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Sideshow: Listener Emails

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Sideshow: Listener Emails

Jul 20, 2021

What exactly is fatty liver disease and how is it treated? And what do you do if your doctor tells you that you're "healthy enough" despite your personal goals to further improve? Scot, Troy, and Mitch read through emails from listeners and discuss future episodes.

Episode Transcript

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: We got a couple of good emails, incredible emails. At one point I thought, "Mitch has put somebody up to these."

Mitch: And I thought that Scot had put . . . One of the persons who wrote in left their name and I just assumed it was you. It seemed like a made-up name.

Scot: Yeah.

Troy: Was it John Smith?

Scot: No, it was Scot, and Scot spells his first name with one T.

Troy: Oh, wow.

Scot: What are the odds of that?

Troy: What are the odds?

Mitch: I'm like, "Scot, come on. You've got to try harder than this."

Troy: He's like, "Scot . . ."

Scot: Scot made-up last name.

Troy: Yeah.

Scot: One was from a guy named Brett, and here's what he wrote. "Dear Who Cares team, I've been listening for a while, thought I'd ask a question after my last physical. I was diagnosed with fatty liver disease, but my physician didn't explain it too well and I've been searching for more answers on what it is, why I should worry about it, and what I should do to treat it. I Googled a lot of stuff, but I'm still unsure what to do. My doctor recommended I avoid fatty, greasy fried foods, but I wasn't sure if I should consult a dietitian or do anything else. I'm willing to share more if needed about my health, but is this something you could address in a future episode? Thanks again for a great show. Brett."

Troy: Is it Brett with one T? Then I know it's you, Scot.

Mitch: You got a Zodiac over here.

Troy: Exactly.

Scot: So that's awesome. I'm working on getting a couple of experts to talk about that. I'm working on getting a guy that's an expert in fatty liver disease. And I think Thunder would be a good guy to have on too being a nutritionist.

Troy: Yeah. It's a great topic. And it's so funny, this just came up in the ER the other day too. I had someone who same kind of thing. Looks like they probably have some fatty liver disease. We're talking about how do you treat it? What do you do about it? It's a fairly common thing and it would be, I think, obviously good for Brett and a good discussion to have.

Scot: Do I need to bring an expert in, or are you pretty good on fatty liver disease? I guess I didn't think . . .

Troy: An expert would be great. My recommendation, I think Thunder talked about, is it's not about fatty, greasy foods. A lot of it is about weight loss. If people can drop 10 pounds, they're going to find that the fatty liver disease often resolves or at least improves. But I'm curious too. It's something I will diagnose and I'll say, "Oh, CT scan shows the fatty liver disease, or your liver function tests are a little bit higher. It's probably what it is." But in terms of real monitoring and treatment and long-term stuff, that's not something I do.

So that's something usually a primary care physician does, and a GI doctor, or a hepatologist specifically, would be the ones who probably see this and give recommendations on it and can talk a lot more about why it happened. Is it genetic? Is it just because your diet? Is it because of weight? And do you treat with medication? Is it weight loss? What is it?

Scot: Cool.

Troy: Yeah.

Scot: And then the other one was from a guy named Scot. Scot said, "Hello, I really like your shows. I think you all do a great job. I appreciate learning about a wide variety of topics in an enjoyable format from knowledgeable people." That almost sounds like I made it up. I will admit.

Troy: Yeah.

Mitch: "Dear Scot, you're amazing."

Scot: Nobody writes . . .

Troy: "I love Scot."

Scot: It didn't say, "I love Scot." But nobody writes emails to shows. I've been in radio for a long time. You don't get that.

Troy: Yeah.

Scot: If you ever hear a DJ reading something that starts out like that, they wrote it.

Troy: Or their mom wrote it.

Scot: Yeah. All right. So anyway, after buttering us up, Scot goes on to say, "I have a question that might be applicable to one or more of your shows. I'm mid-30s male, that's in acceptably good health. BMI is 26.6. Overweight by NIH standards, but I run a 5k once or twice a week, go biking, I can do five pullups." Need to talk to him about how to do that.

"My right knee and feet give me some pain if I try running more than 7k, but generally not a problem at all. My blood pressure hovers around 128/75, elevated per NIH. My health has stayed pretty consistent over the last decade, even with me putting effort into improving it. So I'm trying to improve it but it's kind of stayed consistent, stayed the same.

"When I chose a primary care physician, I looked for someone that had a focus in sports medicine thinking they'd be supportive of younger people being their best selves, but the last time I went in for a yearly checkup and brought up my small health deficiencies, I was told flatly, 'If I got after everyone that came in here with a BMI of 26, I wouldn't do anything else.'

"I understand that medical resources are finite, but does that mean I'm doomed to become an obese senior citizen with high blood pressure because I can't find support how to push me to lose a little bit more weight and lower my blood pressure just a little bit more?

"If a PCP isn't the right person to help me, who should I look for? A physical therapist? A life coach? Accept my current situation is good enough? Find a new PCP? I wish I could just power through it, but I've been trying that for a decade without moving the needle one way or another. So I figure I need to try something different. Regards, Scot."

Troy: Ah, that's a good email. That's a great question too.

Scot: Yeah. So who should we hit up on that? Is that a primary care physician?

Troy: That's more primary care. I think his first issue is that he's gone to a sports medicine doctor thinking they will optimize his health. And sports medicine is really non-operative orthopedics. That's really . . .

Scot: I think they have some primary care physicians nowadays. This is where the BS talks to the MD kind of thing.

Troy: Yeah.

Scot: I think that they have some primary care physicians who do specialize in sports medicine, though.

Troy: Well, they do. And emergency physicians do too. Chris Gee is an emergency physician who does sports. In sports medicine, they're probably family medicine trained and did a sports fellowship, or emergency medicine trained and did a sports fellowship. But that being said, their practice is primarily non-operative orthopedics, so back pain, shoulder pain, that kind of stuff. They're not really like, "Hey, how can you drop down to a BMI of 24 from 26?"

Scot: Yeah. All right.

Troy: So, in terms of that stuff, I think . . . But it's true, though. I think a lot of people are going to give the exact response he got, like, "Hey, you're fine. I just had a guy here who's your same age and has a BMI of 40." But I don't think that's the answer a lot of us want to hear. We want to be like, "Okay. I recognize that. Yeah, I'm better off than most people, but I'm not where I want to be."

Scot: And I think part of the problem . . . and this is, again, the BS talking. I think part of the problem is our healthcare system, and I've heard experts say this, is not set up for optimizing health.

Troy: No, it's not.

Scot: It's really set up for you go in and "We're going to prevent . . ." It's not even really set up for prevention, is it?

Troy: It's not.

Scot: It's more set up for, "I've got a problem. Can you help me solve that problem?" And the problem needs to be . . . I don't know how to categorize what that problem is.

Troy: It's like a school teacher in a lot of ways. The school teacher teaches to the middle of the class. They're not teaching to the slowest guy in the class and they're not teaching to the sharpest guy in the class. They're teaching to the middle of class. That's where I think a lot of . . . in healthcare, it is like, "Well, hey, you're above the median. If you've got a BMI of 26 and you're running two 5ks a week, you're doing great compared to most of the people I see." So that's part of the challenge.

And you do find, though, a lot of programs do really, I think, try to then help people optimize and go to that next level. And it's not necessarily a primary care physician. I know PEAK Fitness at The U has different things. It's more about optimizing than just about being like, "Oh, you're okay." So I know they offer a number of programs with that, which I know we've talked about before.

I know Intermountain has their wellness centers where they do that as well where they really get into a lot more of getting you on the treadmill, seeing what's your VO2 max is, or whatever they're measuring there, getting a lot more into the specifics of diet and exercise routines, and that kind of stuff, where it is I think more about optimization.

Scot: Is that something, though, that Scot would really need? Because it just sounds like he wants to get his blood pressure, which is a little high, and his BMI, which is just a little high, lower, and you're talking about putting him on the treadmill and checking his VO2 max and . . .

Troy: I don't think he necessarily needs that. But they do offer I think a combination of services that do that sort of thing. So I don't think it's necessarily getting him on the treadmill, but I think they do a lot more than a primary care physician would where they really do get more into the specifics. Because it sounds like he wants to drop a few more pounds and he wants to improve his blood pressure a little bit. And honestly, his blood pressure is really . . . it's fine. 126 over 78? That's all right.

Mitch: That's what I was focusing on. Is this a conversation about a doctor minimizing what he feels is a problem, or is this something where the definitions are giving us a strange feeling of what is and isn't healthy?

Scot: Oh, yeah.

Troy: Yeah, and that's a good question too. We talk about BMI and we've talked about that before. Is his BMI of 26.2, is he truly overweight or is this just a guy who has a lot of muscle? And what's his body composition?

But that's where I think, again, teasing that out is probably going to be more . . . maybe a primary care physician would help with that, but it's probably going to be more like one of those programs where they get you in the BOD POD, they get your body fat percentage, they really look at the specifics of your diet and what you can do there, and that kind of thing.

Scot: Yeah. So this even comes back to a bigger conversation that maybe this is not the time or place for, but I want to throw this premise out there because I find it fascinating. It's this population health premise, which is where medicine I think would like to move, where instead of going into a hospital and the hospital gets paid for solving a particular problem or an illness you have, the hospital or the healthcare system is given a certain amount of money to manage the health of a population.

And now that changes the priority. It changes the priority to instead of curing disease, preventing disease. So then you would start to see infrastructure pop up where you could go into a clinic, and when you are a little bit overweight or your blood pressure is elevated, then instead of just having that conversation with your primary care provider where they're like, "Well, you need to eat a little healthier and maybe get some more exercise," you get to walk right on down the hall to some people that can help you figure out why that's not happening in your life and how you can make that happen in your life.

Troy: Yeah. So much of the healthcare system is about putting out fires rather than really . . . The forest analogy, it's just about, "Oh, put out this forest fire. Put out this forest fire," rather than creating a healthy forest and that kind of thing. I don't know who the best guests to talk to him about that would be to have on, but maybe . . .

Scot: I was thinking, Dr. Pohl because she is into lifestyle medicine. She seems to subscribe to that.

Troy: Yeah. That's a great point. She would be great. I was going to say either her or . . .

Scot: I always come back to Thunder because Thunder is our nutritionist, but he's also so smart on so many other things.

Troy: Yeah. Thunder would be great. She would be great. Who was our guy's name that did the culinary medicine? He kind of did some of that stuff. He was a little more bigger picture as well, but I think someone like that would be . . . But yeah. I think Dr. Pohl would be great.

Scot: There's another physician I've talked to before that . . . I guess at our Sugar House Health Center we have a clinic that actually does help people with these types of things, losing weight, improving their blood pressure, the thing that I just talked about where you go in and then you actually have experts in those particular areas. As you said, a primary care provider might not necessarily be the best person to spend an hour and work through, "What are you currently eating? What's your current exercise look like? What are your barriers?" that sort of thing.

Troy: Yeah.

Scot: So I can look at that clinic as well and see if there's somebody there that might want to talk to him.

Troy: Yeah. And if they've got that kind of clinic, that'd be great. That'd be a great way to highlight what they're doing there because that's . . . Yeah, if they've got that sort of thing where there are people taking that time with people, I think that would be a good resource to have.

Scot: All right. Is this the point, Troy, you tell us that you actually put these people up to these emails?

Troy: I didn't. I promise. I sometimes joke with Laura that she needs to call in on the listener line and say something, but she never has, as far as I know. I'm like, "Please call the listener line."

I swear I had nothing to do with this. That's really cool to see. I do get occasional emails too. I think I told you about the one I got, the guy who was concerned about rabies and recognized me as a national rabies expert or something. He was like, "I've been handling bats. My family thinks I should get the rabies vaccine. What do you think?"

Mitch: That's such a good story.

Troy: I'm like, "Yeah. I agree."

Mitch: "Go do that."

Troy: "Yeah. Right now. Don't wait."

Scot: That's the nationally recognized rabies expert, Troy Madsen.

Troy: This is what the expert says. Yep.

Scot: Quit playing with bats. Quit dressing them up in little outfits. They're not dogs.

Troy: They're not dogs. They're not mice.

Scot: You can have all sorts of other exotic pets, but bats are not the best choice.

Troy: Don't recommend it.

Scot: All right. Well, those are a couple of interviews that will be coming up. Both of those individuals said they would be open to being on the show.

Troy: Nice.

Mitch: Cool.

Scot: What I'm currently trying to do is just track down who it is that we're going to have them . . .

Troy: Oh, those specific individuals that sent the email?

Scot: What's that?

Troy: The people who sent the email said they'll be on the show?

Scot: Yeah.

Troy: Oh, that's awesome.

Scot: Yeah. Now, we just have to find the right people to have on the show to talk to them, which I think illustrates another interesting component of our healthcare system. I did struggle with that. I'm like, "Oh, is it really a primary care physician?" Because they do know a lot of things and they do get a lot done and there are some that do specialize in that kind of stuff, but infrastructurally wise, they're not really set up to be able to have those conversations with patients because they've got other conversations they have to have.

Troy: Well, Dr. Pohl might be great for both of those, because actually now that you mention her, she may be a great one to talk about fatty liver disease too. It does relate somewhat to weight loss and that optimization. It's one of those things where you don't worry too much about it, but I'm sure she sees it. I'm sure she deals with it. So maybe even ask her on that.

Scot: All right. I'll start reaching out. Those are a couple of episodes to look forward to coming up. And if you want to get a hold of us, you can do so a lot of different ways. That listener line number, if you'd like to actually leave a voicemail, is . . . what is it? 601-55SCOPE?

Mitch: Yeah.

Troy: Yeah. 601-55SCOPE.

Scot: And you can also go to and you can enter in just a private message to us there if you want to do that as well.

All right, guys. As always, it's a ton of fun talking. Thank you very much to the two listeners that reached out. We're going to go to work for you so we can try to figure out if there are some solutions to your problems.

Thanks for listening. Thanks for caring about men's health.

Relevant Links:

Listener Line: 601-55-SCOPE
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