Sep 22, 2020

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Scot: I'm sorry, give me a second here. I've got all these reminders coming up telling me I need to eat a salad.

Mitch: A salad.

Scot: What?

Mitch: Note to self: Eat salad.

Scot: Yeah.

Mitch: Okay. All right.

Scot: Because if I don't remind myself to eat, I don't. So I go, "Hey, Siri, set a reminder at 4:00 to eat a salad." And then at 4:00, I get a reminder that says, "Eat a salad," and I have to dismiss it so I can see all of my screen. If I want to set a reminder to eat a salad, there's nothing wrong with that.

Troy: It's a little odd, but that's all right. It's all right, Scot.

Scot: Providing information, inspiration, and motivation to better understand and engage in your health so you feel better today and in the future. The podcast is called "Who Cares About Men's Health." My name is Scot Singpiel. My role here is I own the microphones. I'm also the manager of thescoperadio.com, and I care about men's health.

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

Scot: So today, we're going to talk about something that can contribute to negative health outcomes. Now, on the podcast, we talk about the core four plus one more. Try to make it simple because sometimes I think people make health more complicated than it needs to be.

The core four is to be healthy now and in the future you worry about your nutrition, you worry about getting some activity, your sleep, your mental and emotional health, and plus one more is genetics because you can't outrun those genes. Sometimes you're just genetically predispositioned to head down a particular health path, although there are lifestyle things you can do to counter that. That's important to say.

And one of the other things we talk about too is we talk about addictive behaviors. And one I would imagine that many men at one point in their lives, whether they're younger or right now, have struggled with is maybe perhaps drinking too much.

There are some situations where somebody realizes they might be drinking too much and they want to do something about it. Then there are some situations where you're like, "Oh, no, I'm fine. I need to blow off some steam. I like to unwind." And maybe you don't realize there's a problem yet.

So we're hoping just to talk in a very non-threatening way about this because that really kind of changed my perception on how much is too much for alcohol.

Dr. Madsen, you're telling me about a screen that you do in the emergency room. And when we talk about alcoholism, we're not talking about the obvious . . . back in my day, we used to call them winos or the obvious person [slurs speech], like that all the time, the obvious.

Was that totally politically incorrect? I'm sorry, if it was.

Troy: It was, but . . .

Scot: We're talking about people that have three, four drinks a night. They otherwise live what would appear to be just a regular existence, but maybe that's a little too much alcohol. So tell me more about CAGE and what that indicates because that was eye opening for me.

Troy: It is. Yeah, it's sometimes surprising. It's one of those things too . . . I think, like you said, as I went into medicine and medical school, sure, you say, "Well, yeah, clearly this guy is an alcoholic. You can see it." But then you are sometimes surprised as you go through some of these questionnaires and some of these things that look at alcohol use disorder at people who are very, very high functioning who may have an alcohol use disorder. And in many of those cases, we see these individuals in the ER coming to get help, or maybe you're doing a screening tool and something comes up on that.

But we do have a screening tool we use. We all learn this in medical school. And it is something that we will then use in our practice, is a quick screen to say, "Does this individual potentially have an alcohol use disorder that we should look into further and ask some more questions and see, 'Well, how much are you drinking? Do you need some help?'"

This is a tool. It's called the CAGE questionnaire. And each letter in this, it's an acronym, stands for the question in the questionnaire. So the first C, the C stands for cut down. Have you ever felt you need to cut down on your drinking? The A is annoyed. Have people annoyed you by criticizing your drinking? So for each of these, you get a point if you answer yes. G is for guilty, G of CAGE. Have you ever felt guilty about drinking? And E is for eye opener. Have you ever felt you need a drink first thing in the morning, or an eye opener, to steady your nerves or get rid of a hangover?

Now, if you answer yes to two of those questions, so if you have a score of two or higher, it has a 93% sensitivity for identifying excessive drinking and a 91% sensitivity for identifying alcoholism.

Scot: Wow.

Troy: It's a pretty good tool for potentially identifying individuals who may be needing some help, again, just answering yes to two of the four CAGE questions.

Scot: That is fascinating. And this is research-supported? When you say over 90% accuracy that that person may have a drinking problem, this is research-supported?

Troy: It is, multiple studies. This CAGE questionnaire has been around for many, many years, decades. And so it's something where it's been studied. Then they've looked at individuals who are testing positive on this. They've got studies going back into the '80s on this. So it's something that has been studied over many, many years and many, many people.

If you're answering yes to two or more of these . . . let's say you've had people tell you, "You really should cut down," and let's say people are critical of you, you get annoyed by it, if you've got two of those four, that's potentially a sign that maybe you need to look into . . . maybe you need some help. Maybe you do have an alcohol use disorder.

Scot: What if you just have one? Is that supported by the research? Does that necessarily mean anything?

Troy: So that's considered a negative screen. If you just had one, let's say you felt guilty about your drinking, so you got the one point there, but you didn't answer yes to any of those others, like, "Well, no one has ever told me I should cut down. I've never really felt annoyed. I don't really need an eye opener in the morning to take care of a hangover," if you just get the one, technically, that doesn't get you a point.

Obviously, there are a whole lot of other variables that play into this, like who you are hanging out with. If you're hanging out with people who are drinking a lot, they're probably not criticizing your drinking and you're probably not getting annoyed by it.

Scot: There's two of the four right there.

Troy: Yeah. So it's like, "Yeah, you're covered there." It's one of those tools where it's not a perfect tool.

The advantage of this tool is just something quick that we can do as healthcare providers. It's a quick screen. Just talking through those questions took us maybe 30 seconds. And if you're getting a score of two or higher, it doesn't mean you have an alcohol use disorder. It just means "Let's do some additional screening to see if that's potentially an issue."

Scot: And just very briefly, because I'm curious, why do you do this? If somebody comes into the ER, why are you concerned if they might have an alcohol use disorder?

Troy: That's a great question. I'm concerned, number one, because if the patient is under my care, and they do have an alcohol use disorder, and they're not drinking alcohol, and let's say they're there for a prolonged period of time or they're admitted to the hospital, they can go into alcohol withdrawal. And if they have alcohol dependence, physical dependence on alcohol, they can have life-threatening symptoms.

I mean, alcohol withdrawal, it's not something you want to mess around with. People die from that. So I want to know, number one, is there potentially an issue there? And number two, if there is, let's make sure we treat it. Let's make sure they get the medication they need to prevent that.

Alcohol is an interesting thing. Every year, about a week after New Year's, I'll see someone come in the ER, maybe just a few days after New Year's, who their New Year's resolution was to stop drinking. They stopped cold turkey, and I see them a few days later with severe alcohol withdrawal, sometimes to the point where it's life-threatening.

So you can really see the dramatic effects of people who may have an alcohol use disorder, the impact it has on their body, and that's why I want to know, "Do they have an issue?" so I can make sure I treat that and prevent it.

Scot: If somebody has an alcohol use disorder, now that's going to be that obvious alcoholic, right? Like, it's going to be very obvious. Or is it not necessarily as many drinks as I might think that it would take to form an alcohol use disorder?

Troy: Yeah, it's really not. Over my career, I'm kind of at a point where you don't get surprised by a lot. But I think early on I was sometimes surprised by some individuals who would come in the ER looking for help and wanting to get help, and recognizing they had an alcohol use disorder. These are CEOs of companies. These are even local celebrities or very high-profile individuals who are very high functioning. I mean, they're very successful in their career. They do very well, but they do have an alcohol use disorder.

And it's not the stereotypical image, like you said, of someone who's out and publicly intoxicated and tripping over themselves. It's not that image. It's something where it affects people in all walks of life, and people who are extremely successful, to maybe that stereotypical image of someone who does clearly have an issue. So, yeah, it's not always obvious.

Scot: So the CAGE is just a quick screen that you use to determine if somebody might have alcohol use disorder. If you're answering yes to two or more of those questions, it might be worth a little bit more investigation into your life or just an honest look.

I believe at some point in my life, in my younger years, I was running around with some people who drank a lot and I probably, by definition, was an alcoholic. I think if somebody would have called me on it, I probably would have dismissed it or would have gotten annoyed by it. This group always used to say, "You know what? We blow off steam, we party hard, but we go slay the dragons the next day. We get up and go do our jobs and we function, so that's not a problem." But actually, in retrospect of what I've learned, that could possibly be a problem.

Troy: And that's a challenge, like you said there, because I think that's what a lot of us will think is that, "Hey, it's not affecting my life. I get my job done. I get my work done. Work hard, play hard," whatever the mantra may be. Again, the people I've seen that have surprised me are very, very successful, but clearly they have an alcohol use disorder.

Scot: All right. And to look at it a different way, according to the National Institute on Alcohol Abuse and Alcoholism . . . Now Dr. Madsen, Troy, talked about some attitudinal things that he asks questions, the CAGE test. This is actually, according to them, their drink guidelines. If you're drinking more than this amount, then you are beyond the moderate or low risk range. And for men, they say no more than four drinks in a day, or no more than 14 drinks per week.

So if you're sitting down in any given day, like on a Saturday, and you're drinking more than four drinks, that is considered beyond moderate or low risk. Or if you are having more than 14 drinks per week . . . like, if you sit down and you have a couple of beers every day, according to them that's low or moderate risk. But if you go to three beers every day, then that's not.

Their guidelines are based on the standard drink sizes. Do you know what these are, by the way, Troy?

Troy: I usually have to look it up. But yeah, it's basically 12 ounces of beer, it's 8 to 9 ounces of malt liquor, 5 ounces of wine, or 1.5 ounce of 80 hard proof liquor. So that's what is considered one drink.

Scot: Yep. So if you have a mixed drink and you do a double, if you do three ounces of liquor, you're done for the day to be considered moderate or low risk range. If you're over that and you do that more than a couple of times a week, that four drinks per day, then they're considering that that's beyond moderate or low risk range.

Troy: But to clarify this, Scot, you're saying four drinks per day. But that's once a week if you're having more than four drinks. And then they're saying 2 drinks a day, 14 total in a week.

Scot: Yeah. So they're saying no more than 14 drinks per week, but they're saying in any given day, you could have 4.

Troy: Sure. So you could come home and you could have 3 evenings a week where you have 4 drinks, for a total of 12, and there you're not over the 14. So I guess it's kind of how they're defining it.

But even there it's interesting. I think you said maybe it sounds like a lot, 14 drinks in a week, but if a person is coming home, and let's say in the evening their usual routine is to sit down and have a couple of beers or whatever, right there, if they're having 2 beers a day, they're right at that 14 mark. And then if you have one evening a week, you go out and you have 4 drinks, right there you're over the 14.

So you can see how it doesn't . . . it sounds like a lot, but when you think day to day, if that's part of your routine, you can get over that 14 number fairly easily.

Scot: There are two considerations when it comes to alcohol use. One is the physical impacts it has on your body. Troy talked about alcohol withdrawals, which could be potentially deadly. What are some other physical problems that drinking can bring about that you've seen?

Troy: Well, there are certainly the immediate impacts, just intoxication. It increases your risk of accidents and injuries. Just affects your judgment. That's definitely a component of a lot of injuries we see in the ER. It seems like that magnifies your risk. If you're on a motor vehicle, if you're on an ATV, you're around fires, anything like that, you're increasing your risk of being injured in those sorts of things.

Then there are just the obvious physical effects. And sometimes these aren't immediate, but just the cumulative effects of individuals who it affects their liver. And then with the liver effects, you can have liver failure, which is a devastating thing. That's just awful to have. It's not something that is easily treated and sometimes requires a transplant. And even there, it requires being able to get a transplant. Unfortunately, people do die on the transplant list while awaiting that after they've had an alcohol use disorder and have had effects from that.

That can also lead to gastrointestinal bleeding, so bleeding in the stomach. We have people who have liver disease that then that makes them more likely to have bleeding. They can have severe bleeding, life-threatening bleeding. So it definitely has impacts there.

It also increases your risk of cancer. We've had studies come out showing that moderate drinking can improve or reduce your risk of heart disease. But then I think further studies that have come out in the last 10 years have shown that potentially the impact of alcohol use on cancer, and here we're even talking moderate alcohol use or potentially even just a drink a day, potentially the increased risk of cancer may outweigh the reduced risk of heart disease.

The instructions that have been given through the internal medicine physicians and family physicians is that if someone is drinking in moderation, not a big deal, but it's not something where you would ever counsel a patient to start drinking in order to reduce their risk of heart disease, just because that risk of cancer is there and that may outweigh it, especially for people who are more prone to cancer with their genetics.

So, yeah, you've got the immediate effects. You've got the long-term effects. It certainly can have its impacts, and again, something we see, I think, full range of that in the ER from the people with the injuries to the bleeding and cancer and all those sorts of things.

Scot: It impacts your sleep too. People don't sleep as well. A lot of times, people do drink to sleep. But I've talked to physicians that say that the research actually shows that you might think you're sleeping, but you're actually sleeping lighter or you have disturbed sleep. And, of course, that's one of our core four, so you're not getting as good a night's sleep.

And there are just kind of a lot of impacts. For me personally, when I was probably drinking more than I should, I started having digestive issues. I just was always miserable in my stomach. It wasn't as soon as I stopped, but within probably three, four months after really cutting back, that all improved for me.

So if you're experiencing some of those things and maybe you might be drinking a little more than you should, to me, that was almost worth it to give up a couple of beers to feel a little better. I hate stomach issues.

Troy: Yeah, the acid reflux. That's a common issue.

Scot: So a little bit later in the season, we're going to have somebody on the show who has had a journey with alcoholism, has gone through some of these steps. And we hope that having that individual on the show will perhaps help some other people through their story perhaps recognize a situation in their life that maybe you have time to turn around. You can turn this sort of thing around.

Is there anything else you want to add to this episode, Troy?

Troy: One thing it may be worth mentioning, too, Scot, we talked about the CAGE questionnaire. That's obviously such a quick test we can do. Let's say we talked about the CAGE questionnaire and you thought about, "Maybe two of those four I could answer yes to." Then you may ask, "Well, that's a pretty quick test. Is there anything more detailed I could go through, like a questionnaire, to see is there an issue?"

There's something called the Audit questionnaire, and you just search for that and you can find it online. But that goes through in more detail about getting into exactly how many drinks you have per week, like you mentioned, Scot, how many you have at once, getting into the whole binge drinking thing.

And some of those CAGE questions, it kind of goes through some of those again as part of it, but it's a 10-question questionnaire. And that really then breaks things down by a score to say, "Are you a medium risk? Are you a high risk? Are you at a point where addiction is likely?"

So it's an additional questionnaire. We don't need to go through all the questions on it, but I think that can be helpful as the next step to potentially see, "Is there an issue that I should get some help for, or where are things right now?"

Scot: And then if somebody decides that it is an issue, you've mentioned you've had people come to you in the ER. Is there perhaps a better place to go if it's not an emergent condition that you need to get rid of your dependency on alcohol?

Troy: Yeah, for sure. I think there are certainly lots of community resources. Alcoholics Anonymous being certainly something everyone has heard about if you are at a point where you say, "Hey, I've got an issue. I need to get help." That's a wonderful resource and I think something that's been proven over many years to be effective in terms of helping people.

If you're looking for inpatient treatment where you need inpatient detoxification and you need medically-assisted treatment to be able to just reduce your drinking or cut off from drinking, that's something you can talk to your doctor about. I think, regardless, I'd talk to your doctor. They can help set those things up for you. There are many community resources available for that as well.

In some people, it's just the sort of thing where they just reach a point and they just say, "I need help, and I need it now. I need to make this happen, and I don't have time to wait on that." We see those individuals in the ER on a regular basis. You can come in. We can talk to you about options. In some cases, we admit people to the hospital for this, if they are in withdrawal and they have severe symptoms. I'd say I admit people for this. It's a weekly thing for me where I'm admitting patients for this.

So wherever you are, like I said, there are community resources, all the way to going to the ER, coming in, seeing us, trying to get the help you need.

With any substance use disorder, I think the important thing is just reaching out for the help. And I think that's the hardest part, is taking that initial step. But if you can reach out to family and say, "Hey, I've got an issue. I need help," I think it's a huge thing just to be able to do that. And then you take it from there and you'll get the help you need as long as you just keep pushing forward.

Scot: All right. It's time for a brand new segment on the show on "Who Cares About Men's Health." We've got our nutrition expert, Thunder Jalili, in the studio to answer some nutrition myths. He's going to tell us whether our nutrition myths are truth or if they are going to get Thunder Debunked. What do you think?

Thunder: I like that, Thunder Debunked.

Troy: Can we call it Thunderstruck?

Thunder: Whoa.

Scot: Well, Thunderstruck . . .

Troy: Thunder will strike them down, strike down the myths. I like that.

Thunder: AC/DC may come after us for copyright infringement. But I'm willing to take the risk.

Scot: That's why I want Thunder debunked. I didn't want that to happen. I don't need an AC/DC lawsuit.

Troy: Because I know AC/DC listens to this podcast.

Scot: And I also know Troy wanted to call it Nutrition Myths Jalilied, but I told him that seemed weird.

Troy: I didn't, but I like it.

Scot: Thunder Debunked, Thunderstruck, it sounded so much better. We're going to give you a nutrition . . . something that you might find on the internet, and you're going to tell us whether it's truth, or if it's going to get Thunder Debunked. And I hope most of them get Thunder Debunked because that's fun.

Weight loss. Oftentimes, it's been said if you're trying to lose weight, it's just a simple equation of calories in versus calories out. So if you eat fewer calories than you expend, then you're going to lose weight. Is that truth, or is that myth going to be Thunder Debunked?

Thunder: I think that is going on the road to being Thunder Debunked. In the last few years, there's been a lot of work done in this area called time-restricted feeding. What that's been showing . . . and it started with animal models and it's gone to humans too, but it basically shows if you consume your calories in a short amount of time and have a long fasting period for a 24-hour cycle, you don't really gain weight.

And what's really interesting, especially in some of the animal studies, is it kind of doesn't matter what they feed these animals. They can eat a high-fat diet or things that usually make animals gain weight, and they still control their weight as long as they eat their food in a short period of time. So in the 24-hour cycle, give them 8 hours or 10 hours of eating, and then 14 to 16 hours of not eating.

That's why I think the calories in equals calories out is a little too simplistic now.

Scot: All right. Weight loss is just really calories in, calories out, that has been Thunder Debunked. Troy, will you do me a favor?

Troy: Thunder Debunked.

Scot: Will you do the honors of singing, "You've been Thunder Debunked?"

Troy: I think you already did it.

Scot: All right. Weight loss, is it really just calories in, calories out? That nutrition advice has just been Thunder Debunked.

Troy: Thunder Debunked.

Scot: "Just Going To Leave This Here." It might have something to do with health. It might be something totally random. Troy, why don't you go ahead and start "Just Going To Leave This Here"?

Troy: You're putting me on the spot again, Scot. I have to . . .

Scot: I'll take it. That's fine.

Troy: I'm going to let you . . . Scot, it's time for "Just Going To Leave This Here." How about you start us off today?

Scot: All right. Just Going To Leave This Here. So a couple of episodes ago, I was talking about how I wanted to look into exercising with kettlebells. I also mentioned my frustration that, because of COVID-19, home health equipment whether it's new or used, is becoming very scarce, kettlebells being one of those things. I contacted numerous people in the want ads, went to numerous exercise stores, "Nope, don't have them. Don't have them." Finally got my hands on some kettlebells.

Troy: Nice. You finally found them.

Scot: It was like doing a deal, man. It was like doing the seediest deal you've seen on any movie or TV show. I met a guy in a parking lot at a Walgreens in Bountiful. He popped his trunk. We did a quick per-pound price negotiation. By the way, kind of the going rate for kettlebells, $1.50 to $2 a pound. If you're paying more than that, they better be competition-level kettlebells, like really good quality ones . . .

Troy: Good to know.

Scot: . . . or you just really want them badly. I got my kettlebells for $1.10 a pound from the guy in the Walgreens parking lot.

Troy: Oh, he cut you a deal.

Scot: Yeah, cut me a deal. I don't know if he's just giving me that first kettlebell taste hoping I come back a little bit later.

Troy: He probably is like, "He'll get stronger and he'll need more. This will not be enough kettlebell for this man."

Scot: Anyway, I put them in my car, and I drove home, and they've sat in my garage since.

Troy: I was just hoping the next step in this story was that you did go back for more kettlebells.

Scot: No. I've messed around with them a little bit. I've got a routine I want to start. I just haven't quite gotten to it. Things have just been crazy. It's kind of that familiar story, isn't it, Troy? We go into our health things with the best intentions and sometimes we're just not ready for it.

Troy: And look at that effort you put forth. I mean, you met a random stranger in a parking lot.

Scot: Yeah, I did.

Troy: You did that. But at least you have the kettlebells now.

Scot: I do.

Troy: So you're ready to move forward.

Scot: And every once in a while I'll go out to the garage and I'll look at one of them . . .

Troy: You're like, "Man, that looks heavy."

Scot: I'll pick it up and I'll swing it around, try to lift it over my head. I want to have somebody on the show that's done kettlebells before that maybe can give me some pointers or tips. Everywhere I read said 35 pounds is kind of where a guy that's just beginning should start. I don't know how that's possible. But hopefully, we'll have a guest on later. In the meantime, I'm . . .

Troy: Scot, I know a guy. I guarantee he will talk to us about kettlebells.

Scot: All right. Well . . .

Troy: We've got to get that guy on.

Scot: The drug parallels continue with the kettlebell.

Troy: Scot, I'm just going to leave this here. I'm not using kettlebells, but something I am using . . . do you do whiten your teeth? Do you use the whitening strips or anything like that?

Scot: I do not whiten my teeth. No.

Troy: Okay. Well, I found something I kind of like. I don't like the whitening strips just because those feel kind of gooey on my teeth. It's kind of a weird feeling. And I'd read some stuff online about using charcoal. I know this sounds weird. Have you ever heard about using charcoal on your teeth, like brushing your teeth with charcoal?

Scot: No. That sounds like something that we're going to debunk in a future episode.

Troy: It probably is. We need to get a dentist on here. I want to get a dentist on here just to ask all these dental questions to. But according to the internet, it works great. And I can tell you it's one of those things that looks really gross. It's like this powdered charcoal. I don't know what the source of the charcoal is, but it's purified, whatever. I'll just buy it online. You just brush your teeth with charcoal and your teeth look really gross, like your mouth is all . . . there's just black stuff all over it and all charcoal-y looking. Then you just wash your mouth out and your teeth look whiter.

So there may be someone out there listening who is like, "That is just the stupidest thing I've ever heard," like some medical professional or dentist, and is like, "Okay . . ." So let me know, contact us at hello@thescoperadio.com to let us know if I'm a total idiot for using charcoal to whiten my teeth. I think it works. It seems to be working. I've been using it for a few months. I'm happy with it so far. But maybe I'm totally off base here.

Scot: All right. So, as a medical professional, you're not recommending it. You are actually soliciting to find out if it's a good idea or not.

Troy: I will say I am not a dentist. When I use charcoal . . . this is interesting. We use charcoal for certain types of drug overdoses. We actually have the patients drink the charcoal, it goes in their stomach, and then it will bind to these things. They may have overdosed on pills. So we do use charcoal. That's the only time I've used charcoal.

And usually when they drink this stuff, it makes their mouth kind of look all black and all that just from the charcoal on their lips. That's how I look after I brush my teeth with charcoal. It's kind of weird stuff. I don't know. I think that's the idea. It's supposed to kind of bind to the stuff on your teeth and whiten them. Again, I'm curious. This is more a curiosity, but yeah.

Scot: I will reach out. We'll get a dentist on the show. We'll talk about that . . .

Troy: We need a dentist. We really do.

Scot: . . . and get the rest of your dental questions as well.

Troy: Yeah. We've never had a dentist. So I'm going to ask him about charcoal.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of our podcast. Troy, you get to start today. What do you want to say at the end of this podcast?

Troy: Hey, I want to say thanks for listening. Be sure and subscribe anywhere you get your podcast. If you like us, give us five stars. Tell your friends about us. You can reach out to us at hello@thescoperadio.com.

Scot: You can also go to facebook.com/WhoCaresMensHealth. And we have a brand new listener line you can leave a message at. You can leave your name or you don't have to. You can say you're John Smith. You can ask a question, leave a comment, tell Troy that he needs to get it together with the charcoal and brushing his . . . use toothpaste like normal people do.

Troy: Please. Hey, I use toothpaste too, just to clarify. I do use toothpaste. Anyway . . .

Scot: 601-55SCOPE. That's 601-55SCOPE. Thanks for listening. And together, Troy . . .

Together: Thanks for caring about men's health.

Scot: That's hard to do when you're not face-to-face and online, isn't it?

Troy: I tried to screw it up just to mess with you.

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