54. Lessons Learned: Robyn Tiger, Melissa Mondala & Adeel Khan

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. Welcome back to another Lessons Learn episode. In the past three episodes, we've had some amazing guests covering a wide variety of topics. In episode 51, Dr. Robin Tiger raised on what it means to be stress-free and how we can become more stress-resilient. We've followed that up with a discussion with Dr. Melissa Mandela and revisit the topic of lifestyle medicine across many cultures. Last but not least, Dr. Adil Khan joined us on the show to talk about regenerative medicine, a topic that keeps getting hotter and hotter. But of course, the listeners on this show know it as a term of orthobiologics. And so it was really cool to speak with a fellow colleague and pick his brain regarding how he practices sports medicine and learned a lot about orthobiologics, particularly for us arthritis and some of the breaking insights into the field of regenerative medicine I should say. Now, with that further delay, please enjoy this Lessons Learn episode. All right, guys, welcome back, Dr. Darshan Shah. Another Lessons Learn. Time to learn, man. What's going on? How are you doing, buddy? Coming in and there, chilling. I'm on my complex care rotation, so a lot more back to that intern near, man, a little bit. I'm doing a lot more internal medicine. I like it too much. I like the clinic life better. What's complex about it? Is it just like a medical complexity time situation or is it just a little brain injury, spinal cord, like what? Yeah. So it's more internal medicine patients. It's more cancer, LBADs. It's more of the complexity of medicine, more wound care, more ortho. So yeah, it's more of this general, hodgepodge of patients that are medically complex than then come on to our exercise. I enjoy the medical complexity, like the transplant patients are very, very challenging. Oh, yeah. It's a world that we really didn't get to see much intern near. I didn't. And so it was, was that completely the new learning experience for sure? Especially the rehab setting, man, it's tough because you know, you're expecting stable patients. You're not drawing lives all the time. And like these patients need it all that they need, let you know, but they're not being rehabbing the rehab, but they also need that medical attention all the time. So it's definitely a balance between the two. For sure, man, how much more time will you be on that month and a half left, and then I go back to brain injury to round off the second year. So it's a two month block. Yeah, we do two month rotations, yeah. Wow. That's intense. That's a lot. All right. Well, dude, we had a couple of awesome guests, right, and a lot of learning to be done. So where do you want to start it off, man? See, so Robin Tiger was our first guest of this three part series here. Awesome. I'm of an episode, you know, when I first kind of looked into her, I was thinking, okay, you know, this probably might just be like a generic episode on meditation, burnout, nothing that we haven't really seen before, but then you bring her on and it's a lot more than that. I mean, she drew the perfect balance between the science behind burnout, spirituality, stress, yoga, breathwork, alongside the art of all of those practices as well. And I think she really combined both of them perfectly. You know, I know this isn't one of your favorite books, but again, still working on the books, which, right, and they often talk about leading the elephant and the rider in it. And I think that that's exactly what she did to spend a job at, right, feeding the left brain and diving into the autonomic nervous system and explaining that physiology a bit further, but also looking at and feeding the right brain, explaining how just the real life examples for her own personal story, which she talked about being in complex case that nobody wants to be, but also some of the folks that were really close in her life, how they didn't end up making it on the other side, right, and how that affected her emotionally at a deep level. And also, actually, I think we were able to resonate with it because, you know, maybe not directly, or maybe directly, you know, we've been able to see those types of cases in our life, and that's impacted us, which is why we're so passionate about what we're doing. So I think that that's it for me, what made it special. Yeah, man. I think the fact that she was vulnerable enough to bring up her journey and the things that she's seen, right, I mean, she lost two very close colleagues, you know, one during her training, and then I believe the other was kind of during her attending life both lost the suicide overdoses, right, and we fail to recognize as a community how often these things occur, you know, amongst healthcare professionals, especially physicians. We go in as a pre-med thinking, we know how to, we know how we want to practice. We know the things we want. We understand there's going to be money that we want to make, but we never truly understand it until we're living in it. And then it's a complete shock. And I remember I was telling, you know, you guys in that episode about what I went through in January, and I never felt burnout, never thought I'd get burnout, always preaching about burnout. I mean, you follow me on Instagram, I talk about it a lot, giving tips on how to get through it, but you really don't know until you're in it. And then you look back and like, holy shit, what did I just go through? And so to hear her and her journey and how, honestly, I think the biggest thing is how open she was to her own journey, right, not closing it all. So she's a radiologist, right, I think being somebody in medicine who looks at things very objectively, I mean, that is anything but an objective experience of going through burnout and the pair of seizures and the symptoms that she had. Yeah, I think that's, that's well said right there. It's so subjective and the symptoms are so vast and for her, it seems like she was heading across all the symptoms, right, which makes it so much more challenging. You know, from a musculoskeletal standpoint, which is kind of what I'm subspecializing in now, sports medicine, a lot of times when somebody comes when, well, pain is usually the chief complaint, right, rarely that's not ever and it's so complex that we've talked a little bit about, well, we talked quite a bit about. And when it doesn't make sense, you always go down this diagnosis pathway and I think that again, you know, being in medicine, when you're privileged and you see colleagues, you're more likely to pull the triggers and get the MRI and that kind of stuff. She mentioned how orthopods were just getting MRIs over her knees and hips and ankles and it's like, okay, coming back clean, coming back clean and it reminds me back of what Dr. Amy Shaw talked about, a bit similar story with that respect like all these labs are coming back and then they're completely normal and you're almost feel embarrassed, right? You almost feel guilty like, oh man, I just wasted my, my colleague's time and not, there's nothing wrong with my knee or nothing wrong with my hip or my, I don't have an elevated whatever count. So I can only imagine how that must have felt and how challenging it was. I loved that she kept pushing down and ultimately said that, you know, the one who was, be able to make that diagnosis was her, despite her husband being in medicine, being so close to her, but she was able to guard from him to which, you know, makes me just think that even, I mean, we're in this every single day, right, day in and day out, we see these patients, we take, sometimes we take their pain, other times we can't disconnect from their pain or their struggle, whatever it is. And even the ones closest to us, right, you kind of touched on this, we tend to hide it from them, we keep the guard up from them just because I don't know at what point in our training, we're taught that you just have to, you just have to go through it. It's like self-sabotage, right, I mean, it's, why do we do it, why don't we ever just ask for help, why don't we, why, you know, let go of the ego, let go of our pride and just say it's okay, you know, I know I'm out there taking care of people, but hey, sometimes I need my own cup filled from others, so yeah, man, I totally agree with that. Well, you know what, I think it's a little bit more than that though, right, I'll tell you what I think we routinely talk about that is, and even in that last year and a half that we've been doing this, I've found myself having those feelings and going through those moments and felt a bit hypocritical. And I think part of it is, sure, I think ego and just the perfectionistic concerns that you might have, you don't want to be short of those expectations of yourself, that's one aspect of it. The other aspect though, when you're a resident or you're a trainee or something like that, and if you stand up for yourself and you say, hey, listen, you know, okay, let's just go back to your example of when you were in the rotation, right? I imagine you probably had a co-intern or a co-resident or something like that, right? You were part of a team and if you say, listen, I need a mental health day or I need that, like that work is going to fall in somebody else. And that person's probably going to hate you, right? And the resident's going to hate you, the attorney's going to, it's just, yeah, it's important. And I think that most people know that. And then that's the reason that they, well, I shouldn't say most. I think sometimes I felt that and I don't want to do it. And if it wasn't like that you're, if you took the time off for yourself and if it didn't sabotage everybody else, I think more people would be inclined to do it. I know that's the case with me. Right. Oh, yeah, totally, right? If you take off as a doctor, who's going to, somebody has to cover your work, you know, that's regardless of attending resident, whatever level you're at, it's not like working on a big corporation where you can take a day off, you work for a big team, all right, it's cool. You know, the work move goes on, but you having your own individual patients, like, this is why there's a shortage, right? I mean, we don't, we obviously cover too many. It's not like there's two doctors covering just set, like I'm covering seven patients. It's not like two of us are covering seven covering each other. So it, you know, it's, it's, they give us more work than we can handle all the time. And so that's kind of, yeah, that's kind of where the, the land land is. Now, what strategies, so I mean, so I guess what we're touching on is this is a systemic issue that we talk about time and time again, that needs to be addressed, right? In the interim though, because we know it takes a long time, she mentioned a bunch of strategies, right? Well, does anything stick out for you that you're so much better at this than I am? What is it that you already do? What else did you pick up that you might start doing? Sure. Oh, yeah, I definitely have started doing some of this stuff. So I think the biggest thing about Robin that I love is how open she is. So if you go to her, if anyone goes to her site, right, you're going to see meditation, life coaching, breathwork, yoga, but that's not how it started. I mean, she was anti all those things. But then she said, you know what, let me, one day just try it. She felt a difference in her body, went to the literature, saw that there's actual scientific benefits behind all of those things, and then routinely started it again. So for me, at least, the advice that has helped meditation, for sure, I think that just allows me to get perspective, right? Yesterday, I had the case of the Sunday scary, being on a tough rotation, like we talked about, but then, you know, waking up this morning and being like, you know what, I'm going to sauna. I'm going to cold shower. It's going to wake me up. And then I'm going to realize, like, I'm going to play my game, like, you know, residency, you don't play your game. It's not your game. You're not playing against your, you're not playing your strengths. You're playing your strengths and weaknesses, right? We are, quote unquote, somebody else's, bi, you know what? So you have to go in with a mentality of how can I win the day? Like, how do I turn this day into my game, right? And for me, that's working out, that's meditating, that's getting those things that I need to, right? The podcast, working on social media, all these things. If I can do that, and I still have a crappy day at work, I still won the day, because I at least played my game. One of the things that she talks about is breath work, right? And how we can stimulate our parasympathetics and calm down. And so something I've been incorporating daily now is prana yama yoga. And so if people want an app out there, it's called prana yama. It's a seven, you can do it for like seven minutes. It's just box breathing, essentially. So I'll try to do this when I'm in the sauna or afterwards, but seven minutes a day is all it takes. And then I just bought the book Breath by James Nestor and its fire. It's really good right now. I'm like two chapters in, but just, you know, the first chapter is talking about nasal breathing. And just like the amount of experiments and the science that shows behind how key your breath is in terms of longevity and health and depression, just so many key factors, right? Either you go back ancient history, it was the breath. And you know, as Kelly Starritz says, the breath controls the brain, I believe, you know. So and the brain controls the body. So those are some of the strategies that I've just been using. I love that, man. How can I win the day? That's awesome. For me, what I'm taking about that, I'm just going to start my day and just now, when you do that, do you plan about, well, do you do strategize how you can win the day the night before or you wake up and you're like, how can I win the day today? What am I feeling? Dude, my mind's like ADD, like if you asked mirror, she'd be like, dude, you're thinking all the time. It's 24 seven for me. Like I'm thinking right now, like after this podcast, what do I do? Like what do I do? You know, it's constant. So it's, it's not fun, but it is at the same time because it helps me grow. So yeah, the night before I look at my day and I say, okay, I can go to the gym here. I can go to the gym here. What are the contingency plans? If it doesn't work here, well, how do I use this time to do something else and then go here? But if I have to go here, you know, so I'm constantly thinking in flowcharts almost and like trying to optimize as much as possible for the day and seeing where can I fit these habits so that I can even have more room to chill out, grow, do whatever I need to do. So it's interesting that you say that, right? Because that goes, that's at odds with the thought that you want to be present in the moment. Like for instance, I'd loved her analogy about the kid with a thought bubble and the sunshine and that's what they're seeing, whereas the adult has another 100,000 thoughts, right? If you're constantly thinking about how you can win forward, right? What the next step is going to be, next step is how are you, how are you, how's your thought bubble reflected looking at the screen looking at me? I know I'm not very attractive, but you doubt yourself, sir. No. Yeah, no, that's a very good point, right? I get asked that all the time. Like if you're constantly thinking about the future, how are you? So I try to relate it back to the past as well. So this is getting super spiritual in meta, but I believe the past, president, future are all connected, right? They're all living in the same timeline. So when I listen to a podcast, I'm constantly thinking about how is that related to my life right now and in the moment? So I see my life in the moment as these three lines, the past, present, and future kind of happening. And so it doesn't really make me anxious thinking about the future. Like, oh, what am I going to do after this podcast, but I almost see it as a pattern and a cyclical pattern in a way. I don't know if anyone's following it right now. I'm like, what the hell is going on? I'm following. Okay, but that's kind of the way I think about it is like, how is that going to help me in the future, but also my meditations that I do, which are super present, you know, how does that allow me to expand my mind so that I have, I'm that I'm able to have these thoughts and do this kind of mental roadmap. I like that, you know, one of the ways that, and insight that I had a long time ago. I remember, I'm not sure if I heard this somewhere or who I can give credit to or if I came up with it in an alternate mind of my own reality. You know, somebody said, like, okay, when you're living life and you really don't have a good grasp on it, if you're not mindful, you're living life through first person shooter action games, right? And those who played video games would know that when you get a sense of it, a grasp on that, you're all the sudden playing a third person shoot or like action game, right? And other way that I look at it, even I think when you really take a step art, when you have this practice for years and years and years, it's almost like going to a play and watching it in from the audience, right? And so what you're kind of describing it to me is you can kind of, it's like one of those old school plays and you can see like the bad guys coming from the back and but the main character cannot and you are the main character about watching it from there. That's exactly, that's exactly it, yeah, that's it, I love that man. That's exactly it. And like the way, you know, I love Gary Vs principle and I talk to us all the time is that he believes in living life on both extremes, like whatever you do, do it on both extremes because when you pull so hard, it's extrashing a rubber band, it snaps back into the middle and that's where you get that perfect balance, you know, and it's kind of what Kelly Starrett talks about in terms of you're constantly moving, you know, back and forth, you're never going to be really in a straight middle. So enjoy that pendulum, but also push as hard as you can, right? So it's like for me, I want to make the most of my inner world, I want to be ambitious, I want to, you know, keep create that legacy, but at the same time, I'm going to die one day with the hell of cares, you know, I don't mind just sitting here, laying here, meditating and not do it anything. And I kind of have both of those perspectives and I think that allows me to reach that balance. I love that, man. You know, the other thing I wanted to touch on is, you know, when we ask for about the great resignation, we've talked about this and we've asked several other guests, right? Because this is, I mean, this is contemporary issue and it's something that needs to be discussed a lot and so we can avoid it from, you know, for separating, but also from not happening again in the future pandemics, whatever they're going to be. And she talked about remaining calm in the chaos, right? And how a lot, a lot, if not all of her clients were physicians who were part of that struggle and saying, hey, should I leave medicine, should I stick around because EMR and all that kind of stuff? And that goes hand in hand when we asked her about the question about healing the healers, but the next generation of healers. And you know, she talked about really having these conversations with these practitioners and having them evaluate the why and really digging deeper and not just saying, okay, if I'm going to leave medicine, my problems are going to be solved because I don't know if that's always going to be the solution, right? So it's really about going back to your core why, which is kind of the central theme of every discussion that we essentially have. And even when I asked her about what she would tell the third grade rob, and she said, I was still thought to go for it, but really with a different approach, right? I mean, so for some of the things that she'd done, you'll get therapy right, 1000 hours there, life coaching, something that you're passionate about, maybe it's in your future. And I also loved her analogy of how she described life coaching versus what was the other one? You know, she gave, maybe CBT, maybe a psychologist kind of brings you back to, you know, like a rehab specialist, brings you back to the life coach kind of takes you forward. Although that was really unique. If you get more thought to that, is that something you want to continue doing, or is I do? Life coaching. I do. You know, I just talking about, talking to me or about this today actually, you know, is it worth pursuing an actual sort of certificate or is it something that you can kind of just do, right? It's both. It's hand in hand. But I would like to get at least a little bit more formal education because I think it is worth it in some ways, right? Actually learning psychology and learning motivational interviewing and certain topics that I think that can just help. But, you know, spoiler alert, we're bringing, you know, ban on in a couple of weeks here. We talked about it. He does life coaching. He never got a certificate because he was like, dude, I live life. Like my life is tragic enough to where I've gone through stuff for people to relate. So yeah, I don't know. I think for me, it's going to be going to the flow. And if it's something I'm like, you know, why not kind of learn this? Then I might do it. But I feel like I already do some of it a little bit at least in terms of getting perspective. So it's more about now just how do I put that in stone and define that by certain principles. Hmm. Awesome. Well, I think overall an amazing episode, I really enjoyed it, learning about her journey. And I think we'd be remiss if we didn't mention the tremendous, you know, it's just free resources that she offers. So her website is stress-free MD. You guys can Google her. She's got a podcast. She's got a lot of free resources. She also does a 101 coaching with folks. And she's got a great demeanor. And just she was extremely approachable, extremely personable. And you know, I highly recommend that you guys check her out for sure. 100%. Yeah. Cool. All right. All in turn, next guest, who was a Dr. Melissa Mandala, who is the wife of her former guest of ours, Dr. Micah Yu. So this was also an interesting episode. You know, she also does lifestyle medicine like her husband, but she does primary care. And I think she did some psychiatry kind of certifications along the way, too. What did you take away if anything? No, the direct primary care model is fascinating, right? You know, I so this was this was you so well, I actually didn't look into the direct like so I think direct access for physical therapies, one thing, direct primary care. I don't know. Did you end up asking her about that? It's like most of her clients are reaching out to her and setting up through just reaching out on themselves, or are they being, you know, are they consultations from referrals from other place? Like what did that mean exactly? I think they're reaching out to her. So if you go on her website, like Dr. Lifestyle Clinic, it's more so she does subscription packages. So you can be like a gold member of VIP and that just means you get different like privileges, you know, for different prices 24 seven access versus this many visits, but people are mainly reaching out to them, just because her social media presence, as well as, you know, her husband and both of them kind of teamed up together. Yeah, I love the reframing of the perspective, right? I mean, she talked about, you know, everybody's again, I mentioned this before, how fascinating I find people's different journeys about what was the inception for this pivot interjectory? I mean, the last person that comes to mind is Rogov who came and talked about that, how there was in one pivotal moment, but it was really okay, you know, his endocrinologist, just nudging, nudging, nudging, and eventually be like, okay, get your ish together, dude. And then something just snapped, right? Just on off switch. I kind of got the sense that it was similar for her, although she was having some medical stuff for herself and she was like, this isn't making sense, this isn't making sense and all of a sudden she was like, okay, I need to figure it out. I thought that was pretty cool overall. Yeah, she had a IBD, right? So she was having some like bowel symptoms, just like throughout college and she, you know, talks about living, you know, living the fast life and whatnot grew up. She says quote, like carnivores or she was eating a lot of meat, but then she was like, hmm, something's not really working here and then met Micah and then Micah tried the whole plant-based option kind of convinced her to start and then she did and she started seeing her symptoms kind of get better. Now she's fully plant-based as well. So yeah, it's always something that triggers us to kind of try something new and be like, okay, this is just starting to work. So yeah, that was kind of her story. Well, I think for what's cool about them is they are a unit, right? So I think that when we talk a lot about instilling these change and these habits that you were bringing up earlier on, it's much easier to do it when you have an accountability partner, right? I think it's more like a house that you're also working with and you've got this lifestyle, medicine, just clinic with essentially. I think it just overall overarching, it just feeds into the brand and I think that makes it a bit more feasible to carry those healthy habits, that healthy lifestyle for nobody intended, into your home life and integrate that back into your work life and you're kind of just, you know, living what you're preaching. So I think that makes it really, really cool. I 100% think accounting. I think accountability is like the biggest driver for have a change. Like more than anything, I think more than discipline with a will like if you have somebody who's holding you accountable or you like post on the social media and you're like, I would be riding a marathon in two months, like there's nothing better than the fear of embarrassment or not doing something or feeling like you're the anchor holding everyone down. I think that's like the biggest driver. So I've always said like I want to create like an accountability like WhatsApp or like a discord for like students and stuff to actually who like want change and like post things. I know there's apps out there, but the problem with apps is like, you don't know these people, right? Like accountability really matters with people who can hold you accountable. But I think I don't know how you feel about that, but I think it's it's probably the biggest driver. Well, so let me ask you that, right, how social media different, like you've got somewhere in the neighborhood or several thousand followers, I know you do your best to get to know or your followers really will. Well, but there might be people following you who you don't have a personal connection with you haven't had and do count them as people who are holding you accountable when you do that. No. So I guess like for me personally, I've never been like I'm my goal is this on social media. Like I don't think I need accountability and I'm not saying that because like, oh, I'm great and all, but like I've been very motivated by my own kind of virtues and things like that. I think for a lot of people who just like need a head start, I think accountability is perfect. I just don't I think a lot of people are afraid to put things on social media because one, they're afraid of meeting that goal. And then two, a lot of people are just afraid to change, right? I think there's this concept of when you change for the better, people think that, oh, now you have to live this hard life, right? But they don't realize that in order to get to that goal, it's going to take small change anyways to the point where you're just going to be living that life forever. Excuse me, it's the reason why I'm not a fan of like people who cut and they like within a month lose like 10% body fat. It's like that's not sustainable. Like you're going to bounce that right back up, like you need to take it slow. Like you need sustainable change over and over and over to the point where that is now your lifestyle. You know what I mean? So yeah, I don't know. I think psychologically a lot of people are afraid of accountability because they want to want to let other people down. Yeah. Well, I do agree, I think that it is an extremely effective tactic when you are trying to make change and bringing it back to Melissa's point of view and a whole perspective from a lifestyle medicine approach. I mean, that's the most effective thing, right? Is instilling good habit change from these pillars of lifestyle medicine, which is what they focus on now and just a quickly recap for those who don't remember. I mean, so you've got, you know, a plant-forward lifestyle, right, a predominant plant based however you call it. And I think it's important to make the distinction that the pillar doesn't necessarily, although people might practice. I think she is primarily vegetarian. That's not what the pillar is saying if we just need to incorporate more vegetables, which is a central theme. I think there's no denying that. Okay. I was going to say is the pillar actually plant though? I thought it was just nutrition. It's just that I think it's just nutrition, but then most lifestyle practitioners are plant forward or, you know, well, no, I think the American College of Lifestyle Medicine recommends it plant predominant. Really? I did not. Yeah, sufficiently the recommendation. I'm pretty confident about that. Got it. Do. Well, why don't you, why don't you tell us the rest five while at Google this search really quickly? All right. So we got plant forward. We got exercise. We got stress resilience. We got sleep. And then we got risky behavior, substance abuse, things like that. Yeah. Avoiding, I think, substance abuse. Yeah. Avoiding substance abuse. Yeah. I am not doing this as fast as I thought. Sorry. Yeah. We'll move forward. Yeah. Let's talk. Yeah. We'll come back to it. While we talk about our last, but not least, our guest from across the border, Dr. O'Deal Han, a South Asian colleague, a daisy like us. That's right. Adicon. Yeah, man. So another episode on orthobylogics, PRP, touch it on sports medicine as well as fitness and weightlifting, which he's passionate about. The last time we had a talk on orthobylogics was with Dr. Malanga episode 12. So if people really want an in-depth analysis on that, then you check out that episode as well. What did you take away? I know this hits closer to home for you than it does to me. Yeah. I think this concept of cyto-rich PRP that they use, I think, is really, really cool. You know, the terminology tends to be a little bit different, which is why I wanted him to kind of expand on that a little bit more. And the closest thing, the analogous one is what he described is the folks over regentex folks that are using like platelet lysate and they're kind of actually mechanically lysing or manipulating the platelets to augment them, you know, for a lack of a better word. And it's not, I don't think it's the overwhelming practice or the current practice in the states. But you know, I'm not as familiar with the rest of the folks in Canada seems like they're few and far between the people who are actually doing it relative to the states. You know, I deal with what argued that still there are a lot of people who are maybe not doing it the right way. But I thought that was pretty cool. I, you know, it is a very, very challenging space to be in, right? I think when the PRP, the literature has gotten to be stronger and stronger every single day, particularly with osteoarthritis, like we have multiple level one studies to support that, but still, if you actually look at those studies, as he brought up time and time again, like the definition of PRP is so vast, like what does that even mean? And then there is very poor regulation in how people are creating their PRPs. And so it's hard to say, you know, always, and this is a point exclusive to him or hit this episode. Dr. Malanga talked about this too, is whether or not it worked or didn't work, because if it worked, I'm not really sure what worked and if it didn't work, I'm also not sure what really worked. So standardization is the central theme of everybody who does orthobiologics and actually cares about progressing the field. And yeah, so I couldn't agree more with that. Let me ask you this, what's the one thing, you know, when you think about PRP and orthobiologics that you wish for? Like what's the one thing that you wish, when you think about the topic, you're like, you know, I wish that. Wow, you put me on the spot, that's a tough one. I think that it goes hand in hand with standardization. I think we need to be clear and cautious with our message, both when you're communicating with patients, but also with our colleagues and practitioners and everything. You know what I mean? Is what are we exactly saying? Do you have, do you have patients coming up to you asking about like PRP, I mean, how much are patients understanding this, yeah, they just hear it kind of from their own research and stuff, come to you? Yeah, you know, a lot of it is a referral based thing as well as because we've established a pretty robust practice doing that. But yeah, you do have people, people who will Google it and they'll see good things and they'll also see not so good things. But I love it, man, that actually makes it really, really easy when patients come in informed about that. That makes life a lot easier. Earlier in the days, I think maybe four or five years ago, patients would come in and they would see all kinds of nonsensical stuff. I think now the good information or the better information I should say is a bit more easier to access. So patients actually come in and they're, I find this is just anecdotal that over the last six months or so, I found that patients are coming and they're saying things. I'm like, yeah, yeah, that sounds about right? What you're saying. And before I go, where the hell did you, did you read that, don't go there again. So yeah, that's always good. That's sick, man. I'm excited to learn more about it. So we do more of it with our sports medicine rotation. So next year, we don't really do much of it, you know, in the PM and R realm here at Penn State. I feel like once you're closer to it is where you really start to learn and hone in and, you know, give your own opinions and stuff that wherever you can. So yeah, thanks, man. Cool. I think the, you know, the, the next thing that deal really delved into that we talked about were kind of just labs and also just looking into fitness and weightlifting. I mean, that guy is obviously throwing weight, you know, he was a trainer in the past, but his, his whole Instagram's just throwing like 120 pound dumbbells just around the gym. So he's all about building muscle and he's all about muscle being the, that organ system that can really protect you as he says is the body's armor and protects you from a host of diseases because we know, you know, there's cytokines, right, which are the inflammatory kind of substances that help out with regulation, but there's also myokines now that we know about. And something he's excited about, as I think all three of us are, is kind of the research coming out about muscle as an organ system. And not only just its role with inflammation, but also it's role in almost everything, right? Like insulin regulation, testosterone, longevity, you name it, it's, it's getting up there. Yeah. He's someone who walks the walk right and I think it's so important. Again, you do a spectacular job at that. And I, I know you at a personal level and I think some people who just perfectly follow your social media, see you posting a lot and whatnot and they wonder, you know, I think that that's the case with anybody who's posting if that, that's the life that they live. And it really is impressive because you do, you, that is the life that you live in. A deal is a similar person and I think that again, this goes back to where we're talking about Melissa and, and, and Mike, them as being couple is when that's the life that you live, it's so much easier to have that conversation because it integrates into your practice and it's seamless, you know, for me, it's more challenging to talk about meditation because I don't do it as much. I did at one time, I had an amazing six months, I'd love to get back to it. But whereas exercise comes, you know, much easier to me and that kind of stuff. And, and I think, and that's super, super important. And when you do that and you let your, but so that's one point and the other point that I should say is the credibility piece of it, right? So he trains high level, you know, elite, like elite top 1% athletes, bodybuilders, Olympic athletes and that kind of stuff. And he's been on several podcasts of just these, you know, national and world level competitive bodybuilders. And I think that it's instant attraction and they'll go to that and, and they just say, hey, look, you're speaking the same language. And therefore, like that's that therapeutic alliance piece of it, right? The Dan Pope talked about a long time. It's easier to get that. Yeah, it's funny. Dr. Blade, you know, the, our payment or colleague over there is freaking jacked, put up a post last week about like, hey, do you guys, is it easier to like follow the advice of somebody who walks the walk, right? Like from a doctor who is fit and he's healthy and does these things, like every, you know, he gets a lot of comments, every single comment was like, yeah, absolutely. Of course, of course, of course. Right? Like, these are lay people telling you, telling doctors out there that I will agree with you or probably see you if you walk the walk. Like what other feedback do people need, you know, especially our colleagues like that want to get in shape, that want to attract more patients, that want to have more influence. Like right there, that's that's probably the best way to start, right? Now the flip side of it and one could argue that, you know, if you look like you walk the walk, but don't necessarily walk the walk, you're still more likely to get more buy-in, right? And I think that's, I think about what was it Dr. Arnt who came back way, way back in the archives and talked about how, you know, these, I don't think maybe it might have been Dave Otay coming on talking about how, you know, just because some trainer doesn't look absolutely shredded and whatnot, they, and they could be the most intelligent, the most successful, you know, the one of the best outcomes in their athletes and they might not get the buying. And I think about, like Bill Bellcheck doesn't look like the greatest football player of all time. I'm pretty sure he played football at a high level. Yeah, he played college, yeah. College, right? But, but there's, I mean, there's very little question that he's the greatest coach of all time. That goes the same with Greg Popovich, who is now the most winningest coach of all time in the NBA, but I don't know if Greg Popper, which is the greatest basketball, you know, so on the flip side, there could be lots of, like, okay, let's take my Jordan, like Jordan's amazing, right? I don't know if my Jordan would make a fantastic coach. If anybody has questions about that, you should wash the last dance and learn it. I'm on my, like, a Jordan coach, like me. So I think we also have to be cognizant of that that it doesn't preclude you, but I can see the point that I do think that it does make it a bit easier. At the very least, I think about a cardiology, not a rotation, actually, I was in medical school. No, no, this was an undergrad. So pre-med shadowing, I remember shadowing a cardiologist who was probably about a hundred pounds overweight. I don't know, he had to have, again, I'm judging, but the point that I'm trying to make is I remember him smoking in the parking lot during lunch, coming in and just having chicken wigs and just having sauce in his hands, barely cleaning it and walking into a room and then having a conversation with the patient, how this is a cardiology of his and how they should stop smoking. And I just stood there and I was just like, I don't understand. I almost felt an obligation to interject and say that this is inappropriate. It's, but, you know, I was, I don't know, I was like 20 years old, but I, so that's not going to cut it either, right? And so, yeah. Oh, that's too funny, that's too funny. It happened, so. Oh, yeah. That's absolutely, absolutely. Yeah. Damn, man. Well, any last thoughts? No, I'm hoping you have a better, that was a bit of a somber note. Overall, I think the message is that, you know, I think we're heading the right direction. I know that at the inception of the podcast, there's a lot of room for us to grow. There are a lot of things that need to be fixed, but there are a lot of awesome things happening. I mean, just, just the fact that we get a lot of great guests who come out here and, and they're not somewhere really far ahead of us who are paving the way and, and are pioneers. And others are just a few years ahead of us and just also trying to figure it out. But I think that collectively, we all have to kind of get on board and kind of help share this ship as you set on a previous episode. And so, I'm excited, man. It's, it feels like the tide is turning, and I'm just excited to be a part of it. Absolutely, man. Speaking of cardiologists, we got some fire cardiologists coming up, so they're all listening. Stay tuned. Got some great episodes coming up, so, right on. All right, man. We'll see you later. Stay by. Thank you so much for tuning into another Lessons Learned episode. 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