Nov 24, 2020

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: All right. We're starting it over. I hit Record.

Dr. Chan: Rookie mistake. Sorry, Scot.

Scot: I swear to God. But you know what I didn't do? I didn't look to verify that numbers were moving. I did a rookie mistake. You're right. Here we go.

Dr. Chan: I'm just teasing you, Scot. I make that mistake still to this day.

Scot: Nope. I deserve it. I deserve it. That is as rook as it gets. Like I was born yesterday. Don't act new. All right. Here we go.

Your health is the currency that enables you to do all the things that you want to do, and that's why you should care about men's health. That's the name of this podcast, "Who Cares About Men's Health," giving you information and inspiration to better understand and engage in your health so you feel better today and in the future.

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

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

Dr. Chan: I'm Dr. Benjamin Chan. I'm a child and adolescent psychiatrist here at the University of Utah, and I also care about men's health.

Scot: All right. We talk about the core four on the show of course. Troy, why don't you go ahead and remind our listeners what the core four plus one more is?

Troy: Don't make me do this, Scot. You know I can't remember the core.

Scot: That's why we made it the core four, to make it easy.

Troy: I know. Seriously

Dr. Chan: Troy, teach me about the core four.

Troy: Diet, exercise, sleep, mental health, and the fifth one, the one more besides the core four is know your genetics.

Scot: Yeah. Those are the things if you pay attention to will help you stay healthy now and in the future. Of course, mental health is a big one that us guys generally don't talk about or think about that often. That's why we have Dr. Chan on today. So even though you're a child psychiatrist, can you talk to us about adult manly things?

Dr. Chan: I can do it my best. And sure, yes, I'll try to talk about manly things today.

Scot: And for our women listeners, who I know that we have women listeners, no jokes about how having a child psychiatrist on a men's health show is just perfect, because we're not laughing at that joke that we have the psyche of children. Okay? We're not laughing at that.

All right. So, Dr. Chan, before we get to what I wanted to talk about today, which was the practice of showing gratitude . . . we're coming up on Thanksgiving. It's in the name of the holiday Thanksgiving. But a gratitude practice is actually just a really good way, from what I understand, to remain mentally healthy. And I want to get your take on that and talk about that a little bit.

But first, I want to talk about what are you seeing right now as a result of COVID? Have things changed in your practice from a mental health standpoint?

Dr. Chan: They definitely have, Scot. First of all, I just hope everyone is safe and healthy and doing the best they can out there, and I'm glad you're listening to this podcast as a way just to learn more. And yeah, we're about eight, nine months into this pandemic, and we're definitely in a marathon.

Going back to your question how this has impacted mental health, we're seeing higher rates of depression, anxiety, post-traumatic stress disorder across the board. And this has been incredibly taxing for men and women alike as well as for children and adolescents, because we're living in truly unprecedented, challenging times.

How we communicate, how we connect to others has been dramatically altered. Many of us who are used to working are now doing it through Zoom or teleconferencing. Children/adolescents who are going to school have had their school schedules disrupted. It is incredibly hard and difficult right now, and just the amount of stress and anxiety that is placed upon us during these times is just totally new and unexpected and it's just ongoing, going back to my marathon comment.

Troy: Ben, I'll tell you, Scot has run a marathon, I've run a marathon, and I would much rather run a marathon than do this. I'll tell you that. But you're right, it is a marathon. I think we thought that two-week shutdown in March that it was going to be a sprint and we would get through the two weeks and we'd emerge on the other side of that and everything would be back to normal. But I keep telling people, "Hey, circle 2022 on your calendar and maybe that's when things will be back to normal. Maybe."

Scot: Dr. Chan, question for you. So if there's a guy or a person listening and they're like, "Oh, this hasn't affected me. I'm fine," is that generally true, or are we just not in tune to the symptoms that are indicating that maybe we're not fine?

Dr. Chan: So if someone is thinking that they're fine, I would say that is probably true for a small minority of people. The vast majority of us are not fine. And I would argue that if someone feels that they're "fine," I'm not sure that is also true for their loved ones or their family members or the person they interact with at the grocery store or their local school or if they belong to a church.

This is impacting everyone everywhere. And when people are stressed or overwhelmed or feeling isolated around you, it's going to impact you eventually. So even if people feel fine right now, I don't think that's sustainable.

Troy: It is tough. And it's interesting you mention that about maybe thinking you're fine and maybe you're not fine. I've found it kind of interesting these studies that have shown how many people report increased anxiety, depression, etc. And for me, the most surprising thing out of these is that more people aren't reporting that, like it's doubled or . . . What's your take on that? Do you think people are under-reporting or maybe in denial over some of the symptoms they're having?

Dr. Chan: Yeah, there's definitely a denial piece to it and under-reporting symptoms. I think all of us manage our stress differently. I think people are kind of going to extremes, as it were.

Again, this is all very anecdotally because this is unfolding real-time. I've had a number of patients and colleagues tell me that they have children or adolescents who are just bingeing more video games or watching more Netflix or just kind of tuning out reality, turning more towards social media, reading the comment section on social media, commenting on social media. Anecdotally, I'm hearing higher rates of drug abuse or difficulty sleeping.

Right now, one thing that is thriving is all the drive-throughs. So, again, is it a positive coping skill to go to your favorite restaurant? I think it's normal to kind of go out to eat, but going multiple times a week is probably not as healthy, and I think that violates one of the core four as it were.

So I think all of us are running towards coping skills that are not really positive, especially in big doses such as social media, plugging in, eating out. These are all things that people are turning to and that, Troy, is maybe why it's being under-reported.

Troy: Yeah, I was going to say it's funny you mentioned that about eating out. Every night we look at doing something, my wife and I, we're like, "We'll go to a movie. Oh, there are no movies. What about shows? Oh, there are no shows. Let's go eat out again. Let's go to the drive-through." So yeah, I understand that.

Dr. Chan: I've got little kids and we've turned to Crown Burger because they give out free kiddie cones and my kids love those. Again, before the pandemic, maybe we would go on the weekend once and that's turning into more than once a week.

Troy: I know. It's like every other night.

Scot: So us guys can sometimes be notorious for not recognizing when we're stressed, when we're anxious. We just think it's part of life. We just kind of discount those feelings. It sounds like maybe one thing that might indicate that mentally you've got something going on is what you just described. Are you bingeing things? Are you doing some things to excess? I consider those distractions. I'm trying to distract myself from whatever it is going on. It sounds like that might be one indication. What are some other indications?

I mean, it manifests itself differently in everybody, right? So what are some other indications that somebody might be dealing with some mental issues and not even really be aware of it? I've heard getting angry could be one of them. Losing patience could be another. Is that true?

Dr. Chan: Yeah, I agree with that, Scot. That's all true. If you feel your temper, if you're just being short with people, if you're not being as patient, that is definitely a warning sign because that's not who you are. But I think everyone right now is stressed, and stress, again, as we talked about, manifests itself very differently.

Another one that came into my mind too, Scot, is just lack of concentration, the inability to focus. I don't know how many people I've talked to told me that projects that used to take a short amount of time now take a lot longer. That book you pick up at night to read, now people are tuning out after a couple of pages. It's just much more difficult to focus right now, and that is definitely a warning sign of stress, depression, and anxiety.

Troy: Maybe it's just me, but it seems like on the road people are just edgier, like more aggressive drivers. And there's certainly been an increase in traffic fatalities and they've said, "Well, it's because there aren't as many people on the road, so people are driving faster." But I wonder if that's a manifestation as well. People are just kind of edgier and more aggressive and maybe one other symptom of this we're seeing as well.

Scot: So if you notice some of these symptoms, of course that can impact your health, not only your emotional health but your physical health, as Dr. Chan said. Maybe if your outlet is drinking too much or eating the wrong kinds of foods too often, that might not necessarily be healthy. So what are some things that one could do to perhaps put themselves in a better mindset?

Dr. Chan: First of all, we cannot take care of people around us if we cannot take care of ourselves. So I've been more and more preaching self-kindness, self-awareness, taking breaks. I know we talked about a marathon earlier, but I really advocated exercise and going for walks just to start healing yourself. And that helps with sleep. That helps with body regulation.

I really believe that we just need to be less hard on ourselves, because going back to what I said about the projects . . . and I'm guilty of this too. I'm not responding to emails as quickly. I'm not as effective in a meeting because our brains aren't used to Zoom.

The cognitive load of trying to balance all these different things with my team across . . . everyone is working from home. Everyone is working remotely. Things just take longer. And so I'm just trying to be much more patient both with my family as well as the people I work with, just knowing that everyone is doing really the best job they can. And people's efficiency is not as strong as it once was.

Scot: Troy, do you have a gratitude practice in your life?

Troy: That's a great question, Scot. I know you've mentioned you do journaling and that's something I do as well. I think since we've talked about it, I've tried to do that more consistently on a daily basis. And as part of that, I do try and think through some of the things I'm grateful for.

It is sort of a process every morning of doing that. And so I've long believed that gratitude and expressing gratitude and feeling gratitude certainly makes a big difference, and it's probably become a lot more important to me during the pandemic and during what we're experiencing.

Scot: Yeah, you're right. I do journal and I try to come up with three things I'm grateful for every day. And some days it's really hard, but I find that just the act of looking for that makes me feel better about things. And sometimes that gratitude might be, "Hey, you know what? I learned a new skill today," or, "Hey, I got this major project done," and it gives me a chance to be grateful for something that I might not have necessarily thought about and then would have just let my mind go, "All right. What do you have to do next?" It's like a little party, a little celebration.

Dr. Chan, do you have a gratitude practice, and has it been proven to help people feel better and actually help their mental health?

Dr. Chan: I do have a gratitude practice. I like to send thank you notes. And especially in today's age of email and social media, I really feel like a handwritten letter of gratitude goes a long, long way. All of us on this call used to remember a time when we would run to the mailbox to look for mail. Now, email comes to us instantaneously, but I still think a really nice, well-written card or letter really can touch people in a positive way.

As I alluded to earlier, I think people are looking for a way to connect to others. And even if you can't meet with your loved ones, even if you can't meet with your team, your work colleagues, I still think there are other ways to express gratitude.

So the research has shown that people who express gratitude have lower rates of depression, increased rates of happiness. They feel connected to others. There's a warmth there. There's an ability to have empathy.

Again, all of us are working incredibly hard. Everyone is doing the best job they can. And to have a meaningful way to say thank you goes a long, long way to feeling that you were listened to and heard.

The research also talks about the ability to form alliances and building trust between people when you express gratitude. I know this is a men's podcast, and so I was looking up some other literature, and there's this old stereotype that I'm not sure if all of you have tackled, that men are a little bit less likely than women to express their emotions. I think this gratitude concept falls into that. Men are slightly less on average -- again, it's a very stereotypical comment -- to express gratitude to others as opposed to women. So I think there is something there.

Again, let's use this time as an opportunity to say things and have men thank the people around them for either the love or the jobs well done.

Troy: Ben, it sounds like it's not so much, like Scot and I are talking about, just writing it down. It's more that expression of gratitude and that connection that comes to others as we let them know we're thankful for what they do, we're thankful for their role in our lives, or whatever that may be.

Scot: Troy, I think we've been doing gratitude wrong. Dr. Chan, I thought the gratitude practice was finding two or three things every day that you were thankful for, but it sounds like truly it's reaching out and connecting to somebody. Or are they both gratitude practices that could give you benefits?

Dr. Chan: Well, Scot, I would say both the way you phrased that. The gratitude practice, yes, you can identify two or three things every day that you're grateful for. But again, we're in a pandemic. People feel isolated, people don't feel listened to or heard, people are feeling a little scared, so I think this is an opportunity to connect to others and give thanks for who they are and what they are in your life.

So if I asked all the listeners out there, "Who are the five people you're most thankful?" some of you will think about your wives, yours husbands, your partners. Some of you may think about your friends. Some of you may think about your coworkers. When is the last time you said thank you to them? When is the last time you took a break, took a pause, and connected with them, and just genuinely let them know you're appreciative of who they are and what they are to you?

To me, that's Thanksgiving. That's what we're trying to do. And so, yes, I would argue that there's a connection aspect to it.

Scot: Troy, I really appreciate that you're in my life.

Troy: Thanks, Scot. And I appreciate that you're in mine, and, Ben, I'm grateful you're on our podcast.

Dr. Chan: This is so cheesy. I love it.

Scot: What I'm getting at, though, is that feels weird. Even though I grew up on a ranch, which has its own stereotypes. My dad was as stereotypical of a rancher as you could get. I'm a little bit more sensitive, as my mom likes to describe it.

And sometimes when I do say things like that to other men, like, "I really appreciate that you did that for me. Thank you very much that . . ." and I maybe might give a specific reason why that made a difference to me, I feel like guys pull away from that, like I'm stepping over some line I shouldn't have stepped over, like I did too much.

Dr. Chan: Yeah, you don't need to do it on a podcast in front of hundreds of thousands of people who listen to this.

Troy: I think you underestimated our numbers, Ben, but go on.

Scot: We'll forgive you.

Troy: We'll forgive you.

Dr. Chan: But think about how hard you worked on a project, Scot, and if someone, your boss, your supervisor, we all have bosses, we all have supervisors, just that short little email, like, "Hey, Scot, that was a great job," how much that would mean to you.

So I'm not saying it has to be in person or over a podcast. Everyone accepts praise. Everyone accepts that ability to connect in different ways. And I think that's who we are. We as humans have different ways of communicating our emotions to others.

So I guess what I'm saying is this gratitude idea, this gratitude project, what are some ways you can express gratitude to those around you? And it might be a handwritten note, it might be an email, it might be a phone call, it might even be a text.

I mean, my best friend from high school I don't talk to very often, but I get really sweet texts from him every once in a while and it just makes the world to me, and I save all of those. So I think you just have to know your audience. Who are the people you're trying to connect with?

Troy: I'm feeling guilty now. I feel guilty. I'm thinking about my best friend from high school. I haven't been in touch with him in probably seven or eight years. Like you said, this is a time where I think we just need so much more connection and just a text or something to say thank you to someone. I'm sure it means a lot to that person, but just personally, to have that connection, I think, can help us out a lot as well.

Scot: Dr. Chan, I think you've given us all a really great idea as we head into Thanksgiving, especially a Thanksgiving unlike any Thanksgiving that we've had. It might be a Thanksgiving where we might decide as a family unit, each one of us, that perhaps getting together with other family units as we have in the past is not necessarily a great idea this year, but there are other ways, it sounds like, you can reach out and let somebody know that they matter to you and they mean something to you.

And it doesn't necessarily have to be a family member. It could be a friend, somebody you haven't talked to in seven years, and you don't have to go all Scot on them. You don't have to get all gushy. Maybe start with just a thank you and then see how they accept. You described your interaction with your friend as these sweet texts, which to hear a guy say that about a text from another guy is a little strange.

Dr. Chan: But as a psychiatrist, I like to feel that I'm in touch with my emotions. The people in your life, be it men or women who care about you, they'll communicate that to you in very profound, meaningful ways.

All of us have bad stuff happen in our lives. I mean, the thing that's impacting all of us right now is a pandemic, but all of us have had breakups, we've had loved ones pass away, we've received failing grades, we didn't get that promotion at work. And just those negative emotions are really difficult. How do you leave them when someone reaches out to you that cares about you and just lets you know they're thinking about you and you can share some of that burden with them?

So I say sweet texts. I can just think of moments in my life where I felt pretty down and my best friend reached out to me and just let me know he was thinking about me and he was thankful that I was his friend, and that just meant a lot to me. So that's what I meant by sweet texts.

Troy: Scot, I didn't even think twice. I thought Ben was just like, "Sweet, man. That was so sweet."

Scot: Sweet text.

Troy: "Sent me this link to this awesome ACDC video."

Scot: I love your challenge, Dr. Chan. Think of five people that mean something to you, reach out to them, let them know. Even if it's just reaching out to say hi it sounds like.

How many times have each of us or any of us just been like, "Wow, I haven't thought of that person in forever, and we were so close at one point"? Well, when they pop in your head, then sometimes you're like, "Well, maybe I'll reach out," and then you're like, "Nah, I don't want to interrupt him or anything." Maybe instead of going that path, you go the path of reaching out. That might be a good place to start.

Dr. Chan: I mean, the weird thing is, and I talked about this too, we exist in this culture right now where we spend hours Netflixing and bingeing or social media-ing. But compare that to how many times you've had like a real conversation with someone you care about in your life. I mean, the ratio is dramatic. That's why I'm just kind of recommending and talking about just connect with others.

Scot: Get out of Twitter. Maybe text or call a friend and show a little bit of gratitude this Thanksgiving. It could do wonders for your mental health.

Dr. Chan, thank you so much for being on the podcast, and thank you for caring about men's health.

Scot: Paging Dr. Troy Madsen to Scope Studio for "ER or Not."

"ER or Not," that's where we throw out a scenario for you, you decide whether or not it's something to go to the ER or not, and Dr. Troy Madsen is going to let us know whether or not you guessed correctly.

Today's "ER or Not," you have some food stuck in your throat. I'm talking about you're breathing fine, it's not obstructing your airway, which is definitely always a reason to go to the ER if that airway is blocked, but it's just there and it won't come up, it won't go down. It's uncomfortable. ER or not?

Troy: Well, this is one of those things, again, emphasis on it's not affecting your airway. It's just something you feel is stuck in your throat. People often point to the base of their neck. They can't swallow even their own saliva. They're just spitting it out.

It's something you very well may have to go to the ER for, but there's a trick you can try at home before you go to the ER. And that is take a soda, usually a Cola, and try and drink a little bit of it down or get some of it down where it's not coming back up and let it sit there. Now there's something about soda, and Cola in particular, where it can relax the esophagus. And it's a trick you can try to potentially get that food to pass and get down to the stomach.

So this is something that you may avoid a trip to the ER for because your only other option is to come to the ER. You can't go to an urgent care for this. You have to come to the ER, ideally a larger ER, a center that would have a gastroenterologist on call because they're going to have to come in and retrieve that piece of meat or whatever it is and either push it down to the stomach or pull it out.

Scot: The soda route sounds like a thing to try first before you do that.

Troy: Absolutely. If it were me, I would try and grab a soda. And again, the challenge is sometimes that it's obstructing things so much that you're even spitting up your own saliva. But if you just feel like something is stuck there, try and get some soda down there. Just let it sit there, five minutes, see how you feel. Give it another five minutes. For me, personally, I'd try three or four times, and if it's just not working and nothing is going down, then you've got to get to the ER.

Scot: And again, to stress, in this scenario, you've got something stuck in your throat like a piece of food, but it is not obstructing your breathing. It might be causing that you can't swallow your saliva, but you can breathe okay.

Troy: Right. Anything that's obstructing your breathing, that's something you need to get immediate help for. Even then, not just ER, but call 911.

But if you do this and it's not obstructing your breathing and you drink the Cola and it resolves, you probably still should get in to see your doctor. You may sometimes have these rings in the esophagus, little things that food get caught on, that it would be worth having an endoscopy done at some point to look to see if that's there to prevent future problems. But no rush to do anything once it resolves.

Scot: "Just Going To Leave This Here." It's a part of the show where we might talk about something having to do with health or something that's going on in our life, or it could be something completely random and fun hopefully.

Troy: Hopefully. It's always questionable.

Scot: It is questionable. We'll see. Here we go. Just going to leave this here. I've made an observation about myself and I want to know if other people have this same kind of issue. If you give me a decision, which line to choose in the grocery store or which lane of traffic to choose when I'm driving somewhere, I'm always going to make the one that takes longer. Always.

Troy: That's the rule. That's how it always works.

Scot: I'll be standing in a grocery store line or I'll choose between two of them and I'm like, "That one looks like it might be faster." And as soon as I get into it, inevitably that's going to be the one that takes longer.

Troy: Every time at the airport. You've got four lines to choose from and I always choose the wrong one.

Scot: I don't know why that is, but that's my "Just Going To Leave This Here."

Troy: I'm glad I'm not alone in that. I'm just going to leave this here. You said this could be interesting and fun, so now it's not because I'm talking about science fair. My nephew just competed in science fair.

Scot: That's awesome.

Troy: Did you ever do science fair?

Scot: I did. I got the people's choice award for my telegraph, which would have been a great science . . .

Troy: You invented the telegraph? Scot . . .

Scot: Which would have been a great science fair project in 1890.

Troy: A hundred and fifty years ago, it would have been awesome.

Scot: But I don't know.

Troy: You would have been a thousandaire by now.

Scot: Yeah. It was a study in magnetic because that's how old telegraphs worked. But that was what intrigued me. My friend, by the way, did a solar-powered engine, so he was way on the cutting edge of things.

Troy: Oh, wow. He was on it.

Scot: Before solar power.

Troy: So my nephew did a project. He looked at golf balls, and he had these golf balls soaking in water for various periods of time to see how it affected how far they would bounce and fly. The idea being that he would fish golf balls out of streams by golf courses and sell them to golfers. He found they don't work as well. It was a cool little project, just a fun kind of idea.

I'm just such a nerd. I did science fair when I was in high school and junior high. This is what I actually did. I actually took soda bottles and did swabs on those bottles to see how many bacteria are on soda bottles, and it was disgusting. This was the stuff you'd buy out of vending machines.

Scot: Oh, so a vending machine soda bottle?

Troy: A soda can. I shouldn't say a soda bottle. A can that you're putting your mouth on and drinking out of. So not a bottle.

Scot: That has not been opened. So you'd go to the store or vending machine, you'd buy one of these, and then you'd swab it, and then you'd see what's living on it.

Troy: Yeah. And this is what we're putting our mouths on. So that was my science fair project, was taking soda cans out of vending machines and from stores, doing a swab, and then growing it and seeing the stuff that grows there.

Scot: Nasty. Like stuff that could impact our health?

Troy: Potentially. I don't know. I never . . .

Scot: You didn't quite get that far.

Troy: I didn't quite get that far. I did not isolate the exact strain of E. coli that was on there.

Scot: There wasn't E. coli on there, was there? I don't want to start rumors on the show.

Troy: I'm going to have to go back to my science fair project, so don't quote me on saying there was E. coli.

Scot: We'll look at the data. I know people that wash off or wipe off the top part of their soda cans before they use it. So that might not be a bad idea.

Troy: I would. Even if it's coming from a box, it probably sat in some factory for a while, and there's a certain limit on the number of rat hairs and the amount of . . .

Scot: Oh, come on.

Troy: I'm not joking. You can have X number of rat hairs . . .

Scot: Oh, I see.

Troy: . . . and X amount of rat droppings and urine within some kind of facility that still meets health code. I know this is disgusting.

Scot: And we're not saying that's actually on there, but the potential . . .

Troy: I'm not saying there's rat urine on the . . .

Scot: There's an acceptable range as opposed to not an acceptable range, which I would think . . .

Troy: Exactly. Some is acceptable. Anyway, this is a long way of saying that science fair is great. I enjoyed the process of discovery, and it's fun that kids are getting into this. So that's my "Just Going To Leave This Here."

Scot: All right. There you go. That took a completely interesting path.

Troy: It sure did.

Scot: And that's sometimes what happens with "Just Going To Leave This Here."

Troy: Exactly.

Scot: Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, thank you so much for listening. It means a lot that you're taking ownership of your health and you're getting some information and inspiration here. If you haven't yet, please subscribe so we can be a part of your life every week.

Troy: Yeah. Subscribe through anywhere you get your podcasts. You can check us out on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. You can contact us, hello@thescoperadio.com. Thanks for listening and thanks for caring about men's health.

For Patients