Jan 26, 2021

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Scot: "Who Cares About Men's Health," providing information, inspiration, and motivation to better understand and engage in your health so you feel better today and in the future.

All right. Time to do a little roll call here. I need to know who cares about men's health. My name is Scot. I am the senior producer at thescoperadio.com, and I care about men's health. Who wants to join me?

Troy: I'll join you, Scot, because I think it's my turn next. I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Gee: And I'm Dr. Chris Gee. I'm a sports medicine physician here at the University of Utah, and I care about men's health.

Scot: All right, Dr. Gee. Welcome back to the show. Next time, I need a little bit more enthusiasm, though. Say like you mean it, okay?

Dr. Gee: All right.

Troy: Say it like your life depends on it.

Scot: That's right. Today, we're going to do a listener question episode. Some listeners have sent us some questions for Dr. Gee, who is a sports medicine physician. Why do I get cramps in a muscle, and can I fix that? We're going to talk about rotator cuff rehabilitation without surgery and is KT tape for real?

But before we get to the main topic, I have a question for you, Dr. Gee, or Chris, or whatever you want me to call you. Do you do time-restricted eating? Do you even know what that is? Like, fasting?

Dr. Gee: I've done some fasting, but I'm not very good at it. I hate fasting, let's put it that way.

Scot: So what does fasting look like? Because it means a lot of different things to a lot of different people.

Dr. Gee: The basic premise behind this is that it's probably not great for our bodies to get huge boluses of food and to eat just kind of grazing all through the day. And so the idea is to have a time for your body to kind of process things. Some religious groups do it routinely with monthly fasts and ceremonial fasts. But obviously, the time-related eating is more that you eat certain times through the day, and then at night, you stop eating overnight, or whatever it is that you decide to do.

Scot: Yeah, that's exactly right. It's that time-restricted eating. We've had another guest on who's a nutritionist. He's a big proponent of it, like 12 hours of eating, 12 hours of not eating. Or if you want to try to lose a little bit more fat, you can make that 10 hours of eating, the remainder not eating, or 8 hours. So you have done that time-restricted eating and just don't like it?

Dr. Gee: Yeah. I am probably the worst nutritional person out there as far as my diet is just not great. I've done a little bit of it and tried it and I have a hard time. Let's put it that way.

Scot: Yeah. What's your challenge to that? Because I just started doing it again. I did it for a couple weeks before COVID and then COVID came along, and every routine I had went out the window. But I felt better even after two weeks, and I feel good now after just a few days of doing it. So how did it impact you?

Dr. Gee: For me, whatever the problem is, I tend to be really great with a diet or with some time restriction or something like that for a couple of days. And then it just goes out the window for whatever reason. I'm just like, "Oh, I'll just have this snack. I'll just break it this one time." And so I don't know. I've kind of done that. I know I need to kind of adjust that, but for me getting through the first day or two is just hard.

Scot: Yeah, it is a little tough. Troy, have you been sticking with it? I know you had talked about doing it.

Troy: I have been sticking with it, yeah. I do 12 hours, Scot. That seems to work for me. And I just tell myself I'm not going to eat after 8:00 p.m. and I'm not going to eat before 8:00 a.m. Just restricting it to 10 hours of eating, I think, would be really tough because then I'd be looking at stopping eating at 6:00 p.m. So I find 12 seems to work and it seems to be working okay. But I agree, it's tough.

Dr. Gee: Can I ask Troy a question?

Troy: Yeah.

Dr. Gee: How do you do that with your shifts? Do you still do a number of shifts in the ER?

Troy: I do, yeah.

Dr. Gee: I always have a hard time with that.

Troy: You're right. Yeah, that's what really throws me off, is if I work . . . As you know, Chris, we'll do these shifts that are evening shift. We call it an evening shift, but you get out of there at like 1:00 or 2:00 in the morning and get to bed at 3:00. So those days, I'm probably not eating after 11:00 p.m. and I'm not eating before 11:00 a.m. So it's probably still working out to 12 hours because I'm trying to do better at eating at work. That's what I found. If I don't eat consistently at work, I get home and it's like 2:00 a.m. and I'm so hungry that I eat a ton, and then my stomach just hurts when I go to sleep and I can't sleep well. So that's how I've tried to adjust it, just by bringing plenty of food for work and trying to be consistent about eating so I don't come home hungry. But it's hard. With shift work, it's really hard.

Scot: And have you noticed a benefit, Troy? What does it do for you?

Troy: I have, Scot. When I first started doing it, I did feel like it did reduce my body fat somewhat. The other thing I like about it, I feel like I don't have to pay as much attention to what I eat. I know that's bad, but I kind of feel like it kind of gives me a little wiggle room there where I'm like, "I can eat more stuff that I was a little more concerned about eating before."

And then just going to bed, sometimes I would eat at 9:30 and then maybe I'm asleep at 10:30. And it wouldn't be until about 1:00 or 2:00 in the morning that my stomach would really feel okay, because that food just kind of sat there. So I felt like it's helped my sleep as well.

I feel like it's made a difference, and I feel like I've done okay with it. I've tried to do this since we first talked to Thunder about this. It must have been a year ago or so. And it's one of those things I've kind of taken from these talks we've had with Thunder that I feel has definitely been beneficial.

Scot: Well, I just was curious because I was curious to know, Chris, if you did anything like that as well and what your challenges were. I guess now we know. I feel like I wake up a little bit more clear-headed for sure and a little bit more alert.

By the way, I did see a documentary that talked about fasting. And there's some research out there that says even if you do it five days out of the week and two days you're not as religious, you still get the same benefits. So for somebody who works Monday through Friday, and then the weekends maybe they let themselves go a little bit. Maybe that would help. Chris, you think we can get you onboard or just no way?

Dr. Gee: You're tempting me for sure. I'll have to try it.

Troy: Maybe just three days.

Dr. Gee: I need to have a new plan. And so that'll be good. If I can only do a few days a week, maybe I'll start with that.

Troy: Scot, if there's benefit to five days, there's got to be benefits just to even three days, you know.

Scot: You would think.

Troy: You'd think so. Maybe you could say, "Hey, this is going to be my Monday, Wednesday, Friday thing," and start there. Don't eat after 8:00 p.m. Don't eat before 8:00 a.m., or whatever works, 7:00 p.m. and 7:00 a.m. Because I feel like 12 hours for me is doable. I feel like beyond that like, to consistently do it is . . . there are definitely days where I'm maybe restricted to 10 hours, but it's hard to do that consistently.

Scot: All right. Let's get to the topics here. So our listener questions, lots of ways you can get in touch with us. There's email, there's our listener line, and that's how we got a hold of these questions right here.

Dr. Gee, let's go ahead and start out with listener question number one. This individual says they get cramps, and they're wondering why they get cramps. What does a cramp mean, and is there something you can do to fix it if you have a muscle that's kind of consistently cramping? I've had this with my legs, my calves, for example.

Dr. Gee: There are a number of different reasons why a person may have cramps. First of all, and the most common, are related to maybe dietary things, or you're dehydrated, or you've been working out a lot and at a certain point during your workout or your run or whatever, you're getting cramps. So those are more nutrition-based recommendations where make sure that you're well hydrated, that you're not getting dehydrated through the course of your day or your workout.

Also looking at making sure that you're getting electrolytes with that, so some kind of Gatorade or something like that, that you're using to replenish those electrolytes as you are sweating.

But then the second group of cramping, the way I look at it at least, is that there are times where your muscle maybe isn't as strong as it should be. And so, if you imagine maybe you've got a calf cramp or something like that, and as you start to run and work out, maybe you're well-hydrated and you have good electrolytes, but the muscle is a little bit fatigued, it can't quite keep up with the demand that you're putting onto it, and it basically has to go into a bit of a spasm to hold the demand that you're putting onto it.

And that will often happen during workouts and things or even kind of after the fact as people are walking around. Those cramps, depending on where they are and what's going on with them, they can benefit from doing some more dedicated directed exercise at those areas.

There are different types of strength within muscles. A lot of times, the way we think of strength, we think of, "Oh, I can pick up this really heavy weight," and that is a type of strength, but there's also dynamic strength, which is basically where your muscles are holding your joints and your body through the course of motion. And if they are fatigued, if they are not up to where they need to be, they will basically have to go into spasm to try to hold that dynamic control, and that's oftentimes when people will start getting cramps.

Troy: Chris, imagine that you're mountain biking somewhere or you're running or competing in some kind of event, and your leg just cramps up. It's kind of like related to what Scot said. Do you recommend just stopping at that point and trying to massage it, or stretching, or just slowing down a bit, or just pushing through it? What's your typical advice when that happens?

Scot: What I love about that is Troy never, ever said, "Or just quit?" He never even offered that as an option.

Troy: I'm imagining, Scot, you're somewhere where you probably have to get home. You're on a trail. You can't just call Uber. You've got to get home somehow. So, yeah, how do you get through that?

Dr. Gee: Yeah, that's the next version of Uber, the mountain bike Uber.

Troy: The mountain bike Uber, just a little trailer on back.

Dr. Gee: That's a really good question. And I think all too often as weekend warriors and just recreational athletes, we tend to push through those things. And what I find is that that tends to make it worse. You really tend to have more problems as you continue to work out. And so I do suggest that you stop, you rest, try to stretch out that muscle, do a little massage. Think back on what you've been doing with your hydration. Have you been hydrating well enough? Have you urinated recently?

That's always a good sign to see where you're at with your hydration. If you've been pounding a ton of fluids and you're urinating really clear, you might be going a little too hard hydrating. But if you haven't peed for a while, and when you do try to go it's really dark, then you need to really try to push some fluids and recover and then kind of build your way back into your exercise. Try to maybe go just below that threshold at which you were cramping before, which can definitely be difficult if you're pretty far out and you're trying to work through a cramp as you're trying to finish.

Scot: So, in that situation, just want to make sure I understand correctly, and it's cramping, you should stop. Did you say you should rub it, try to massage? No, stretch it. You should stretch it.

Troy: And massage it sounds like, yeah.

Dr. Gee: Both. Yeah. Oftentimes, I find that when it's acutely in spasm . . . so we'll have an athlete come off the court or the field and they're acutely in spasm, really the only thing that's going to help or the thing that helps the fastest is to stretch that muscle. So really just try to stretch it back out, and then some gentle massage to try to work fluids around through that muscle to kind of break down some of the more tight areas that might be more likely to spasm.

Troy: That's good to know, though. Yeah, start with the stretch, though.

Dr. Gee: I've had people try, both personally and professionally, to just massage that cramp, and it takes a while to get it to release. And so I find stretching it first and then working into a massage is probably a better route.

Scot: If hydration was the issue and you started drinking some water, then would that clear itself up pretty quickly, the cramp, or not very quickly?

Dr. Gee: It can definitely help, but it's really hard, I find, once you start cramping to kind of turn that around, or at least within that exercise or that particular workout window. Usually, it's going to take some time for your body to try and correct the electrolytes and the fluid balance as such that it's going to ease it up.

So even as a recreational athlete, really listen to your body and know at what point you're going to start feeling that cramp come on. And if you can get to that point and say, "Okay, now I'm pushing it a little too hard," and start correcting those either fluid issues or technique issues, making sure that you're not pushing beyond that, it usually helps to prevent you from having cramps throughout the workout.

Scot: All right. Question number two. Boy, this is probably going to be a tough one. Rotator cuff rehabilitation without surgery. So do you see a lot of rotator cuff injuries? I find it fascinating that the rotator cuff is called one thing, but it's actually four different muscles.

Dr. Gee: Exactly.

Troy: This really hits home for me, because in high school I injured my rotator cuff. I never saw anyone for it, but I'm certain that's what it is. And I've convinced myself over the years, "I can do this without actually seeing someone for it." So I'm curious what you have to say, Chris.

Scot: You can hurt your rotator cuff like doing sports, but even if you fall, you could hurt it, right?

Dr. Gee: Exactly. Yeah, it's a very interesting joint. And it's one of those things that I see a lot of. We all hit the new year and we say, "Hey, I want to lift and get some definition in my body." So we go and we overdo it with shoulders and start getting some pain in the shoulder, or even getting out and biking and things like that we'll have people crash and have a trauma to the shoulder.

So, in general, just as kind of an educational piece with the rotator cuff, basically, when you look at the shoulder, you have the ball and socket joint. Now, the socket is really very shallow. I make the analogy it's more like a golf ball and a tee. So you have a big humeral head, or a big ball, that's trying to fit into this small little depression of the shoulder blade. And so there's a group of four muscles that come off the shoulder blade, and they surround the humeral head, and they move it around.

Now, because there's not a lot of bony restriction, it gives us great motion of the shoulder, but it's at the compromise of stability. And so that's always the problem, is that if those rotator cuff muscles aren't working together, and they don't have that dynamic strength and control I was talking about earlier, they will allow that ball to slide off the socket and cause things to get stretched and cause pain and impingement and other problems.

And so, when we're younger, when you're in high school and you injure your shoulder, usually that rotator cuff will just stretch. It'll stretch out. It'll cause some instability problems. But unfortunately, as we get older, ages . . . the rough estimate is 35 to 40, which that throws me in the old category. I don't like that. But as we get older, the rotator cuff doesn't tend to stretch as well, and it tends to tear.

And so those little things that maybe you can recover in a day or two as a teenager are going to do more damage as an adult and you can tear part of the cuff, and that may require more treatment than what you had as a youngster.

Troy: So when you say treatment, are you saying you definitely need surgery, or is it something where physical therapy or strengthening or those kind of things are going to help you recover?

Scot: Yeah, this listener is hoping without surgery.

Troy: Hoping you're going to say no surgery.

Dr. Gee: Honestly, I find the vast majority of these do not have to have surgery, which is great.

There are a few different buckets that these fall into with these rotator cuff injuries. If you're young and otherwise healthy and you haven't . . . like I said, it takes a lot of force to tear the rotator cuff when you're young. So most of the time, we'll put those people through some physical therapy working on rebuilding the rotator cuff. Working on shoulder blade positioning and posture helps with that rotator cuff, and that allows them to progressively get back to normal.

Even when you have an older patient that maybe . . . I've had patients that are in their 70s that are just pulling up something, maybe the sheet on the covers of their bed, and they've torn part of the rotator cuff. So, at that point, as everybody's rotator cuff gets weaker, believe it or not, you can do therapy with that group too. So getting out and getting some physical therapy, strengthening that rotator cuff, what's left of it, or the muscles around it, will actually calm their symptoms down and they do pretty well.

It's really the ones that have an acute traumatic injury. You fall really hard when you're skiing or you dislocate the shoulder and you acutely tear the rotator cuff. Those are the ones that more often need surgery. And the rest we're pretty successful with being able to rehabilitate the muscles and maybe doing an injection to calm down inflammation, but they do fairly well.

Scot: And I also think it's just always good if you have hurt yourself to go see somebody just because you start making those accommodations and then who knows 20 years down the road where that's going to get you. I think it's kind of gotten me into a bad place, and I'm trying to undo some of those things. It's not going to get better if I don't do some actively with it.

Dr. Gee: Exactly. Yeah.

Scot: All right. Question number three is KT tape for real? So this KT tape, this is the tape that sometimes you see athletes . . . I went to a chiropractor once and they put some KT tape on me. They cut it up and made it into some tribal looking design on my shoulder and my bicep. Is that the real deal? Is that legit or not?

Dr. Gee: KT tape has kind of been the rage over the last number of years and you see a lot of athletes doing it and Olympians doing it. When you look at really what it's doing, it's not going hold the joint into place because it's not connected to any muscle. It's not connected to any bone or anything like that. What it is doing, though, is giving a little bit of feedback through the skin, through the nerves that are in the skin, just to kind of remind you a little bit about that position.

So, for example, in the shoulder again, it's probably not going to keep your shoulder from sliding out. It's not going to prevent you from using your shoulder wrong. But what it can do is remind you as you start to slip into maybe a bad position, you start to feel a tug on your skin, and you go, "Oh, okay, I've got to bring my shoulder back, and I have to kind of get that better position."

The way I try to use it is maybe using it early on just to remind people of positioning. We'll use it sometimes around the knee and the shoulder just to kind of help people to think about positioning and activation of muscles. But over the long term, I definitely want people to get dynamic control and strength of their joints so that they don't have to use those things.

Troy: And do you find, Chris, it's more helpful than just wearing an Ace wrap or some sort of thin brace on your knee or something? I mean, does it seem like it does better than that kind of thing to provide that reminder that maybe you need to do things differently as you're going through those motions?

Dr. Gee: It can help in certain scenarios. So, for example, if somebody has an unstable knee, meaning their kneecap is kind of wanting to drift off to the side, sometimes taping it a certain way can help to encourage that to stay back and it can remind people. But you can get the same effect with even a sleeve over the knee that has a hole in the front that kind of encourages that kneecap.

So, as far as when you look at studies, they really say that any kind of proprioceptive feedback with an Ace bandage or a sleeve or a brace can help just to remind you of positioning of that joint, and it doesn't necessarily have to be the tape.

Troy: Duct tape?

Dr. Gee: Yeah, there you go.

Scot: I think it doesn't stretch as well as KT tape, right?

Troy: Maybe not as good, but . . .

Scot: In a pinch? All right. Dr. Gee, again, awesome job answering our listener questions. Sure do appreciate having you on the show. And thank you for caring about men's health.

Dr. Gee: Yeah, it's always a pleasure to be here. I love getting the questions and hopefully got some things answered.

Scot: All right. Welcome Producer Mitch to the show. I guess Producer Mitch has a question for Dr. Troy Madsen. Mitch, what was your question?

Mitch: I've been going to doctors and I've been reading the after notes in my chart. Is "generally pleasant" code for anything? I've been described by two doctors now as a "generally pleasant 32-year-old male."

Troy: That is great. It's not code for anything.

Mitch: All right.

Troy: It just cracks me up when people use that.

Scot: Hold on. This is in your chart? What medical purpose does this description serve, Troy?

Mitch: It's at the top, right?

Troy: It's so funny. Yeah. I never use adjectives like that to describe anyone because it's just . . .

Scot: In the ER, do you have to describe people?

Troy: I never use that. No, some people just do that. It's just habit, I think, just because the average person who is nice, who comes in, who they enjoy talking to, they will describe as, "This is a pleasant 30-year-old male who comes in with a chief complaint of," whatever. It's just habit for them.

It is not code for anything. It doesn't mean they think you're weird or something. Yeah, it's funny when it's in there because when I see that, I always think, "What are they going to say about the person who's not pleasant? Are they going to say, 'This very unpleasant, 40-year-old man'?"

Mitch: And that means something.

Troy: Yeah. Exactly.

Scot: I love how they use the word "generally." Mitch, does that concern you that in that short interaction that there was possibly a moment where you were not pleasant?

Troy: That is the one piece that jumped out to me. Typically, they'll say, "This is a very pleasant 30-year-old man." The fact that they said generally, yeah, that's a little bit of a red flag, Mitch.

Mitch: Oh my god. It was an ENT too. I'm like, "What did I do?"

Troy: Yeah. "What did I do wrong? What do I have to do to get very pleasant?" Ask them that the next visit, like, "What does it take to get a very pleasant description?"

Mitch: "What do I have to do?"

Scot: Yeah, "What can I do to just have you drop generally, just so it says a pleasant?"

Troy: Yeah, just need "a pleasant." "This is a pleasant."

Scot: Oh my gosh, that's fantastic.

Troy: Oh, yeah. It just cracks me up when I see that. It's kind of like this old-school thing. Yeah, like I said, I never use adjectives like that, but it's just funny.

Scot: But some doctors do and there's no purpose to it, Troy?

Troy: Yeah, there's really no purpose to it. It's not like I look at that and say, "Oh, good. I'm so glad I'm going to see him now, because if he hadn't said pleasant, I would not want to see this patient in my clinic." So it's not some code between doctors. Don't worry.

Mitch: Well, it's almost embarrassing, because I'm trying to read all their instructions, but I can't. In that first line, I'm like, "What did they mean? What did they mean by generally pleasant?"

Troy: You're trying to decode it.

Scot: You don't actually make it to the important stuff about your health.

"Just Going To Leave This Here." It could be a random thought, it could be something to do with health, or it might just be something that really couldn't find its place elsewhere on the show that we wanted to share.

So, on Instagram, I follow some health accounts. They're not your typical health accounts. This one is @letstalk.mentalhealth, and they have this little graphic that I love because I think it sums up the things that we're never taught that we should have learned at some point in our life that are so crucial.

This says, "What I learned in school: How to multiply eight times seven, and what H2O stands for. What I wish I learned in school: The importance of mental health, mindfulness, self-esteem, reframing negative thoughts, self-care, emotional regulation, personal finance, and the importance of sleep." And that's why we talk about some of those things on this podcast and some of those other things that we don't talk about. It's never too late to learn something new about any of those areas. They will pay dividends.

Troy: I'm going to add two more to that list: home maintenance and car maintenance. I wish they taught those things.

Scot, I'm just going leave this here. I'm just going to let you guess. What is the top-ranked diet of 2021?

Scot: Well, if you're bringing it up, I know you're a fan of the Mediterranean diet, and you probably want to give it some props. So that's my guess, Mediterranean diet.

Troy: No, it's the see-food diet. I see it and I eat it. Just kidding. It is the Mediterranean diet. We always come back to the Mediterranean diet. It's come up many times as we've talked about different diets. It is the number one ranked diet of 2021 by "US News and World Report."

The thing I love about the Mediterranean diet is it's such a straightforward diet. It makes sense. And then there's good research to back it up looking at heart benefits, weight loss, general health, all those sorts of things. Really good research to back it up.

So, if you're looking for a diet for 2021, and trying to switch things up a little bit, look into the Mediterranean diet. Again, we've talked a lot about it. But it's a very straightforward, great diet.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE, and leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

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