41: Staying Sane During a Pandemic

Scot: Nobody has noticed that I have the megaphone back.

Troy: Oh, trust me, we noticed.

Mitch: We're trying not to acknowledge it.

Troy: It's just like ignoring a little kid. We'll pretend we don't notice the megaphone, but it's there.

Scot: Pay attention to me. The podcast is called "Who Cares About Men's Health." We have a theory that men do care about their health. They might not talk about it that much, but they do care and we're trying to break that stereotype and also give men an opportunity to think about and talk about their health in a different way.

My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.

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

Scot: All right. Again, audio quality might be a little different, or maybe you don't notice. Maybe it's just geeks like me that notice that, but we are socially and physically distanced. I should say we are physically distanced. We are socially together. We're all in our respective homes right now recording this episode.

And for today, since Dr. Madsen is an emergency room physician I thought it would be interesting and insightful to talk to him about how things are going for him in hopes that not only we can learn how to support other healthcare workers like him, but also how we can maybe support ourselves in these difficult times. I'm sick and tired of hearing that, by the way, "in these difficult times," that phrase, but I guess they are difficult times.

Troy: They are, though. I know it's tough, but it really is. This is our World War II in a sense, and it's kind of like the event that we will talk about for years and years to come, and, "This is what I did during the COVID pandemic, and this is where I was, and this is how I handled it."

Scot: I'm also noticing it's a little like 9/11, except for unlike 9/11, which the interest and the heightened whatever came and went within about a week I felt like, this continues on. So I'm curious, Troy, how are you doing?

Troy: I'm doing all right, Scot. Thanks for checking in. I think in general in the emergency department, I have this sense that after a month of this we've all kind of settled into this in terms of a lot of that initial stress and anxiety. I think there's still a reasonably high level of stress just based on the exposures, and certainly we're seeing quite a few COVID-positive patients, but I think some of that uncertainty has sort of worn off just with experience and with seeing these patients and with getting protocols in place.

So I think in general feeling okay about things. It's still a stressful time, and quite honestly a very strange time to be working in the ER. We're seeing a lot of our numbers of patients coming in have actually dropped. I think this is what a lot of ERs are seeing, because people are staying away, which is good to keep room for the COVID patients.

So it's kind of just a weird situation where we're not seeing the high volumes of patients, but we're certainly seeing COVID-positive patients, and in a lot of ways just kind of waiting for a surge. We haven't seen a huge surge here in Utah. We're waiting to see when that comes and what happens once that comes, but it's kind of the situation we're in right now.

Scot: I think it's worth saying, just throwing out there that if you do have an issue that you need to go to the ER or an urgent issue, you should still seek care. Perhaps call first. Call an urgent care first. Call an ER first. I mean, unless it's a 911 situation, then absolutely do that. But that's interesting that people are staying away. But I don't want to discourage people from seeking care if they have to.

Troy: Exactly. And that's one thing we've talked about that we're a little bit concerned about, is people may be staying away and putting things off where they do need to get medical attention. So I would emphasize that. If you need to see a doctor, if you need to go to the ER, come to the ER. We have a separate area for anyone with respiratory issues. So if you're there for abdominal pain, you're not even in the same general area as someone who's there with a cough and with possible COVID and getting ruled out for that. So we're trying to make everything as safe as possible for patients and for staff.

Scot: Curious, I was talking to a psychiatrist the other day who is also a veteran and said that . . . seeing similarities between people in the service and what first responders are kind of going through right now, because they are asked as a first responder to perform at a high level under stressful situations, and then they have difficulty going back home to a family who is not under those pressures.

So if you're in the military, you'd be around a bunch of people that are all in the same boat, right? So you're all at this same kind of emotional level or psychological level. But here, you have to go in, amp yourself up for that performance, and then go home. Have you been noticing anything like that, personally?

Troy: Yeah, you're right. I mean, to be completely honest, I really have. It's been a little bit of an emotional roller coaster this last month. I think, personally, I've had my struggles just with working in this setting and being concerned. Everyone else is practicing social distancing. I'm quite the opposite. I'm up in the face and caring for people who are COVID-positive, and there's a lot of anxiety that comes with that.

And you're right. It's kind of like we're expected to perform at a high level and then somehow return to a normal life. And seeing people working from home, out running, just having a good time, there's been a lot of emotion, and in some ways a little bit of resentment toward everyone who's like, "Hey, it's hard to do social distancing." And I'm like, "Well, I just had patients who are COVID-positive coughing on me today."

And then people who are kind of disregarding a lot of the social distancing concerns, that is a little tough to see as well when you're dealing with this. So, yeah, I mean, there's no doubt.

I think that analogy probably to some people in the military, it's accurate. I've never been in the military, but I've heard people who have talked about that and have talked about some of the similarities there, I think, with emergency medicine in general. But with this heightened concern and fear now, I think that that's . . . maybe fear isn't the right word. Maybe just more anxiety. I think a lot of us are experiencing that, at least to a certain degree.

Scot: What's the most helpful thing for us to do as non-first-responders or healthcare workers to support you and other people that are doing the same types of things you are? I mean, that could be the gamut, right? It could be you, it could be nurses, it could be environmental services, people that have to make sure that the rooms are clean and infection-free when patients leave. How can we best support you?

Troy: Great question. I think the greatest support I've seen, and I've mentioned it before, is just when people come in and they thank you. It means so much. It really does. And for people to come to the ER and say, "Hey, thanks for what you're doing," or if you have a family member or friends who are working on the front lines or in healthcare, just let them know, "Hey, we're thinking about you. Hope you're doing well. Check in with us if you need to."

I've had a number of family members who have reached out and who have done that. My sister, she's a physician assistant, and she's also on the front line. She's working in an ED in the Bay Area, and kind of same thing with her. So I think it's meant a lot to both of us to have family members reach out and just touching base. "How are things going? Thanks for what you're doing."

If you have a family member also, I think it's great to let those individuals vent a little bit because I think that helps us given that we are experiencing a lot of stress and in a situation we've never faced before. But allowing those people to vent a little bit about what they're feeling and some of the situations they're in, I think that's helpful as well.

Scot: Yeah, the psychiatrist that had told me this analogy, the comparison to the military, just said also be forgiving. You might see some changes in personality, which is caused just by this. When you go in, you have to be in a different mindset than when you come home. So I think just be sensitive and aware of that, that hopefully that will end, and if it becomes a problem, then maybe cautiously or politely, I don't know what the word is, bring it up.

But other than that, I think we all need to give each other a pass in these times. And I think people that are really doing what you're doing maybe deserve a little bit more of a pass. Is that all right? Do you want more of a pass?

Troy: Please, please, please. Could I just get a free pass, just like IOU? Like, "I owe you one positive response because that was a really negative response to what you just said."

But it's frustrating for me personally, because all those things you mentioned, I think I've been slow to acknowledge it. But I've experienced those things in the last month and I've just been like, "Hey, it's my job. I do this. I deal with sick people. I deal with difficult scenarios. What's my deal?" I come home, and I have. I've felt on edge. I haven't slept well, other things.

And I think I think that psychiatrist nailed it on the head in terms of what a lot of us are experiencing. I've sensed a lot of this in my colleagues as well. I think, number one, there's a sense of anxiety you experience, and then I think some people respond to that almost at times with a sense of apathy where you're just trying to turn it off, which I don't think is great.

And it's challenging. Again, it's something none of us have experienced who are currently working in healthcare. It's something none of us have ever experienced in our careers. And I think it just creates a lot of stress and I think it's a challenging emotional response to keep those emotions in check and to hopefully have a healthy response to this while processing a lot of these things that are naturally going to result from being in that setting.

Scot: What are some of the coping mechanisms, Troy, that you've been doing to kind of get through this time? Do you find that you're getting back to the basics, or do you find that you're hitting the peanut butter cups a little harder than you used to maybe or the snack foods?

Troy: Oh, man, it's a struggle. I think all of us are struggling with the snack foods right now. I've really tried to be aware of that and know that I don't want to just start stress eating. And some days . . . and I always justify it. I'm like, "Well, I did a long run today." So I got the Domino's Pizza and then I got the Domino's brownies, and I ate almost all the brownies. Yes, I have been stress eating. There's no doubt about it.

Scot: It turns out . . .

Troy: It turns out I have been. But no, I've tried to keep it in check.

But in terms of coping mechanisms, it always comes back . . . for me, I love to run. I think that's been a huge thing for me. It's also an excuse to get out and just get away. I go in the backcountry. Right now, I run on snowshoes, which is typically what I do in the winter, and I rarely see anyone out there, which is wonderful. So that's probably been a huge thing for me, is just continuing that routine and using that time as a time of meditation and trying to process a lot of things.

Beyond that, I've really tried to recognize, and I haven't always been great at it, but try to recognize those times like after night shifts, or after late shifts, which for us often end at 2:00 in the morning, you're getting to bed at 3:00, so you're operating on not a lot of sleep the next day. I've tried to recognize that that tends to not . . . I just find after those shifts I'm often a bit more emotional and on edge with all of this everything else going on. So I've tried to kind of be like, "Hey, I'm just going to go hang out upstairs," and just work on some stuff or watch TV or whatever, just to avoid being too on edge.

Again, it's been something I've found, where I have probably been a bit more on edge this past month. My family, I've got a great family. We've got this group text. I love getting pictures from my siblings and seeing pictures of their kids. That's been a great outlet, just to be able to chat with them. And I think we've been chatting in general a lot more this last month, which has been a nice positive thing. Just checking in with them has been fun and I think a nice sort of coping mechanism as well to see how they're doing and just kind of see everything that's going on in their lives.

I've been trying box breathing. That's been a great thing, from our previous episode. Yeah, doing some box breathing at times, especially in the ER when it's kind of like, "Okay, things are getting to me a little bit," or whatever. Wearing those PAPR, those big hoods you have to wear, for an entire 10-hour shift can get to after a while. Trying a little box breathing and that can be helpful as well. So drawing definitely from the podcast.

Scot: Of course, the box breathing technique is you take a breath in for four seconds, you hold it for four seconds, you breathe it out for four seconds, you wait for four seconds until you take the breath back in. Is that right? Did I get that right?

Troy: That's exactly right. That's what I've been trying. And it is really a great way to really sort of come into focus and focus on your breathing and slow your breathing down. So it's something I have thought about at times when I'm feeling kind of stressed, like, "Hey, just try some box breathing." And I think it does help.

Again, I think, for me, I'm trying to check in every morning and just be like, "Okay, where are things? How are things going?" Keep things in perspective, the whole cliché "take it a day at a time." But it really is about taking it a day at a time.

I'm also trying to have once a week what I call my COVID-free day, which is essentially . . . it's usually when I'm going out for a long run, and I don't check work email that day. I just try . . . because my work email, like everyone, has just doubled in the last 30 days. So many emails about COVID and policies and procedures and everything else. I just try to avoid it, say, "I need to get away from it at least for a day." I try not to read a lot of the news that day because everything's about COVID. Just some way to sort of detox from it all, and at least have a day where I'm just not immersed in that world. I think that's at least somewhat helpful.

Scot: And I think for regular people who are also working from home for the first time . . . and this is not to diminish, Troy, what you are facing because by far and away out of the two of us, I know your situation is a lot more stressful and challenging than mine. But the fact of the matter is that people are working from home and they've had their routines completely interrupted. And I think much like you, now the line between work and not work is becoming more and more blurred, right?

Troy: Exactly.

Scot: So I think that advice of getting away is so crucially important for all of us now working from home and not maybe letting it creep into the weekends, like it has for me on occasion, and making sure that you're doing those things that you enjoy to help rejuvenate yourself for the week ahead.

I thought this was an interesting tweet I saw from a guy named Duncan Davidson. He said, "For all of you working at home for the first time, it's usually not like this. This isn't working from home. This is working during a pandemic. Totally different experience. Be kind to yourselves."

Troy: Yeah, exactly. And that's the challenge. It's like you can't get away from it. You're surrounded by it. You want that release, just that sort of escapism of, "Hey, let's go to a movie." "We can't go to a movie." "Let's go out to eat." "We can't go out to eat." There's really no escape.

And I've often thought of that, too. On the one hand, yes, my job is stressful and we've experienced a lot of stress at work in the last month, but I'm also very fortunate that I still have that routine. I can still go and I leave the house and I go to work and I see people and I talk to them.

And so I've also tried to keep that in perspective, like, "Hey, in many ways, I'm so fortunate to be doing what I do because I have that," and certainly have job security because of the area I work in. So I feel very fortunate.

I think a lot of people are really struggling right now, like you said, with adapting to working at home, and not a typical working at home sort of thing. We're in the middle of a pandemic, and potential threat to their job, or they've lost employment or a spouse has lost employment or has reduced employment.

So I think we all have our struggles in various ways. I don't want to magnify my struggles or the challenges I've faced in the emergency department when I think so many others have had various, very, very stressful experiences as well.

Scot: Yeah. And I like that you bring up social support, because that is something . . . you're with a bunch of people that are all in this thing together, so you still have that social support.

And we've talked about how important social support is. So if you are finding now that you're working from home you don't have that same kind of social support, maybe try to find ways to bring that back in your life.

And the other thing that I loved that you said, and we know that this is also effective from past shows, is just finding something to be grateful for. It's ironic that the thing you're grateful for is also the reason you're stressed out, and that's your job, but if every day you can try to find one thing you're grateful for . . .

For example, my wife and I now go on evening walks that we just absolutely treasure, and I think it's brought us closer together. Whereas there are other things that are not so great, that's pretty good right now. So just try to focus on those good things in your life, and say them out loud or write them down. Acknowledge them. And I think that goes a long way for helping mental health as well.

Troy: Yeah. Scot, one thing too you can just look at during this is just trying to . . . not just the gratitude, but just trying to celebrate the small things or even kind of the silly things.

Like last week, on April 15 was our dog Abby's 12-year adopt-iversary, so we call it her birthday. Twelve years ago on April 15 we adopted her. She's an old dog now. But we took her out for a special outing to McDonald's to get her a hamburger. Just made a big deal out of it. So you do what you've got to do. Find the small things to celebrate. Take your dogs out through a drive-thru to celebrate whatever. And I think that helps too, just having kind of these little things to celebrate and look forward to.

Scot: One last thought that I want to bring up is this feeling of control. And again, when I was talking to Andrew Smith, he said that we're in times of uncertainty, and in times of uncertainty, it is more important than ever to try to find things that we can control, because there are so many things that are out of our control right now. If we found ourselves without a job, that is totally out of our control. We aren't responsible for it at all. So then what can you control? That might be how you treat your family. You can control that. Or you've been putting off that garage project, cleaning it out. You can go out there and exercise control and see a result because of your effort.

And I did ask him, "That seems so silly in comparison to the bigger problems we're all facing." And he just said, "Those are the small steps that you take to try to get back to a place where you're feeling better about everything."

So finding things you can control on a micro level . . . I mean, even choosing how we decide to exercise or choose and decide what we're going to eat, saying, "You know what? I'm not going to do those peanut butter cups today," which I don't know if today's my day.

Troy: Perhaps not.

Scot: But maybe I'll exercise control over that tomorrow when I need to. But in times of no control, trying to find on a micro level things to control, it's so crucially important to mental health from what I've been told.

Troy: And great point too. I think it's good, and I've tried to remind myself of this also, of what I can't control. I cannot control that we're in the middle of a pandemic. I can't control the impact that this has had on our emergency department and on our protocols and on . . . I think a lot of the emotional response we're experiencing, it's just something that that we cannot control. I can't control that we're on quarantine, that the vacation we had scheduled next week has been canceled. All these things that I think bring up a lot of frustration for a lot of us.

So I think just reminding ourselves of that. Let's control what we can, but recognize that so much of this, we have no control over, and it's a tough position to be in, but that's, unfortunately, just the way it is. And we can't blame ourselves for it.

Scot: You just reminded me, Troy, about canceled plans and stuff. You had qualified for the Boston Marathon, which is a dream for a lot of people, a goal and objective. When is that supposed to be?

Troy: Well, Scot, if things had gone according to plan, I would not have been talking to you today. I would be in recovery from the Boston Marathon. So that was supposed to happen yesterday. I would have been somewhere in New England right now and driving around. We were planning to drive around, visit Vermont, which is where I was born, spend some time in New England in general after the race.

I think like a lot of us have experienced, it's a hard position to be in where we've had to cancel vacations, things we were really looking forward to. After having been in the quarantine now for over a month, I think these things are starting to pile up, or we're starting to look ahead and saying, "I'm not going to be able to do that because we can't travel," or whatever the situation is or, "That event has been canceled."

But that would have happened yesterday. And the Boston Marathon has been rescheduled for sometime in September. Hopefully it'll happen, but I guess we'll have to see.

Scot: Yeah. It's just one of those things you can't control, right?

Troy: Exactly.

Scot: Have you been lamenting it or have you just kind of accepted it?

Troy: I've been lamenting it. I really have, honestly. It was one of those things where I had looked forward to it. I was excited about it. And just excited about the getaway, just to be able to go back to New England, run in Boston, and then have a week where we were going to travel around, So it's been tough.

It's one of those things . . . again, it's a minor thing in the big picture, but it's something that . . . again, like so many of us where our plans have had to change for whatever reason, stuff is canceled or financial reasons. It's just one more thing I think that's been a little bit tough to accept and say, "Well, we're not going to do that." You do what you can.

Scot: Another psychiatrist that we interviewed that you can find a couple of those on thescoperadio.com was Dr. Benjamin Shannon. He said something that may or may not be helpful to you right now. But he said, "We as humans are terrible at acknowledging bad feelings. You should actually acknowledge them, not run away from them. Experience them, and allow yourself to do that."

So, I mean, the fact that you've been kind of disappointed and you've been experiencing those emotions and you've allowed yourself to do that, my takeaway from what he said is that's actually a good thing, that you should allow yourself some time to do that.

Troy: I agree. I totally agree too. I think it's good to allow yourself to mourn in whatever form you're mourning, whether it's loss of something you were looking forward looking forward to or the bigger things as well. So great advice coming from a great guy. I know Ben well. Great guy. So, yeah, I agree. It's something we need to do.

Scot: And then it's how you move on from that point that makes a difference. Then it becomes unhealthy if you hold on to it for too long, but you should allow yourself some time to just experience that emotion, which a lot of us don't want to because it's uncomfortable. It doesn't feel good, so we just tend to avoid them, but that's not necessarily the healthy thing to do.

Troy, I'm glad that you're doing okay.

Troy: Thanks, Scot.

Scot: It's been a good discussion. Has it been good for you?

Troy: Sure.

Scot: Was this helpful at all or . . .

Troy: It is helpful. The things you've said about what the other psychiatrist, Andrew Smith, had said, about it being like combat or like being in the military and coming home to your family and maybe they don't understand, that is really helpful. That, I think, has given me some insight into a lot of what I've felt over the last month, and it's been a challenging month.

Like I said, I think I haven't wanted to acknowledge it. I've just said, "It's my job. This is what I do. I deal with sick people and I deal with crazy cases and that's what I signed up for." But I have experienced a lot of those things you've mentioned. So I think it's been helpful for me just to gain some more insight into a lot of what I've gone through.

Scot: Well, again, the offer always stands. If you want to come over and just talk, we will stay physically distant six feet apart on my back deck. I've got a big deck, so we can do that.

Troy: We'll sit apart. You can eat chicken wings, and I will eat some carrots or something. You mentioned your chicken wing night you do.

Scot: My wife, she has these veggie chicken wings that she eats. So, I mean, I could make sure we have a box of those.

Troy: They sound delicious.

Scot: Oh, yeah. Totally.

Troy: "I'll throw it in the microwave." No, actually some of this can be can be all right.

Scot: Here's the key to those: It's ranch dressing and lots of it.

Troy: Oh, yeah. I was going to say you've got to put tons of the sauce on it and tons of ranch dressing. That is the key to eating any sort of meat substitute.

Scot: Well, Troy, thank you very much for sharing with us today. We do appreciate that.

Troy: Well, thanks, Scot. It's been good to talk about everything.

Scot: All right. Time for "Odds and Ends." We're just going to do a quick one right here. Producer Mitch of "Who Cares About Men's Health" had something that he wanted to share. What is it that you wanted to talk about in today's "Odds and Ends"?

Mitch: Yeah. So a couple weeks ago we were doing our episode that was all about mental health tips with Kevin Curtis and his buddy Ben. Do you remember that one?

Scot: One of my favorite episodes.

Troy: That was great. It was a fun one.

Mitch: Oh, absolutely. Well, we went ahead and cut out the three big tips that he did for your mental health toolbox, the tactical and box breathing, the reach out, the . . . what did you call it, Troy? The power grip?

Troy: The power grip.

Mitch: Where you reach out to two people, right? And the blast conditions, right? Checking in with yourself and making sure you're doing okay before you make major decisions.

They're doing really well on Facebook. I think especially in the time that's going on right now, we've had over 3,000 views on each of these pieces. And we've had a whole bunch of people sharing them with one another.

I just wanted to reach out and appreciate our listeners who are taking it upon themselves to share this content with one another, who are commenting about it. I just think it's great. I think it's great that we are starting to see a community come together to share with one another and to take some of the stuff that we're producing and actually incorporating into their lives to help them through this situation.

Scot: Yeah, I also love that men are taking these mental health things to heart because that stereotypically can be one of the challenges that a lot of us guys face. So that's awesome.

Troy: It is, and it's relevant to everyone. Obviously, we've said it before. We're a men's health podcast that's relevant to everyone. My sister Melanie just texted me a couple days ago and said, "I love your podcast. I love the episode talking about the box breathing and blast, all that." So I think it's stuff that's relevant regardless of your gender or anything.

Scot: All right. Well, thank you very much for listening. And if you haven't heard the full episode, you can go to whocaresmenshealth.com and subscribe. I think it was an episode or two episodes ago. It was the one with Ben and Kevin Curtis. And it's just a super good episode, so check it out.

All right. Time for "Just Going to Leave This Here." It's an opportunity for us to talk about something that might have something to do with health or just random thoughts that we have.

Just going to leave this here. I'm going to make an observation. I don't know if anybody else is experiencing this, if anybody has any answers, but I've noticed . . . I've had a habit for a long time of picking up my thumb cuticles and picking the skin at my thumbs. And it has become so much worse nowadays. And I think part of it is because I'm washing my hands all the time and that skin is dry, and I think part of it might be a release for my stress and anxiety. I don't know. I'm trying to stop doing that, but it's really bugging me and now my hands hurt. That's how bad I'm doing it.

Troy: That plus hand sanitizer, your hands are probably hurting.

Scot: Yeah. If anybody has any advice on how to stop doing that, let me know. I've been putting Band-Aids on them, whatever . . .

Troy: Duct tape.

Scot . . . but I just I can't stop. So, anyway, there's that confession.

Troy: Well, here's my confession. I'm just going to leave this here. I think we all have our stories lately of what's happened on conference calls. I think Mitch told the story about a toilet flushing in the background on a conference call and no one will acknowledge it. In my story, everyone knew who it was.

Yesterday, I was on a conference call and I said, "Baby, baby," and it was like, "That didn't sound good." You just hear, "Baby, baby." It was my dog who sometimes . . . I have various names for. Sometimes as we call her Baby Pup. It's one of her pet names. But she was chewing on a bowl, like chewing up all the plastic on it, and I'm going over to . . . and that was my response to try and get her to stop. I was like, "I'm not muted. That probably did not sound good in the middle of a conference call." So one more story for the stuff that comes up during a conference call.

Scot: Yep. And here's the lesson: Always make sure you're muted.

Troy: I looked down and was like, "I'm not muted. Did anyone notice? Oh, well. Who cares?"

Scot: Being from a radio background, before I said anything, always make sure the mic is off. If you're on the phone, always make sure you're muted. That's good advice.

Troy: And it gets you, though, if you've just been talking, because I was just talking, and then someone else was talking and as the person is talking they're hearing me say, "Baby, baby." I'm just like, "This . . . okay." And I didn't even try to explain it. I'm just like, "Okay, that doesn't sound good."

Scot: Yeah, we'll just go ahead and let that drop.

Time for the things that you say at the end of podcasts because we are at the end of ours. I'm going to go ahead and start out by saying if you want to reach out, if you have any questions, comments, thoughts, anything about the podcast, we're creating new social alliances and maybe this podcast might become one for you. You can email us at hello@thescoperadio.com. You can go to whocaresmenshealth.com, and you can also go to Facebook facebook.com/whocaresmenshealth.

And, Troy, tell them about how to subscribe to this fine podcast.

Troy: Well, subscribe wherever you get your podcast, on iTunes, Google Play. I just heard someone is using it through Pocket Casts. That's something I haven't used before, but they said they were able to find it on there. Spotify. You can always contact us. We'd love to hear back, get some feedback, hello@thescoperadio.com. And thanks for listening and thanks for caring about men's health.