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Scot: I like to warm up before you show up.

Troy: Do your . . . some jokes.

Scot: I tell a couple of jokes and I pretend to laugh. I pretend to laugh . . .

Troy: Pretend to laugh at my jokes.

Scot: Yeah.

Troy: Okay, practice the pretend laugh. That's pretty good.

Scot: Yeah, I have different levels.

Troy: Nice. I like it. I like it.

Scot: I have different levels. I have kind of the low chuckle.

Troy: Low chuckle versus the . . .

Scot: Yeah.

Troy: I like it. I like it.

Scot: All right. Time to talk about some more men's health issues with Dr. Alex Pastuszak. He is a urologist here at ÑÇÖÞ×ÔοÊÓƵ of Utah ÑÇÖÞ×ÔοÊÓƵ and one of the favorites on our men's health podcast. Welcome back, Dr. Pastuszak. How are you doing today?

Dr. Pastuszak: I am great. I'm so happy to be here with you guys.

Scot: Before we get to our topic, which is about what you and your partner need to know about infertility and there can be kind of a stigma I think. A lot of times if a couple's not getting pregnant, I think the woman gets unfairly kind of tagged. It's her issue, but there's a lot of things that guys are doing or not doing that contribute to it. So we'll dive into that in a second here. But question, have you always been physically active? On the show we always talk about being active and remaining active and Troy and I did an episode just on our turning point. Like when we knew we needed to be more active in our lives. Both of it labs came back.

Troy: Exactly.

Scot: Cholesterol for Troy, for myself, it was a fasting glucose. How about yourself? Have already always been active or was there a turning point for you?

Dr. Pastuszak: Oh, there was definitely a turning point. So I grew up in New York City and until I was 13 led a really sedentary life to the point where I've weighed like almost 200 pounds . . .

Scot: Really?

Dr. Pastuszak: . . . when I was like 11 or 12. So needless to say, that's a brutal city to grow up in. I got a lot of verbal abuse and you know, and at one point just something in me clicked, then, you know, over the course of a year I started working out and dropped about 65 pounds and got on a good diet. I've been fortunate enough to keep that up. I have had other health issues since, which have caused me to re-examine how I live my life. But that was the beginning of what I like to consider an attempt at a healthy life.

Scot: t's interesting we're finding themes when it comes to this active. It is a continuing process. So I'm glad that you brought that up and in a way, those New Yorkers that were making fun of you for your way could have saved your life. I mean, really.

Troy: We're not encouraging bullying, but . . .

Scot: No, not at all. But that was a huge turning point. I mean, had you stayed on that path, it could be a different issue for you entirely for your health.

Dr. Pastuszak: No, absolutely. I mean, I'm in retrospect, thankful for it and it really kind of helped me with become, I guess for lack of a better word, who I am today.

Scot: Yeah. More active and whatnot. And is that what continually drives you to remain active is the memory of that whole thing and not wanting to go back to that?

Dr. Pastuszak: I think, it's actually the kick you get out of being healthy and active and how good it makes you feel. And you know, I mean, just between us gentlemen here the ability to cheat on your diet on the weekend.

Troy: Oh, that is so rewarding, I have to say. I don't want to admit this, but I think it's so rewarding after exercising a ton just to eat a ton of food, that's a fun thing. You know, it's just a benefit.

Dr. Pastuszak: I don't know if in Utah there's such a thing as excess exercise.

Troy: Exactly. There really isn't.

Scot: The bar here is pretty high.

Troy: Yeah. That's why you just don't talk about what you do here because the person you're talking to probably does that 10 times more and 10 times better than you. That's what I've found.

Scot: All right. So you've been trying to, you know, start a family for a while, but no luck. Is there something you can do on your own and when is it time to involve a professional? So we're going to go ahead and find that out today with Dr. Pastuszak. What do you do when a couple comes in or like, I suppose this happens at parties too. Like, "Oh, Doc, my wife had I been trying to get pregnant for a while. Do you have any tips?" Do you ever get that?

Dr. Pastuszak: I do get that. And first question I ask is "How long have you been trying?" And I often get the answer of, "Oh, you know, I've been trying like a month or two."

Scot: Not enough time.

Dr. Pastuszak: Not enough times. So you know, the definition of infertility, which by the way is absolutely a couple issue. It is not, you know, it is only half the time either the male or the female. The other half the time it's both. So, but the definition is having unprotected sex for a year or more. A year or more. Not two months, not three months, a year or more.

Scot: So you get to that year or more point and nothing's happening. So what do you do then?

Dr. Pastuszak: So at that point maybe you need to do a check. And when I say check, I say both the man and the woman should be checked.

Scot: So are there some things that somebody could do before they go and visit a physician just to make sure they've got the best chance possible?

Dr. Pastuszak: Yeah. So great question. Yes, they should know when the female partners is ovulating because the 48 to 72 hour period around her ovulation point is when she is most fertile.

Scot: By the way, there are calculators online that will help you figure that out.

Dr. Pastuszak: That's right. There is an app for that.

Troy: Yeah. I've seen apps and home tests as well. Do you recommend those home tests to determine that ovulation period?

Dr. Pastuszak: So the home tests, the ones you buy in the pharmacy are actually the most accurate because the apps just base it on, you know, it's calculation of your fertility period. Whereas the drugstore version actually will tell you that you are peaking at this point.

Scot: Okay. So figure out when your best chances, that 48 hour window, is that what it is?

Dr. Pastuszak: Yeah. Okay. 24 to 72 hours.

Scot: And what else could you do there?

Dr. Pastuszak: So you got to make sure that you're not using lubricants because 99% of them are actually spermatotoxic, will kill your sperm.

Scot: I would think most people would know that, but no.

Dr. Pastuszak: No. And nobody advertises it. There are literally one or two lubricants on the market. This is, you know, going against all the KYs and whatnot that are not spermatotoxic.

Troy: Wow. So 99% are going to cause issues.

Dr. Pastuszak: Maybe not 99%, but you know.

Scot: Quite a few.

Dr. Pastuszak: All but a large majority, yes.

Scot: All right. What are some other things to try before you actually have to go see a professional?

Dr. Pastuszak: I think those are actually the two main things, you know, but I mean obviously having a clean lifestyle, diet, kind of getting rid of or minimizing your alcohol intake, minimizing or getting rid of any smoking you might do, those are all things that can hurt your sperm, but are general lifestyle issues as well.

Troy: And I know a lot of men are probably hesitant to talk about this, obviously, you know, as we've talked about already, I've seen some of these home tests for men to determine their sperm count, to determine if it's adequate. Do you recommend those? Are those really accurate?

Dr. Pastuszak: So I stayed away from that on purpose because, at least on the male side and certainly on the female side as well, you know, the concept of fertility versus infertility is somewhat nuanced. You know, these tests can tell you how many sperm you have. Right? And I know a number of them. But they can't tell you whether you're for fertile. The only way you can tell whether you're fertile versus infertile, and say it binary for on purpose is if you have no sperm, if you have no sperm, then you are infertile. Even though there are ways of potentially helping you make more sperm or finding sperm in you. But that requires somebody like me.

Scot: All right. So after some preliminary troubleshooting, trying to figure out when the best time is, using the test for the woman sounds like it is pretty good to figure that window out. You got to put a year, which I make it sound like it's torture, don't I? Put in that year. After you put in that year, then it's time to involve a professional such as yourself. Or should you go to an OB-GYN? And maybe I'm even wrong on that. Would you go to the a man doctor, a woman doctor?

Dr. Pastuszak: So the woman should go to a woman doctor and that, you know, that can be an OB-GYN to start, right? Because they can do a basic evaluation. But I always, and our professional societies also recommend that they go see a reproductive endocrinologist. And then for men seeing at least a urologist, if not someone trained in fertility evaluation would be the way to do it. So two separate doctors, two separate people.

Troy: So you would do both at the same time? Say you go to the OB, I'm going to go to the urologist, let's figure this out.

Dr. Pastuszak: Right. And in practice it doesn't always end up that way, but that is the most logical thing to do because again, remember 50% of the time, coin flip here, you know, it's both the guy and the woman that have issues that can and should be addressed.

Troy: What about in terms of insurance coverage? I mean, do people have this covered? Is this something . . . I've heard of people paying out of pocket a lot for fertility treatments. What should people expect?

Dr. Pastuszak: So I think you're opening up exactly the kind of box that we need to be talking about. So there is some insurance coverage for these types of things. And it really depends on who you work for to be perfectly honest. A lot of the sort of high end, Silicon Valley companies use fertility insurance as a way to recruit and keep their workforce. But by and large there's actually fairly little fertility coverage across the board right now.

Troy: So even that initial visit, if I'm coming to see you as a urologist, is that something my insurance would cover or is it kind of that step beyond where I'm not going to have coverage?

Dr. Pastuszak: So a lot of times, you know, your initial type of workup and treatment to get to the point where . . . and this is for both men and women to get to the point where we can tell you, "Well, here are the issues that you might be experiencing. Here's how we can address them," that's oftentimes covered. But once you get past that point, once you get to the point where you're having procedures or sometimes having to pay for certain drugs, particularly on the women's side, that can get pretty expensive. Because that's often not covered.

Troy: So it sounds like you're going to at least start to get some answers. Say this is the step we need to take and then determine what's the cost, how do we do this?

Dr. Pastuszak: That's right.

Scot: All this just to have kids and it seems like when you're a teenager it just happens all too easy, doesn't it?

Troy: That's the irony.

Scot: All right. Well, Dr. Pastuszak, thank you very much for helping us out. We sure do appreciate the conversation today.

Dr. Pastuszak: Guys, thanks so much for having me.

Troy: Thank you.

ER or Not: I've Burned Myself

Scot: All right. Time for another edition of ER or Not today. Burns. So let's say somebody burnt themselves like you know, maybe they're out camping and got a burn in the campfire or I mean what are some other ways people burn themselves that you see in the ER?

Troy: Well, campfires are a surprisingly common thing. Often it's involved with alcohol. People are intoxicated, maybe they're messing around. I don't know what happens.

Scot: Well, yes, . . .

Troy: That's always the story.

Scot: . . . I've had a few beers. It's like, "Hey, check this out," and then.

Troy: Yeah. "Watch this. Hold my beer."

Scot: Yeah. And then something happens.

Troy: Something happens. One thing I have seen on more than one occasion as people with a charcoal grill who are spraying lighter fluid on it and that flame tracks up the lighter fluid then explodes. So that bottle of lighter fluid explodes. So that's not a good thing.

Scot: It'll explode.

Troy: Oh, it'll explode. Yeah. I mean people come in . . .

Scot: It doesn't just catch on fire. It explodes.

Troy: No, you figure you get that coming up there. I've seen people with pretty significant flash burns from that explosion tracking up the, the lighter fluid. You know, fireworks not an uncommon thing. Again, those are more kind of flash burns sometimes take fingers off, things like that.

Scot: My propane grill sometimes doesn't light right away. And if you sit there on that igniter too long, then it'll . . . It'll do that too. So that might be possible.

Troy: Certainly have seen that. Yep. You get the flash burns in the face from that.

Scot: So, okay. If somebody does get burned from any of those reasons, ER or not, and how would you even know?

Troy: Yeah, great question. So it really depends. Number one on the location of the burn and number two on the type of burn, and you've probably heard the whole grading system, there's a first degree, a second degree and a third degree burn. First degree being like a sunburn. The second degree being the blistering. Third degree being, you know, where it's really a deep burn. The skin appears white, you touch it, there's no feeling. So third degree is bad, that you go to the ER for no question about it, no matter where it is.

The second degree burn, it depends a lot on where it's located. So those what we call partial thickness burns, the blistering if it's on the palm of your hands, your face, if it goes around joints, that's a reason to go to the ER. Because there we worry about scarring, about contractures where it actually tightens the skin down so your joints may not work as well.

And if it's a large surface area where it's going over, say your entire leg or even part of the leg, the wrapping around the leg completely, all reasons to go to the ER to get checked out. So it's kind of tough because you have to use your judgment in this. If there's any question, just go to the ER. If you're getting the blistering, if it's more than just a sunburn, light burn, no one's going to fault you for going to the ER. But certainly some of these more severe burns wrapping around joints, large surface areas, any of those third degree burns, all reasons to get checked.

Scot: And those ones that wrap around joints, those can affect you for the rest of your life then.

Troy: They absolutely can.

Scot: The movement and the mobility so.

Troy: Exactly. That's why it's worth being seen soon. Typically then we're going to get you to see a burn specialist who's going to follow up with you. Often they'll do debridements, where they unroof that blister, get that off there, get that good tissue healing. So it's often a long process. But again, any question at all, go to the ER, get checked out.

How Much Screen Time is Too Much for You?

Scot: Troy, pop quiz. How many hours in a day?

Troy: 24.

Scot: 24, yes.

Troy: I had to think about that.

Scot: Second question, how many of those hours do you think the average adult spends staring at some sort of a screen, whether it's a computer or a phone, a tablet or some other electronic device?

Troy: I'm going to say 11.

Scot: Eleven is absolutely correct.

Troy: I got it right.

Scot: You read the same article I did.

Troy: I did. I read the same article.

Scot: This is from Scripps ÑÇÖÞ×ÔοÊÓƵ. How much screen time is too much and you hear a lot about screen time for kids, but what about screen time for adults? And we saw this article and I wanted to get your take on it. So it sounds like there is no consensus according to this article on how much screen time is negative for adults in the same way that kids. However, too much screen time can cause some other issues and especially like if you work eight hours a day staring at a screen, what are your thoughts?

Troy: My thought is that's an amazing number. There are 24 hours in the day like you said. Let's say you get a nice 8 hours of sleep at night, and so that drops it down to 16. Eleven hours of a screen. So you have of five hours a day you're not staring at a screen.

Scot: Yeah. That is pretty insane, isn't it?

Troy: You're probably commuting. Hopefully, you're not staring at a screen there. So maybe have a 30-minute commute. So that's now four hours a day and then you walk into work and maybe you walk around a little bit and you see your family but most of the time you're staring at a screen. That's amazing. And that's an average. That was the biggest number that stood out to me. Yeah.

Scot: I think for me too, that number means you're trading in and this article kind of alludes to that. You're trading in that time for time doing other things, which I think can become dangerous because as we talk about a lot on this show, you've got to get out and you got to get some activity of some sort. You got to get up and move. You know, sitting around too much can be detrimental and if you're spending a lot of time on screens, then that's time you can't be spending doing those other things.

Troy: Exactly. And I think for a lot of us it's unavoidable that you will have eight hours a day staring at a screen. It's your job. You're at work, you have to stare at a screen for what you do. When I'm in the ER, I see patients, but I often joke that I'm a specialist in computer medicine because I spend so much time staring at a screen, entering notes, typing, looking up charts, you know, looking up results, all those things. It's just part of what I have to do.

And I've experienced a lot of these effects. I mean they go through things here like headaches, eye fatigue, back pain, neck pain, you know, there's a whole insomnia piece of this as well. Tendinitis, carpal tunnel. I've had all these things to one degree or another because of prolonged periods staring at a screen, kind of hunched over, a computer, typing, trying to get notes in. And so, you know, I think we're all familiar with this, regardless of what our line of work is, you know, unless we're outside working in construction or something where we're not forced to be in front of a screen, so we have to be aware of this and know how to address it.

Scot: I can mirror a couple of things. One, I developed a pain in my thumb from laying in bed in a certain way, supporting the weight of my phone and then scrolling with my thumb. I just started hurting one day and I'm like, "What is causing this?" And then the end of the day I lay in bed, "Oh, I see." You know, and that on top of the fact that this is the hand I use on my computer keyboard and my mouse and my track pad. So a real thing.

The other thing that happens to me if I spend too much time on social media in front of a screen, is I get this urge to want to just fall off the face of the earth. Like to disappear up into the wilderness in a cabin . . .

Troy: Just go off the grid.

Scot: . . . where I hunt my own food by, you know, tracking down a deer and breaking its neck with my bare hands. Is that healthy?

Troy: I don't know. The whole tracking down a deer and slaughtering with your own hands, doesn't sound appealing. The rest of that sounds wonderful.

Scot: Yeah. Doesn't though.

Troy: Sign me up. I will be the experiment of what happens to a man when you take him away from 11 hours of screen time a day and give him no screen time.

Scot: Yeah, gladly. So it's just something to be aware of. I was lucky in noticing that this thumb pain was caused from that because I initially noticed it doing something else and then it finally kind of dawned on me that it was because I was sitting there with my phone.

Troy: That's funny. I've had the exact same experience too with my phone and you know, and it was the same thing. I was like, why is my thumb hurting? And then you realize, well it's because I'm texting, you know, I was trying to do all this stuff with my right thumb, trying to send messages and whatever else. But you know, it really comes down to what we've talked about so much before. It's just trying to find balance.

And you've talked about your multiple steps you take a day and your 10 minute break every hour and we've talked about just getting up to get a drink of water every hour. Those sorts of things are going to help with multiple things. And this is one of those, just getting up, take time every hour, go to the water cooler, fill up your water bottle, whatever it is, just to get away from the screen, realize there are some detrimental effects from just staring at that screen, hunched over a computer or whatever else you're doing all day.

Scot: One final thing, I did an interview with a doctor at the Moran Eye Center. And they have the 20, 20, 20 rule of screen time. So if you do have to work eight hours a day in front of a computer screen, they say every 20 minutes, stare at something 20 feet away or look at something 20 feet away for 20 seconds. And then that kind of help recharges your eyes and you see that a lot.

Troy: Easy to remember to 20/20 vision, save your eyes 20, 20, 20.

Just Going to Leave This Here

Scot: Just going to leave this here. That's our opportunity to kind of talk about something that may or may not have to do with anything to do with health. Just kind of a random thought. Just going to leave this here. I tried Tai Chi for the very first time last week.

Troy: Tai Chi. It's like slow karate, right?

Scot: Yes, it is.

Troy: It's like old person karate.

Scot: And it looks so cool when people on TV and the movies or you drive by a park and somebody who's good at it does it. It does not look so cool when I do it. But I got to tell you, it was a lot of fun and I did enjoy it. Although this was my observation that I made. There was one point where the instructor said, "Okay, we need you to find your hip joints."

Troy: And you pointed and you're like, I know this. I know this.

Scot: No, I didn't know it.

Troy: Oh, you didn't know your hip joint?

Scot: He had to talk me through how to find it. And even then I was still questioning it, which is just crazy to me because I know a lot of stuff. You could ask me about a lot of things and I could probably tell you about it. But my own body, I can't.

Troy: What did you point to?

Scot: I can't go where my hip joints. I didn't know . . . they're like right here, aren't they?

Troy: Yeah. Where did you point?

Scot: Well, I didn't point anywhere because I'm like, I think they're on the side here. Aren't they? Isn't that where they are? But no, I mean, he told us, you know, you have to kind of follow down here.

Troy: So he actually showed follow your pelvis and then go to the insertion point there.

Scot: Oh, and that was the other thing too, was find your pubic bone. I didn't realize the pubic bone was that low. And I'm poking around. He says, "Well, it's going to be the first bony thing you feel." And I'm like, I'm still going.

Troy: Scot, do we need to talk about this instructor? I don't want to . . .

Scot: No, he's fine.

Troy: Okay.

Scot: Let's not . . .

Troy: He wasn't finding your pubic bone for you?

Scot: No. You need to find these things in order because the hips are kind of the core of a lot of these Thai Chi moves.

Troy: Interesting.

Scot: But I just thought it's ridiculous that I thought I knew my body well, but apparently I didn't. I got to go back to the skeleton, I guess.

Troy: I guess. I don't know.

Scot: And see.

Troy: No, that's cool. Yeah. Well, I'm just going leave this here. I was reading an article recently about an epidemic of loneliness in this country, which is a fascinating thing to think that we are such a connected world with social media, with all of these interactions, yet we are extremely lonely. Our suicide rate is the highest it's been since World War II.

But the thing that's article talked about in terms of how to address loneliness is volunteering, trying to find causes you believe in, getting out to volunteer, interacting with other people and using that as a way to really connect with people outside of social media, outside of this, you know, digital interface. It's a great thing to do. My wife and I try to volunteer a lot with animal rescue, with working with different groups, volunteering at adoption events, taking in animals into our home. I am scared to tell you the number of cats that are in my home right now.

Scot: Cats?

Troy: Cats.

Scot: I knew about dogs. You have cats too?

Troy: We have cats. I am really . . . I don't know if I want to say in public the number of cats in my house because they'll sound crazy.

Scot: I don't want to know.

Troy: But these were all homeless kittens who had no mother. It tears your heart out. It does. I mean you got to take them in. It's like, well, they need a home and we're fostering them all for a rescue group. But you know, this is just a tangent, just to say loneliness is an issue.

Scot: Find your thing.

Troy: Find a volunteer, find your thing. It's a great way to connect with people and to do, you know, stuff that you find rewarding.

Scot: And I think there's research that supports this too.

Troy: Absolutely. I'm sure there is.

Scot: That one of the ways to deal with depression and loneliness is to actually go out and do other things for other people. Interact with them and give of yourself.

Troy: And I like this idea so much more than, you know, just like a book club. Like maybe some people like book clubs. It doesn't work for me. Like I can't work it into my schedule, you know.

Scot: You got to read the book.

Troy: You got to read the book.

Scot: And they shame you if you don't.

Troy: Yeah. You can't fake it at a book club. So this volunteering is a great thing. You're there to volunteer. In the process, you get to meet other people and have those interactions.