49. Ragav Sharma, DO, CSCS: Understanding Preventive and Evidence-Based Medicine for Life-Long Goals

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Our guest today is our PM and our colleague Dr. Rogov Sharma. Now Rogov is currently an intern in PM and R, whose mission is to help others live their best lives possible. Rogov completed his undergrad degree at the University of Illinois, Chicago in bioengineering before attending medical school at Midwestern University, Chicago College of Osteopathic Medicine. Now, born in San Diego, Rogov suffered from his very own health issues. He was diagnosed with hypothyroidism at an early age, and he suffered from severe obesity for nearly all of his childhood. Because of his endocrinologist, he began changing his lifestyle and unknowingly began a lifelong journey of learning, sharing, and self-improvement. Since then, he has been sharing any knowledge he acquires in various formats, including public speaking, written articles, YouTube videos, and recently podcasting, and his podcast is called The Preventive Medicine Podcast, which we delve into in our discussion with him. Now, again, Rogov has made it his life mission to help others live their best lives possible through his professional career as a physician, personal pursuits, and business ventures. He aims to learn and share topics not only within medicine, but any topic that may improve others' lives. And that's exactly what we delve into in this episode. We interview Rogov to understand his journey as somebody who is a physician now, but looking back at how he was essentially a patient, somebody with hypothyroidism, dealing with severe obesity, and then for him, going through this mentality shift of understanding how to become healthy, he now has a coaching, he is a strength and conditioning coach as well. If you check out his Instagram, he has lifted heavy weights out there, and he is someone who definitely understands that progression and journey, and it only makes him a more confident physician because of that. This is a very interesting episode. I think you guys are going to learn more about definitions, terminology, different perspectives from how people like to think about lifespan, health span, preventative medicine, longevity, and what we can do to educate the public. So enjoy. All right. What's up, everyone? Welcome to another episode of Medicine Redefined. This is going to be an awesome episode. We have a peaman art colleague of ours, right? Finally, we get somebody of Fizzai Chi with near proximity to training to us, and that is none other than Rog of Sharma, a host of the Preventative Podcast, all right. So Rog of, what's up, man? Not much. I'm not technically PMR yet. I'm still in intern. I'm getting there, but I'm not there yet. I'm excited to get there, but not a colleague yet, for sure. But are you in a categorical program? Are you doing advanced? No, I'm doing a TY right now, and then start PMR next year. Yeah, you're official, you're. Where are you going? Where are you going for PMR? I'm going to Medecology, Wisconsin, right across the border, right up north from Chicago. Gotcha. Nice. Nice. Is that home? Is Chai Tai home for you? Chai Tai is home. I've been here for about 21 years now. I was originally born in San Diego, actually, everyone's like, oh, did you like it better over there? I was four years old. I haven't remembered much when I moved, so I've been here my whole life. Yeah, dude. I've only been in Chicago once, unfortunately, and that was really for an interview over what's now, Shirley Rine, and it was so cool. I went to... What's one of those? It's a pizza chain, deep dish pizza chain, but it's supposed to be highly regarded. What's it called? There's several. There's Luminati, which is my personal favorite of the chainless. Yeah, I remember walking out like a couple of blocks and just not adequately being prepared for the wind chill and stuff like that, just like a nice p-coat and really a t-shirt or anything. It was the longest three blocks I've ever walked my entire life, let me tell you, but the pizza was good. The pizza was good. I literally had it like right outside, that was my dinner right on. Dude, so I know you're short on time, so we got so many different things that we want to talk to you about, and I think to correct Darsch, my colleague here, it's the preventative medicine. Yeah, I feel like that's my bad. There you go. That's right. Thank you. We're going to ask you about that for sure. But, dude, give us a quick primer on your origin story, man, who is Raghav Sharma? So I'm actually terrible in elevator pitch. I always end up going on too long and rambling, and it's probably been worse right now in my sleep deprived state, but I am a dude who deeply cares about helping other people reach their goals. I find great happiness in doing so. I originally started out pretty obese myself. As a kid, I was diagnosed with hypothyroidism when I was like five years old, crazy story for that. And I gained a lot of weight in a year that I was undiagnosed, kind of kept it on for essentially until I became a late teenager. I was just dealing with it for a long time, and then finally my endocrinologist was like, yo, something's going to happen. You're going to start getting diabetes, heart disease, all of these things. And I was like, 17, some reason, at that point, the bell started ringing, and I started doing something about it, transformed myself, found a tremendous amount of power in it, and then I was like, all right, how can I help other people with this? Because this greatly impacted me. I found a lot of benefit from this. So everything from there has kind of slowly been a progression of that. I started out making YouTube videos, eventually got to training other people, started writing more articles, science-based, all those kinds of things, and here we are. Right on, man. That's actually very cool. When was that conversation with your endocrinologist? So this was when I was in my junior year of high school. So 16, 17, something like that? Okay. Okay. That's fair. Yeah. I mean, we recently talked to another person about just having these deeper conversations with children, and yeah, I was going to ask you, but when is it appropriate to have this fear-based conversation? Yeah. If you don't do this, you will die. It doesn't always tend to work, but of course, it seems like it, for you, it turned out to be the better. Or was that not the inception of your changing trajectory? I mean, my endocrinologist, I've been pretty obese like this entire time, like I was saying, I endocrinologist kept saying it every time, like you need to watch a portion control, kind of hinting at it versus just obliquely saying, yo, you need to do something about this now. Otherwise, you're not in good shape. And then I think eventually after enough wearing down, I was like, okay, let's do something about this. Him saying diabetes, heart disease, I'm 16 years old. Something's not right here. That just seemed to click with me for some reason. But still though, you know, as a 16, as a teenager, we don't tend to have the foresight, right? Like as we do, I think one of the things that people who were in medicine were extremely good at is doing gratification, right? I think everybody kind of post it because we have to, right? You got to lay that for 10, 15 years or however long your training is going to be. And so I think just the genetic makeup of whoever goes into that, there's a little bit of piece of that. But still, I think that for, when you're 16, 17, it's hard to kind of think about what's going to happen at 40, 50, 60. But you had the insight to be able to appreciate that and make some serious changes, as you said. Did you have, were there family members, was there anybody close to you who you might have seen, you know, have the negative effects of diabetes, obesity, stuff like that, that really also inspired you? Fortunately enough, no. No one in my family is like on that kind of spectrum where they're suffering from these chronic diseases. I think it was more so a really individual and personal decision that I made. It was really something that was, because I kind of shifted my lifestyle. Like you grow up with Indian, with my parents are Indian, they grew up kind of making food, roti, subgi, all this kind of stuff. And all of a sudden, I'm not eating that. And they're like, what are you doing? Like, I'm trying something new. Let's see what happens. So I think it was very unique for everyone around me. But it was honestly a pretty personal approach, your personal endeavor. Now, would you say the transformation was unique or was it even you kind of being obese? Well, the rest of your family doesn't really have any of these chronic conditions. Was that unique in like their eyes as well? Like, how was the dynamic? I mean, you know, without kind of throwing our parents under the bus. Like, I mean, I was there too at some point, right? But what was that like for you, kind of growing up? I was definitely accepted by my family. I don't think there was any issue with people saying, like, oh, he's the fat one. Yeah. Yeah. So in that regard, we're okay, man. I'm happy to hear that you were loved. Yeah, that's always good, right? Yeah. So I don't think there's anything super unique there is just that my parents, I'm very grateful that they've always been super supportive in anything that I want to do. They're always a little bit more like being the cautious side because I am the more of a ambitious one of me and my sibling. So they'll always be a little bit cautious, but they're all supportive, which is great. Gotcha. I was going to ask you this actually later in our conversation, but I think right now it might be the appropriate time because I mean, you've gone through a transformation at a younger age. And I think you can now look back and you've probably learned some lessons, right? And you as a coach, you have more empathy, I'm sure, when you when you talk to your clients, what would you tell the younger Raghav, you know, when he was diagnosed with hypothyroidism, going up from the age of five to 16? I mean, there's a lot going on there. There's a lot of identity crisis, right? That we all go through in middle school and then high school and et cetera, but knowing what you know now, what would you tell younger Raghav going through this? So if I was to go back all the way until five-year-old's Raghav, I don't think honestly I would tell him that much differently because I don't think I ended up suffering like a lot of the consequences of developing chronic disease. I never actually tipped that scale and got to that point. And I think that a lot of my childhood, the way that I grew up helped me become the way I am. There's definitely a lot of the way that I am now came from after that transformation. And I think if I did not hit that transformation, if I had changed when I was five years old, I can't tell you where I'd be right now, because a lot of where this trajectory is coming from is after that transformation and a lot of why I really wanted to go into medicine and all those kinds of things. Yeah. Is there anything that I guess, so I have a lot of students that, you know, I talk to you that kind of want to transform me, whether whether it's their health, how would you tell your clients at least to flip the switch, right? Like what does it take for the mindset to go from, wow, this is serious. Like I really need to do something to live a better life moving forward. So I think it really depends on the person for everyone. It's not going to be a switch moment for me. It happened to be a switch moment. And I think that just happened to work for me. I think a lot of things in my life end up being a switch moment where I decide, okay, I'm going to do this and I somehow have the willpower enough to be able to do it. But for other people, I don't think it's necessarily always going to be a switch for some people. It is going to be more of those chronic changes over time. And I think being in a position as a coach, it's important to recognize that so that you kind of don't force or kind of have everyone try to turn that switch, even though that's not something that they're necessarily compatible with. And identifying if someone tries to flip the switch and fails, then being, okay, that's okay. We need a different approach. Or for someone who's trying the gradual approach, it doesn't work. Okay, it's time to flip the switch. I think being part of a coach is being able to realize that and kind of working with the circumstances in the specific individual. Right on, dude. I mean, often we talk about how being a physician is the same as being a coach, right? And actually a good physician is going to be a coach and in your corner and there's various coaching styles as you alluded to, right? It really depends on your client, your patient, your athlete, whoever you're working with. So you know, we talked a lot about your childhood or the inception, your motivation to be where you are today and you referenced your podcasts earlier, the writing, your website, all those cool things. So let's fast forward to the inception of the podcast, right? Darshan, I started this maybe a little over a year ago and we were just really debating this, you know, does the world really need another podcast? And obviously we felt like it did and so far it's been pretty awesome. What was your thought process? Why start the preventative medicine podcast? Definitely. So I think there was a couple of reasons. So one of the reasons was that I was already making YouTube videos at that point, which I'm not doing as much anymore. So I was making YouTube videos, was kind of writing articles, was making Instagram posts and all these things and being kind of the more ambitious individual, trying to create a personal brand, quote unquote, I was like the only thing missing here that's kind of going as a podcast. So that was one of those kind of personal, selfish type reasons for starting a podcast. But then the other reason was when you look at the space and you see all of the other podcasts that are out there focusing on health, a lot of them are kind of on those fringe health topics that are like cutting edge research, potentially pseudoscience, but not necessarily applicable to people and not necessarily applicable to clinicians, individuals. And it's just like if you adjust your vitamin D a little bit, then you can have all these health benefits when they're not talking about this large basis of preventative medicine that's based in fact. So that's kind of where we started. The other way that this started was one of my, we were communicating on Instagram. It's a colleague of mine. We weren't necessarily friends. We just knew of each other through a mutual friend of my med school. He messaged me and he was like, yo, I like what you're doing out there and let's kind of put this together. His name's Jason. Let's do something together. So then we sat down one day and I said, I want to do a podcast and something I always wanted to do. And he was also kind of a similar mindset. We wanted to put good evidence based information out there regarding kind of building a basis for health. We kind of spitballed ideas at each other. That's how we got here. So on that note, Jason, as I understand that he's kind of stepped away, right? He's no longer. So you've done this as, you know, as a team and you've done this solo. What are the main differences that you found for both the purchase? Definitely. So as a team bitch approach, I think it's, a team bitch approach was great. It's how we started. It's really nice to talk with someone to kind of spitball ideas back and forth and not necessarily have that doubt of is this idea something that I want to put out there. It both of you are kind of locked in, both have a similar background, but also very rooted in like evidence and both think that this is a good idea that we go ahead. There's certainly times where I'm a little bit maybe on the like forward edge of evidence, let's say, where he's like, that's not necessarily based in evidence. I don't think we should interview that person. So let's not do it. So that's, we've done that before. We've denied guests because they're a little bit too far off the evidence, whereas doing it solo, it's definitely a little bit more responsibility in my end of kind of vetting everyone and staying true to our name, but also it does allow a little bit more. I can do things on my time without having kind of the restriction, not necessarily restriction, but without having to like work out two schedules when you have two schedules people who are in medicine. It's very difficult to coordinate that. Yeah. We're both laughing because of course we can appreciate that. Now you brought up this concept of evidence-based discussions, right, not necessarily medicine, but I'm curious. What does that mean to you? Sure. I think evidence-based practice has a very broad definition of what people would say. At the root of it, evidence-based means there's some sort of literature out there that supports your statement. People take this to mean a variety of different things, unfortunately. Some people take this to mean if there is a paper out there that says what I'm saying, it's quote-unquote evidence-based because it's in the literature. When you look at that paper, it might not necessarily have the best study design, it might be biased in one way or another, things can get published. It might be like a low-mockuity journal, all those kinds of things, and then they can still say it's evidence-based. Whereas another sort of evidence-based, there's these large robust trials which are shown over and over that this is kind of the way that this is, and that'd be a little bit more based in evidence. For what I think is that I don't typically talk about anything that's on the fringes where there's one paper out, it's animal models, all of those kinds of things. Those are great to think about. They're great to kind of pontificate, potentially have a debate about, but it's not going to apply to humans at this point because there's just not enough evidence. We've seen countless times in literature that things apply to animals, but then the second they come to humans, either nothing happens or sometimes it's even harmful. My kind of base for evidence is if it has been kind of robustly tested in humans, then that is something that I would consider evidence-based and something I would think to talk about and apply it to a broad populace. That's, I truly respect them, and that's very interesting. At the same time, I think about it, one of the things that we've started reframing is maybe looking at it as evidence-informed medicine rather than evidence. We try to, at least I do, I don't want to speak for dorses, I try to let the evidence support the practice rather than dictate the practice. There's a subtle difference. I agree, I agree. I think the examples I'll give you is, again, let's just assume we're on PM&R because we're on PM&R. I think one of the strongest things in our specialties, the field of orthobiologics, what we've learned today is we have several randomized control trials and meta-analysis to support the use of PRP, played in the rich plasma. We've talked about that with Dr. Malanga, and its role in various musculoskeletal issues. If you rewind the clock maybe eight years ago, maybe even five years ago, there were a lot of folks with like, that doesn't work, this doesn't work, and of course, we appreciate that those mechanistic studies, I mean, that's where science starts, right? Of course, on the latter, for those not familiar, there's a pyramid, right? The pyramid isn't great always, but anecdotal evidence, case report starts at bottom, then you have series, and that's how it builds up. I know you know this, but of course, for the listener. And I'm wondering, you did mention previously that you were maybe in the quote unquote, forward process of that evidence-based medicine. So I'm wondering, how do you reconcile that, right? Like some of this needs to be done, and anecdotal evidence has to support something, maybe one paper, two paper. How do you think you'll put that in your practice? How have you put that in your practice, but also have the randomized control trials to support it? Definitely. I think that's a very important question, something I'm happy with you brought up. I think the major difference there is that, well, first off, let me answer the part, I am not putting into practice right now. I'm just trying to learn stuff right now. I'm unlike the basics bread and butter medicine, and then eventually maybe we'll get to being able to apply some of the other stuff, so let's put that out there first. I'm still in training. And how I kind of reconcile that is there's kind of two ways to think about this. And one is what you were telling a broad population, like for example, whoever's listening to this podcast, we don't know if there's someone who has a deep fund of knowledge of what's going on, that they have all the context behind it, or we're talking to someone just off the street and they're the ones who are listening to this podcast. We have varying levels of education, varying levels of context. So to that person, if you were to talk about something on a podcast as a way that this could be beneficial, they might not have the background and education to kind of appreciate that and understand its place in that spectrum of evidence informed or evidence-based medicine. They might think that, oh, this is the mainstay of therapy, everyone should be doing it. If I'm not getting it, then I'm being jipped by my physician. And then they go in demanding this when it's not necessarily applicable in their case and whatever their pathology is. And all of a sudden you have an issue. And I think this is a lot of the reasons that you have what's going on with COVID, where you have these kind of fringe therapies that have maybe shown in animal studies, maybe that they're beneficial and then everyone's like, oh, it's evidence-based, someone talked about it, so that must be standard of care. So that's kind of at the large population base. But then when you look at it in what you're doing in practice, the vast majority of people will benefit from what the large amount of evidence says. And if you are someone, if there's someone who's like maybe not responding to it, or if there's someone who could benefit from something a little bit more based on your clinical acumen, your clinical judgment, that's the other part of evidence-based medicine, then you can try it and then make sure to kind of log that and have some sort of mental processes so that you're kind of omitting your own bias of, did this work, did this not what was the context for this, so that you don't see one success and you latch onto it, and that's all you do after that. I love that, man, dude. I think that that's a very thoughtful way to approach. And thank you for sharing that. I think the way we deliver the message, and of course the message at a population level is so important. I think today, especially in social media, right, I mean, the louder the voice is either raised or subdued for lack of a better word depending on following, right, whether there's Twitter, Instagram, and stuff like that, and you know, there are various different ways to get a following, and like you said, I think it's very, very important for people to appreciate that we spend a lot of time, and even as clinicians, we're not really taught that well to evaluate and scrutinize the evidence. I think we have a background. You really have to have an appetite to be able to sift through some of the literature, as you mentioned, and evaluate and criticize the methods of the process and just not go to the read the abstracts or go to the collusion and say, hey, is it good or not? But at the same time, respect your biases and also be honest and be open-minded. So I do love that. Now coming to the meat of this, you know, one of the premise and possibly the most important questionary podcast that you ask is, here it comes. I hear it comes in, and I love this part because I get to flip the script on you, right? You're in the hot seat. Yeah. You know, what does preventative medicine mean to you, man? Sure. So I actually just wrote an article on this. I have yet to kind of speak about this post and social media, but it's up on our website. And I think preventative medicine is very unique because I think the definition changes based on the context and who the person is. I don't think there's one specific definition that will fit any one person. Prevention can mean a lot of different things, but I do think there are several concepts that kind of outline what preventive care is. The first one of those is that preventive care is kind of an ideology where you are being a little bit more proactive about kind of disease processes and benefiting your life versus kind of being in the reactive end. So that's probably the first thing. The second aspect of prevention is that it can be practiced at any point, so it doesn't mean that you can only practice it if you are completely healthy. Only 100% healthy people can practice prevention because if something's happened to you, it's too late. You're gone. It's good at any point. We have like primary, secondary, tertiary, quattenary prevention. And even quattenary. If someone's like, for example, I just had a little spoiler, we just had some podcasts. We were talking about hospice care and all that kind of stuff. We'll be out on my podcast soon. But even in there, you can practice preventive medicine because you're kind of increasing the quality of life and reducing over medicalization. That's quattenary prevention. And then the other, the third aspect which I kind of already alluded to is that preventive medicine is not about chasing health. Health isn't the destination or the outcome of preventive medicine. It's building that base of health so that you can do something with it. We prevent all these conditions so that we remain more mobile, more agile, more able to do what we want to do in life. So that definition changes for each person. So if you are a young person who is a triathlete who wants to compete in triathlon, like Jason, for example, my previous co-host, then his definition of prevention is different. He acts differently. He does different behaviors, all those kinds of things. There's just someone who might be older, let's say they're 50, 60. They want to be able to lift up their grandkids, play with their grandkids, run around. That's a different kind of level. So those are kind of some of the basic things that I think kind of outlines preventive care. But I wouldn't say there's necessarily one definition. Dude, I love that. There's a lot that you said in there that I think there's a lot to gain for listeners. The first thing is not everyone has the same definition, right? To public health. Doctors, it's going to be a different version of preventive medicine than it will be to the pediatrician, than it will be to a geriatrician, then it will be to a family medicine, right? I think they're all looking at different levels of preventive medicine. And then you said the other thing is like, you're not chasing health, right? And I think that's where a lot of people get stuck. Is that they're chasing numbers, right? We live in a data-driven world or a rings whoop. A lot of us are just chasing sleeve or chasing counting calories. But no one really stops to think about, well, why are we doing this, right? Like, what is the deeper level as to why we want to cut calories? Why are we tracking our sleep, right? At what point do we raise above those numbers and start putting them into action and actually living our best lives? So I absolutely love that. So I want to ask you, you know, with the preventive medicine podcast, with all the guests that you've had, how has it changed you personally, right? Because I think for me, ever since the inception of our podcast, I was like, yeah, I was kind of on the forward end of things, you know, whenever I see a new product out of it, oh, you know, let me look at that. Let me kind of see what's going on. And what I've learned is to kind of dial it back a little bit, right? Because a lot of these things take time and we're living in a very entrepreneurial world right now where people are trying to bring things to market very quickly. But how has it kind of changed you personally? Definitely. I've changed a lot. I've learned so much. I'm incredibly grateful to have all of these like incredible guests. Half the time, I'm just amazed that these people agree to come on. Yeah. I'm just this random at that point in that student, not even like, not even physician or resident or anything. And that just agreeing to come on, which is absolutely mind blowing. But I think one of the biggest things that I've learned is that health is not complicated and that a lot of people over complicate their health. Like to our point of speaking about numbers, people are like, how do I optimize my vitamin D levels? Yes. Why do we care about optimizing vitamin D? How do I make sure that I'm getting the exact perfect fitness routine? Why do we care? What is your fitness routine for? What do you want to do with that fitness routine? That's how we tailor it. So I think a lot of our guests have brought a lot of great perspective because their clinicians, a lot of them are experts at what they do and they have a great amount of experience, something which I don't have and which I haven't been able to gather from them, which has improved me greatly. And I'm able to get more perspectives about what the average person or what the common person is dealing with versus what those fringes are that you and I were talking about, what the cutting edges. People don't care about the cutting edge. They just want to get a little bit healthier. They want to fix themselves and they get confused. And a lot of this milieu of just crazy stuff going on out there. So I think it's the biggest perspective that I've gained and I've kind of, like, very much like you dialed it back into what I would say, what I'd recommend and really my perspectives. Absolutely, man. We totally get to clinic next year if you get to do clinic. I had a patient today that was great. You know, I got to talk to them about insomnia. We just, you know, Jade Wu obviously we both had her on our podcast. So I was able to talk to her about, like, sleep physiology and about vitamin D and, like, optimize levels, quote, unquote. So it was just really cool to kind of just put into what all these guests talk about, but then start to also have some evidence behind it. And it's really fascinating that journey. Absolutely. I think that the, just the amount of experience that I've gained from all these people who've been in practice for like 20, 30 years or however long they've been doing it has greatly kind of enhanced my own learning so that I'm able to put into practice and kind of see how these apply in the real world and just make me better clinician overall. 100%. So dude, on the note of having amazing guests, I mean, we obviously feel the same way, you know, with that respect, who are some people that you are still following in this space? You know, with the exception of the folks that you've had on your podcast, I assume you follow them. That's what they're kind of there. But who are people that you're still following in this, in the health, quote, unquote, whatever that means to the individual and who, or maybe even future guests that you'd love to have on your podcast. Oh, man, if I, if I mentioned this, I'm going to spoil a lot of our episodes. Oh, okay. All right. The ones that might leave, how about that? Yeah. I might leave a couple names office, but I can tell you as like a, a very broad basis. I, at one point I was like chasing individual names, right? When I first started in fitness, I was like, oh, this person is huge. I really want Austin, Baraki or Jordan Feigenbaum on my podcast. They're amazing, but they, they, they are, and we've had both of them on their amazing people and there's some of the people that I look up to the most. But I now kind of base my things on the evidence. I try to read as much as I can and then see what people are kind of talking about that same thing and have a large platform and are really embodying that literature and I kind of focus on those people and try to get them on the podcast versus kind of chasing the person. Because I feel like when you start chasing the person, chasing the name, you get attached more to their image and exactly what they're saying versus kind of what the literature says and kind of amplifying their message. So I'll say some of the people that I have had on right now, the podcast that will come out in two weeks is actually, he was the neurocritical care physician who's kind of working with us in the ICU. And he was phenomenal at teaching us this stuff. And one day I talked to him the cafeteria and he was like, you know what, I'm actually interested in a lot more than this. I don't just do stroke and like teach you all of this stuff. I do all of this chatter with him for a while and he was phenomenal. So then we ended up talking about kind of goals of care, patient physician communication, all of that relating to ICU and still preventive medicine. So stuff like that where I think there's a broad base of evidence and all the stuff that I'd love to get out there, but this person doesn't necessarily have a voice. So I'd love to bring them on as well. And he doesn't have social media, he doesn't have anything like that. But I want his perspective and his voice to get out to the world. Well, if it makes you feel better, so we're recording this at the end of January. Your podcast is going to release in two weeks. This will probably release after that. So there will be no spoilers. So if you're listening to this now, I want you to go back and check out that episode at the preventive medicine podcast, please. So again, coming back to this evidence idea, you said you'd love to read and you're trying to stay informed, right? Man, is it hard being in here? I'm trying. Yeah, is it? I mentioned you're in the ICU, again, for those folks who haven't done ICU and only in the winter ICU, I can only imagine, again, props to you. And Darsher, Darsher did this as an intern as well. I was very lucky that I did it as a sort of as a BGY4. I did not have ICU though. So I got lucky. Fair. So most of the props to you, Raghav. But what's your process, man? What's your process of, you know, staying informed best on the literature? Sure. So I think it really is a daily, concerted effort to stay informed and to do your best to do that so that you can do the best for your patients. And I will admit that this kind of all went by the wayside in ICU because for those of who don't know what goes on in ICU or kind of the physicians behind that, they're very long shifts, typically 12 hours at the minimum if you're not kind of staying there longer. And the days are absolutely exhausting because they're using your brain at 100% capacity to take care of critically old patients the entire day. And at my hospital, we have interns that somehow cover 15 beds like over, if you're working overnight, you're typically covering alone. Sure you have help if you absolutely need it, but for the most part, you're alone. So it's really exhausting having been able to do that once reading over the past month and a half. But typically what I would do is I try to wake up in the morning because I found that my brain is fresh and ready to learn and that's when I absorb material the best so that I'm able to kind of think about it, ruminate on it the rest of the day. So in the beginning of the day, I try to read at least 30 minutes, ideally an hour of whatever I find interesting. So let's say that I'm in the clinic one day, I have this question popping to my head. For example, I'm doing rheumatologist and elector right now. And I had the question popping to my head, is it safe for people with ankle-using spondylitis, which is a spinal condition kind of brittle spine as the crude wave saying it, is it safe for them to participate in resistance training? So that's a question because typically in these rheumatologic conditions, it's fine, right? Like, resistance training is mostly beneficial, but what if your spine is actually like brittle and that's a medical condition, is it safe? So a lot of these questions popping to my head and the next day I'll kind of read up, see what I can find on that and then either I come to an answer, a crude answer, I have an inspiration to find a guest who talks about this, or it's a research question and it's something that goes into one of my notepad somewhere where I can, at some point, when I have the capabilities to act on it. Just curious. What's the... I didn't find anything. I didn't find anything. Okay, got it. Okay, great. All right. So for any medical students, they're enthusiastic. Here's their research design, reach out to Raghav Sharma and he'll have to coordinate that. So for those who don't know ICU, intensive care unit, most people have probably heard it. Super busy time, terrifying to take care of 15 critically ill patients, but at the same time, I'm sure it makes you a spectacular physician coming on the other side of it. Obviously, you mentioned it's near and dear to your heart, training, exercise, obviously employing these things that you routinely talk about in your life. Curious how you were able to do that with such a busy schedule, not only in the ICU, but just generally as an intern? Definitely. So I think one of the things that I have been able to do in my life, which I'm very fortunate is that training, training itself, not necessarily nutrition, training has become a part of my life. If I don't do it, I don't feel normal. I feel drained. I feel worse. So despite whatever is going on in the day, I will stick to a training routine no matter what. This kind of has developed over time. I won't say that it started this way when I was in high school first starting on this. It was a chore like it is for many people. But at some point, something happened and now if I don't lift or if I don't train whatever it is for that specific goal, I feel terrible. So that's something that I'm very blessed, very fortunate to be in that position where I will get myself to the gym no matter what. It also helps to have kind of set goals. So I send it for powerlifting meat on March 12th. So with having that kind of meat in mind, if I don't train that I'm not going to perform to the best of my ability, so that's kind of another motivator there. As far as nutrition, I will say my nutrition hasn't necessarily been the best. I absolutely love food. Love food is something that is a comfort to me when I come home from a long shift. I just want to enjoy food. I don't want to count my calories. I don't want to think about that much, but I try to base all my food around protein. I weigh over 200 pounds. So requiring, I require a good amount of protein. So if I don't try to make every meal with at least a good amount of protein, like 40 grams at the minimum, then I won't hit my protein goal. So that's kind of what I base everything off of and then from there, I kind of build around that. Yeah, that's kind of what EC Sinkowski talks about, right? With her 800 gram challenge plus protein, she says, if you get those 800 grams of fruit veggies, all the nutritious stuff in, plus get your protein goals. I mean, there's not much room for else or anything else. And you're going to get full and you're likely going to hit your goals. So you also ran a marathon recently, yeah. Yeah. What was your motivation behind that? Because I mean, you're posting heavy bench press, heavy deadlift. So take us through that journey of your training and why? So my previous co-host, Jason, he is even crazier than me when it comes to me. I wouldn't say I'm necessarily crazier. I'm a normal dude. I just like to live, but he has some very serious training goals. He's currently training for triathlon. And at that point, when we had first start of the podcast, he'd already run a marathon and he's starting to train for an ultramarathon. So he ran 100 kilometers or 66 miles. So that number one was motivating him of itself. I was like, how do you run for that long? And at that point, I started getting introduced to people like David Goggins. I read his book that are like running these crazy amounts and just crazy will power. And I was like, you know what? I'm going to try to do this myself. I am not a runner. I can't run like I've defined myself as can't run. I could like barely finish a mile without having to walk at some points. I was like, all right, let's let's do this. And like I was saying early in this podcast, I'm like type of person who has a switch. So I said, I'm not going to try to like run a 5k, screw the half marathon. We're going for the full thing. So I sat in for a marathon and had that goal and then I hired a coach. So one of our previous guests, Alyssa Lennick, she is phenomenal. And I was fortunate enough to have her as a coach. She doesn't actually coach people. But I was really fortunate to have that connection for her to do that. So she just sent me a plan. I just kind of executed and that's what happened. Sick. So are you, I mean, obviously you have to be someone who enjoys the work, enjoys the process, right? In order to run 26 miles in order to do the weight that you're pushing, that you've said that wasn't always the case. Do you use, so what motivates you? Do you usually have something that you have to attain? Like you have a meat coming up or is it literally just the journey that you're enjoying? It used to be the meat and now it's just become the journey. I just enjoy pushing myself because I found that you really grow a lot when you face new challenges. As a person, you grow in your mentality, you learn a lot of new things. It's a great way to accelerate your learning by actually participating in it, going through all of the various pitfalls. So going through the process is a great way to learn, a great way to gain empathy for others who are potentially training for the same thing. It makes you better coach. There's just so much to gain from the process. And it comes to like some of these metals and stuff like that. It's whatever it ends up as a decoration. But the process is where you learn so much about. I'm able to have more of an impact able to talk about it with guests. We have the podcasts, all of these things. So I absolutely love the process. Like dog and mentality. And Gary, I listen to a lot of Gary. So dude, I suspect that, you know, again, we've seen some of your, your training videos. Again, you'd like to go hard, which is awesome. Again, I know you said you're regular dude, but unfortunately with the standards that there are out there today, you're probably more than a regular dude, right? And that's just maybe the unfortunate truth and the unfortunate reality we live in. But I suspect, you know, you get this question asked, I also like train really hard. And his, in the past high school college, it was, there was four purpose, right? For an event for training, whatever, for, for a sport, that's not the case anymore. Now it's just about the process, but people often ask me, what are you training for? And, you know, once I was like, I don't know, nothing, just life. And then I was like, oh, that's a really stupid answer. Because they just look at you the weird. So I was just thinking about life. So he's called me stupid. I took offense to that. I apologize. It's getting out of the room. It was coming out of my mouth. How about that? But because the person, it was actually the look the person gave me, like, what are you talking about? So has anybody ever asked you that question when you're going hard or, and if so, how do you respond? So thankfully, no one has asked me that. So I don't look stupid. I honestly don't know how to respond. I just, I just train at this point. It's something that I find enjoyable. It's something that's a part of my life that gives me a lot of pleasure. It gives me a lot of kind of the ability to help other people. It's the way that I help myself so that I can help others. So I don't, I don't know if there's a way to put a good way to answer that question, unfortunately. No worries, man. So obviously you're doing a lot. I want to break it down into different sub-sacks, like personal, payment-arvelated. But what are your goals? Where are you looking forward to? Short-term, long-term, take us through kind of what, what you have in mind? Oh, man, sure there's a lot of you want to dive into my mind? Let's, let's, let's get in there a deep dive. So I think the, the first way that I frame everything that I look at is I look at kind of one year, five year, ten year. And I, I'm looking all the way down. I try to look at like the 20, 30 year and a lot of us come from Gary Vee of, I'm like, I'm still an infant. Oh, yeah. I'm 26. So I'm still super young. I have so much more to go. I'm still not even in the first quarter. I'm not even in the first base yet. So that's what I kind of look at it. So on the one year scale, I just try to set some of these more personal goals of what I want to achieve in, let's say, my 26th year, my 27th year. Just how do I want to get better than I was the year before? And then kind of the longer-term process, the five year processes, what skills can I gain in those five years after every year, where I can kind of build on that and help other people with that. And then after that, it kind of comes to how do I kind of scale all of these skills that I've learned within this time, and be able to impact more and more people. So that's kind of how it goes from like the one year of what can I do to the five year of how do I put all these together into a package to help someone. And then the long-term, the 10 year plus is, how do I package all of that to help people at scale? So that's kind of an easy way to put it without going super deep into what do you, what do you think I'm doing within PM and R? Do you know how you want to grow? Oh, man. So my personal PM R mentor is Dr. Azlan Tareek, phenomenal dude. Absolutely love him. He is. Twitter, he has posted a lot of his phenomenal guy. So he has guided a lot of my thought process on this. I definitely do not enjoy hospitals. I'll put it that way first. I think that hospitals have kind of taken healthcare and made it a commodity. They're not doing right to patients. It's not the way that I think healthcare should be. And I've talked about this a lot on my podcast with various guests, all these kinds of things. So I definitely wanted to do something outside of the hospital and I want to be able to help people. I don't know whether that's in the traditional kind of insurance system. I don't know if that's going to be around by the time I get to practice because a lot of things are moving right now, especially with the COVID pandemic. Yeah. I think it's changed a lot of how people look at healthcare, but I definitely want to help people. And I want to do that through musculoskeletal care. I think one of the things that all the listeners and you guys can tell for me is that I want to help people do what they want to do. And a lot of that comes from the musculoskeletal system and keeping people healthy. So what I want to do is eventually be able to help in the way that can help people get comprehensively healthier in a sense. Whether it's musculoskeletal, or if I can help bring in other clinicians that can help them with their other issues, medical issues, diabetes, hypertension, all those kinds of things, to help them do what they want to do. Awesome. What form that takes? I don't know. Yeah, absolutely. I mean, I'm in the same boat, right? As a PGI 2 literally diddo what you said, you know, thinking about the functional integrative lifestyle medicine route with some exercise physioprp or the biologics, et cetera, but it's tough, you know, until you kind of get into it. I mean, ultimately, as a fellow, I guess he's got a little more experience than we do in terms of. He's got more gray hairs than us. Exactly. So, dude, I mean, that's all awesome. You know, I love the fact that you haven't really bottled it in. You know, we asked, he asked you straight forward answer. And I think the simple answer is like, oh, I want to do fellowship in XYZ, but it's really so many different things. And sometimes, I mean, this is kind of how some fellowships develop, right? And now you have one of the things that they'll say is, Pimanar is really not limited. I mean, you can go into cancer rehab, you can go to palliative rehab, right? There's now a quote unquote regenerative medicine fellowship. And there's so many different things. And this is the beautiful thing about our field. There's such a young field, relatively speaking, that you can continue to develop, right? That niche or niche, whatever you want to say. So that's awesome. Super excited for that. I want to come back to your podcast without spoiling some of the ones that are coming. You know, up front the future guests. You've talked about various topics pertaining to quote unquote help. Nutrition exercise, sleep, you know, the things that we kind of look at the foundation. What are other things that you would love to explore on the podcast as guests and stuff? Like maybe people you'd like to bring on or maybe not people topics you'd like to explore. Definitely. I love that you brought that up. I think that like I was saying previously, and I think that you guys have mentioned that health is not necessarily about just like the fitness in exercise. It's not about just hating the gym and all these things. There's so many other things out there that impact our health. One of the things that I'm actively trying to get someone on, I actually have a Zoom call with someone who we're kind of discussed. Go over these things, see if it's the appropriate person to come on the podcast. But it's about kind of how the built environment of kind of the structure of cities, urban planning, impacts our health and how we can plan cities better to kind of build out our health in a more systematic approach. Because if you think about a lot of the social determinants of health, for example, in the South Side Chicago, look, if you look at the life expectancy, it's like 10 plus years lower than people who live in a loop, which is kind of like the more business industrial area. Why? Why is it that way? A lot of that's because that's the way the environment is built. They don't have access to a lot of these things. They don't access the gyms, they don't access to public transportation, gross shores, all of these things. So that's something that I'm really interested in having on there. Kind of the impact of environmental, like the environment in general, like global warming, climate change, whatever you want to call it, the impact of that on health. I want to talk about kind of more public policy, how we can shape health care and the policy on the higher level, dim factor health, because I think a lot of times people can have a lot of individual willpower to make change. But if you look at the vast populace, it's kind of guided by policies in the way that countries kind of shape their policies in the way that they steer and kind of, I don't know, the way that they steer things. So if you look at countries like the Netherlands, Denmark, all of those kinds of places, they're more bike friendly, it's a little bit more accessible. People are quote unquote happier because they're able to communicate with their families, friends, more sense of community, all those kinds of things. So that's something I'm greatly interested in kind of having on the show. It's something that I'm a little frightened about to have on the show, because I don't really have a good evidence base on it. So I don't necessarily know what to look for in people. It's very difficult to read evidence for that because I'm not trained to do so. I've never looked at that. So that's something I'm excited to have on, but also a little scared. Dude, I am also stoked about that. I think that's more than just a podcast. That's probably like a seminar series is what you're talking about, right? Because when we're talking about policy change and it's interesting. We recently had an awesome guest at Peterville in Zuella where we talked about the quote unquote issues with the healthcare system, right? A lot of the the quarrels that physicians have, you know, you're now getting more and more familiar with documentation. And when you get into clinical practice, or when you get to clinic, I should say, when you're seeing a lot of patients and you're trying to spend the quality of time, which we know is important for building therapeutic relationships. And how much, how valuable that can be when somebody comes in with pain, which is incredibly complex as you've talked about before. I mean, simple things as that. I mean, another thing I was all mentioned is like just the insurance model, right? At least in this country in the, in the U.S. space healthcare system, where I don't have, I couldn't cite data to support this, but I would suspect that, you know, people who have higher, you know, deductible or simple as that are less likely to see preventive care. And what we know now is during the COVID-19 pandemic where people are less likely to go and stuff like that, the cold more conditions, people talk about the maybe undiagnosed cancer, stuff like that. If you're not having those frequent visits for whatever reason, um, sans COVID for financial reasons, as you alluded to, that can be detrimental further down the road, right? So super excited for that one. I want to thank you, dude. I want to thank you for the amazing work you're doing. Like I said, I'm, I'm so, I'm inspired to honest it in one word by, by you being able to do this at the med student and as an intern, again, props to you guys for being able to do this. I know, as you know, how much work it goes into, to creating this. And I think people have a lack of appreciation for that. So thank you for everything you're doing. So still for some of the things that you mentioned that are coming in the near future. Um, the preventive medicine podcast, that's where people can find you. Where else can people find you, man? So they can find me. Unfortunately, uh, my name is Taken. So you can't just look up Rog of Sharma. It's underscore, um, at, it's on all platforms at underscore, Rog of Sharma, R-A-G-A-V-S-H-A-R-M-A underscore. So it's kind of like the signature line and put my name at some point. I'll have to buy my actual name, but the person has like one follower. Oh, so it's not you. It's not me, not my creep account. Also, well, we're going to link all those, uh, in the show notes. And Rog of, I also want to say thank you, man. Definitely inspiring, you know, you said you're not even at first base, but you're definitely hit at home run. So not sure how you do it. But it's, it's, uh, well, I'm staying from, from my perspective, I've been turned here. You're doing it solo. I mean, you got the cool podcast set up. We don't, um, so you guys got to get a video component. So I can show this off at some point. How else am I going to show? So, okay. So we'll get you back on. That's, that's a yes. Um, but last, last question here for you that we ask all our guests is, how do we put the health back in health care? That having the tables flipped down, it was very difficult. I always asked people, how do you get healthy in two minutes? But how do we add the health back in health care? I think there's a lot that comes with that question. I think it comes from the individual level, the kind of community level, the policy level and all those things are different. I think when it comes to health, I think the biggest thing we can look at, like we're just talking about is the policy level. What are we doing with insurance policies? What are we doing with our built environment? What are we doing with the kind of environment and as like climate change was? A lot of that kind of guides health at a large population level. So one of the things that we can do is we can elect leaders who are in tune with that and who understand that kind of the health of people is what everything base, it's based off of, um, so that's probably the best way to vote people in who are good for health policy who actually want to help people get healthier. All those things instead of the perverse incentives of monetization capitalism. That's probably the biggest thing. The second thing when it comes to health is let's think about health and what we're able to do with that health as a basis versus just chasing health, going to a doctor to fix and acute problem. Why are you fixing that problem? Fix that problem so you can do something about it. And I think that if we reframe that mind, uh, that kind of reframe everything towards that mindset, then I think we can start looking a lot more about health and a lot less about health care and kind of institutional medicine to like. Well said, bro. That was awesome, dude. Thanks, Rogov. Thank you. No, thank you. Thank you. It was a weird coming on someone else's podcast. I haven't done this that much. Usually I'm on the other end. So I appreciate the opportunity. All right, take care. All right, take care. Yep, bye. All right. If you guys want to check out everything that Rogov is up to, we will put all the links in the show notes that includes his podcast, his website, his YouTube, and whatever else he may be working on. And there's always, if you're enjoying these episodes, please go ahead and leave a rating, either on Apple podcast, and now Spotify also allows us to have ratings. So that would be a huge help if you're able to do that. And of course, if you'd like to give us a few shout outs, please leave a review, subscribe, and then share this podcast with anyone that you think could benefit from it. Time for that medical disclaimer. Everything in this podcast is for educational purposes only. It does not constitute the practice of medicine that we are not providing medical advice. No physician patient relationship is formed and anything discussed through this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health related issues. See you next week for a lessons learned.