's something else out there, some other cool experience where you're taking in the views and just enjoying the rewards of it.

Scot: Or how Mitch heard your analogy, you reach the peak and then you go back down into a deep, deep, dark valley. And then you try to figure out how you're going to get out of it.

Troy: How do I get out it? But sometimes they are dark valleys. I kind of had that thought yesterday morning when I went out. It was raining out and the temperature was in the low 30s, and it was dark and I kind of did have that thought, like, "Do I need to do this every day? I did Boston. Do I need to do it?"

Scot: Your cholesterol does not know that you did Boston, so that's why you continue to do it.

Troy: That's right. My genetics do not know that I did Boston.

Scot: They don't care.

Troy: They don't care, yeah. And that's a great point too. They don't care. They're not going to be like, "Oh, you're good for life."

Scot: Yeah, you're kind of doing it for a different reason, and I think maybe Boston was just kind of a cool little outcome of the real reason why you're doing it, and that was so you can manage your health issue that you have and be that 80-year-old that is still out there and moving around.

Troy: Yeah.

Scot: Mitch, do you want to say anything to Troy before we wrap up? Do you want to give him your own personal congratulations?

Mitch: Oh my God. Yes. Congratulations.

Troy: Mitch, please do.

Mitch: It really is really inspiring, as someone who's trying to get back into fitness, who's been struggling in his own way or another, to have a different approach and a different framework. And I really appreciate you sharing that on this podcast in particular.

Just do it. Just find something you enjoy and do that every single day. That is so much different than, "You've got to kill yourself. You've got to be sore if you're going to get those gains." It's such a different approach to health that I cannot tell you how proud and appreciative I am that you have done Boston and were able to do that.

Troy: Well, thanks, Mitch. Well, I'm obviously incredibly proud of you and what you've done with your health change. I mean, it is inspirational too.

Scot: It is actually.

Troy: It is.

Scot: I'm just sitting here thinking, "I'm kind of the one that's bringing the group down."

Mitch: Come on, Scot.

Scot: This is why guys should talk about it, I guess. I didn't think I was competitive until very moment right here.

Troy: See, that's the point, though. It should never be a competition. I don't think it ever should. And for me, six years ago . . .

I have to say this too. So they had this board where people could put up pictures and messages to you near the finish line. So Laura posted a picture of me six years ago running with her. It was the furthest I had run at that point since college. I ran the second half of the California International Marathon with her. So it was me running with her and I said, "I'll join you at the halfway point. I'm going to try and finish. I don't know if I can." But I met her at the halfway point and I did it and I ran that second half with her.

And she posted a picture of that that said, "Look how far you've come." And the of picture me, when I saw it, I was like, "Oh, wow, I've lost a lot of weight." I was definitely in the overweight category at that point. But I think the larger point I'm trying to make here is you just say, "Hey, I'm just going to start small and just try and be consistent," and then I think, over time, that just builds on itself.

So I hope that's the takeaway for everyone. It's a message I think we've tried to share with some of our listeners and when we've had some of our listeners on here as well, of just the value of consistency and really just enjoying the process, and then I think the results follow from that.

Scot: Congratulations, Troy. This is a very exciting moment for all of us, I think. I was excited when you qualified and I was excited when you were able to finally run it, and I feel a little let down now, I guess. So what are you going to do next? No, I'm just kidding.

Troy: Well, it meant a lot to me, Scot, to get done, and Laura told me afterwards. She's like, "Scot was texting me during the race. He's like, 'Oh, look how fast he was going. Look at what he is doing.'" But it meant a lot. It did. I am so glad I didn't know you were doing that, but it meant a lot to me after. And from everyone else, like family and friends and everyone who reached out and supported me, it was really cool.

Scot: Yeah, it was fun. It was fun to support you.

Troy: Thank you.

Scot: Hey, Troy. Congratulations. It's just awesome having you on the podcast, and what an awesome accomplishment. And now we'll never speak of it again, I guess. I don't know. You said you were never going to talk about running again.

Troy: Well, Scot, I'm going to wrap this up and I'm just going to say thanks for your support, and I am looking forward to the day I get to track your Boston Marathon progress. I'm expecting it's going to be in three years, so let's do it.

Mitch: Oh, man.

Troy: No pressure.

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.

Troy: You've got to say something like, "Troy puts the stud in studies," or something like that. Something good. I'm just kidding.

Scot: I will never say that.

Troy: I was just trying to think of something better than "Troy's articles" or whatever you called it.

Scot: That's us. It's a "Sideshow" episode. That's what we like to call a soft start. You caught us in the middle of a little prepping trying to decide what we're calling this segment, where Troy scans the medical journals so you don't have to and then shares an article that hopefully is of some interest.

Troy: Hopefully.

Scot: Yeah, this is "Who Cares About Men's Health," a "Sideshow" episode. My name is Scot. With me, as always, the MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: And Producer Mitch.

Mitch: Hey there.

Scot: All right, Troy. Let's take a look at your articles, hear what you've got. Go ahead and put those articles on display.

Troy: Look at the articles.

Scot: Yeah. Go ahead and put those articles out on display for us. We're going to pick one.

Troy: Oh, we're picking?

Scot: Oh, yeah. I mean, unless you just decided you had one that you . . .

Troy: I decided.

Scot: Oh, okay.

Troy: This title is so good that I knew even if I gave you my list of five, including the one on green urine that I keep trying to get you to pick, I know you'd pick this one.

Scot: All right.

Troy: And I'm just going to read it to you and if you don't like it, if you're just like, "No, we would not have picked that one," let me know and I'll pull up some other ones.

Scot: Okay.

Troy: The title of this article from the "Journal of Emergency Medicine," the title is "Battlefield Acupuncture Versus Standard Pharmacologic Treatment of Low Back Pain in the Emergency Department: A Randomized Controlled Trial."

Mitch: Oh, Troy, I did a bunch of interviews about this. Keep going.

Troy: Yeah. Tell me I have not piqued your interest.

Scot: So when you say battlefield, you mean like a war battlefield?

Troy: That's a good question.

Scot: Oh, okay. Well, I guess, Troy . . .

Troy: I'm hoping I piqued your interest enough that I can . . . I'll explain what battlefield acupuncture is. I didn't know before this article.

Scot: Move forward with this one. Go for it.

Troy: Okay, we got it. So battlefield acupuncture, to your question, is a technique using acupuncture. So you're familiar with acupuncture? You use these little needles in different spots. Ideally, the way this is designed, it's supposed to then relieve pain or lead to different effects.

Acupuncture, of course, is considered an alternative therapy, and it's one of those things where it has gained more mainstream acceptance as these types of studies have come out. But it's been considered a traditional therapy, an alternative therapy. It is not something I have ever done or have ever practiced. I did spend a day shadowing, spending time with an acupuncturist during med school, which was really cool, to kind of see what she did and hear her philosophy and see her approach and see the patient's response.

But battlefield acupuncture is a technique where there are certain little needles that look more like little tiny darts that are placed in specific places in either one or both ears.

The idea behind this is that these spots are said to influence the central nervous system pain response. And by putting these little needles in these different spots in the ear, they then decrease pain that is coming from other sites in the body. I mean, that's the theory. Again, I'm not a traditional practitioner, but I'm just kind of reading what I found on it.

Scot: Time out. In the ear, or in the part around the ear, or the earlobe?

Troy: In various parts. So yeah, let me clarify that. Not in the tympanic membrane. You're not going in the ear hole. These are different spots . . .

Scot: Okay.

Troy: Yeah, these are different spots on the auricle of the ear. You do not want to puncture the eardrum. These are spots . . .

If you just do a Google search for this, you can see photos of where these spots are. They're basically at the very top of the auricle of the ear, so the very top of the ear, and then kind of maybe half an inch down from there. And there's another spot half an inch down from there. There's a spot on the earlobe. There's a spot just on the very front part of the earlobe.

So they're like little tiny darts, and they actually have a tool that you use to place these. They just stay in place until they fall out. So it's usually three or four days. You put these in there, you leave them in, and you just send people home with these in place.

Scot: Wow.

Troy: Yeah, it's fascinating. Again, I have never done this. I've never been trained on this. This is the first article I've seen looking at treatment of low back pain.

And then you might ask, "Why would I even care about this? Because surely I have some great treatment for low back pain." I can tell you that when you see a patient come to the ER, the first thing you'll see is their name and a chief complaint and that's what shows up. And when the chief complaint is low back pain, that to me is one of the most frustrating things to go and see because there is so little that I can offer.

It used to be these patients would come in and everyone would just get opioids, like, "Okay, here's your script for Norco or Lortab." That's a horrible way to approach it and that's what's led to the current opioid epidemic.

So now when people come in, I say, "Well, you can try ibuprofen or Tylenol." "Well, I've already been trying that."

"Well, you could try some lidocaine, some numbing cream on there." "Well, I've tried that."

"Well, you could try physical therapy." And we actually had a physical therapy in our emergency department and did a study on it, and that was great. But that person was only there 30 hours a week and the emergency department is open 24/7, so that's not something I can offer that often.

So if there was something I could actually do and say, "There's evidence behind this and this is going to help you," and people actually did it and said, "Wow, it helped me," that would be really cool.

So this study, essentially what they did is they took patients who came into the emergency department . . . It's a fairly small study, more of a pilot study we would call it, where it's kind of like, "Hey, let's try to see if it works. If it works, let's do a bigger study."

So they only had 52 patients. Twenty-six of these were randomized either to getting this battlefield acupuncture done or to just standard treatment, which would be the stuff I talked about where it's just like, "Hey, do whatever you normally do."

The patients with the battlefield acupuncture had a significant decrease in their pain score when compared to the patients who just had standard treatment.

And they then contacted these patients two to three days after they were there and found that the patients who had the battlefield acupuncture continued to have a significant improvement in their pain scores compared to those who were sent home either with a prescription or with just standard stuff we would do for low back pain.

Of course, there were no difference in any adverse effects. It's not like these patients were getting a lot of infections, they were complaining of a lot of pain or bleeding, or anything like that.

So their conclusion was that this potentially shows some promise. I can tell you please don't come to the ER right now and ask for battlefield acupuncture, because we don't have the tools there. It is not something we're doing. But maybe a study like this and some subsequent studies, if they continue to show this works, maybe it's something we're going to learn to do. I would love to be able to offer something better than what I can realistically offer in the ER.

So kind of a cool study. A pretty simple thing, it looks like, to do. It's just something we're not doing now, but maybe we'll see more of this in the future.

Mitch: I have to chime in because I've done it.

Troy: So when you say you've done it, have you performed this on people?

Mitch: Yes, I have.

Troy: Wow. This is cool.

Mitch: Okay, so 2011, it was my old life as a documentary filmmaker. We were working on a project called "The Painful Truth," and we were traveling all over the country investigating chronic pain patients and how they are treating their different conditions and how it impacts their family. And I got to actually go to this big medical conference. And one of the rooms where they were doing a breakout session was all about battlefield acupuncture.

You go in there and up on front, there's like this cute small woman who's been studying it and she published the paper. And then there are these military guys in full uniform with all their awards and medals and everything, talking about how they were using acupuncture in the ears and the tragus and all these different parts to stop people from going into shock on the battlefield.

Troy: Wow. So that's where it got the name then. I had no idea before this.

Mitch: So I was actually able to get one of them to be interviewed with us. And when we were talking about the interview, he pulls out first an orange and he's like, "Here's the tool. I want to show you how easy it is here. Here, why don't you go ahead and put some of these little brads in." And it's like a little gun and it's just, "Pew, pew, pew." So I bedazzled an orange.

And then he's like, "Do you want to see what it feels like?" And I'm like, "Absolutely, yes, a thousand times." And so he clips my ear. I'm trying to find some photos of it right now. But he clips my ears, and I didn't feel anything because I wasn't going into shock. But I'm like, "Wow."

And then he asked if I would feel comfortable doing it with my cameraman, and I said, "For real?" And the guy was not sure, but I'm like, "Oh, come on. It'll be fun." So yeah, I got to basically bedazzle my cameraman's ear with this tool. And it was just . . .

Troy: Did they draw the spots on there for you to shoot this little gun into, or did you just see it and you're just like, "Okay, there, there, there"?

Mitch: So they had a little printout and they were like, "Here's where you're going to do it." And then when I was doing it, he took his little Sharpie and did little dots on the guy's ear to be like, "Here's where you're going to shoot it."

Troy: Make sure you hit the right spots, yeah.

Mitch: And so the big part of it is that this for them at that time was . . . This was not necessarily something that a battlefield medic would need to have special training for. They can train anyone to do it, right?

Troy: Yeah. It's sounds so simple.

Mitch: So it was really kind of cool to . . . And especially for him, the guy who was giving me the interview and everything, he was like, "These for so long have been treated as 'alternative medicine.'" Big quotation fingers there. But they're starting to find real applications. And so it's kind of exciting to hear that you also found a study about it.

Troy: Yeah, that is fascinating. Again, it's not something I've ever been trained on. And there probably are other emergency-department-based studies that have done this kind of thing, but there are not a lot. And maybe there are some others with low back pain, but this is the first time I've seen this.

I would love to be able to do this. Again, I would love to also maybe see some larger studies just saying, "Yeah, this panned out and we are seeing an improvement and this works."

Again, Mitch, like you said, it sounds super simple to do. As I've looked at pictures of it, it's like, "Okay, just hit these five spots." It's not rocket science, and you just need that tool, the same tool you had, which we don't have. But that's so cool you were doing that.

So if we can do this, I'm going to bring you in to teach us all how to do it, Mitch. Apparently, you're the expert now. You have more experience with this probably than any physician in our emergency department. So you're coming in.

Mitch: Okay. All right.

Troy: I love it.

Scot: Can we get you one of these guns on eBay?

Mitch: I don't know.

Troy: They have them on eBay?

Scot: What do they cost? What does one of these things cost?

Troy: I don't know. I've never looked into it.

Mitch: It was like a handheld staple gun. It was between a hole-punch, like one of those single handheld hold-punches. It was kind of like that plus a staple gun. It didn't feel too technical.

Troy: Yeah. We should probably clarify. Don't do this at home with a staple gun. It would be unwise and unsterile. But yeah, it seems like if you have the proper tools and a sterile device that's designed for this, it doesn't sound difficult.

Scot: Troy is a physician, right? Mitch mentioned something that resonated with me. Alternative medicines, right? There's a lot of stuff out there that people swear by. But as a physician, or at least many physicians I've talked to, until they can see some hard evidence that it actually makes a difference, they don't really accept it as a treatment. But it sounds like you would be in all the way on this because of this study?

Troy: I would like to see at least a couple more studies that replicate the results. At the same time, I don't want to just do something just to do it. It would be nice to see something that helps. I would be open to doing this if a patient . . . if I talk to them about options and I said, "Hey, there's been a small study. It seems to make a difference."

The big thing for me is, "Is there a big downside to this? Am I going to be causing harm?" And if I'm not going to be causing harm, and they did not report significant adverse effects with this, if I'm not going to be causing infections in their ear, or a lot of bleeding or things like that, and there's reasonable evidence to support it, I would offer it to a patient specifically that way. I would say, "This is something . . . there's been a small study." I'd say, "We can try it if you're interested."

Scot: And if this really did work, that sounds like it would change your life. It would make you go from seeing name and back pain to name and I can help this person. Name and back pain, going, "Oh, geez," to name and back pain and, "I have something I could probably do."

Troy: I would love to have that. If anyone asks me, "What is the most frustrating thing you deal with in the emergency department?" it is back pain, because people come there wanting answers and wanting a quick fix and it's a 15-minute discussion often of saying, "Hey, this is what you need to do. It's going to be a long process. You're going to have to do physical therapy. I'm not going to prescribe opioids for this. I do not want to do that. I do not want to create potential for addiction." And then I'll offer them the Lidocaine, things like that, and say, "Well, maybe this will help."

But yeah, to be able to just be like, "Yeah, I can try this. We can do this and there's evidence to support it," would be wonderful.

So we'll see what happens. Again, it's one of those articles where you see it like, "Oh, that's really cool." I can't say it changes my practice right now where I'm going to start doing this. Obviously, I don't have the tools to do it right now or the training. But it's one of those that maybe we're going to see more on this. It takes a while for these things to come into practice, but maybe in five years, this will be a standard approach in the emergency department. Who knows?

Scot: All right. You made it to the end. Good for you. Be sure to check out some of our other "Who Cares About Men's Health" episodes.

What you just heard is what we call a "Sideshow." It's where sometimes we talk about health topics that aren't necessarily directly related to what we normally would talk about, which is the core four plus one more. That is to be healthy now and in the future, you should concentrate on your nutrition, your activity, your sleep, your emotional health, and you've got to know your genetics.

Plus, we also have episodes that are dedicated just to men's health issues. So check out some of those episodes as well.

And if you know somebody that would find any of them useful, please go ahead and let them know about the podcast. It's the best way that you can help us grow the podcast.

If you want to reach out, lots of ways to do that. You can call us at 601-55SCOPE and leave a voicemail, you can email us at hello@thescoperadio.com, or you can check out our Facebook page. That's facebook.com/whocaresmenshealth.

Thanks for listening, and thanks for caring about men's health.

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

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.

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.

Troy: We're here.

Scot: Welcome to the "Who Cares About Men's Health Sideshow." We're all here.

Mitch: Yeah.

Troy: We're here.

Scot: Are you here, Mitch? You're here. Good.

Troy: Mitch is here.

Scot: All right.

Troy: Scot is here.

Scot: All right. My name's Scot. His name's Troy, he's an emergency room doctor. He brings the MD, I bring the BS, and then Mitch brings the microphones. He's our producer.

Mitch: Hello.

Scot: Just in case you're tuning in for the first time "Who Cares About Men's Health?" we have three different types of shows that we do, so you can pick the one that's most interesting to you. We talk about the "Core Four," which is nutrition, exercise, sleep, and mental health and we have episodes that focus just on the Core Four. So if that's of interest to you, you might want to check those out. We have our "Men's Health Essentials" episodes. Those are the issues that affect men like men's health conditions.

And then we have the "Sideshow." It's a little loose but we do talk about health things, it's just more of a personal slant. So if you're into that, you're in the right place. So a few episodes back, we had a headache expert on. Her name was Karly Pippitt, and we talked about men and migraines. And that's a great episode to listen to. The interesting discovery that we made during Karly Pippitt's show is we knew Troy had them, but Mitch learned that he had them too. And this episode of the "Sideshow" is to see if either one of you two went in to get treatment to do something about them because Troy self-diagnosed, he's never seen anybody about them. Mitch didn't realize he had them until after the episode. So give us an update. Let's start with Troy.

Troy: It's funny because we talked about it on the show and I said, "Yes, I'm going to go talk to my doctor." And then I kind of wavered a little bit, but then I worked the next two days shifts in the emergency department, with just this horrible migraine. And at the end of that, I just thought, "I've got to do something about this. This is ridiculous." So I saw my primary care physician and I made sure beforehand when I filled out the stuff, like a week ahead online, I said, "Migraines, I got to talk about migraines," so that I did not back out. So it was on there. And I was committed. Then I talked to him and I said, you know, "I record the podcast," and he's an avid listener. Just kidding. He's not. He's not an avid listener.

But I said, "We had Karly Pippitt on there. We talked about migraines." He knows Dr. Pippitt. And I said, "I kind of self-diagnosed this. This is what I have." He says, "Yeah, I think you're right on. It sounds like you have migraines and here's what I'd recommend." So he prescribed some medication for me. I have not, fortunately, yet had the opportunity to use it, but I have a night shift coming up in about three days. And I expect . . . Usually the pattern is two days after that I've got a migraine so I've got the medication and I sure hope it works. So that's where I am.

Scot: And when we talked to Dr. Pippitt, there's a few different types of medications. One is, like, a recovery, isn't it? To help you recover?

Troy: A rescue.

Scot: A rescue.

Troy: Rescue. So it's when you're having the migraine, you take it, or as soon as you know, you're going to have it.

Scot: And then there's other medications that you would take more consistently that would help prevent them. What kind did you get?

Troy: I got the rescue medication. And that's exactly the discussion I had with him too. He said, "Well, it sounds like you're having these about once a month, which has been the pattern. So that's not frequently enough where you would need to be on a preventive medication." And that's what Dr. Pippitt talked about as well. Like if it's frequent enough, you know, more than, like, every two weeks I think was the cutoff, she said, or at least every two weeks, they'll do a preventative.

He said, "I don't think you need to do that." He said, "Let's try this, see how it goes, and then we'll circle back and see if we need to do something differently." So I hope it works. I've got the medication, ready to use it. Hopefully, I don't get a migraine coming up in the next week. But if previous experience holds true, I probably will. And again, hoping this does the trick.

Scot: All right. And Mitch, you went. What'd you discover?

Mitch: Well, first I realized that I still have some toxic masculinity I need to work through because I, like, bust in there. And it's just the . . . it's just my annual checkup that I started doing and I'm like, "Oh, and by the way, there's this thing. I'm on this podcast, whatever, like, it's probably nothing." No, she gave me a side-eye and she's like, "That sounds like migraines," you know? It was just . . . that was just it, is it was like, "Oh, well, I get these headaches every so . . ." Same thing that happened on the episode, you know?

And she's like, well, "Do sound and light really bother you?" I'm like, "Yeah. But, like, you know, that happens with headaches." She's like, "No, like, and how long do these last?" I'm like, "Oh, just a couple hours. I just, you know, curl up in a ball in a corner of a room and, you know, I just do that." And she's like, "That sounds pretty terrible. We should probably fix that," you know? And so sure enough, she diagnosed me with migraines, and I got the rescue agent as well. She got me on Imitrex or sumatriptan, I guess, is the generic.

Scot: Same sort of thing.

Mitch: Sumatriptan.

Troy: Same med for me, Mitch. So it's, you know . . . I was hoping you got something different so we could just, kind of, swap meds and see which works. I'm just kidding. I would never recommend swapping meds.

Scot: Do not do that.

Troy: Just for . . . Make sure I'm clear. I would not recommend swapping meds. We joked about it.

Mitch: The interesting thing that I think I'm different than Troy is Troy, you've been having these long enough and recognizing them and diagnosing them that you kind of know your triggers. I have no idea what causes mine. And so she's like, just add it to my diary of pain that I work on. So now, I'm tracking both my ankle pain and any time I have headaches. So I have not had a migraine since, so I can't tell how effective it was or whatever, but I'm oddly, like, looking forward to the next one.

Troy: You're really excited about it.

Mitch: I'm like, "Oh my God. I have some emergency meds in a cabinet I can use to make this better," so . . .

Troy: I'm kind of feeling the same way, Mitch. I don't want another migraine, but I know it'll hit so I'm kind of like, "Bring it on. I'm ready."

Mitch: Let me try this.

Troy: I'm kind of excited, too. I'm like, "Bring it on," because I want to try it and see if it works. Just because it has been such a frustrating thing that I've just dealt with. And, you know, I've tried different treatments and we'll talk a little bit more about one of those treatments I've tried that there is some evidence to support, but hopefully, this works and hopefully, it does the trick.

Scot: I hope so too. I mean, talking about this, I'm getting all nervous for you guys that, you know, they'll hit and then it won't . . . and there'll be disappointment. I hate disappointment.

Troy: I know.

Scot: Like, you'll take your medication . . .

Troy: That's kind of how I'm feeling too. Like, I don't want to take it and . . . yeah.

Scot: . . . and it doesn't work. I'm going to feel terrible. I mean, but I guess, you know, if it doesn't work, when we talked to Dr. Pippitt, sometimes it takes time to figure out what's going to work for you, right? There's a lot of different medications out there so, you know, maybe it not working would be good because we could play that out, and not that I wish a migraine upon you, but we could play that out in real-time and see what that process looks like so . . .

Troy: Right. And, and that's kind of how I look at it. I've got something to try. I'll try it for six months. That probably means, you know, six migraines over the course of those six months. See if it works, see what the best approach is. If it doesn't work, then I can circle back with my primary care physician and look into some other options. So it's good to know there are a lot of other options out there, like she said. You know, it's great. It's a great time to have a migraine. There are multiple treatment options.

Scot: And you know, they are associated a lot of times more with women than men, but men absolutely do get them. A lot of times we deny that we get them or we blow them off or we don't acknowledge them.

Troy: Or we self-diagnose and self-treat.

Scot: So if you, you know, do suffer, check out that episode 78, migraines. We called it "Man Up and Get Help." I don't know, maybe that's a little too much.

Troy: Those were her words. Not ours.

Scot: It's true. That would be a good next step if you want to learn more about, you know, getting relief from your migraines or if you think you might have migraines. There's just no point in suffering. There really isn't. All right. So yeah, this week, then on the Sideshow Troy's article is going to focus on migraines, all right? What did I call this segment again? "Checking Out Troy's Articles?" "Troy presents his articles?"

Troy: Can we do a better . . .

Mitch: It's "Troy Is Presenting His Articles."

Scot: All right. It's time for "Check It Out, Troy's Articles." He's going to talk about perhaps something that you could use for your migraines that the research supports. So go ahead. Let's check out Troy's article.

Troy: Let's check it out. So we're not giving you choices today, Scot. You get one choice and the choice is "The effect of ginger for the treatment of migraine, a meta-analysis of randomized controlled studies." The question is, do you choose to hear more about my article or not?

Scot: Yeah, I will.

Troy: You don't get to pick. Usually, we'll give you a series of articles you can choose from, but . . .

Scot: No, we do.

Troy: . . . we're keeping it focused today.

Scot: I find it fascinating, the concept that ginger could help migraines. I mean, probably . . .

Troy: You know . . .

Scot: Yeah.

Troy: I do too. And this is something . . . We're talking about this because we talked about a little bit with Dr. Pippitt and it's something I have used for several months now after reading this article. This article appeared in November of 2020 in the "American Journal of Emergency Medicine." And they did a meta-analysis, which means they found several studies that were done, they combine these studies and then look to see, does ginger help people who have migraines? They found that ginger, when they gave people ginger supplements, so ginger is just an over-the-counter medication. You can buy it anywhere. It's just a supplement. You know, granted the formulation's probably going to differ from one to the other. Usually buy it as ginger root, comes in these capsules.

So they just treated people with ginger who came into the emergency department for treatment with migraines, and they found that people at two hours had a significant improvement than those who said they had zero pain. And those who didn't have zero pain, but still had pain, still had much less pain than those who didn't get ginger who got the placebo. So the placebo just being, you know, being, like, a sugar pill. And they found that there was no significant worsening in, like, adverse events, and those who had ginger, it's not like they were having a lot of side effects, which you wouldn't expect. This is just . . . it's ginger. It's, you know, like, ginger ale, ginger, you know, people take ginger for nausea when they fly. It's not, like, a big deal taking this stuff.

They also found that people who took ginger had much less nausea and vomiting. So their takeaway from this was that in the emergency department setting, it's probably something you could use to help treat people with migraines. The way I use this was I, you know, after I read this article, I thought, "Well, that's a great idea." Like, ginger is something that you often use for just saying, "Hey, you can try this when you fly." That's why ginger ale is such a popular drink on flights. The ginger kind of settles your stomach, helps with nausea, maybe a little bit of vomiting. So I thought, well, "Try it with the migraines," and what I've done, I've just gotten these ginger capsules, just, you know, standard sort of supplement and taken that, like, every four to six hours when I've had migraines.

And it has absolutely made things better for me. One takeaway, though, I think from our discussion with Dr. Pippitt last time is if it is something where it's debilitating, where it's very distracting, it may be worth just saying, "Don't do the ginger. Just talk to your doctor, try getting on a prescription medication." That's the conclusion I came to after trying, even with ginger and Tylenol and all this over-the-counter stuff, you know, which I've been trying to self-treat for years. The conclusion I came to is, "Hey, I probably just need something else."

Scot: So, for some people, it might work?

Troy: Yeah. For some people, it might work. And, you know, if your migraines are something where you do fine with Tylenol, you feel fine and maybe a little bit of nausea, try some ginger with it too. It probably will help.

Mitch: So are these like tablets? Like, what's the dosage? Or were you just gnawing on a chunk of ginger?

Scot: That would be a cool new trend. I love it.

Troy: I love it.

Scot: I love it. Just . . . Guys . . .

Troy: Just getting ginger root?

Scot: Yeah. Gnawing some ginger root.

Troy: Ginger.

Scot: Like, instead of cigars, when you got to invite the guys over for poker, you're all gnawing on ginger root.

Troy: "Hey, guys."

Mitch: And spitting it out.

Troy: "Here's some ginger." No, these are ginger capsules. The formulation, it differs, it differed across these studies. If you go online or you go to a store and you just buy the ginger, it will tell you how much of that they recommend taking, how often. Again, that's part of the challenge is this is not an exact science. I think you can try it. You could try, like, one capsule and see if it makes a difference. And then if it says you could take two capsules every six hours, you could try that. And there's not a lot of downside to taking a lot of ginger. I wouldn't take more than it recommends, but ginger is a pretty safe thing to take. And so it's again one of those things you can, kind of, try it out and see what seems to work for you and adjust that dose based on your experience.

Scot: All right. That was the Sideshow, guys.

Troy: That was the Sideshow. I know.

Scot: It's done.

Troy: Hopefully, you like it. Hopefully, people like it. I don't know. It's pretty loose.

Scot: If you want to learn more about the "Core Four," you know, go ahead and go back through our . . . We're trying to get them labeled so you can, kind of, very quickly at a glance see if it's a "Sideshow" or if it's a "Men's Health Essential" or if it's a "Core Four." You might find that more interesting than Sideshow. It's a little bit more straightforward information and advice. Thanks for listening to "Who Cares About Men's Health?" Blah. You guys have a sign-off noise you'd like to make?

Mitch: Like a "Woo?"

Scot: Well, I just went "Blah." I guess that's my sign-off noise.

Troy: Womp womp. That's my sign-off noise.

Scot: That's great.

Troy: Sorry. What other noises should I make? I mean I don't know. We got to have a better one than that.

Mitch: Fun noises with the boys.

Troy: Exactly. We're just like an acapella group.

Scot: We haven't heard your noise, Mitch.

Mitch: Like a "Cuckakachoo."

Troy: What was that?

Mitch: I don't know.

Troy: Is that a bird? Sounds like a bird.

Mitch: I think so. It was like a . . . Yeah, it was definitely a bird.

Scot: I'm going to stop recording now. This is a waste of bits.

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Scot: Hey, this is Scot from "Who Cares About Men's Health?" What we're trying right here is a brand new concept we're calling the "Who Cares About Men's Health Sideshow." So as the podcast is developing, we've come up with some different themes. One is our "Core Four Plus One More," which is activity, nutrition, sleep, emotional health, and then also knowing your genetics have a big impact on your current health and your health in the future and also can help prevent disease in the future as well. So we do episodes that focus around those areas and how to improve in those areas and just education in those areas.

Another concept that we have are "Who Cares About Men's Health Men's Health Essentials." These are diseases and conditions that impact men, stuff you need to know in order to remain healthy. And now, this particular concept, if you see a show called the "Sideshow," we're going to be a little bit more loose. Could talk about some of the Core Four stuff, probably going to involve a few more personal stories, and might be some articles that Troy has, or just some other interesting things we think you might find interesting. But if you're here because you want to focus on your "Core Four Plus One More," check out those episodes. That'd be a good place for you to go. If you're interested in specific men's health conditions, check out our "Men's Health Essentials." If you're interested in a little bit more free form, then that's what you're going to get right here. So pick and choose what you like and enjoy.

I need to talk about nutrition because I was a freak at one point. Like before this podcast started, I was logging and weighing all my food, and I scheduled my times to eat, and I stressed about what I ate, and I didn't want to eat any bread, and I hesitated on fruits because I was trying to keep low carbs. And I didn't want to, you know, eat too much fat and . . . I should talk about that, because I changed a lot with my nutrition. I think I feel pretty much okay.

Troy: Well, that gets to that orthorexia and . . .

Scot: What's orthorexia?

Troy: Well, do you remember . . .

Scot: Oh, that eating disorder.

Troy: Dr. [Pohl], Susan Pohl, she talked about it very briefly, buy it's not anorexia. I mean, it kind of obviously has that same root.

Scot: [inaudible 00:02:02]

Troy: But it's orthorexia where you get like a very strict diet and to the point that it becomes like a compulsion where it's just like, "Oh, I can't do that, I can't do that, I can't do that. I have to do that exactly this way," where it is classified as an eating disorder. It's a newer thing that's come out in the last 5 to 10 years I think. But that might be interesting to talk about your experience and say, "Hey, do I meet the criteria for orthorexia?" And I can dive on mine too. Like, sometimes I wonder, "Am I orthorexic?"

Scot: You know what changed all of that was, first of all, realizing that I didn't need as much protein as I thought, because I was building my life around protein. Second of all . . . Actually, the first thing was when Thunder said, "If you just alter the time that you eat. Like, if you do 8 on, or 16 off, or even 12 on, 12 off, you can eat what you want and you're going to maintain." I'm not going to go crazy with junk, but at least I'm like, "Well, I don't have to weigh my food anymore." So that was kind of good. And I kind of have an idea of how much I'm eating now anyway. That's so freeing and it's freeing to know that I can have bread. I just had some great sourdough bread. It wasn't made by Mitch this time, but . . .

Troy: It's all good.

Scot: . . . Bob and Randy Harmon made it and they did a pretty good job of it.

Troy: Nice.

Scot: Yeah. Troy, what do you got there? Looks like you got some sort of medical journal there. You want to tell us a story from that book of medicine?

Troy: Well, I have several options today, Scot. Would you like to know about the effectiveness of honey for symptomatic relief of upper respiratory infections?

Scot: Okay.

Troy: The efficacy of ginger for the treatment of migraines?

Scot: Okay.

Troy: The effect of vitamin D supplementation, omega-3 fatty acids, or strength training for older adults?

Scot: All right.

Troy: A man with a gnawing sensation under his scalp?

Scot: Eww, that sounds creepy. I bet you Mitch is going to vote for that one.

Troy: Maybe he will.

Scot: Yeah, so which one of those are you going to vote for, Mitch? What do you like?

Mitch: Oh, I don't know.

Troy: Or let me give you the last one. A pilot trial of topical capsaicin treatment for cannabinoid hyperemesis syndrome. Basically, how do you treat retching when you smoke marijuana?

Mitch: They all sound so good. I can't choose.

Troy: I know. Every one of these I could use in some form.

Mitch: All of them, please.

Scot: I don't know. Which one, Mitch?

Mitch: We can we talk about the cannabinoid one? I am interested.

Troy: Yeah, absolutely. And this is something I use in the ER.

Scot: Really?

Troy: Yeah.

Scot: Oh, this technique, if somebody . . .

Troy: Yeah.

Scot: . . . comes in with this problem. All right.

Mitch: I'm in.

Troy: I put it on myself before I go to work. It's how I get through the shift.

Scot: All right. I'm into this. So essentially, it's about people that smoke marijuana, and then they start retching, what to do about that?

Troy: Yeah. How do you treat it, yeah.

Scot: Okay. So what journal is this from?

Troy: This is from the journal "Academic Emergency Medicine."

Scot: All right. Troy reads them and finds a good story so you don't have to. So . . .

Troy: That's right.

Scot: . . . go ahead and go.

Troy: So Scot, so this is an interesting article. I love articles that just show you a fairly simple treatment, and maybe it's not a huge study, maybe it's not the best done study, but it shows it's effective. And then you try it at work and you treat someone with it, or maybe you try it yourself and it works. So as you know, the use of marijuana is becoming more and more prevalent. Maybe they have a prescription for it. You know, there's several states where you can use it recreationally legally. So we are seeing more and more cases in the emergency department of what's called cannabinoid hyperemesis syndrome. And what this means is that people who use marijuana frequently can sometimes just develop just retching vomiting. They just cannot stop vomiting and they feel miserable. Sometimes they treat it by taking a hot shower. For some people, that seems to work. But there was a study that was done, and this appeared in the journal "Academic Emergency Medicine." So not a big study, they had 30 patients, and 17 patients, so about half of them, they treated with capsaicin cream. Are you familiar with capsaicin cream?

Scot: No, what is that? Mitch, do you know what capsaicin cream is?

Mitch: It's like the granola version of IcyHot. What's that brand called?

Troy: Yeah. Well, actually the brand is called Capzasin, C-A-P-Z-A-S-I-N, so you may have heard of it. But yeah, something you can use to treat muscle soreness. I mean, capsaicin is a pepper. So it's actually like this pepper in this cream, and people put it on sore muscles, sore joints, things like that. Kind of like IcyHot, it relieves the pain because it just stimulates these nerves in a certain way that the nerves are then more focused on that or it just, you know, overstimulates them in a sense where then you're not so focused on the pain there. But the bottom line is that's what it's used for. It's over the counter, super easy to find this stuff in any pharmacy, any place you want to shop.

But basically, they treated 17 patients with the capsaicin cream and they treated 13 patients with the placebo, just another cream that was not a capsaicin cream. They found, in just about everything they measured, in the patient's nausea, in just their vomiting, you know, like the 30 minutes, at 60 minutes, they found that the large majority of the patients who had the capsaicin cream did better. And patients who had the capsaicin cream, 29% had complete resolution of the nausea versus none of the patients who had the placebo treatment.

Scot: Wow.

Troy: So, yeah, pretty significant improvement, and that's complete relief. But then just looking at, okay, how much did you improve? Maybe not completely. People who got the cream did a lot better. So it's something I use in the ER, because we see this surprisingly frequently, people who come in who just are having this retching vomiting and feel miserable. And I'll just order up some capsaicin cream. I'll have them apply it to their abdomen and the large majority of the time, with an hour, they feel better. And I say, "Just take this home. If this happens again, use this cream."

Mitch: You take the cream and you rub it on your belly?

Troy: Yeah, you just rub it on your belly.

Mitch: Oh wow.

Troy: It's very simple. You're not rubbing it on joints or anything like that. You're just rubbing it on your belly. Don't drink it, don't eat it, just rub it on your belly. Just use it externally. It's just a cream. You know, I don't know if this will work for any other types of nausea, I've never tried it there. Certainly there are other meds that can help with those sorts of things. But a lot of times with these patients who come in with this type of vomiting, it's like you give them other stuff and nothing seems to help, like a lot of the standard medications we use. You use some capsaicin cream, makes a difference, they feel better, I just tell them, "Use it at home."

Scot: And you have to put it on your abdomen? If you put in your arm, then it doesn't help?

Troy: Yeah, don't put it anywhere else. Just rub it right over your belly. Right over that spot that's cramping up, that's miserable.

Scot: Do we know why it works?

Troy: I don't know why. And I don't know [inaudible 00:08:48]. It's probably the same thing as the hot shower. It's one of those things, I remember seeing case reports about this, you know, a few years ago where people are like, "Hey, we tried this and it worked." And I don't know if it was the same thing as the hot shower, where some dude is just like, "Hey, I've got some of my grandmother's arthritis, while I'm in here I'm going to rub this on my belly," and then he told someone else, and then someone reported it in a medical journal, and then here's this really small study that said, "Hey, it really seemed to help." So I don't know the origin or the rationality behind it.

Scot: It's a bizarre thing to try.

Troy: It is.

Scot: You know, like any time you look at anything, sometimes I look at like foods and I'm like, "Who decided to try that first?" You know? And it's like who decided to try this first?

Troy: Who decided to do this first?

Scot: Like what was the connection that they made that they're like, "That could work."

Troy: Yeah, I don't know. And again . . .

Scot: Why ask why sometimes, right?

Troy: Why ask why? I'm sure there's someone who's come up with some sort of physiologic explanation for why it worked. But I guarantee that's not the reason someone used it in the first place. It's not like someone thought, "Well theoretically, this could make a difference." Again, the only reason this study happened, it's because of some of these case reports that were out there that I saw, you know, appearing in journals several years ago. And so someone tried it at some point, it seemed to work, and now here's a study, very small study, but says, "Yeah, it does seem to work." And my experience is that it does seem to work.

Scot: Hey, thanks for checking out "Who Cares About Men's Health The Sideshow." If you liked what you heard, we'll have more Sideshow episodes coming up. I also ask you to check out our "Men's Health Essentials" and our "Core Four" episodes to help you lead a healthier life today and in the future. Feel better now and later.

By the way, check out our migraines episode that we just recently did. It's really, really good if you know somebody that suffers from migraines. And if you know anybody that might enjoy what you just heard, do us a favor and just share this podcast with that one person. If you share that podcast with this one person, it will help us get to more people that we can help and more men who want to care about their health.