28: Men's Health Essentials—Pulmonary Embolism, the Silent Killer

Scot: Open up your phone for me.

Troy: Don't take my phone from me.

Scot: I just want to see what apps you have. ECG guide.

Troy: Oh, so those are my medical apps.

Scot: Oh, so you use medical apps?

Troy: That's just for reviewing different EKG types. Just for, like, study.

Scot: I think this is a future bit.

Troy: You think so?

Scot: I don't know how yet.

Mitch: Take a person's phone?

Scot: I was just going to . . .

Troy: Because it's, like, very invasive.

Mitch: That's what I was about to say, like, my millennial senses just are like, that is not okay. Like, you are not allowed to pick that up.

Troy: I didn't know what you're going to find on there.

Scot: The podcast is called "Who Cares About Men's Health?" There seems to be a notion that men don't care about their health. It is time to dispel that notion and take our health back.

My name is Scot Singpiel. I am the senior producer at thescoperadio.com, and I care about men's health.

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

Stacy: And my name is Stacy Johnson. I'm an associate professor here in the department of internal medicine, also the medical director of the thrombosis service, and I too care about men's health.

Scot: Wow.

Troy: Nice.

Scot: That guy's voice, man.

Troy: I know.

Scot: For the rest of the podcast, we're going to have to talk like this.

Troy: Like, I need to take it down a couple octaves here. I just can't compete.

Scot: You've never done radio before?

Stacy: I have not. People keep telling me I should do radio.

Troy: You should.

Stacy: But it probably doesn't pay as well as the day job.

Scot: No, it doesn't. So part of our job is to make you aware of potential threats. As men, we should know what might be threatening our health, and younger men a lot of times don't have a lot of things to worry about. It's not until you get older that you start kind of seeing some of these diseases set in. But there is one thing that is, actually can kill an otherwise young, healthy individual, and that's a thing called pulmonary embolism, and we're going to dive into that.

And here's how it can play out. I did some research and read some people's stories about how the symptoms played out, and I found this fascinating. So an otherwise young, healthy person, and then all the sudden one day and over the course of the week they begin to develop having trouble breathing so badly they can barely walk to the bathroom without going out of breath. They go to urgent care. Urgent care says go to the ER. Ends up they've got blood clots. Could have died of a pulmonary embolism.

Somebody was training for a race, experiences calf pain, thinks it's a pulled muscle. Kind of sits on it for a few days. It's not getting any better. Thinks, huh, this is kind of weird. Goes to the emergency room. Blood clots in the leg, which lead to pulmonary embolism.

There's a lot of other kind of very similar threads. Otherwise young, healthy people that all of a sudden develop these symptoms that could possibly kill them. So what are some of the other ways that it presents?

Stacy: Yeah, I mean, the classic way is sudden onset shortness of breath. It's usually not an insidious onset. It's usually overnight or instantaneous, you get a quick change in your breathing pattern. You may also have some pain in the chest or pressure within the chest, depending if it's a peripheral embolism or more of a central embolism. Dizziness or passing out or syncope is another symptom. And then one of the later symptoms would be actually coughing up some blood or hemoptysis.

Scot: So it gets pretty serious towards the end.

Stacy: Yes.

Scot: Then you know something's up.

Stacy: Yes.

Scot: Mitch, the producer of the show, yeah, you have a story?

Mitch: Well, my father actually had one and had to get rushed to the ER and everything. And he thought it was just like an air bubble or like acid reflux. He thought he had taken a weird sip of Coke, and we had no idea was something that serious.

Stacy: Yeah, it's fascinating. I've seen patients with very small pulmonary emboli or very large, what we call saddle emboli, and their symptoms are unpredictable. They may have a lot of symptoms with a small clot or no symptoms with a very large clot. So it's, you really can't predict.

Troy: And that's what's crazy about it. It's one of these things where I think you see enough of these things, and it just, it scares you. And you see, as you mentioned, people with very mild symptoms. I had someone who passed out and just, you know, had some of the most profound symptoms, and the guy's just in a bed laughing. We're talking to him. He's just laughing and, you know, and it's like, "Do you have any chest pain?" "No, I'm fine." We get the CT scan. He's got a massive pulmonary embolus. It's just, it's a crazy disease, and that's why we take this very, very seriously.

I think as you mentioned, Scot, too, it's one of those things where it really affects young people. Someone comes into the emergency department, they're doing CPR on them and they've gone down suddenly, just sudden cardiac arrest, pulmonary embolism is one of the top things on my list I'm thinking about. It's a killer of young people, absolutely.

Stacy: Sure is. I think some of the statistics say that up to a third of pulmonary embolism will die before they actually get recognized in an emergency room setting or in the hospital.

Troy: Wow, a third.

Scot: Yeah, and that's the danger, right? Because pulmonary embolism, through some of these stories that I read, is not something that you want to go, oh, I'll get that, if it, you know, if the symptoms hit you on a Friday, I'll just wait till Monday and get this checked out.

Troy: Right.

Scot: Because I have some calf pain but, you know, I'll wait till Monday. You do not want to do that.

Stacy: Definitely not.

Scot: Why do people not act on the symptoms? Is it because they're just strange? They don't feel as threatening as they are?

Stacy: Yeah, and I think they're very vague symptoms. You know, as Mitch pointed out, it can feel like indigestion. It may feel like just a pulled muscle, or they think they have a little cough or pneumonia, and they think it's going to get better, and then a lot of patients will present two, three, four days down the road or they'll see their primary care doctor first, and they get an x-ray, and they kind of slowly work through the diagnostic process until eventually their symptoms get so severe, they do end up in the ER, or someone finally puts the pieces together and orders the right diagnostic test with a CT of the chest.

Scot: And Mitch shared his story about his father having a pulmonary embolism. I think, certainly we think a lot about genetics. We talk about genetics on this show. What, how do genetics play into this? Should Mitch be a little more concerned potentially about . . .

Stacy: That's a great question.

Scot: You know, a pulmonary embolism.

Stacy: Yeah.

Troy: What's wrong?

Mitch: I just, I don't know. I just, it's like every episode, it's like, hey, Mitch, the unhealthy millennial. Let's talk to him. Like, no, we're fine.

Troy: This isn't fair to Mitch. I've got to throw myself into this too, because I can say, because, I'll let Stacy answer this, but I can say . . . I'll get into this a little more after Stacy answers.

Stacy: Yeah. So a great question. I mean, genetics definitely plays a role in some cases of pulmonary embolism, not all cases. And yes, there are multiple well-known genetic mutations that can increase your risk. Some of the studies I've looked at show there's over 100 different genes involved in the clotting cascade with over 5,000 mutations, but yet we only test for five different things in clinical practice.

Scot: One of the stories I read talked about a guy that had a pulmonary embolism, and he even going in knew that he had a family history of it, and said, though, that he had some genetic tests done that indicated he did not have the gene, so he thought everything was going to be okay. Is this one of those things like the 23andMe, they're giving people this information?

Stacy: Yeah, they're two of the common mutations that are tested for within the 23andMe. It's Factor V Leiden, and then the other one is called a prothrombin gene mutation.

Scot: Oh, okay.

Stacy: Mm-hmm.

Scot: So anyway, yeah, anyway, the test said that he did not have that mutation, but he ended up having an embolism anyway, so . . .

Stacy: Right, and so I think it gives you a false sense of security. If you test negative, it doesn't mean you're not going to have one down the road, or it doesn't mean you don't have a different genetic mutation that is going to increase your risk.

Scot: So one third of people, you said, don't actually ever make it to the hospital. Is that one third preventable? Like, is there anything we could say or do that could help members of that group actually make it in? Or is that just by the nature of what it is, that's going to always be the number? What do you think?

Stacy: I think that's the nature of the disease. I mean, I think people will . . .

Scot: That's a killer.

Stacy: . . . develop these large clots that go unrecognized, and when it breaks free, it's just, it's sudden cardiac arrest. And if they can, if it's a witnessed arrest and get in fast enough, yes, we can do some heroic things to try to save them, but unfortunately, a lot of people probably just pass away at home and are found down.

Scot: Yeah. Okay, aside from that, though, like, what about, how do I tell regular calf pain from a pulmonary embolism, then? Like . . .

Stacy: That's a . . . well, so calf pain would be a DVT or blood clot in the leg, and the most common symptom that people tell me when they have one of these is it feels like a charley horse that won't go away. That is exactly how people describe it. And they massage it, they do all these things, and it just doesn't go away. And so then eventually, if they seek care, we'll do the ultrasound.

Scot: Hmm. Is there other, are there other phrases that people use when they describe some of these symptoms that might . . .

Stacy: Pulled muscle. My leg was sore. My leg is swollen. Those are the most common things that I see.

Troy: Yeah, and that's probably the most common thing I see, as well. Certainly there are those cases where it just hurts and that's it. But then you do see the classic cases of just that swelling, and you clearly look at it and you say, well, my right leg is definitely more swollen than my left leg. I tell people in those cases, absolutely you need to get an ultrasound. Get to the ER. It doesn't have to be something where you're scheduling this a week or two out. Just get in there and get the ultrasound done, get things checked out.

Stacy: Agree. Agree. And there's other predictive scores that we can do to, maybe don't even have to go as far as the ultrasound. You can do some clinical risk scores or you can do a blood test to try to rule this out easily in certain situations.

Scot: Would you advocate for a patient, if they feel as though that that this is what it is, and if they, like, maybe they go to an urgent care something and they're like, "Oh, no, we just think it's probably asthma," or something like that? Would you advocate for them to say, no, I would like an ultrasound? I would like tests done.

Stacy: Yeah, I think if they don't have a history of asthma and their symptoms seem out of proportion to what they've experienced throughout their life and they're concerned, absolutely. You know, go seek the next level of care.

Scot: And it's an ultrasound I want to get, or is it a CT scan?

Stacy: So if you're looking for a pulmonary embolism, so if you have breathing problems or chest pain, you would need to get, depending on your risk, a blood test first, and then depending on the results of the blood test or your risk, if you're high risk, then you would go straight to a CAT scan.

Scot: Okay. So pulmonary embolisms, they start in your legs always, right?

Stacy: Not always, but the vast . . .

Scot: Oh, I thought they always, deep vein thrombosis. Is that what it's called?

Stacy: Correct, yeah. So they do start typically in the deep veins, most commonly the legs. Sometimes they'll actually start in the arms. And so what it is, is a blood clot that forms and one of your arms or legs, and then it breaks free, travels through the veins, through the heart, and gets stuck in the lungs. The lungs act as a filter, and that's when we get symptoms of the chest pain.

Scot: Yeah. And that's why pain in the calf or pain in the shoulder or pain in the arm.

Stacy: Right. Yeah.

Scot: All right.

Troy: But I think, getting kind of to that question, too, what precipitates it, what's the cause? You know, we hear about long airplane flights. Get up, walk around. Surgery. You know, if you're injured, things like that anything. Anything else that comes to mind or people should be a little bit more aware of their risks?

Stacy: The list of risk factors is very long, and so one of them is age. And so as we get above 40, which I'm now in that category, your risk doubles every decade. So your risk between 40 to 50 doubles. Your risk between 50 and 60 doubles, etc. And so advancing age is one of the major risk factors. Cancer is another risk factor. So if you're a man over 50, you need to make sure you're up to date on your prostate cancer screening, your colon cancer screening. There's lots of, surgery is a major risk factor. Diabetes is a risk factor. Smoking is a major risk factor.

One that probably isn't recognized a lot is testosterone supplementation. And I've seen this . . .

Troy: And we just had another episode on testosterone.

Stacy: Yes. I've seen this in a couple of guys that go to the men's health clinic. They want to have, you know, good muscle mass, and they want to, they're competing on their bike, and they will supplement, and then all of a sudden their blood count starts to rise, and they get more and more red blood cells, and their blood gets essentially thick, and then they will develop a clot from having too many red blood cells.

And, you know, one of the gentlemen that sticks in my brain, he did a long 12-hour bike race in the west desert, and he presented with this clot from his ankle all the way to his groin.

Troy: Oh, wow.

Stacy: And I asked him about his supplementation, and he's like, oh yeah, my doctor told me I should go donate blood a couple weeks ago. And so when he came in, his blood counts were normal, but it was because he had been donating blood to treat the side effects of his excessive testosterone.

Troy: He was trying to get his blood levels down. It was just so high from the testosterone.

Stacy: Yeah.

Troy: Wow.

Scot: Thank you very much for covering that. Again, it's just something that if the symptoms present or you found yourself in one of these situations where you are not moving around, or maybe after a long airplane flight and all of a sudden you're short breath, I mean, take that seriously. Go and get it checked out. Because if you don't, if you put it off till Monday, it could mean the difference between life and death.

Troy: Exactly. And if we were to do an ER or not and you asked me, someone says they have calf pain followed by sudden onset chest pain, shortness of breath that's worse when you take a deep breath. Should you go to the ER? The answer is yes.

Scot: Okay.

Stacy: Definitely.

Troy: That's the takeaway.

Scot: All right.

Troy: Get it checked out.

Scot: Stacy, thank you very much for being on the show, giving us some information to perhaps stave off something that could be potentially life threatening, and thank you for caring about men's health.

Stacy: My pleasure. Thanks for having me.

Scot: If you haven't already, register to win a DNA health and ancestry test that we're giving away on "Who Cares About Men's Health?" You can go to our Facebook page, whocaresmenshealth.com, if you want to find out how to enter, or you can go to our website, whocaresmenshealth.com. I'll be taking it and then we'll be giving away one, and throughout the next few weeks, we're going to be discussing these tests, their accuracy, what you're getting into. I got a couple for Christmas. Troy is absolutely, if you've been listening to the show, you know, he's absolutely no.

Troy: I'm a no. I don't want to do it.

Scot: And Mitch, you already did it.

Mitch: Yeah.

Scot: You're like, what's the big deal?

Mitch: Yeah, I even transferred my information over to this database that'll help me catch a serial killer. So, you know, whatever.

Troy: Or get you caught.

Mitch: Or get me caught. I don't know yet.

Troy: If you're a serial killer.

Scot: Just throwing your DNA all over the place, right?

Troy: Searching all around.

Scot: Yeah. I got it for Christmas, and I was initially excited, and then I started doing some research like, well, the first research is I went to their website and I started looking at the different health things I could learn about, and I'm like, wow, this is kind of scary. Do I really want to know if I have these or not?

Troy: Yeah.

Scot: But there are other things that you need to worry about, as well. So this is from Cracked.com. The title of the article, "The Horrifying Reality of Consumer Genetic Testing."

Mitch: Jeez.

Troy: See, I'm already scared. I, yeah, you really talked me out of it now, Scot.

Scot: They list six things that, you know, that go along with their concept that there is a horrifying reality to consumer genetic testing. Any guesses as to what those might be?

Troy: Loss of privacy. I think health insurer, not being insured because of some of the results. Knowing that you have a horrible debilitating disease in your future.

Mitch: That was the, finding stuff about families was one of them, because I've heard a couple stories on podcasts and stuff about, you know, you get your test for Christmas and then you find out your dad isn't your dad, right? And then . . .

Troy: I was thinking more the implication for family members because of what I found, but yeah, that would be one to know.

Mitch: Oh, yeah, no, paternity stuff.

Troy: Finding the skeletons in the closet.

Scot: Yeah, you're all excited to find out how much, jolly good, how much British am I, and then the next thing you know, you find out your dad's not your dad.

Troy: He's not papa.

Scot: Huh. Well.

Troy: Yeah.

Scot: All right, so "The Horrifying Reality of Consumer Genetic Testing" from Cracked.com. You did a pretty good job. So number six, tearing families apart. The tests are tearing families apart.

Troy: Ah.

Scot: And it's exactly what you talked about. Previously unknown relatives are expanding your family tree is the hope, but sometimes the reality is finding out that your dad's not your dad, finding out your mom's not your mom, your brother's not your brother, your sister's not your sister. You know, do you want to know about those sorts of things?

Number five. I was going to skip this one, but it's interesting. There's no longer any such thing as anonymous sperm donation.

Troy: Oh.

Scot: So it used to be, you know, you could donate anonymously, but now, 18 years later, somebody can get one of these tests and track that right back to you. So I don't know if that impacts . . .

Mitch: Geez, that's, like, the opposite. You find out who your dad is.

Troy: Yeah, exactly.

Scot: Right? Maybe you didn't want to know that.

Troy: Maybe you didn't want to.

Mitch: Well, maybe the donor didn't want to know.

Troy: And yeah, that's probably the bigger thing.

Scot: Absolutely. Number four, you might get really difficult medical news without a doctor around.

Troy: Mm-hmm.

Scot: So I think that's something that we're going to talk about in more depth. We're going to have a genetic counselor on the show. Because you get the test back, you open it up, you do have to click, you know, some things that I completely understand that this information I get, yada, yada, yada. But now you find out that you've got some genetic predisposition, and you're just sitting there by yourself and you're like, great. What do I do with this?

Troy: Yeah.

Mitch: Because they identified two potential genetic disorders within me, and they give you these little graphs with, like, little people, like, bathroom sign people, and it's like, this many people have what you have, and hey, you might not have it, but here are some steps you can take. And, I don't know, it did feel a little like, well, shoot, like, what am I supposed to do now? And there wasn't someone there to, like, tell me everything was going to be okay, or, so yeah, I can totally understand that. I did have that experience.

Scot: I might want to have an appointment with genetic counselor after I get the results so I can actually sit down and ask some of those questions.

Troy: We could do it on air.

Scot: If I decide to take the test.

Troy: That's fair. That's fair.

Scot: That's what this is about. All right. The test might not be all that accurate. That is number three. So they're saying that this is a very complicated thing, and that these DNA tests might not be entirely accurate not only from a health perspective, but they tell a story about identical twins that have taken tests from different companies, and even within the same company, their genetic history was identified as different.

Troy: Wow.

Scot: Which, Dr. Madsen, if they're identical twins, is that possible?

Troy: No.

Scot: Thank you. So accuracy could be a consideration, because these are a long way away, I would imagine, from the type of test you might get if you come to a medical institution like University of Utah Health and they decide to test you for some sort of genetic variants.

Number two, DNA theft could be the next big thing in data breaches. They're talking about how, you know, somebody could hack in there, and then how many ways could your genetic data be used against you? I think we all think, best case scenario, these companies have de-identified the information. Things are cool. If that information gets out, no big deal. But maybe not.

Troy: I mean, the privacy issue, I think it's a big deal.

Scot: And it comes back to what we talked about before, right? Like, how, if an employer or a future employer got a hold of this and find out you had a genetic predisposition for a particular disease, would that influence their hiring you because they know you're going to need treatment for that down the road or they think that that might impact your work. Or, you know, what about insurance, as you mentioned, Dr. Madsen.

Troy: Yeah, health insurance, yeah.

Scot: If somebody gets a hold of that information, would, you know, is there a day where insurance companies will have different tiers depending on what your genetic test shows?

Troy: Yeah.

Scot: And number one, testing companies are making a fortune off your stored DNA. This article talks about one particular company who paid $10 million to one of these direct-to-consumer DNA health testing kits to get genes of customers with Parkinson's disease. They wanted to use that in their research. Now, is that such a bad thing? I don't know. But, you know, somebody's making a lot of money off this.

Troy: Someone's making money off it.

Scot: Off this information that's yours, and that raises the question, should you be able to get a piece of that back? The good news is you can consent whether or not they store your data or not.

Troy: Oh, good.

Scot: But I don't know how difficult that was. Was that something you saw, Mitch, when you went through the process?

Mitch: Hmm . . .

Scot: Like, is it easily presented to you?

Mitch: You can, you just go into settings and it's a couple of clicks on the app, but you have to know where it is. I mean, they don't make it easy.

Scot: Gotcha.

Troy: So it wasn't obvious. You had to opt out.

Mitch: You had to opt out, yes.

Troy: So the default is you're consenting to have all your information used.

Mitch: Mm-hmm.

Troy: Interesting.

Mitch: Well, and not only that, they frame it in a way like, this could potentially save other people's lives. You could be part of science. And then . . .

Troy: And you probably can.

Mitch: Right.

Troy: But you just, you wonder what it's being used for, though.

Scot: Oh, it's so difficult. I don't know. And, you know, we were talking about giving this away. So if you're still in . . .

Troy: If you're still in. We haven't talked about it.

Scot: If we haven't talked you out of it, you can to whocaresmenshealth.com and you can register to win this DNA test. But I think the point that we're trying to make is, I got mine as a Christmas present. A lot of people get these as Christmas presents. You know, there are some other considerations you need to take, and I think you need to go in with eyes wide open. And if you still decide, hey, it's not that big of a deal to me, then that's cool, right? But I think a lot of these companies are selling this is as it's fun and it's exciting, but there can be potential dark sides, as this Cracked.com article did show.

Troy: Yeah, exactly.

Scot: We're very excited. We're going to be celebrating a little something right now, Troy.

Troy: Oh, good, and I can't imagine what it is.

Scot: Yes. We are celebrating Mitch, our producer. Today is his hundred day quitaversary. Or we're close to it. What is actually, the actual count?

Mitch: It just passed two days ago.

Troy: Quitaversary.

Scot: It just passed.

Mitch: Yeah.

Troy: For quitting smoking.

Scot: For quitting vaping.

Troy: For those who aren't familiar. For quitting vaping.

Scot: Well, nicotine, yeah.

Troy: Quitting nicotine, yeah.

Scot: You used to smoke.

Mitch: Mm-hmm.

Scot: Then you vaped.

Mitch: Mm-hmm.

Scot: And you're a hundred, I can't even believe you're a hundred days into this.

Mitch: Oh, well, I can.

Troy: You're feeling every bit of it?

Scot: We want to check in with you. How's it going a hundred days in?

Mitch: The last few bits were really rough, but after I did my very last step down and I was a complete wreck for a little bit, I'm good now. I still have little bits of cravings now and then. I get stressed, especially over the holidays, I kept hitting these little stress triggers, and all I would want to do is find a Maverick in the middle of Wyoming and find some cigarettes, and that didn't happen, and instead I had a little piece of gum, just like our episode with Clint Allred, Dr. Allred was . . .

Scot: The nicotine gum.

Mitch: Yeah.

Scot: Yeah.

Mitch: And I just, you know, a little one here or there every now and then for breakthrough type super-craves. But other than that, I'm doing pretty well.

Troy: That's great, because yeah, you picked probably one of the hardest times to do it. I mean, to get through the holidays going through this, that's impressive.

Mitch: Oh yeah. And that was that last step down, like, because we've had a lot of response on Facebook and stuff to the quit episode, people talking about their own journeys with quitting smoking and different substances and things. For me, it was really, really hard even with the nicotine patches and gums and this, you know, every time there was a step down, I was beyond irritable. Like, I was crying into a rack of ribs, you know? And my poor boyfriend's just like, what is wrong? And I'm like, I don't know. I'm just upset at everything. And, like, shout-out to him for being supportive and dealing with me during these step downs. But it was, every couple weeks, there was, you know, two or three days of just me being a, like 12-year-old wreck.

Scot: And one of the hard things that you talked about to me is, you know, you would, you were very public with this with your friends, and then you would get these Facebook messages. Oh man, I just quit. You know, it's not that big of a deal.

Mitch: Yeah.

Scot: Oh wow, how tough that is and what a, I don't know, I'm going to sound terrible. What a terrible thing to say.

Troy: Right.

Scot: Because everybody's going to process it differently. Maybe for that person, it wasn't difficult.

Troy: Yeah.

Scot: But that was tough. Was that tough for you?

Mitch: I know that it started, it was really kind of difficult, because here I am having a really hard time every few weeks, and then I'm reading, you know, things online of people being like, oh, it was easy, or oh, I read a book and it was all, you know, that's all it took, and I never picked up a cigarette again. But at the same time, I also read people who were having a more difficult time, and it kind of was really meaningful to kind of realize that it's, everyone has their own personal journey they're going through, and you just need a little bit of support. I think that was really big for me is having people around me that wanted me to do it and cared about me and called and checked in and bought me chocolate cinnamon bears, and, you know, whatever. But it was, that's, everyone's on their own journey, and you've got to just kind of judge yourself by that.

Scot: Through the process, you had some emotional reactions that you talked about just briefly right there, some physical reactions.

Mitch: Yeah.

Scot: Some just crazy dreams, all that sort of stuff. For somebody going through this process, is there a light at the end of the tunnel? Are those things kind of, have they gone away, or are they still there?

Mitch: No more crazy dreams. The light at the end of the tunnel is that I'm in control with my health again. That I am not terrified that every weird cough or chest pain or bit of indigestion is lung cancer or a stroke or something like that. That peace of mind is worth everything I went through.

And yes, I still have cravings. Yes, I still have these bits of irritability that, from what I read, can last for a year or two after all of the nicotine I've used in my life. But taking that control of my day-to-day, my future, etc., is what it's all about.

Scot: Kind of like a shield.

Mitch: Yeah.

Scot: Like, all this other stuff can come at you, the cravings, the irritability, but you've got the shield that is going to protect you.

Mitch: Yeah.

Troy: Yeah, and, I mean, it's got to be empowering in so many other things, too, you know, to be like hey, I did this. I'm making it, and I've done something extremely difficult. I can do this other stuff, too.

Mitch: Yeah.

Scot: We have a very special guest on today.

Mitch: Oh no.

Scot: On this episode.

Mitch: Who is it?

Scot: Hello, Mitch. This is your old habit.

Mitch: Oh no.

Troy: Oh no. This is Old Habit come back.

Scot: This is your vaping pen. How are you doing?

Troy: The ghost of habits past.

Mitch: You doing okay?

Scot: And congratulations, I guess.

Mitch: Oh no, what are you doing?

Scot: Do you miss me?

Troy: What are you doing to Mitch?

Mitch: What are you doing?

Troy: Come on, man. Poor guy. He just talked about how difficult it's been.

Scot: So you're saying there's a chance? Can we get back together sometime?

Mitch: No. No, no, no.

Troy: It just got really dark.

Mitch: I know. I don't know about this.

Scot: Actually, I should ask, what flavor did you like?

Mitch: It was the cinnamon roll.

Scot: I don't know what cinnamon roll's voice would be.

Troy: Okay, Mitch. Cinnamon roll.

Scot: I am so incredibly proud of you. I mean, I struggle saying that to people because, like, I had nothing to do with it, right. So why should I be proud? But I think what you've done is just incredibly hard and amazing, and I just admire, I admire that you've done that, so . . .

Mitch: Well, no, you did. And that's one of the things I really want people to realize, either whether they're on their own quit journey or they're, like, figuring out their own health is just, I mean, just checking in and, like, you asked me, how was I doing? You were saying, hey, I recognize that you had a step down coming up. How did that go? Those kinds of check-ins, those kinds of, knowing that you're not doing it alone was a big part of why I think this time succeeded. And I think that's a big goal of this show is to talk to one another. Guys, talk to other guys. Talk to your partners. Talk to your people in your life about your health and what you're going through, because it makes it a whole lot easier to have other people that are part of your network.

Troy: Yeah.

Scot: Can't wait to check in in another hundred days.

Troy: Keep it up.

Scot: All right, just going to leave this here. That's where we get to talk about maybe something random. Could have something to do with health. Sometimes entertaining, sometimes informative. Troy.

Troy: Sometimes not.

Scot: No, it always is.

Troy: Always entertaining and generally informative.

Scot: Troy, why don't you kick us off?

Troy: Yeah, so Scot, I went through a little bit of a crisis recently. I had this old iPhone, well, it was an iPhone 5, and I every time I pulled it out everyone said, oh, wow, I can't believe it's an iPhone 5. Then we went on a trip two months ago, and the front of the iPhone, like, you know, the screen there just started to peel off and lift up, and I thought maybe my iPhone 5 is done. And I finally lost it. I dropped it on the ground, and that was it.

And it's really crazy, because I'm kind of the type where I've always been like, okay, I'm not putting a lot on my iPhone in case it crashes, but when it crashed, I thought, wow, I have lost so much stuff. It's amazing how much lives on our phone and how disorienting it is to lose that.

Scot: Even when you don't think you're that dependent on it.

Troy: Even when you don't think you're that dependent on it. And then it was like this moment of just, like, you know, when I got my new phone and I backed it up, like, oh, hey, everything's there. It backed up. Actually, you know, it was a couple weeks I missed, but it was such a relief to get that back.

But it made me realize, even as someone who tries not to depend a ton on technology, how dependent I am, and I think we're kind of all in that same situation regardless of our efforts.

Scot: Just going to leave this here. I had an orthopedic issue that I had to go to the walk-in orthopedic clinic for. It was for my shoulders, I got the norovirus and I must have slept, I slept for two days straight, essentially. And I must have hurt myself. But anyway, the doctor looked at that and then, as I left, wrote me another prescription to go to physical therapy. Talk about not feeling very manly. She diagnosed me with a dowager's hump.

Troy: Dowager's hump, like, a dowager. That's, like, an old term, like, an old English term for, like, an old British lady.

Scot: So it's the old, it's that hump that you see that old people get. It's usually associated with old women.

Troy: Yeah.

Scot: But she said this little bump right here, she said that's the beginning of it, and it's something I, well, first of all . . .

Troy: So we're going to see you, like, walking around with a scarf over your head soon, like, hunched over.

Scot: I hope not. But I was fascinated. She said that a lot of people think that it has to do with posture, and a lot of what I've read says, but it could also be other causes as well. Like, I recall having this strange formation in my kind of neck area most of my life. But what I was really excited about was the fact that she said physical therapy has been proven very effective for reversing that.

Troy: Oh, nice.

Scot: And the reason you would want to reverse that is because, you know, as you get older, that goes forward and forward, and it can cause other problems. Muscular problems, pain, digestive issues, those sorts of things. And through my research, I also found out that a lot of guys, actually, over the age of 50 start developing this. So . . .

Troy: Probably all those years in radio. You're, like, leaning forward to speak into the mic.

Scot: Well, that, and we talk about technology nowadays, that's what some of these websites indicated that, you know, we're shoulders forward, head forward on our phone a lot or on our computer, so from a postural standpoint. So I think I was predisposed to it, but I'm almost a little strangely excited about going to physical therapy and maybe correcting this thing I've been self-conscious about, not only from a physical appearance standpoint, but also from a health standpoint, so.

Troy: I can see it, 20 years from now, we're going to have an epidemic of DH. We're going to call it DH.

Scot: Let me . . . turn. I want to see your profile. Do you guys have one?

Troy: Probably I probably am developing it. I'm just making up the whole DH thing.

Scot: Mitch, you can't sit like, Mitch is like . . .

Mitch: [inaudible 00:29:19].

Scot: I've never seen you sit that straight in your life.

Troy: I'm super self-conscious now. I probably do, too, because I always hunch over at work. It's not good.

Mitch: I know I sat up when he mentioned that.

Troy: I know. Me too.

Scot: Everybody sat up as soon as I mentioned it.

Troy: Like . . .

Scot: So I'll keep you up to date on how that process goes, but, I mean, first of all, it was a little bit of a shock, but second of all, I'm actually excited about maybe solving this problem.

All right, time to say the things that people say at the end of podcasts because we are at the end of this one. Thank you very much for listening. If you want to reach out, it's super simple. You can go to a couple places. You can go to whocaresmenshealth.com or facebook.com/whocaresmenshealth.

Troy: You can also contact us, email us at hello@thescoperadio.com. Be sure to subscribe through Spotify, iTunes, Google Play. We'd love to get your feedback, and thanks for listening and thanks for caring about men's health.