185: House of Horrors: Health Edition

Scot: If you've ever been to a haunted house, you know they have different things that kind of play on our fears, like some of us are afraid of monsters, some people are afraid of demon clowns, some people are afraid of vampires. They throw all these things at you to terrify you. But you know what? Most of those things don't scare me. I can't speak for Mitch and John, whether they scare you or not.

But if you want to scare me, you know what you do? You put together a health haunted house, the Health House of Horrors. There are a couple of health things that truly terrify me, and if you were to put those in a haunted house, I'd pee my pants for sure.

And that's what we're going to talk about today. We're going to talk about our own health fears, how they might make us act in less-than-optimal ways for our health, and maybe why we ignore them and what we can do to overcome them.

This is "Who Cares About Men's Health," with information, inspiration, and a different interpretation of men's health. My name is Scot. I'm bringing the BS. And today, the MD to my BS, our very own doctor of men's health, is Dr. John Smith.

Dr. Smith: Howdy.

Scot: And our health convert, Mitch Sears.

Mitch: Hey there. I'm excited for this high-concept haunted house.

Scot: Yeah, if nothing, we're not high concept on this podcast. So Halloween is done, but I was just thinking of this notion of a haunted house and things that scare us and I thought, "You know what? There are a couple things you could put in this haunted house that would truly scare me. The monsters, the ghosts, none of that scares me."

So today we're going to share some of our own personal health fears. It's a great way of modeling talking about these things, as sometimes us guys tend not to, and then how we can work through them, and then maybe why we don't always talk about them.

So first, before we get to our own health fears, I'm curious, Dr. Smith, you're a urologist. You're in a unique position as a men's health doctor. What kind of health fears do you hear most often from your patients?

Dr. Smith: I think a lot of the patients that I see are scared of . . . I think we're kind of all scared of mortality, but I think the aging process, getting older, slowing down, not being able to do the things we want to do. And then in my practice, I see a lot of people who are scared of losing, say, their sexual function, or others who have a family history of, say, prostate cancer, things like that, that come in.

They truly have a healthy fear of, "Hey, I've seen other family members or friends go through this, and it's not something that . . . I want to make sure that I'm proactive and I take care of it."

Scot: Yeah. So I think it's important to say that because you are a urologist, you have a unique perspective as opposed to maybe a cardiologist who deals with heart issues. They might have a different group of patients who would have different health fears, like cardiac events because of family history or whatever, lifestyle, that sort of thing.

So how often do you find these fears influence men's behaviors in your experience, Dr. Smith, from the patients you see, and what does that look like? How does that manifest itself?

Dr. Smith: I think it comes in two different ways. The people who are proactive and they get to your office immediately and they're like, "Hey, this is something that I've seen in my family," or, "This is something that I worry about," or whatever, and they immediately make an appointment. And then there are the guys that are like, "Yeah, this has been going on for like 10 years and I just figured if I didn't talk about it, it wasn't real, and now it's on the doorstep."

And so those are the two types of people that I have, the ones that are really proactive and they run in there and they're like, "Let's get this done," and the ones that have just tried to avoid it and bury their head in the sand until absolutely necessary to come in, or there's something that pushes them to come in where they can no longer deal with whatever the issue is.

Scot: Right. Like in the haunted house, when we see something super scary, maybe we close our eyes. Some of these guys close their eyes.

Dr. Smith: I had a roommate in college who was kind of that way. He'd say, "If we don't talk about it, it won't happen." So he did not have health insurance in college and he's like, "Don't talk about that, because if you start talking about it, then something bad will happen." Kind of similar concept.

Scot: All right, Mitch, pop quiz. Which one of those behaviors that Dr. Smith just mentioned do you think is more productive?

Mitch: It's so embarrassing because I've been both of those people. The one that maybe is a touch even on the edge of hypochondriac, needing to go in and get something checked immediately, to also, "Let's just not think about it. Let's not think about it ever."

Scot: Right. Because if I don't go in, I don't get diagnosed, then . . .

Mitch: Yep. Then I'm fine.

Scot: . . . it's not a thing. Yeah. So avoiding doctor visits, downplaying symptoms, those might be some common behaviors.

All right. Let's talk about our own personal health fears. If we were to build a haunted house just for each one of us of our health fears, what would be jumping out from behind the corner at us? I'm going to start with you, Mitch. What's yours?

Mitch: I've got two. So, first, you enter into the room, and then your stomach is a little achy or you got a bad cough, you've got phlegm in your chest, and, "Oh, no. It's all of the terrible things that can happen because of mistakes from your past."

Scot: Right. Smoking, drinking.

Mitch: To this day. I went hard in college, and so there are times that I'm just like, "Is this stomachache indigestion or is this my liver failing?" And this is one of the ones I didn't go to the doctor to for sometimes, where if I was wheezing or if I had a bit of congestion even, just a chest cold, I would be like, "Oh, no, it's the lung cancer. It's showed up and it's because of something I did forever ago." So that's my first big one.

Scot: All right. Dr. Smith, do you have any comments on that?

Dr. Smith: I mean, that's a legitimate fear. But at the same time, a lot of times some of those things, like smoking, once you've quit smoking and you've been out of it for a considerable amount of time, your risk of those things becomes relative to that of the general population if you look at the data. So I think if you've been out of that for a little while, Mitch, you may be able to breathe a sigh of relief.

Mitch: Oh, that's my hope. I do have a relationship with my primary care doc, and so he does do checks every so often for my liver function, etc., because he knows that I have had this fear in the past, and it's very appreciated.

Scot: Yeah, it's like having a big strong friend holding your hand as you go through the haunted house.

Mitch: You got it. Yep. Or it's like, "No, don't worry. This is not real. This is not going to get you this time."

Scot: Which is so important. I think, as guys, sometimes we think that going to the doctor should only happen when we have something going on, but there, again, having a relationship with a primary care provider that you perhaps go to and see once a year for your checkup and you have this little list of things that you can talk about can bring you such peace of mind, or help you develop a plan in case there is something that potentially goes wrong.

Just having that information is okay. Just to be able to talk about things is fine. I think that's a legitimate use of a doctor's appointment.

Do you agree with that, Dr. Smith, or does that annoy you when guys come in and that's their agenda?

Dr. Smith: No, I think it's great. I think one of the things that we do poorly with in our healthcare in our country just in general is preventative medicine. I think that that's something where if we had more people willing to come in and have those visits, I think we'd be better off. You'd know what to look out for, you'd be watching things, you'd have your team in place for if something did go wrong, but you also would know some of the pitfalls to watch out for on your way there.

Scot: Yeah. And if that ghost of smoking jumps out from behind the corner and you know, "Oh, I haven't been doing this for 10 years," then you're just like . . .

Dr. Smith: The ghost of Marlboros past.

Mitch: That's what I was going to say, the ghost of Marlboros past.

Scot: You just go, "Oh, you're not that scary because I know the deal with you." So you can then worry about the things you should maybe worry about or put your attention towards. What's your other one, Mitch?

Mitch: So you open the door and then it's just a whole bunch of icy stairs. No joke, I find myself grabbing railings and stuff these days because I've had some major accidents in the last couple of years. I slip, I fall, and then I'm in an ankle boot or considering whether or not I have to have ankle surgery on the same stupid ankle.

And there's part of me that's just . . . I keep slipping back. I'm not as active as I once was because I hurt myself. And there's a part of me that's like, "What happens if I were to hurt myself really bad? What if I were to have a really bad accident that maybe it would be very difficult for me to walk? What if it was really hard for me to do this, this, or this?" And so there are sometimes concerns about that.

Scot: Yeah. Is it concerns as you get older that stuff kind of starts to tend to happen anyway and you're already predisposed to it? Is that what you're afraid of?

Mitch: Well, I've been predisposed most of my life. Going back to college, I'm very proud to say I had six concussions in a year just because of my antics. So I think I'm the only person that has been on a CTE watch that has not played any contact sports.

Dr. Smith: Life is a contact sport for Mitch.

Mitch: Yes. And that's what's been kind of interesting, is that I'm still working with my physical therapist even though my ankle is stronger, because we're working on balance and stuff. Is there something about me that I'm a little clumsy, and can we strengthen me so if I do have that fall, it won't be as big of a deal?

Scot: I've got a couple personal health fears that I'm willing to share today. Number one, I like how you set yours up. I don't know that I'm going to be able to set it up as well. You go into the room and . . . I'm just making this up as I go now.

Mitch: I love it.

Scot: You see a Future Scot that can't get around and he's just got no mobility whatsoever. He can't bend down to pick something up off the ground, and he can't go out and do the things he wants to do as he gets older.

Mitch: Like a spooky hall of mirrors.

Scot: Yeah. So that's one of the things I'm afraid of. As I get older and as I watch people in my life who are older than me get older, just losing their mobility and their independence. For whatever reason, the muscles aren't as strong, so they can't . . .

And part of it kind of ties into what you're saying, Mitch. The balance goes or the strength goes, so you're afraid you might fall and hurt yourself, or you just can't even get out and do a two- or three-mile hike anymore and enjoy nature, or enjoy time with your dogs, or you're all hunched over when you walk.

So mobility is the big one for me. I'm terrified of getting older and losing my mobility when I'm 60 or 70 and I don't want to.

Mitch: That's interesting, because that's my same thing with the accident, but it's next year. It's now. So yeah, totally.

Scot: Dr. Smith, do you see people with mobility issues come in that that is one of their fears?

Dr. Smith: Well, actually, you'd be surprised. So a lot of the people who come in who've had injuries . . . I've seen patients with spinal cord injuries or that are just born with mobility issues come into the clinic because a lot of times it affects the urinary tract. I have patients who've had injuries via car accidents or extreme sports or things like that where they come in, and I've had those conversations with folks.

Sometimes I get the opportunity to kind of just dig in and, "Hey, we're going to help you out." Get to know them a little bit, know their backstory and how their injuries occurred, things like that.

I mean, I have a couple people who were swimming in the ocean and got pushed and had a neck injury, or people who are doing other things where they have these injuries, and now they're limited in their mobility as well as urinary function changes. Then they get to come and see me and we get to take care of them and help them have the best quality of life they can have.

Scot: My other one is you walk into the room and . . . I don't even know how you paint this picture. I can't do it, Mitch. You did such a good job. I'm just going to come out and say it. Metabolic disease.

Mitch: What?

Scot: Yeah.

Dr. Smith: Oh, diabetes, huh?

Scot: Yeah, diabetes, or just even in the short term on the day-to-day, I'm terrified that I'm spiking my insulin too much and that's going to lead to metabolic disease. Any time I have a sweet or a cookie or even a big plate of spaghetti, I'm like, "Oh, I'm spiking my insulin," and that kind of terrifies me because I'm terrified of what it might lead to.

Mitch: So the room is . . . there's a bunch of tables with big piles of cookies and your favorite treats, and there's a bunch of people guilting you to eat it all.

Scot: Yeah. Or the cookies and treats have legs and arms, and one can hold your mouth open and they start shoving themselves into you.

Mitch: Oh, that's worse.

Dr. Smith: Yeah, that's way worse.

Mitch: Why do you think you're so scared of that?

Scot: I don't know why. I mean, I have been tested and even though pre-diabetes is 100 to 130 fasting glucose, I've kind of been in the 80s and 90s a lot. One doctor thought maybe I might . . . they brought up pre-diabetes to me, so I think maybe that's what started it.

So that does scare me a little bit, I guess. It scares me a lot. And on this podcast before we talked about metabolic disease. Dr. Smith, metabolic disease is one of the . . . that's not good. That's one of the worst. As far as health outcomes, it can lead to a lot of bad stuff.

Dr. Smith: It affects everything. I mean, it affects top to bottom, eyes, feet, erectile function, blood vessels, heart, everything. It affects every system in your body. It's definitely one of those that's an aggressive one that can impact multiple areas.

Scot: Yeah. So if I'm, for the most part, pretty good, but once in a while maybe I go on a little bender and I'll have a couple of dishes of ice cream in a day, or around Thanksgiving I have two or three pieces of pumpkin pie, is that going to spike my insulin in such a way that it's going to lead to metabolic disease? Help me with my fears here.

Dr. Smith: I mean, a lot of it just comes down to what you're doing consistently. You've got to have those times where you have some of those things. Those things are there. You're not going to get diabetes from eating a couple pieces of pie. Now, if you just make it a point to eat two pies a week for the next couple years, you're going to set yourself up for something big.

Mitch: Marie Callender's challenge.

Dr. Smith: But it's the long-term stuff. I mean, the short term where you have a cheat day or whatever, when people are on diets, those things help your body to kind of reset and go, "Hey, wait a minute."

And so, yeah, I think you're fine. And if you've had testing done, that's reassurance. When you receive reassurance, you should be reassured. It shouldn't make you more anxious.

That's one of the things that I find with some people, is I give them reassurance and they're still super angsty about whatever it is that we've just given them reassurance about. That reassurance should be reassuring.

Scot: Yeah. Plus I try to be good about getting my activity in, which I know is a big component of metabolic disease, right? If you do strength training and you do some vigorous activity, in addition to consistently kind of eating for the most part okay, that can really manage it. But that is something that scares me.

All right. Dr. Smith, how about you? Do you have a health fear? What scares you?

Dr. Smith: Mobility is one of mine. So I had some knee injuries in college. I had three ACL reconstructions done on one knee, and so that's a big fear of mine, is that at some point I'll have an issue with this leg where I'll lose some of my mobility ability to do things. I had ankle surgery on that same leg as well twice. I've had five, six surgeries on that one leg, so that's a big fear of mine, that later on down the road it's going to turn into an arthritis situation or something else.

Mitch: I didn't even think about that. Ugh, okay.

Scot: Dr. Smith just jumped out behind the wall and scared Mitch, right?

Mitch: Got clicky knees or something. Yeah.

Dr. Smith: I mean, I've had four surgeries on the one knee. They did three reconstructions for an ACL, and then they had to do what's called a tibial tunnel rebuild where they had to put a bone plug in because they'd already kind of blown up the bone. And so I know I already have arthritis in that knee. It gets sore after I get done doing things here and there, when I go a little bit too hard. That's a legitimate one for me where I feel like my knee is 75 and I'm still 45. So that's a tough one.

And then for me, I don't have a lot of family history. My parents split when I was really, really young, and so I don't have a lot of family history on my dad's side of the family. And so that's always one of those things where a lot of people have had cardiac issues on his side of the family, but a lot of them were also heavy smokers.

So, for me, trying to parse out how concerned I should be about my heart health versus "Was it the two packs of unfiltered cigarettes a day that made him have a heart attack, or was it that he actually had cardiac issues to begin with?" Because it's been pretty rampant on that side of the family. So that's another thing that I have some concern about.

Mitch: Just the unknowing of the family history. Interesting.

Scot: Or just knowing what caused it. Is it the smoking or is it the family history? So I take it you don't smoke, Dr. Smith?

Dr. Smith: No, I've not been a smoker. They were really good examples of what not to do. It was very helpful.

Scot: Then it's like, "Well, I haven't smoked, so does that mean I'm still going to be at risk, or was the smoking the cause of the risk?" I totally get that.

I have a similar thing with my family. My grandparents, both sides of the family, smoked until the day they died, and it wasn't lung cancer that got them, it was something else entirely. But nobody drank, and I drank beer early on my life. So much like you, Mitch, I'm concerned about, "Our family hasn't tested that. How do we react to that?"

Mitch: Right. And I guess for me, too, my family is not . . . I mean, mean they're around, but they are not good at talking about health. And so I know that I have some grandparents, some aunts and uncles, some people who've had real issues with everything from diabetic issues to what I can only assume is cardiac issues. But they play it off as, "Oh, it's just the flutters," when it comes to their heart palpitations.

It's like, "So did you have a heart attack?" "Well, I was just overthinking whatever." I can't get straight answers, and that is something that also kind of scares me sometimes, is just, "Ugh, what does that mean?"

Scot: Dr. Smith, any other ones you want to share?

Dr. Smith: Those are the main ones that really get to me. I've tried to improve my diet and my weight. After residency, I was ballooned up to about 260, and then I'm down about 60 pounds at this point. I realized that weight wasn't going to be sustainable for my body. So I think just maintaining healthy eating habits.

Kind of like you, I have a sweet tooth. If there's a good treat in front of me, I'm probably going to eat it, and I might eat the whole bowl of it. I'll not even feel bad about it.

But yeah, those are things where I'm just putting myself in a position to hopefully have better health and be a better example for my kids hopefully to see eating habits that maybe I didn't get the example for.

Scot: So as we kind of start to wrap this episode up, what are some ways that we can manage these fears? I think fear is a useful emotion insofar as it causes us to examine something and to potentially change when necessary. And I think we've hit a couple things.

Dr. Smith, do you want to start since you are the doctor, and give us some ideas? And then Mitch and I can jump in if there's anything that's kind of missing there.

Dr. Smith: Yeah. I think one of the things . . . obviously, I could give you the, "Go to your doctor, get a health checkup, check your blood pressure, blah, blah, blah. Get those things done." Important things to do. So I would be remiss if I didn't tell you to do that.

But I think one of the things that I have found is most people that I've met with who have health issues, they all knew it, and a lot of times they didn't listen to themselves or trust their gut.

That's one thing that I think nowadays with all the, "Do your research and look on the internet and blah, blah, blah" . . . What does your gut tell you? Deep down, what do you know? You know your body. I mean, I've lived with mine for 43 years now, right? And so when something doesn't feel right, I have a lot of people who will push it away and go look for an answer somewhere else instead of just trusting their gut.

And I think that's one thing where most of these folks, when they're honest with themselves looking back, they go, "I thought something might've been wrong a little while ago, but I didn't want it to be true."

And so I think when you have those thoughts, just act on it. Go in and say, "Hey, something didn't feel right." And if you get that reassurance from your doctor and you do the test and everything looks good, great. That would be my recommendation.

Scot: Yeah. That'd be the best-case scenario. And sometimes when we go into the doctor and the doctor's found nothing, we feel like we've wasted time or, "Well, they couldn't find anything." Well, that's good actually.

Mitch, any ideas how to manage those fears?

Mitch: Oh, yeah. One of the big ones that I have found through the years of doing this podcast is just talking with other guys, talking with friends and family, being vocal about your health, health journey, etc.

One of the things that I've kind of run into is that I have people who have talked to me about, "Hey, trying to quit smoking and I'm kind of scared of it," and it's like, "Well, I've done it a billion times now. Let me tell you what does and doesn't work for me."

It's been interesting to kind of be that person for other people, the one who can actually talk about health and help put other people's . . . give them a little bit of reassurance, let them know if there's a treatment or something I've heard about, etc. It's been kind of cool to put people's minds at ease a little bit by having those open discussions.

Scot: One of the most powerful ways . . . Us guys like to solve problems, right? So what is that health fear? Figure out what you can do to minimize that health fear risk.

And the internet is a good resource if you find reliable sources, not just necessarily what you're seeing on TikTok or Instagram. Not that there aren't some out there.

But talking to your doctor and saying, "Hey, you know what? I have this fear of metabolic disease. What can I do to alleviate that?" Come up with a plan of what can be done. "Well, let's take a look at your diet," and then you take a look at your diet and you start to make some small changes. Then you take a look at your physical activity, and you start to make some small changes. You start to do the things that can help make those potential problems go away. You're taking some action, so then you don't have those fears quite so much anymore.

So I think let fear do its job. Fear is telling us that something is not right and we need to maybe do something about it. Figure out what that something is, what those important somethings are, and then just start taking small steps. It doesn't have to be all at once, but just those small steps.

So another thing that can terrify guys is just sharing their fears, right? Doing what we just did, showing some vulnerability and talking about our fears and putting aside some of our masculinity, like, "Oh, I'm not worried," those social expectations of how we're supposed to behave. How did you guys feel about this? I mean, I didn't have a problem, but we've had some practice on this podcast. Mitch?

Mitch: I did find it interesting that I immediately made a joke out of all of it, right? I know that's kind of the treatment we were going for, but there is something interesting about just taking that approach.

But yeah, it felt weird kind of sharing it, even to this day. It's one thing to be like, "Hey, I'm working on my health." It's another thing to be like, "I am afraid of this thing." That was an extra level for me today, but I'm feeling pretty good about it.

Scot: As a doctor, I doubt any of this bothered you at all. Right, Dr. Smith?

Dr. Smith: I mean, I'm not bothered by sharing things. They do a lot of role-playing in medical school too, so you get used to just saying stuff like this a lot. Or at least in my medical school we did. We kind of helped each other get through things and answer those questions, and so it's become more of a normal thing.

It's still not the easiest thing in the world, but I think it's one of those things where we're committed to helping men improve their health. We've got to lead out by example. So to me, that's one of the things that helps me just say, "You know what? To hell with it. Let's go. Let's put it out there because all these people that are going to listen to this are going to hopefully take that as an opportunity to go in and be vulnerable with their doctor or their healthcare provider, whoever it is that they end up seeing, or family member or friend that they're talking to."

Scot: Do you as a provider find that sometimes just getting things out in the open and talking about them like this with patients that might have been hesitant before can motivate them to be healthier, to take action?

Dr. Smith: I found that just being very direct about things is the best approach, because a lot of people have these fears of coming in and this fear of the discussion. It's just like, "Hey man, this is what you're here for. Let's go. You don't want to take an hour to beat around the bush and then finally get to the point. Just tell me why you're here. Let's get through this. And then at the end of the day, we're going to have this relationship together where you're going to come in and we're going to be able to talk openly about everything going on."

I think, to me, that's the best approach that I have found, is just to come in and go, "Hey. So you're here for erectile issues, huh? Awesome. How long has it been a problem? Let's just jump right in." Let's not go, "Well, it's kind of been going . . ."

Scot: It's like ripping that Band-Aid off.

Dr. Smith: And a lot of times, it'll just kind of be a slow moving, like, "It's been going downhill for a while." Well, what's been going downhill? Let's be very direct about where we're going here with the conversation. And I think for some people that works really well, and for other people, it doesn't. So I think reading the room helps as well, but I think for the most part, with most guys, the direct approach works really well.

Scot: Right. It's like turning the lights on in the haunted house. All of a sudden, it's not as scary anymore.

Dr. Smith: You see behind the curtain, right? I mean, the Wizard of Oz is just this little short dude back there who's talking into this big speaker.

Scot: We're mixing our metaphors now, but I think . . .

Mitch: It's fine. I'm in it.

Scot: All right.

Dr. Smith: I do what I want.

Scot: Any final thoughts before we wrap this up? I think this was a good conversation.

Dr. Smith: Don't be scared. Just go in and face those fears and get through that haunted house.

Scot: Just turn that light on and go, "All right. That's not that big of a deal."

All right, guys. Well, thanks for being so open today. I appreciate that. Talking about our fears can sometimes be a very difficult topic to discuss, but it's definitely worth having, even if it's not Halloween, if it's the middle of spring. If you have any health fears, you should find a medical provider to talk to and you should get that out in the open and just face it directly.

I'd like to thank everybody for listening. If you have a health fear that you would like to share, and you can do so anonymously or you can do so on the record, or if our conversation sparked any other thoughts or questions, why don't you let us know? Reach out to us at hello@thescoperadio.com.

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