Latest / The Driven Athlete / Rethinking Men's Healthcare with Dr. Alejandro Miquel of Men's Only Medical | Ep 98

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Rethinking Men's Healthcare with Dr. Alejandro Miquel of Men's Only Medical | Ep 98 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the driven athlete podcast.
• 0:10
  Speaker 1: What's up y'all man?
• 0:13
  Speaker 1: Dr Kyle, welcome back to the driven athlete podcast.
• 0:15
  Speaker 1: We got a really special guest with us, dr Alex McHale from Men's-only medical here in West Palm Beach.
• 0:23
  Speaker 1: So I know you're busy guys.
• 0:24
  Speaker 1: So thank you for coming in and sharing some insights of what you all do.
• 0:27
  Speaker 2: Yeah, thanks for inviting me, so tell people where you're at and what you do.
• 0:30
  Speaker 2: Yeah, so I just opened a place.
• 0:32
  Speaker 2: Men's Only Medical had our grand opening in June.
• 0:34
  Speaker 2: We're in downtown West Palm Beach, on Dixie, between Banning and Clematis.
• 0:38
  Speaker 2: It's 116 North Dixie Highway way.
• 0:46
  Speaker 2: We just created a kind of combination all-in-one men's health facility where we do concierge medicine and provide primary care to members who pay a yearly membership and on top of that we have a wellness center.
• 0:55
  Speaker 2: We provide aesthetics for men, from Botox to laser treatments.
• 0:59
  Speaker 2: We do hair solutions, from hair transplants to hair restoration with PRP injections.
• 1:04
  Speaker 2: We do IV fluids, hormone replacement, weight loss peptides.
• 1:10
  Speaker 2: You know we try to incorporate many, if not everything that a man would need all under one roof.
• 1:18
  Speaker 1: That's awesome.
• 1:18
  Speaker 1: Yeah, so family practice, that's your main education background?
• 1:23
  Speaker 2: Yeah, that's by training.
• 1:24
  Speaker 2: I'm a family physician.
• 1:25
  Speaker 2: Yeah, what'd you do with that?
• 1:26
  Speaker 2: Versus like orthopedics or cardio, or?
• 1:28
  Speaker 2: Yeah, I'm a third generation physician.
• 1:32
  Speaker 2: My grandfather was a surgeon in Cuba and then my father came when he was in his early teens, grew up in Miami after that and then went off to medical school himself and became a family physician.
• 1:43
  Speaker 2: So growing up I just watched my old man do what he did and I like to kind of consider those the glory days of medicine, and I would go to the office all the time and just spend time with him at the office, watch him treat his patients and see the relationship he would establish with his patients, and I just thought it was so cool.
• 2:02
  Speaker 2: You know, not only did I get to see so many people come and just appreciate the service that they were he was providing for them, but but he, the services that he was providing, helped improve their quality of life.
• 2:16
  Speaker 2: You know, it either made them healthier or kept them healthy longer.
• 2:20
  Speaker 2: And as a kid, that's all I could ever remember that I wanted to do, and it wasn't just going to medicine, it was I wanted all I could ever remember that I wanted to do, and it wasn't just going to medicine.
• 2:26
  Speaker 2: It was I wanted to be a family physician.
• 2:27
  Speaker 2: I wanted to treat the whole family.
• 2:29
  Speaker 2: I wanted to treat kids and adults, and what do they call?
• 2:33
  Speaker 2: Family physicians were like the jack of all trades, the bastard of none, kind of thing.
• 2:37
  Speaker 2: So I didn't have to limit my, my training to one particular field.
• 2:43
  Speaker 2: I got to learn about every different organ system, every different body part, uh, and dabble in everything from surgery to OBGYN, to pediatrics, adult care, uh, it was just so all encompassing that that's just what.
• 2:54
  Speaker 2: What really intrigued me as a young kid.
• 2:57
  Speaker 1: Yeah, yeah, that's awesome.
• 2:58
  Speaker 1: Um, that quote Jack, of all trades master of none is still better than a master of one, right?
• 3:02
  Speaker 1: That's the thing I was like.
• 3:03
  Speaker 1: See, okay, yeah, I like that, you know, cause I've been called that too, like some stuff.
• 3:07
  Speaker 1: Um, so, and?
• 3:09
  Speaker 1: And then what led you to pursue, like, opening your own practice in a concierge setting?
• 3:15
  Speaker 2: Yeah, this is um where we were previously, you know, I think, uh, going back to when I used to watch my dad practice medicine back in the 80s and 90s, that seemed to me like a great situation where he had his own private practice.
• 3:36
  Speaker 2: So he was a physician but a small business owner.
• 3:37
  Speaker 2: He got to establish a rapport with the patients, find out what was wrong with them and then work with them to achieve their goals.
• 3:44
  Speaker 2: And you know, if he felt that there was a certain medication he needed to prescribe, he could prescribe it.
• 3:49
  Speaker 2: If he felt that there was a certain study that needed to be done, he could order it.
• 3:52
  Speaker 2: And then, as the years went on, things started changing.
• 3:55
  Speaker 2: When they started getting into this managed care, they started shifting all the risk onto the physician and away from the system and away from the patients.
• 4:03
  Speaker 2: And then they started cutting reimbursements and they really made it difficult for physicians to practice independently.
• 4:09
  Speaker 2: The insurance companies these days are really kind of pushing their protocols and basically dictating what they want you to do for all your patients and it started to get frustrating what they want you to do for all your patients and it started to get frustrating.
• 4:27
  Speaker 2: Then I graduated, did my residency and got out and realized really quickly that it was going to be virtually impossible for me to have my own private practice, like my old man did, because I would have to see 30, something 40 patients a day in order to keep the lights on and make a decent living.
• 4:42
  Speaker 2: And when you're doing that, you're not providing the patient enough time to even learn about them, establish the rapport, earn their trust and find out what's wrong with them, and or deliver the care that they need or deliver the care that they need, that's not dictated by a third party.
• 4:55
  Speaker 1: Correct, you know, and no, we're going to go this direction, right?
• 4:58
  Speaker 1: I don't think they need.
• 4:59
  Speaker 1: On the denied.
• 5:00
  Speaker 2: It's like what do we do?
• 5:01
  Speaker 2: Automatic denials you know for, for imaging studies, certain medications, and then you have to just go through this gauntlet of phone calls and peer to peer calls to try to convince them that your patient needs what you felt they needed all along, and that's for one patient.
• 5:17
  Speaker 2: And that's for one patient Times 30 a day.
• 5:19
  Speaker 2: It's ridiculous.
• 5:20
  Speaker 2: It's ridiculous and, um, you know, I, I I've known for a long time that it wasn't sustainable for me.
• 5:26
  Speaker 2: I don't know how sustainable it is as a profession, because I'm seeing a lot more physicians just being discouraged with how the system has changed care and going into concierge, because it empowers you to be able to kind of practice that old school medicine again, where you can just sit down and talk to your patients.
• 5:49
  Speaker 2: You don't have to rush them in and out in 10 minutes.
• 5:51
  Speaker 2: You can provide them 30 minutes, 45 minutes an hour if you want to.
• 5:53
  Speaker 2: You really can find out what their goals are.
• 5:57
  Speaker 2: Not everybody wants to be reflexively put on prescription medications, you know, and I feel like the healthcare system these days, and even though family medicine focuses on preventative medicine, we're practicing a very reflexive type of medicine where we're just treating a disease process as opposed to trying to really focus on the reason that these disease processes are going on, with the underlying cause.
• 6:21
  Speaker 2: Yeah, the underlying cause exactly.
• 6:22
  Speaker 2: So you know, for me it was probably 10 years later than I would have liked to have made the conversion, because concierge medicine has been around for a while but they don't teach you much business when you're going through medical school and stuff and it's a scary venture to go into opening your own business, whatever it is if it's a healthcare or anything else, opening your own business whatever it is if it's in healthcare or anything else.
• 6:45
  Speaker 2: So there was probably a little fear in there and a lot of just not knowing how to do it.
• 6:50
  Speaker 2: But at the end of the day I just knew that the world of concierge medicine allowed me to practice medicine the way I felt like I wanted to practice it and not just following these protocols and these metrics that the insurances are are kind of pushing out and forcing you to follow.
• 7:07
  Speaker 1: When was that shift in healthcare system where insurances you know they're strong arming everything?
• 7:14
  Speaker 2: It started in the early to mid nineties.
• 7:16
  Speaker 2: Managed care really started taking off in the early nineties 93, 92, 93, 94 on there.
• 7:23
  Speaker 2: What led to that?
• 7:26
  Speaker 2: I think it was cost control.
• 7:29
  Speaker 2: I think there was probably some decent reasoning behind it and then it just kind of went way too far.
• 7:36
  Speaker 2: Yeah, so I think they wanted to control the cost of healthcare, lots of healthcare, and, and to be honest and it's just my opinion I felt like there was so much money in healthcare that everybody wanted to put their hands in the in the honeypot.
• 7:50
  Speaker 2: You know one thing I tell people all the time is when my dad passed away in 1996, he was 50 years old had a heart attack, unfortunately.
• 7:56
  Speaker 2: Wow, when he passed away in 1996 as a family physician, he was making more in 96 than my wife and I were making when we moved back to West Palm Beach in 2012, both being physicians she's a pathologist and I'm a family physician and our two salaries combined was less than what my dad was making back in 1996.
• 8:17
  Speaker 2: So I just don't know any other profession off the top of my head where all these decades have passed and people are are doing worse financially and this the stress increases because now you don't even own your practice, so you always have management and some office manager or somebody medical director who's on your back about seeing more patients, pushing productivity, pushing productivity and pushing certain products, you know, and it's just frustrating Wow.
• 8:46
  Speaker 1: So y'all are just like.
• 8:47
  Speaker 1: I mean, those docs are just, they're just pawns, like they're just being they're puppets.
• 8:53
  Speaker 2: They're puppets.
• 8:53
  Speaker 2: Yeah, I mean, I would joke around all the time, you know, when I was practicing direct patient facing care, that if this is how it's going to be, I could put my son in here and just give him a paper and tell him this is what you have to do for this patient.
• 9:08
  Speaker 2: You know, and it you know.
• 9:11
  Speaker 2: I I think there's we can go.
• 9:14
  Speaker 2: We could probably talk for hours about all the things I think are wrong with healthcare, but for me it was the right move.
• 9:18
  Speaker 2: Going to the concierge and I'll tell you what ever since we opened this place up, I have this newfound, just, passion for medicine.
• 9:25
  Speaker 2: Again, I was waking up every day miserable and just not wanting to go to work, knowing it was going to be a stressful day.
• 9:33
  Speaker 2: Uh, what I've said before is I kind of equate it to like since I've always wanted to be a doctor, since I was a kid, I finally got there and kind of got like hit in the face with all these changes and disillusioned with the system, and I equate it to like you have like your idol, you know if it's an athlete or an actor or whatever it is, and you finally meet them and you find out.
• 9:56
  Speaker 2: They're a dick, you know it's just like, or they're like a jerk, you know that's.
• 10:01
  Speaker 2: That's what happened to me with, with health care.
• 10:02
  Speaker 2: So going back into I mean going into concierge medicine now has me waking up every day, just happy to go to work, excited, yeah, just smiling all the time, just just happy.
• 10:13
  Speaker 1: It's so interesting because, like very similar to the same story that I had, like it's the same kind of thing.
• 10:18
  Speaker 1: I mean just like in a, because physical therapy, you know ortho, ortho, outpatient sports, whatever, it's all the same kind.
• 10:25
  Speaker 1: It's just dictated by insurance and stuff and you're just a puppet trying to get the productivity for whoever owns the practice or the business or whatever like that, and then just to funnel patients and just see more, do more units.
• 10:37
  Speaker 1: Why did you only do these units?
• 10:38
  Speaker 1: We need more units.
• 10:40
  Speaker 1: It's like I don't understand how I can possibly give and at the end of the day, so do documentation.
• 10:44
  Speaker 1: Oh, yeah, yeah, it sucks.
• 10:45
  Speaker 1: So like you're just totally, you're drowning all the time.
• 10:47
  Speaker 1: Oh, it's miserable.
• 10:48
  Speaker 1: So, anyway, I did the same thing, you know, six and a half years ago and, um, I was like it's the same thing.
• 10:54
  Speaker 1: I tell people I get reinvigorated.
• 11:00
  Speaker 1: My passion for like, like this is I can puzzle, piece things together and like problem solve and like work with people, talk to them one-on-one for an hour every time, work about progressions and like anyway, just get excited about, um, using talents, knowledge and skills straight to my ability, versus just like I don't know, just surviving the day and then drowning Right, you know it sucks and ultimately drowning.
• 11:21
  Speaker 2: Yeah, that's what you get and at the end of the day, the more time you spend with your patient, the more trust you can earn, yeah, and the better outcomes you have.
• 11:28
  Speaker 2: Oh for sure, you know, because now they, they really trust you, they really feel like you know what you're talking about.
• 11:32
  Speaker 2: They're.
• 11:33
  Speaker 2: You're developing a relationship I don't know if you want to call it friendships or not, you know with patients and stuff, but you're establishing relationships where they want to come back for their follow-ups, they want to listen to your advice, and if you're just shoveling people in and out, they're leaving frustrated too.
• 11:49
  Speaker 1: And I'm like I'm not going to take this stupid.
• 11:49
  Speaker 1: Yeah, the only people that get hurt are just the patients and then the providers that are getting deflated, like you were saying, like you know, drowning and stuff.
• 11:56
  Speaker 1: We had a patient that she's a physician in the area too and she's in the area too and she's in the in network like hospital type of a system, drowning she's like, she goes home, she has like her, she spends her whole weekend having to finish her documentation to start on monday again.
• 12:10
  Speaker 1: We're like they, they had no time and they're just like pumping out the communication with administration and like the other team docs and whatever.
• 12:18
  Speaker 1: It's just really poor.
• 12:20
  Speaker 1: So patient continuity or patients gets dished off or dissed over or whatever.
• 12:25
  Speaker 2: Like anyway, she just doesn't like it yeah, you know, you know, and we, we bear the the brunt of a lot of the of the discontent from the patients because they almost blame us for it.
• 12:37
  Speaker 2: Yeah, right, and what they don't realize is that we're as frustrated as they are.
• 12:40
  Speaker 2: You know, I I felt it when I was a patient in the hospital.
• 12:43
  Speaker 2: I went in, for I don't remember what it was.
• 12:45
  Speaker 2: When was the last time I was in the hospital?
• 12:49
  Speaker 2: It was years ago, but I remember laying in the hospital bed.
• 12:52
  Speaker 2: Oh, I had a surgery on my Achilles and I had a lot of pain over the night.
• 12:58
  Speaker 2: You had an Achilles repair.
• 12:59
  Speaker 2: I blew my Achilles out being a weekend warrior Playing softball.
• 13:03
  Speaker 2: Solid, as it's said.
• 13:04
  Speaker 2: I blew my Achilles out being a weekend warrior playing softball.
• 13:06
  Speaker 2: That's all I was going to say.
• 13:06
  Speaker 2: A buddy of mine had a tournament going on at work and they allowed them to bring one or two guys that weren't related to the company.
• 13:12
  Speaker 2: He invited me to play Hit the ball.
• 13:14
  Speaker 2: Thought it was a home run.
• 13:15
  Speaker 2: So I'm doing my home run, trot rounding first, and I look up and I see it hit off the top of the fence.
• 13:20
  Speaker 2: So I went from a trot to a sprint and as soon as I planted that left leg I felt the pop.
• 13:25
  Speaker 2: Wow, yeah, I was miserable.
• 13:31
  Speaker 2: But after the surgery I was in a lot of pain and I remember asking the nurse to get me an anti-inflammatory because they had prescribed morphine or something for pain and it just wasn't working and I didn't want it anymore.
• 13:39
  Speaker 2: I wanted the anti-inflammatory.
• 13:41
  Speaker 2: And about an hour passed and she walked by again and I'm like did you ever hear back from the doc?
• 13:45
  Speaker 2: And she's like I haven't even had time to call them because I had to do my documentation.
• 13:51
  Speaker 2: If they don't finish their documentation before a certain time, they get dinged.
• 13:53
  Speaker 2: So now patients in the hospital aren't getting the care they need from their nursing staff, from their physicians, all because of this documentation.
• 14:01
  Speaker 2: And it was supposed to streamline things and make information sharing better Right, but all it does is occupy the, the healthcare professionals, time more, and none of these EHRs really communicate, so they're all independent systems.
• 14:18
  Speaker 2: So so the data sharing is is really the same as it was before, when you had handwritten charts, that you still have to fax it or email to somebody you know it's.
• 14:26
  Speaker 2: So that's another thing that I think kind of backfired in healthcare too, I believe it.
• 14:32
  Speaker 1: That's a bummer.
• 14:33
  Speaker 1: So now you're doing it's men's only medical and you're seeing men from 18 years old and up, 18 and up.
• 14:44
  Speaker 1: Yeah, what led you to want to do men?
• 14:45
  Speaker 1: It's like, hey, I want to do men only.
• 14:47
  Speaker 2: Yeah, no, that's a great question, you know, and it kind of goes against the grain because men are the ones that access healthcare less than women.
• 14:54
  Speaker 2: We're just, you know, we're too proud or, you know, or even embarrassed to to talk about what's going on with us.
• 15:04
  Speaker 2: Yeah, so I think we got to project toughness, right, yeah.
• 15:06
  Speaker 2: Yeah, we have to be a guy.
• 15:07
  Speaker 2: Yeah, we're providers, you know, and to an extent, you know, I kind of buy into that.
• 15:12
  Speaker 2: But at the same time, we do it to our own detriment sometimes, and so the easiest thing would have been to do either a family concierge, a man myself.
• 15:26
  Speaker 2: I just felt like man if there was like a cool place where guys could go feel comfortable, have, you know, manly colors on the wall, leather couches, you know just a certain vibe, and feel to it that men would come.
• 15:40
  Speaker 2: It's kind of like feel the dreams If you build it, they will come.
• 15:42
  Speaker 2: So we kind of threw costume to the wind, my business partner and I, who's one of my best friends from Cardinal Newman High School I'm a local guy here, his name is Chris Lazara and we went into this venture together and when we were talking about it we're like what could we do to kind of differentiate ourselves from the traditional concierge practice and we're like let's do men.
• 16:02
  Speaker 2: You know, I'm very passionate about it.
• 16:07
  Speaker 2: Almost sounds weird to say I'm passionate about men or men's health, men's health yeah.
• 16:11
  Speaker 2: But you know it, to me it's, it's a calling, because I live through all these things that guys are going through.
• 16:17
  Speaker 2: You know, if it's, if it's the decrease in hormone and energy levels, if it's issues with your libido, if it's issues with confidence, if it's hair loss, whatever, it is.
• 16:32
  Speaker 1: I'm also going through it.
• 16:32
  Speaker 1: So I just felt, like you know, it's good that it adds credibility and like a trust factor.
• 16:34
  Speaker 1: Right, Like I know you're going through.
• 16:36
  Speaker 2: Yeah, I've been through this, yeah, you know, and I think it makes it easier for me to treat the patient and I think it's easier for the patient to go on that ride with somebody who they can relate to.
• 16:47
  Speaker 2: So we just decided, hey, let's do an all-encompassing men's health facility, let's build it and they'll come.
• 16:55
  Speaker 2: And we've been open now for just a few months and things have started off, as most businesses do, slow, but they're really picking up now and now we have a good couple dozen concierge members and people that come in for all different services, if it's IV fluids, if it's skin treatments, if it's hair treatments.
• 17:13
  Speaker 2: But for me it was just about stepping out of the box and building something that I haven't seen out there, something totally different, kind of pioneering this new path of men's health.
• 17:26
  Speaker 2: Because, like I said, I feel like there's new path of men's health.
• 17:27
  Speaker 2: Because, like I said, I feel like there's a lot of places women can go to.
• 17:29
  Speaker 2: If it's a med spa, if it's a female doctor, you know, if it's whatever it is a wellness center, a lot of these things cater to women and we just didn't have a place for men.
• 17:41
  Speaker 2: So I said let's, let's, let's get it going.
• 17:43
  Speaker 1: Is there anything else you'd be open to sharing?
• 17:45
  Speaker 1: You had your Achilles rupture.
• 17:47
  Speaker 2: Let's, let's get it going.
• 17:48
  Speaker 2: Is there anything else you'd be open to sharing?
• 17:50
  Speaker 2: You had your Achilles rupture.
• 17:50
  Speaker 2: I had my Achilles rupture, uh, in high school when I was playing football.
• 17:52
  Speaker 2: I had a complex dislocation of the metacarpophalangeal joint, uh, and what that is is the knuckle that attaches your finger to your, to your hand uh, and tore all my tendons.
• 18:01
  Speaker 2: So I had to have surgery to fix all the tendons and to put the bone back in place.
• 18:11
  Speaker 2: And at that time the hand surgeon that operated was a really reputable guy.
• 18:13
  Speaker 2: He had known nationwide for his hand surgery, wrote it up in the journal because it was only the fifth reported case in history of that injury to that particular finger.
• 18:24
  Speaker 2: Interesting, wow, yeah.
• 18:25
  Speaker 2: And besides that, no other surgeries or bodily Interesting, wow, um, and besides that, um, no other surgeries or bodily injury.
• 18:31
  Speaker 2: Well, I guess I did fall out of a tree and broke my wrist when I was little on Thanksgiving day, so that really made my parents happy, Um, but besides that, you know just the typical stuff.
• 18:41
  Speaker 2: You know, I'm completely transparent with everything I do.
• 18:43
  Speaker 2: I did my blood work the other day and my testosterone was low, so, and it was low, I mean, it was low to the point where the lab was like excuse me, ma'am, um, I think you need some help here.
• 18:54
  Speaker 2: And I'm like, uh, so yeah, so we uh.
• 18:57
  Speaker 2: So I got started on that and I feel so much better.
• 18:59
  Speaker 2: I've been on it for about a month.
• 19:00
  Speaker 2: Energy levels are up, I'm sleeping better.
• 19:03
  Speaker 2: Um, you know, I feel youthful again and for me it made all the difference in the world, and a lot of times we don't even know how bad we're feeling until you supplement what's missing.
• 19:15
  Speaker 2: You know we'll go through life thinking that this is the norm, but then, when you do a deeper dive and you start finding little things and fixing them, you realize crap, obviously, the difference it makes.
• 19:25
  Speaker 1: I didn't realize I was living like this what do you guys crap.
• 19:27
  Speaker 1: I don't see the difference it makes.
• 19:28
  Speaker 1: I didn't realize I was living like this.
• 19:28
  Speaker 1: What do you guys?
• 19:29
  Speaker 1: What do you see most Like?
• 19:29
  Speaker 1: What kind of pathologies and issues and things that patients ask you the most?
• 19:34
  Speaker 2: Yeah, I think right now, since we we're doing a lot of like more integrative medicine function, you know, functional type medicine.
• 19:40
  Speaker 2: So most of the guys that come in are about maintaining health or just feeling better On the concierge side with the primary care.
• 19:51
  Speaker 2: The bread and butter of all primary care, as far as pathology goes or diseases go, is hypertension, high blood pressure, diabetes, overweight.
• 20:03
  Speaker 2: Weight's a huge issue in the United States.
• 20:05
  Speaker 2: Yeah, totally.
• 20:06
  Speaker 2: Um, overweight, you know weight's a huge issue in the United States.
• 20:08
  Speaker 2: You know, I have conversations with people all the time and it's like this ongoing kind of joke in the world that if you travel abroad you can tell who the Americans are because they're the big people that are walking around.
• 20:15
  Speaker 1: I hope we were talking with somebody recently.
• 20:17
  Speaker 1: They they were in Europe and then they came back and they were like I was eating more and um, enjoying like my trip and I felt better than when I'm here and I eat less and I'm like trying and like I just feel bloated and like lethargic and stuff like that.
• 20:32
  Speaker 1: Yeah, it's great, I've experienced it myself.
• 20:34
  Speaker 2: So what is that it's?
• 20:36
  Speaker 2: You know it's this whole, regardless of what people want to say and align themselves with.
• 20:41
  Speaker 2: And what do you want to call it?
• 20:43
  Speaker 2: You know they're calling it the Maha.
• 20:45
  Speaker 2: You know, make America healthy again.
• 20:46
  Speaker 2: This movement here, um, you know, pushing the fast food, making, you know, the bad food easier to get than than the healthy food, and so the fact that they're focusing on that, I think is is great.
• 21:15
  Speaker 2: So the like processed food, processed food, everything that you can put in like a microwave and anything you can pick up through a drive-through window and you know the amount of salt and and and preservatives they put in it.
• 21:28
  Speaker 2: It's just not good for you.
• 21:29
  Speaker 2: So that leads to chronic, chronic illness.
• 21:32
  Speaker 2: So everything starts with your weight.
• 21:35
  Speaker 2: You know a lot of people, when they start gaining weight, that's when all these problems start happening.
• 21:39
  Speaker 2: Your blood pressure goes up, your sugars start to go up because you start down-regulating your insulin receptors, because you're kind of abusing them with all the carbohydrates and sugars that you're consuming.
• 21:50
  Speaker 2: It puts stress on your joints and that, you know, kind of speaks to your world.
• 21:55
  Speaker 2: A lot of people that are overweight have low back problems, you know, knees and hips and ankle problems, and so you know we're just an unhealthy and very inactive society, although I'll tell you that I've noticed a tremendous shift in the last couple of years.
• 22:11
  Speaker 1: I feel like I have too Focusing, yeah, on their health, awareness of that and like, wait a second, you know, what should we focus on?
• 22:18
  Speaker 1: Yeah, it's great.
• 22:20
  Speaker 1: One of what you mentioned too is like where do you?
• 22:22
  Speaker 1: Okay then, where do you go for things that's not processed?
• 22:25
  Speaker 1: Okay then, where do you go for things that's not processed?
• 22:28
  Speaker 1: I'm always searching for ideas and stuff like that, because it gets more challenging and picky of where you can go to get that stuff.
• 22:33
  Speaker 1: But I've had other people that are really into that world and stuff and they're like farmer's markets, direct-to-farmer meat, and then produce similar kind of thing or they grow their own stuff.
• 22:46
  Speaker 1: You know, and I love that idea.
• 22:48
  Speaker 1: I love that idea.
• 22:48
  Speaker 1: There's no way do we have three kids right now, like there's no chance.
• 22:51
  Speaker 1: We have no time.
• 22:52
  Speaker 2: No, I mean, and it's still you know, and where do you have the space for you know?
• 22:55
  Speaker 2: And they do have these indoor things.
• 22:56
  Speaker 2: They're getting pretty creative and innovative with some of these like kind of growing systems that you can do, um, hydroponics in your house and stuff like that.
• 23:03
  Speaker 2: Um, but most people, yeah, don't have the room to like farm, you know.
• 23:07
  Speaker 2: And so even when you go to the supermarket, you know you have options, you know you can get the organic stuff or you can get the other stuff, but then the price difference is a real problem for people.
• 23:17
  Speaker 1: Yeah, I also heard something from a guy that's from a Brian Johnson.
• 23:23
  Speaker 1: He's the guy that does the don't die.
• 23:25
  Speaker 1: Yeah, he sounds.
• 23:25
  Speaker 1: Yeah, from Brian Johnson.
• 23:26
  Speaker 1: He's the guy that does the don't die.
• 23:26
  Speaker 1: Yeah, he sounds.
• 23:27
  Speaker 1: Yeah, yeah, yeah, he's like 47.
• 23:27
  Speaker 1: He looks like he's like 18.
• 23:30
  Speaker 1: But anyway, his goal is to age the slowest possible, yeah, so I think it's just interesting.
• 23:34
  Speaker 1: I'm like, all right, I'm going to take what I can't like see what I can hear from this guy and see what he may have to say with some things.
• 23:38
  Speaker 1: But anyway, I heard they were describing a, a study of like where, what meat from what sources has the most microplastics.
• 23:46
  Speaker 1: So, like, what's going to be the best for you and it's a lot of, it's the packaging that it's just like put in, not aside from, like the GMOs and you know all this stuff that they the farm, the, the, the produce that they're eating, like the cows are eating, or whatever the environments the chickens are raised and all the environmental toxins, even just that aside.
• 24:09
  Speaker 1: But then they're packaging it in plastic, then they're shipping it around.
• 24:11
  Speaker 1: But one of the highest density microplastics they're finding in organic meat was from Whole Foods, really, and I was like, oh my gosh, that's supposed to be the place where everything's fresh and organic.
• 24:21
  Speaker 1: That's a safe space.
• 24:22
  Speaker 1: Finally, even the air in here is cleaner.
• 24:24
  Speaker 1: This meat's got to be good.
• 24:26
  Speaker 1: Yeah, that's yeah.
• 24:28
  Speaker 1: Finally, even the air in here is cleaner.
• 24:28
  Speaker 1: This meat's got to be good.
• 24:29
  Speaker 1: Yeah, that's what if?
• 24:29
  Speaker 1: Anyway, I don't know, I mean, that's just what I had heard.
• 24:30
  Speaker 1: Please, people, do your own research and investigate that.
• 24:32
  Speaker 1: I'm always open to ideas and stuff and suggestions, but, like I was like okay, so then where do we go?
• 24:36
  Speaker 1: You know?
• 24:37
  Speaker 2: it's, it's, it's, it's frustrating, you know, because you don't have to go too far.
• 24:41
  Speaker 2: I mean, you know, because I, I did.
• 24:42
  Speaker 2: I traveled to, to spain a few times.
• 24:44
  Speaker 2: That's where my dad went to medical school.
• 24:46
  Speaker 2: So we've gone to visit a few times and I'll eat, you know, normal, or I'll go out and have, you know, a nice steak dinner and I never feel bloated afterwards.
• 24:56
  Speaker 2: I never feel you feel like walking and going around and sightseeing after you eat.
• 25:00
  Speaker 2: You know you go out to a big dinner here and you just want to go home.
• 25:03
  Speaker 2: You want to lay down, get out, just let a truck run you over.
• 25:05
  Speaker 2: It's just not.
• 25:06
  Speaker 2: You don't feel good, that's not.
• 25:08
  Speaker 2: Yeah, it's not ideal, no, but to your point with the supermarkets, you know like when in the world has you know fruit been able to last like two or three weeks on your counter?
• 25:17
  Speaker 2: Like, that's not, it's not normal.
• 25:19
  Speaker 2: Yeah it's not what's supposed to buy it and eat it.
• 25:24
  Speaker 2: You know not just have things stay, but they do it on purpose so that it lasts longer.
• 25:28
  Speaker 2: Yeah, it makes it more convenient.
• 25:29
  Speaker 1: Yeah, so corporations are diving into like how can we make things cheaper and more profitable on our end, right and last longer and it'll look nicer?
• 25:37
  Speaker 1: Just the look.
• 25:38
  Speaker 1: Yeah.
• 25:38
  Speaker 1: To make things fluffy like bread or just fruit look brighter, yeah.
• 25:43
  Speaker 2: With wax over it or whatever.
• 25:51
  Speaker 1: Yeah, yeah, with wax over it or whatever.
• 25:51
  Speaker 1: Like, yeah, you gotta spray some wax on it.
• 25:52
  Speaker 1: Yeah, on the apples.
• 25:53
  Speaker 1: But I had heard that I forget what the label was, but like there was.
• 25:54
  Speaker 1: I had seen this.
• 25:54
  Speaker 1: So an article someone was describing like if you scrape the skin of the apple, you can get the way.
• 25:57
  Speaker 1: You can see like, oh, there's a bunch of wax on here.
• 25:59
  Speaker 1: I saw a video about that.
• 26:00
  Speaker 1: Yeah, yeah, and I was like, oh man.
• 26:01
  Speaker 1: But I looked at apples we're getting unfortunately, you know, we're getting like the organic ones from Costco is what we usually go.
• 26:06
  Speaker 1: We live at Costco oh my gosh, for our family, and they're good.
• 26:09
  Speaker 1: They're not the waxy ones.
• 26:10
  Speaker 2: We have three kids.
• 26:11
  Speaker 2: It's a good place to go to get bang for your buck.
• 26:16
  Speaker 1: Exactly, oh yeah, so the other one would be environmental toxins that I've heard a lot too of, just like, as an example, farming pesticides in the air and then golf courses in the area, and pesticides in the air just for maintaining the irrigation.
• 26:30
  Speaker 2: Yeah, yeah, no, it's bad.
• 26:32
  Speaker 2: You know, and there's been a lot, uh, there's been a lot of focus on that lately.
• 26:36
  Speaker 2: You know, and um, one of our biggest kind of agricultural businesses here is the sugar industry.
• 26:41
  Speaker 2: You know, and um, a lot of people try to kind of pin, you know, some farming practices on the algae that's growing into the rivers and the feeder systems that go out into the St Lucie, whatever it's called, the bay up there or whatever and into the intercoastal, and I don't know that it's coming from them or from where it's coming from.
• 27:06
  Speaker 2: But there's definitely something to be said about the pesticides and stuff, and you don't have to look much further than listen.
• 27:11
  Speaker 2: You can have every intention of eating healthy and people will focus their diet on fish, and then you come to find out that you have these elevated mercury levels from eating something that you're supposed to be eating, something that's healthy for you and it's doing you harm.
• 27:27
  Speaker 2: So it's almost like you know, even when you try your best, you can kind of shoot yourself in the foot, so hypertension seems to be one of the most common pathologies.
• 27:38
  Speaker 1: And it starts with just being overweight.
• 27:39
  Speaker 2: A lot of it comes from being overweight.
• 27:41
  Speaker 2: You know, everything in healthcare is very multifactorial.
• 27:46
  Speaker 2: There's genetic components to it and then there's environmental components to it.
• 27:50
  Speaker 2: There's not much you can do to change your genetics, but there's usually this like two hit kind of model where you have the genetic predisposition for something, but something environmental triggers it so so now it's expressed.
• 28:07
  Speaker 2: So then it expresses, it comes out and it rears its ugly face and then you just got to deal with it, and a lot of times with high blood pressure.
• 28:14
  Speaker 2: Now don't get me wrong.
• 28:15
  Speaker 2: You're going to find people that are in shape and skinny that have high blood pressure.
• 28:18
  Speaker 2: People that are in shape and skinny that have high cholesterol.
• 28:21
  Speaker 2: That's kind of out of their control.
• 28:22
  Speaker 2: But the grand majority of people it's just lack of physical activity and lack of a good diet Interesting, yeah, I had.
• 28:32
  Speaker 1: I had my blood work done recently and my LDL was higher than I mean what would be ideal, you know.
• 28:38
  Speaker 1: And I'm like man, it's interesting Cause I feel like I eat.
• 28:41
  Speaker 1: I mean I definitely have cheat meals, but you know, the weekends usually I let a little bit lower loose, um, or snacking, if my kids happen to get to bed early enough and I'm like I have like 45 minutes before I need to get to bed.
• 28:51
  Speaker 1: Like this is insane, like I want to have a snack.
• 28:53
  Speaker 1: That would be the only times, you know.
• 28:55
  Speaker 1: But anyway, I'm like what do I do?
• 28:56
  Speaker 1: It had been like this actually for like probably 10 years, cause I yeah, when I first started my like, when I graduated grad school 10 years ago, I had my physician's appointment with my previous job this is in Texas and they're like, yeah, your LDL is like elevated and I was like how you know, right, but anyway, the suggestion was like it's a combination of like just the nutrition.
• 29:19
  Speaker 1: It's nutrition, maybe some environmental, but mostly nutrition and then examining like what things in the let's talk about your diet, right, right, and then what of those things might trigger maybe an ldl type of elevated thing and, uh, cheese seems to be one of those things for me.
• 29:35
  Speaker 1: Oh yeah, I love his dairy.
• 29:36
  Speaker 1: I don't really have that much dairy to begin with, but anyway, the cheese.
• 29:39
  Speaker 1: And I was like interesting, I didn't even want to thought of that because, like I have, I have a whole three eggs in the morning every day, and then, um, like a, either a tortilla like or a bagel, or like a croissant or something like a little bread, all right, um, and then, uh, I put cheese on the eggs, yeah, and then at nighttime I'll have like, if we have my wife will make healthy dinners and stuff.
• 29:59
  Speaker 1: I'll put cheese on quinoa, or like cheese on something else.
• 30:01
  Speaker 1: I'm like having cheese more frequently.
• 30:03
  Speaker 1: I was like I didn't realize that.
• 30:04
  Speaker 2: Yeah, you know, and so one of the things that's really interesting about cholesterol in particular is, you know, in in in the medical field, it was all about cholesterol back in the day and low fat diets and and and lower your cholesterol.
• 30:19
  Speaker 2: But then we we've seen time and time again where people with normal cholesterol levels are dying of heart attacks and atherosclerotic plaque and people with elevated cholesterol have zero cardiovascular disease.
• 30:30
  Speaker 2: So there's something more to it.
• 30:33
  Speaker 1: So there's a disconnect between just the elevated LDLs Correct and then cardiovascular disease 100% Interesting and what we found is that.
• 30:41
  Speaker 2: So one of the things we do at Men's Only Medical too, for our concierge members is we do their first blood work.
• 30:46
  Speaker 2: We do it on us.
• 30:48
  Speaker 2: We pay for it because the insurance won't pay for they deem it unnecessary.
• 30:50
  Speaker 2: Because we check uh, inflammatory markers, heavy metals, autoimmune markers, like a full panel.
• 30:56
  Speaker 2: Full panel hormones, and not just your testosterone.
• 30:58
  Speaker 2: We're checking your fsh, your lh, your estrogen levels, your prolactin level.
• 31:02
  Speaker 2: We we do everything and one of the things we do is we do this fractionated kind of cholesterol panel.
• 31:08
  Speaker 2: So we don't just get your LDL, your HDL, your triglycerides.
• 31:11
  Speaker 2: We get what type of LDL you have, the size of your LDL, the size of your HDL, your apple lipoprotein B.
• 31:21
  Speaker 2: We check the full, deep dive into the cholesterol because there are certain types and shapes of LDL that are more kind of atherogenic, where it can cause atherosclerosis in your arteries, and others that are very low risk.
• 31:39
  Speaker 2: So you can have a very elevated LDL and if you have the good type of LDL you're really not at that much risk for heart disease.
• 31:47
  Speaker 2: Plus, your HDL, when it's elevated, becomes cardio protective, so you can offset some of that elevated LDL with a higher HDL.
• 31:55
  Speaker 2: How do you do that?
• 31:57
  Speaker 2: Just changing your diet, changing the types of oils you cook with, you know, eating healthy nuts and stuff like that, just kind of eating cleaner fats, yeah, you know.
• 32:08
  Speaker 2: And the other thing is inflammation.
• 32:11
  Speaker 2: Inflammation is a huge thing and it's not just for joints anymore, you know, and we found that also people who develop heart disease have a lot of inflammation in their inside of their arteries, which allows for the plaque and everything to stick to the walls easier and then contributes to the blockage that'll cause heart attacks and strokes and stuff like that.
• 32:31
  Speaker 1: Yeah, yeah, interesting.
• 32:33
  Speaker 1: So the good fats, like polyunsaturated fats, monounsaturated fats, where nuts would be an option, yeah, and I would imagine like this is also too like I mean a different specialty of like what type of nuts and like what we could for them.
• 32:48
  Speaker 1: So you see, all right.
• 32:50
  Speaker 1: So I would imagine high cholesterol, hypertension and then inflammatory markers on the blood work, common things, that you and someone's overweight, they're feeling lethargic, they don't they low libido If something other things hurt, like their back and their knees and stuff like that.
• 33:05
  Speaker 1: That's a common profile, common profile.
• 33:09
  Speaker 2: You know, and the frustrating thing to me is that when you go to your traditional PCP, your primary care physician, they're going to tell you your cholesterol is high, your blood pressure is high, you need to lose weight, you need to eat better, and that's the end of it, and then take these statins.
• 33:24
  Speaker 2: And then, yeah, here's your statins, yeah, here's your medications.
• 33:29
  Speaker 2: And then you're kind of left to fend for yourself where, if you had better guidance and instruction on how to lose the weight and how to eat healthier and what type of activities you can do to start getting some of that weight off, you would have a good chance of losing the weight, dropping your blood pressure, normalizing your cholesterol, without even having to be on the medications.
• 33:48
  Speaker 2: And that's what the approach we take at Men's Only Medical.
• 33:51
  Speaker 2: We don't just reflexively prescribe medications to people.
• 33:55
  Speaker 2: We're not there to ignore their healthcare issues and their medical issues, but we want to address the root cause.
• 34:01
  Speaker 2: We want to get down to why these things are elevated.
• 34:05
  Speaker 2: Now don't get me wrong If we give it the old college try and we give them the guidance that we need to give them, and we'll come up with a two or three page protocol with all sorts of things that they can do, from different supplements to the type of nutrition they should intake, to the type of exercises, to even biohacking recommendations like cold plunges and infrared lights and different things that you could do.
• 34:27
  Speaker 2: And we do that and you're sticking to that and you come back and you've lost the weight, but your cholesterol is still high and your blood pressure is still high.
• 34:34
  Speaker 2: Then we're going to have an honest conversation about starting medications.
• 34:38
  Speaker 2: But a lot of times you start a medication and it leads to side effects, and then you have to take a medication to cover the side effect that the first medication caused, and now you're just a cocktail of meds.
• 34:49
  Speaker 1: Yeah, you just slide down that slope 100 and we've obviously we've all heard cases of that where like someone's like 14 things, you know, just to counteract the other meds, so bad the bummer, you know it's horrible.
• 34:59
  Speaker 1: Um and the uh with the medic.
• 35:05
  Speaker 1: So medication stuff right with statins.
• 35:08
  Speaker 1: Another thing I've heard a lot of was like well, joint pain is a common thing with that one.
• 35:11
  Speaker 1: Yep muscle pain, joint pain yeah, it's the number one reason people stop taking it but at that point, what were the other suggestions, like imagine, like an allopath, like a western insurance base?
• 35:22
  Speaker 1: What do they do then?
• 35:24
  Speaker 2: so you, what you would have to do is start on one statin, find out they have a side effect, change them to a different statin.
• 35:30
  Speaker 2: This is what the kind of protocol is in traditional medicine and if they have a side effect to that, all that has to be documented.
• 35:38
  Speaker 2: There are other medications now, like Repatha and other things that are injectable that will lower your cholesterol.
• 35:43
  Speaker 2: That is not a statin.
• 35:46
  Speaker 2: That it's not a statin.
• 35:52
  Speaker 2: And we also have other kind of non-traditional treatments like plasmapheresis.
• 35:55
  Speaker 2: So people are doing what's called therapeutic plasma exchange, where you get connected to a machine.
• 35:58
  Speaker 2: It'll take your blood out, run it through the machine and then put it back in into your other arm.
• 36:04
  Speaker 2: After it filters out all of the certain substances it'll filter out your heavy metals, it'll filter out inflammatory components and it'll also filter out cholesterol and triglycerides.
• 36:14
  Speaker 2: So with people with significant issues with elevated cholesterol and triglycerides, it's actually a medical treatment.
• 36:22
  Speaker 2: But you have to jump through all the hoops before you can get there because it's a very expensive procedure.
• 36:26
  Speaker 2: It'll cost like $10,000 and insurance isn't going to pay for that?
• 36:29
  Speaker 1: Yeah, of course, and you mentioned type two diabetes.
• 36:33
  Speaker 1: That's what you meant.
• 36:34
  Speaker 1: Type two, yes, um, from my understanding, that's reversible.
• 36:37
  Speaker 2: It's uh.
• 36:38
  Speaker 2: Most of the time with type two diabetes it it is attributed to lifestyle.
• 36:43
  Speaker 2: So if you can lose the weight we usually see the kind of typical and it's not everybody but the typical type two diabetic is overweight, has not very healthy eating habits and is very stationary.
• 36:59
  Speaker 2: So if you can get people moving and eating well and losing weight, you can bring that patient's sugars down to a level where they wouldn't have to be on medications.
• 37:09
  Speaker 2: Now it depends how deep they are into it.
• 37:12
  Speaker 2: Some people they can be doing all the right things, but it's gotten past a certain point and they're always going to have to be on some type of medication.
• 37:18
  Speaker 1: Yeah, yeah, gotcha, but there is hope.
• 37:21
  Speaker 1: At least there's absolute hope.
• 37:22
  Speaker 1: It'd only be a benefit to try that route.
• 37:24
  Speaker 2: 1,000%, it's part of the protocol.
• 37:25
  Speaker 2: A thousand percent it's part of the protocol and you should do it, regardless if you're on medications or not.
• 37:29
  Speaker 2: But to your point, yeah, type 1 diabetes is.
• 37:32
  Speaker 2: Unfortunately, it's an issue with production of insulin, so you have to introduce the insulin to the body, since you're not making it yourself.
• 37:38
  Speaker 2: Yeah, yeah, have you seen a lot more incidents of type 2 diabetes.
• 37:45
  Speaker 2: You know, in my career I've been in health care now for 20-something years and I would say it's just always been a big problem.
• 37:53
  Speaker 2: It's just always been a big problem.
• 37:55
  Speaker 2: So have I seen an uptick in it?
• 37:57
  Speaker 2: A slight uptick, but I think it's only because when I got into healthcare it was already a huge problem to begin with.
• 38:04
  Speaker 1: Interesting.
• 38:05
  Speaker 1: Is there something you've seen over the last several years?
• 38:11
  Speaker 2: that's like this has, like this, has increased a lot of of incidences.
• 38:13
  Speaker 2: Um, that's a great question.
• 38:15
  Speaker 2: Um, something that I've seen a lot and I and I get to experience it more secondhand because of my wife is cancer, not any particular type of type of cancer, but just cancer in general, and I can't help but think that it's got to be related to a lot of these toxins that are either in our food, you know, in our environment, in our surroundings, and we're just seeing and my wife sees it she'd tell you if she was here it's crazy how many more people are getting cancer these days and how many more women are getting breast cancer younger.
• 38:53
  Speaker 2: It's almost a weekly thing that she gets biopsies of a 30 something year old woman with with breast cancer.
• 38:59
  Speaker 2: Wow, and I would say that you know 20, 30, 40 years ago, and I don't have the data to back it up, but I, I would strongly suggest people look it up, cause I, I firmly believe it and I would be extremely shocked to find out that the data to back it up.
• 39:09
  Speaker 2: But I, I would strongly suggest people look it up because I, I firmly believe it and I would be extremely shocked to find out that the data suggests something otherwise, but more people have cancer these days and people are getting them younger wow, yeah, I uh.
• 39:23
  Speaker 1: I mean fortunately I don't have any first-hand experience with that, you know, and not my field, and what we see, but I I could believe that you know, I know that, um, something recent, like I feel like a type one diabetes has been more prevalent over the last couple of decades, for the same kind of arguments that I've heard, and uh, that seems that's just interesting to me, you know, and of course parents would feel extremely guilty right Of like, oh, I did, I'm feeding them this stuff and how would I have known otherwise, you know, or whatever, um, all the, just the, the, the dietary, you know, intakes of not knowing how processed everything was, just not knowing otherwise, but um, anyway, I think like that's been more prevalent.
• 40:07
  Speaker 2: Yeah, uh, you know, I just think um, you, you know, and the thing is, when you get into family medicine, you tend to live in the world of internal medicine, because the traditional family physician sees kids of all ages, from birth to death.
• 40:23
  Speaker 2: You know we're all encompassing, but because there's so many pediatricians and so many options, people typically take their kids to the pediatrician and then the adults will come and see their family physician and type 1 diabetes is a lot more common in kids.
• 40:39
  Speaker 2: Obviously, those kids go on to be adults, but we do see it a lot in kids and I would say that the pediatricians would probably tell you that they're seeing a lot more type 1 diabetics these days than they did in the past.
• 40:51
  Speaker 2: It's terrible.
• 40:53
  Speaker 1: I mean, we'd love to hopefully make a change with that, you know, with just more awareness and recognition and stuff like that.
• 40:59
  Speaker 1: Yeah, what do you feel like is going to be the next?
• 41:02
  Speaker 1: Like what do you think the shift that we're seeing in medicine, health care, overall health and wellness, and from your end, from like a like what do you think is going to be the next?
• 41:13
  Speaker 1: What direction are we going?
• 41:14
  Speaker 1: Like what's going to be really groundbreaking for?
• 41:15
  Speaker 2: people.
• 41:16
  Speaker 2: I think it's it's all the non-traditional stuff, you know.
• 41:19
  Speaker 2: I think it's like the.
• 41:20
  Speaker 2: It's really the wellness component of medicine.
• 41:24
  Speaker 2: It's it's really digging into preventative medicine and not in the not in the way that we've always talked about it which is screening tests and and vaccines and all that kind of stuff.
• 41:36
  Speaker 2: It's making sure that we are consuming safe products, that we're not experimenting with unsafe products, that we're moving more and exercising, and if we do that and we can get our population to shrink, not in the number of people but in the size of the people, then we're going to have a lot less disease moving forward.
• 41:59
  Speaker 2: Oh, like, body mass index is shrinking, yeah, bmi, if we can continue to go in that direction.
• 42:05
  Speaker 2: Childhood obesity right now I was reading some really disturbing studies.
• 42:08
  Speaker 2: I mean it's something like one in three kids or something is overweight or obese.
• 42:13
  Speaker 2: It's just, it's kind of sickening, you know, and with the advent of gaming and these personal devices and iPads and cell phones and kids don't get out as much as they used to and then, if it starts as a kid, you just end up being an unhealthy adult.
• 42:33
  Speaker 1: That lifestyle, that's the habit, the normal, that's the new norm.
• 42:37
  Speaker 1: I totally agree.
• 42:39
  Speaker 1: We've heard from a lot of different parents and stuff, family members and my nephews and nieces and stuff like that, but they're like, although further along we are with our kids ages, and they were like, yeah, we're not getting our kids a phone, that what I had heard from an expert was, when you're ready for your kid to have um anxiety and self insecurity and depression, then get them social media and a phone.
• 43:07
  Speaker 1: Yeah, like well, I'm not ready for that, I would never be ready for that.
• 43:09
  Speaker 2: I'm never ready for it.
• 43:10
  Speaker 2: We get in fights.
• 43:12
  Speaker 2: I have an 11 and a 13-year-old.
• 43:13
  Speaker 2: Two boys, oh, okay, my older son has a phone now he's getting a lot.
• 43:19
  Speaker 2: He's about to start high school next year and it's more like we want to be able to communicate with him when he's out, friends and stuff.
• 43:25
  Speaker 2: And the 11 year old just like when's my phone coming?
• 43:29
  Speaker 2: And we're just like you're not getting a phone yet.
• 43:30
  Speaker 2: Yeah, you're not, you know, but but my brother got one when he was this age and I'm like, well, you know, you're not your brother and for now you don't get one, because we know, once we get it to him, you kind of lose a kid and they start going down the rabbit hole and try to get them out as much as possible.
• 43:46
  Speaker 2: It's just harder, uh, these days, because kids are, you know, into different things.
• 43:51
  Speaker 2: You know we they had to call us into the house when we were little.
• 43:54
  Speaker 2: Yeah, it's time for dinner, come in here.
• 43:56
  Speaker 2: Yeah, it was just dark out and you're, your parents are full of dirt, yeah parents are driving around like where were you?
• 44:01
  Speaker 1: yeah, you know, we have dinner at six, right?
• 44:03
  Speaker 1: It's like I forgot to try time.
• 44:05
  Speaker 1: Yeah, I'm sorry, I wasn't, I'd watch.
• 44:07
  Speaker 2: I don't have a cell phone, yeah so we started playing manhunt.
• 44:09
  Speaker 2: It was like dark, now perfect yeah, I mean, but those you know, those are the good days and, uh, I think if we can get kids active again and excited about being outside, it would go a long way in in helping them when they become adults.
• 44:22
  Speaker 1: Yeah, for that continuous lifestyle, yeah, um, what about musculoskeletal stuff?
• 44:26
  Speaker 2: and you'll see some of that yeah, I mean, you know I see a lot of wear and tear stuff.
• 44:31
  Speaker 2: You know when, when I start seeing men as as adults already, uh, a lot of them are former athletes.
• 44:37
  Speaker 2: You know a lot of them.
• 44:38
  Speaker 2: If they're overweight, um, so you know, it's a lot of low back pain, um, a lot of knees, a lot of people with uh, with pain in their knees.
• 44:47
  Speaker 2: And again, I think you know the way that we've started looking at medicine and treating these things has gotten, I would say, healthier as well, because before it just used to be, hey, we'll give you a cortisone shot, and that's great.
• 45:01
  Speaker 2: It's a really good anti-inflammatory and it's going to decrease your pain and inflammation for the time being, but it's going to come back.
• 45:08
  Speaker 2: You can only do it so many times before you start causing more damage to the joint than helping it, not to mention that those cortisone shots increase your blood sugars.
• 45:18
  Speaker 2: It just that's what it does.
• 45:20
  Speaker 2: So we're actually contributing to more problems than helping the person when we go that route these days, with peptides and PRP injections and stem cells and exosomes you know so many different things out there that you can use that help people's bodies regenerate themselves and kind of heal naturally, as opposed to introducing, you know, anti-inflammatories and or prednisone, which is also an anti-inflammatory, but a different type of anti-inflammatory, I think is going to be really helpful and beneficial for people.
• 45:51
  Speaker 2: So yeah, knees, backs, ankles, a lot of Achilles.
• 45:55
  Speaker 2: I know I was talking about it earlier how I blew out my Achilles.
• 46:00
  Speaker 2: I just personally, friend-wise, I know a bunch of guys who, oh, every day I play tennis, I wake up the next morning and I can barely walk because my Achilles is painful and it's bothering me and stuff like that, and you know a lot of those things become chronic issues because nobody gives themselves enough time to rest and to get the inflammation down.
• 46:19
  Speaker 2: So they're dealing with it for weeks, if not months.
• 46:21
  Speaker 2: It lingers, yeah.
• 46:23
  Speaker 1: Tendonitis, like lingers, oh yeah, but because we see it a lot, you know stuff like that.
• 46:28
  Speaker 1: But, uh, cause we see that a lot, you know stuff like that, um, the uh for for that kind of stuff.
• 46:33
  Speaker 1: And I was gonna ask about the, uh, the cortisone injections Um, what is it that?
• 46:38
  Speaker 1: Like, how many?
• 46:38
  Speaker 1: When would you advocate for a cortisone injection first, like when it's like, yeah, that's you know, I think it's a good time.
• 46:44
  Speaker 2: Yeah, I think if somebody has, you know, kind of more of an acute pain and it's nothing, that seems that it was from like a significant injury you know, I'm not worried about a significant tear and it's just inflammation, maybe some mild swelling.
• 46:58
  Speaker 2: It's a quick fix, you know, and it's still a really good medicine, it's a really good treatment.
• 47:04
  Speaker 2: Everybody that I've given let me say not everybody, most people I give cortisone shots to in a joint tell me within a few days I don't have the pain anymore.
• 47:15
  Speaker 1: So so it's a good just like quickly bringing down a lot of heightened inflammatory pain.
• 47:19
  Speaker 2: Correct that they're debilitated and it's like all right, now we've got it like settled Now let's do some stuff for it, and that's what I like and and you know very well a lot of stuff, even like the knee, for example.
• 47:37
  Speaker 2: People deal with the knee if it's mild osteoarthritis or if it's some type of inflammation of the soft tissue, meniscus or whatever it is.
• 47:42
  Speaker 2: You know, a people don't give themselves, they don't afford themselves the time that they need to let it heal or to rest or anything.
• 47:50
  Speaker 2: People want to be active but they're kind of re-aggravating the injury.
• 47:53
  Speaker 2: So if we can calm that pain down and then start strengthening the muscles around the joint to give that joint more support, you can actually help prevent it from recurring.
• 48:02
  Speaker 2: And again, instead of giving the cortisone shot, which is an anti-inflammatory to reduce the swelling once it's there, after you've done that, let's go into the world of PRP or exosomes or the peptides, where it can now use, helps your body naturally calm that inflammation down, repair the tissue that maybe have micro tears and stuff in it so that you don't have it recurring down the road.
• 48:30
  Speaker 2: So it's a good kind of fire extinguisher, the cortisone, but it's not going to fix the problem.
• 48:35
  Speaker 1: That's a good one.
• 48:36
  Speaker 1: Fire extinguisher yeah, yeah, totally.
• 48:37
  Speaker 1: What peptides do you usually recommend for that?
• 48:43
  Speaker 2: There's a couple different ones.
• 48:44
  Speaker 2: God, why is it just escaping my mind right now?
• 48:48
  Speaker 2: Another common one is the BPC.
• 48:50
  Speaker 2: Yeah, that's one, the BPC.
• 48:50
  Speaker 2: Yeah, bpc-157 is the one we use, because I was just thinking we just started talking to some guy.
• 48:56
  Speaker 2: He got some other stuff, some AOD and some CJC and ipamorelin, but those are more kind of to help kind of build muscle.
• 49:04
  Speaker 2: Yeah, the growth hormone analogs and stuff like that.
• 49:07
  Speaker 2: But yeah, the BPC, that's the one that we use for all the joints and soft tissue inflammation and pain.
• 49:13
  Speaker 1: It's interesting you were mentioning the wear and tear, joint pain stuff, like that breakdown Similar to the LDL, where it's like well, some people have elevated LDLs and they have no cardiovascular issues and then some people have low LDLs and high cardiovascular.
• 49:29
  Speaker 1: So there's a disconnect between just like LDL and cardiovascular right.
• 49:32
  Speaker 1: Similarly, what we've been exposed to and what we talk with a lot of our patients is we can't change anything with the bone right, the cartilage degenerative changes, whatever.
• 49:41
  Speaker 1: We're not surgeons so we don't go and fix your labrum, whatever.
• 49:45
  Speaker 1: But a lot of the research does show there's a huge disconnect between abnormalities found on imaging with labral tears, cartilage defects or chondromalacia breakdown, osteoarthritis, whatever, herniated discs, facet arthropathy, nerve issues or whatever that cause sciatica type symptoms, right referred pain.
• 50:03
  Speaker 1: And then the imaging where there's people that have like pretty good looking knee MRI or x-ray and they have like a lot of knee pain and swelling.
• 50:11
  Speaker 1: And then there's people that have like that looks kind of bad, you know, like a lot of bone on bone or like narrowing of the joint space in the hip or like narrowing of the disc space in their lumbar spine.
• 50:21
  Speaker 1: We're like I feel pretty good.
• 50:21
  Speaker 1: What do you mean?
• 50:22
  Speaker 1: They're like moving around and they're super limber.
• 50:24
  Speaker 1: I was like there's a huge disconnect then between what the imaging is showing and whether their functionality, prognosis and pain.
• 50:30
  Speaker 1: So people and it's very commonly people will come in um, not as common as you would think, actually, because the type of people that we see are, um, you know they're, they're very motivated and like enthusiastic.
• 50:40
  Speaker 1: They're like I don't want, I don't want to do that, I want to fix this thing, like and I'm going to take the low, the slow route, like I, I want to do what I need to do, you know, yeah, but anyway, yeah, there are still occasionally people that are like, but I have a herniated disc and I'm like everybody does.
• 50:54
  Speaker 1: You know we can't change that.
• 50:56
  Speaker 1: Anyway, everybody has a herniated disc.
• 50:57
  Speaker 1: It's pretty ubiquitous, but hey, like, 75% of people over the age of 43 have some kind of abnormality found on the spine in an image, but you don't see 75% of people hobbling around in severe back pain and referred neurological pain.
• 51:16
  Speaker 1: So, like there's this hey, this is supposed to be encouraging and hopeful.
• 51:18
  Speaker 1: There's a disconnect between what they're finding.
• 51:19
  Speaker 1: So you had no pain six months ago, but now you have like debilitating back, like your back's hurting a lot and you're having some referred pain.
• 51:25
  Speaker 1: The imaging doesn't change that quickly.
• 51:28
  Speaker 1: So five years ago a year ago you had no pain, but now you do.
• 51:32
  Speaker 1: Your back didn't change that much in a year of the image and MRI where it looked identical, so that means you can get back to a pain-free state without changing the internal structure.
• 51:39
  Speaker 1: So it's supposed to be encouraging right.
• 51:42
  Speaker 2: Yeah, it's really interesting that and you make such a great point because one of the things that everybody should do, and you make such a great point because one of the things that everybody should do, and what I pride myself on, is treating the person, not a result, and that's why I don't reflexively prescribe a statin for everybody whose cholesterol is elevated, because everybody's different and really individualizing the care, because if you just do a certain study and get a result and then reflexively treat it, it may not be a problem for that person, you know, but now you're introducing a treatment modality that they may not need, um.
• 52:20
  Speaker 2: So really personalizing the care, um, and and treating the patient, not a result.
• 52:26
  Speaker 2: You know, I think it was that movie patch adams, robin Williams.
• 52:29
  Speaker 2: Oh yeah, Good movie, yeah, and he just says at the end you know, you treat the person, not the disease, you treat the person.
• 52:36
  Speaker 2: You need more compassion.
• 52:37
  Speaker 2: You're going to win, you know.
• 52:38
  Speaker 2: And so you can't just always base it on a result and you can't just haphazardly just order tests because you're going to find something.
• 52:49
  Speaker 2: Yeah, you know, and there's this big trend now of people doing these full body scans, like as a preventative type thing.
• 52:54
  Speaker 2: Oh, just get me in the in the CAT scan machine and just do a full body scan.
• 52:59
  Speaker 2: On one hand yeah, what are your thoughts on that?
• 53:00
  Speaker 2: You know, on one hand, you know knowledge is power, you know, and if there's something really bad and you catch it, but nine times out of ten you're going to find something and it's going to lead you down a rabbit hole.
• 53:16
  Speaker 2: You're going to find some type of benign nodule or cyst on some type of organ.
• 53:17
  Speaker 2: That's going to lead to further testing, non-invasive or invasive, only to find out that it was nothing anyway.
• 53:25
  Speaker 2: So now you've increased your costs, you've increased the stress of your body exposure to something.
• 53:30
  Speaker 2: Yeah, the radiation from a cat scan or anesthesia from a biopsy, the full body MRI, like same kind of same thought.
• 53:38
  Speaker 2: Yeah, I mean the full body MRI is different because it doesn't expose you to radiation, but again, it can still lead you down the same rabbit hole.
• 53:47
  Speaker 1: So your suggestion would be like all right, if you're going to do that, just go in with the right mental expectation, Correct, and then not like jump off a cliff.
• 53:54
  Speaker 1: It's like oh, I have a small little thing.
• 53:56
  Speaker 2: Right, you know you have to.
• 53:59
  Speaker 2: That's why I think it's important you have to be on the journey with your patient.
• 54:01
  Speaker 2: You can't just let your patient go off on their own and try to figure things out on their own.
• 54:13
  Speaker 2: You know you, really, if you're a good physician, you're going to walk that path with your, with your patient.
• 54:15
  Speaker 2: You're going to be communicating with them, you're going to be reassuring them, um, and, ideally, doing what's best for them and what they need.
• 54:22
  Speaker 2: You know you can't just you can't just do the same thing for every patient that walks in through your door.
• 54:28
  Speaker 2: It's just not.
• 54:30
  Speaker 2: Again, that's kind of going back to this whole protocol driven insurance metrics that they're pushing.
• 54:35
  Speaker 2: You have to individualize and personalize the care and not everybody's going to need a full body scan.
• 54:40
  Speaker 2: Not everybody's going to need, you know, peptides or hormone replacement, or to be on a statin, regardless of what their cholesterol is, or be on this blood pressure medication versus another one.
• 54:50
  Speaker 2: You know you have to really be on that journey with them and care, and that's why, going back to our earlier conversation, I love the concierge model because it allows me the time and the ability to learn about the patient, educate the patient and then go down the journey with them.
• 55:08
  Speaker 1: One more question about the cortisone injections.
• 55:11
  Speaker 1: Injections.
• 55:12
  Speaker 1: I haven't heard different thoughts on this.
• 55:14
  Speaker 1: How many would you say like, like, let's say hey, like a knee or back, whatever, and they're going to inject it?
• 55:19
  Speaker 1: How many injections could that individual joint tolerate, or is it a systemic three?
• 55:25
  Speaker 2: three injections in any joint is the max you should ever do.
• 55:28
  Speaker 2: You do more than three, then that cortisone is actually going to start wearing away at the joint, breaking out the cartilage right, that's what I've heard.
• 55:34
  Speaker 1: Yeah, interesting.
• 55:36
  Speaker 1: So three, you got like two free tokens.
• 55:38
  Speaker 2: Third, one's pushing it and what we find is you get the first one that alleviates the pain and inflammation.
• 55:44
  Speaker 2: Three months later it's back.
• 55:48
  Speaker 2: You do a second one.
• 55:49
  Speaker 2: One month later it's back.
• 55:51
  Speaker 2: So it becomes decaf.
• 55:52
  Speaker 2: So it starts they start needing them more frequently and that's why I'm saying it's going to it's going to put the fire out, but it's not going to fix the issue.
• 56:02
  Speaker 1: I had a patient that this this person was a younger person chronic back issues.
• 56:06
  Speaker 1: They were young, like they weren't, they were mids, but chronic back issues and tried multiple routes of some things.
• 56:14
  Speaker 1: I think had at least two surgeries on it and probably had, at this point that I met this patient, 20 injections in their lumbar spine.
• 56:25
  Speaker 1: I was like do you think I'm okay?
• 56:30
  Speaker 1: I'm like, oh my gosh, it's been bothering me a little bit again.
• 56:32
  Speaker 1: I think I might go back for another one.
• 56:33
  Speaker 1: I'm like, and they're like do you think I'm okay?
• 56:33
  Speaker 1: And I'm like, oh my gosh, they're like, it's been bothering me a little bit again.
• 56:33
  Speaker 1: I think I might go back for another one.
• 56:34
  Speaker 1: I'm like stop immediately.
• 56:36
  Speaker 1: It was my opinion.
• 56:37
  Speaker 1: I can't tell you not to do that.
• 56:39
  Speaker 1: I'm just saying like, in my opinion, I would say I would wait, but I'm like who's doing this for you?
• 56:52
  Speaker 2: You know, like handing out, like candy, you know, hey, it's your medical professional trust them, you know.
• 56:54
  Speaker 1: But you know, to a certain extent it's also a business, hopefully.
• 56:56
  Speaker 1: Yeah, right, exactly that's the ethics that come in.
• 56:57
  Speaker 1: It's like well, and with recent events and again we're not going to get political like that but just always question over the last decade were some things pushed for?
• 57:06
  Speaker 1: There's some kind of financial incentives or conflict by any means?
• 57:08
  Speaker 1: But again, this, again, this patient too, like patients are, as we know, they don't always know exactly what the doc is doing, you know.
• 57:16
  Speaker 1: So they might have been communicating exactly what they were.
• 57:19
  Speaker 1: So hopefully it could have been mistaken that it was cortisone every time.
• 57:22
  Speaker 1: I don't know, it could have been something else.
• 57:23
  Speaker 1: Yeah, I guess we don't know.
• 57:25
  Speaker 1: But, they were pretty educated and they were pretty.
• 57:27
  Speaker 1: They're a googler, you know they would google it and they would research everything they would.
• 57:30
  Speaker 1: So they were pretty on it and I was like, oh man, regardless you know, you know.
• 57:35
  Speaker 2: And the thing I'd say is you know, yeah, it's a lot.
• 57:37
  Speaker 2: So I would say, hey, you know, um, after I don't know 10, you know and you keep having the same problem.
• 57:45
  Speaker 2: Maybe it's time another direction different, you know yeah and something else might be.
• 57:48
  Speaker 1: You don't need to get to 20 before you say, hey, well, maybe something else and they were like it was like I think 21 is going to be it, like I think I feel a little bit of stuff and I was like, oh my God.
• 57:57
  Speaker 2: Yeah, no, this is the last one, I swear.
• 57:59
  Speaker 1: Yeah, oh man, until the next one If only we would have was like man, if we could have just talked I could have jumped to talk to off this cliff.
• 58:15
  Speaker 1: Way, different trajectory.
• 58:17
  Speaker 1: That's something I'd like with um team members that we bring on, and like patients we talk about, and like what patients we bring in, I'm always like the stakes are high because, like when somebody calls us and they have back pain or neck pain or shoulder pain or whatever, we love helping people, by no means that we can guarantee anything.
• 58:35
  Speaker 1: We've had good outcomes with the right individuals and we're confident that this recipe that we're able to present is helpful.
• 58:44
  Speaker 1: If they don't come in to see us, then what are the other options?
• 58:50
  Speaker 1: It's usually that other route right where they descend into like more meds, injection, surgery, whatever.
• 58:56
  Speaker 1: They're just despondently living through pain that nothing's getting better, I'm like.
• 59:00
  Speaker 1: So the stakes are high because it's a way different life trajectory, whereas, like other people have success stories where they were going there, where they weren't sure what route to go.
• 59:08
  Speaker 1: Um, fortunately, we were able help those people, which we're not always a fit for everybody.
• 59:13
  Speaker 1: I totally understand that we're not guaranteeing anything.
• 59:15
  Speaker 1: I'm just saying that we've had good success with some people and the people that we did.
• 59:18
  Speaker 1: They were on the fence a way different trajectory.
• 59:20
  Speaker 1: Now they're exercising, they feel really good, they listened, they did the homework that we're supposed to be doing and now they're able to work out and exercise and other than the opposite, which would be like a way different trajectory.
• 59:31
  Speaker 2: Yeah, you know, I think it's one of those things where you really need to educate the pop not you or I, but in general there has to be an education you know, so that people know what their options are.
• 59:41
  Speaker 2: Yeah, because even that that patient probably thought he was doing the right thing, you know, cause he didn't know any better.
• 59:48
  Speaker 2: Yeah, and he's like this is what I'm supposed to be doing.
• 59:50
  Speaker 1: Being misguided, misguided, you know, and then it's like but what rationale?
• 59:54
  Speaker 1: I don't know.
• 59:56
  Speaker 1: I'm not making allegations on anybody.
• 59:59
  Speaker 2: No, no, I don't know the situation at all, but at the end of the day, there was some type of lack of education or of alternative options that this person just didn't have.
• 1:00:13
  Speaker 1: You know that, and I think that's one thing, um, and we can land the plane here.
• 1:00:16
  Speaker 1: But, like with social media and um, the connectivity of information, at least that is an avenue where people are getting a little bit more exposed to alternatives and different things.
• 1:00:27
  Speaker 1: Yeah, double-edged sword, double-edged sword.
• 1:00:29
  Speaker 1: They're just like okay, within reason and moderate, you know.
• 1:00:31
  Speaker 2: And then guidance with the younger individuals and stuff like that, yeah, because you got to take it a step further.
• 1:00:35
  Speaker 2: You know it's.
• 1:00:36
  Speaker 2: You see something, some people, just those people that believe everything they see, you know, and you see it on social media and it's the new, best thing you know.
• 1:00:43
  Speaker 2: Next thing, you know you're eating, like you know, ground up tortoise feet and you're like this is supposed to help me?
• 1:00:49
  Speaker 1: yeah, exactly because, like one influencer said that, yeah, oh my gosh, relax, all right.
• 1:00:55
  Speaker 1: Um well, that will, uh, we'll end it here.
• 1:00:57
  Speaker 1: We'll have to get you in again, like we can dive into other stuff yeah, next time great yeah but tell people where you're, like, how they can best reach you and like get in contact with you yeah, men's only medical.
• 1:01:06
  Speaker 2: Uh, we have a website.
• 1:01:07
  Speaker 2: It's men's only medicalcom.
• 1:01:08
  Speaker 2: We're, uh, downtown Palm Beach, 116 North Dixie Highway on Dixie, between Banyan and Clematis in downtown West Palm.
• 1:01:17
  Speaker 2: Our phone number is 561-725-0206.
• 1:01:21
  Speaker 2: I invite anybody and everybody to come by and check it out.
• 1:01:24
  Speaker 2: There's obviously no commitment.
• 1:01:26
  Speaker 2: You get to come in and meet and hang out with one of the coolest doctors you'll ever meet and one of the nicest environments that you'll you'll walk into as a doctor's office and, at the very least, you know you, you get.
• 1:01:38
  Speaker 2: You get the, not just cause I'm saying you get to meet me.
• 1:01:43
  Speaker 2: But I don't think anything bad comes from having conversations, you know, and there's no commitment for you to just come in and check the place out, have a conversation and see if it's going to work for you or not, you know.
• 1:01:54
  Speaker 2: But, um, we're really excited about it and it's really one of a kind kind of place.
• 1:01:58
  Speaker 2: There's nothing else like it that I've seen.
• 1:02:00
  Speaker 2: That's just for men.
• 1:02:00
  Speaker 2: Cool, that's awesome man.
• 1:02:02
  Speaker 1: Well, thanks again for coming in.
• 1:02:03
  Speaker 1: I appreciate your insights and stuff, um, and if y'all ever have any questions, comments, questions concerns, conflicting opinions, like, please always reach out.
• 1:02:10
  Speaker 1: We're always open to different ideas and conversations and stuff.
• 1:02:13
  Speaker 1: And, um, if you're battling any like pain that you feel like is limiting you with like an active lifestyle, we'd love to help.
• 1:02:18
  Speaker 1: We can at least chat on the phone, um, and talk more about what you have going on, if we're a good fit for you too, and maybe what direction to least to guide you and um, and if they can say if you have any questions, please don't.