Lessons Learned: Diwesh Poudyal, CSCS

Hello everyone, I'm Dr. Darsha Shah, 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 health care. From amazing guests, so grab your wife, your mom, your sister, your best friend, and come tune in as we explore what it means to be a woman in medicine and a woman in this world. Because this podcast is a dose of everything that I needed when I was burned out, exhausted, and ready to quit it all. At the end of the day, I do this to help you feel more connected to yourself and to connect with others. I love to end my show with a kick of encouragement, so here's my favorite tag line. Your life, your calling, your pulse matters. See you over at Dr. Me first. Thank you Aaron, those are some great words because your life and your pulse do matter. And in this world where stress is at an all-time high and so many things are competing for our attention, we need to make sure we're picking things that nourish us, not drain us. And so for myself and Darsha, exercise happens to be one of those activities. And in this episode, we are discussing all the lessons that we learned from our discussion with Dewey. So please enjoy. All right guys, welcome back to another episode of Lessons Learned with myself and Dr. Shah coming off a fresh night shift. Fresh man, super fresh. Yeah, good morning, good night. I hate nights, man. I just think I've never, never, ever want to do nights. It's just miserable because I don't sleep all night. This is my last two weeks ever of nights, at least in internal medicine. So no more admissions for internal medicine. And I am looking forward to it. Absolutely. Yeah. Yeah. Now, do you, when you had Hershey for peaman art, you guys do overnight call or no? Yeah, so we do weekend calls. And I think we do overnight like during the week. I have the same idea. Yeah. All right. Well, today, Darsha, we are talking, we're going to discuss the lessons that we learned from our recent discussion with Dewey Shpudil, who's been my coach for a couple of years. So I've had the luxury of picking his brain and learning from him and, and of course, benefiting from him programming for me. But what were your key takeaways, man? What was one of the first things that you learned from him? Yeah. So the first thing that, you know, really, really took away was the fact that he said that none of it matters, right? Like, none of the physical therapy matters unless that relationship can be formed with his patients, right? Like, that's the only way you can influence people and modify their behavior and lifestyle is that if you have a good enough rapport with them, where they understand the mechanisms, they listen to you, they understand the assessments, and they're willing to go along, you know, the journey with you. One of the best things I've heard like other doctors say is, listen, we're like on this ship together, but you're the captain, and I'm just here to like navigate the seas a little bit with you. So, you know, for me, I think that's just super important for any healthcare worker is forming that relationship so that we can influence change for the positive. I love that actually that metaphor right there. Is it a metaphor? Yeah, it's a metaphor. I'm always using the, you're the quarterback and, you know, people who don't know football are just like, okay, I mean, like, what does that mean? So, but I feel like the ship and captain, that's more applicable to general population who don't understand football, but I love that because it reminds me how privileged we are in this field of medicine as being physicians, what I mean by that is people come to us on that first visit, and within five minutes, you can ask them the deepest, darkest issues that they have, and they share that with you, they entrust you with that information, and no other profession in the world has that luxury. And so, the art of coaching and what the race was talking about, and Dan was talking about something similar is, you know, building that report in that first session, they're spending so much time doing that, and this is why they kind of gave their cell phone information out, and it's just completely outside the normal model of, hey, you know, if you don't let your guard down, it's going to be very hard for them as a coach, as a therapist, to, you know, direct your care, and for you to actually benefit from it. So, that was something that, that really stuck with me as well, and then it allows them to cater this extremely customized program to the person, and you know, this is kind of what the issue with actually some of these group-based classes are, is because you have much more, you have a difficult time establishing a report, at least in the initial phases, right, with a person, and I don't know if we've ever specifically discussed this, this issue, like, I think, I think you're not a huge fan of CrossFit, if I remember, is that exactly right? Yeah, I just, yeah, I'm not. Yeah, so I mean, I don't want to get too sidetracked here, but yeah, I think that it doesn't necessarily have to be CrossFit, but it could be Orange Theory, it could be something else, you know what I mean, all these things have, classes have so much benefit, and they provide a lot of good, but at the same time, when you're in a group-based setting, and any good coach and trainer will tell you, is that's one of the huge limitations. Obviously, there are benefits as well, cost being one of them, it's the huge one, and being as someone who's been on the side of teaching both group-based classes and also didn't one-on-one training, I can tell you that the latter is much more preferable. Oh, absolutely, my group-up media actually has an episode on this on their podcast about the negatives about group-based training, and they go through a lot of kind of what you're saying, you know, in terms of it's not personal, you can't be as vulnerable with your coach, you know, it's just you're going, you're not really using your strength and expertise, right? Yeah. You're just kind of going with whatever the instructors tell you, which might be their expertise, and that actually kind of gets me to my second point here with Doesh, which is interesting, you know, when he was talking about how, when they do their functional assessment, they're like doubling down on people's strengths, right? While they sure try to improve weaknesses, they're really trying to double down, and that's something I don't think we often hear, especially in the gym, you know, you think of Arnold Schwarzenegger, where his legs were so skinny, you know, at the young age of 16, and he used to wear shorts going to the gym, so he could keep himself, you know, saying, okay, I need to work on my legs, I need to work on my legs more than anything. But we often forget that, you know, this is kind of what Gary Vee says, and in the business model sense, like an entrepreneur is, you want to double down on your strengths. I love that. Yeah, it's really empowering the people, and I think specifically what he had mentioned is, you know, let's get people to do what they can do. Let's focus on that, right? Let's not focus on what they can't do. In a sense, we are hamstrung by this because, you know, people come to see us in the clinic, and I'm talking about us physicians, but really any healthcare provider, when they come, they're coming with a problem, right? And so then they come to the problem, they have pain or some limitation or dysfunctional mobility. We have to directly focus on what they can't do and try to work on their weaknesses. And I think that that's the crappy part. That's the whole disease-based model, right? Because you're not many people go to the doctor when they're healthy, and we can be like, great job. Keep doing what you're doing. And let's just see how we can optimize your health, right? It's really about, okay, you are suffering, and let me fix this. I'm going to share another awesome case with you at a different time that we sell. It's a beautiful pain in our case yesterday. But that also kind of, you know, leads into the next point. It's the importance of the warm-up. I think this is something that has been talked about quite a bit in the fitness realm, and now even, you know, transitioned into just a regular, just a healthcare field, as well, that the warm-up is super, super important, but specifically how to structure a warm-up? What were your takeaways, and what did you learn about how to structure a warm-up? Yeah, I think the biggest thing I took away from that is this concept of, you know, dynamic or static stretching. So, you know, as an athlete grown up, I went to a pretty good high school for sports, and our track and field coach was insane, and so he thought he knew exercise busier to the T. So he would strictly only have us do dynamic stretches, because he says static stretches will reduce your power input, and I was a sprinter, so there was no static stretching involved at all until the very end, but our warm-up would include, you know, some sort of plyometrics, active range of motion, and to break it down for the audience who, you know, who might not know static versus dynamic, easiest way I can say this is that dynamic stretches are essentially, you know, things like leg swings where you're taking your limb or your joints and you're going through a range of motion with it, and that's kind of giving the muscle a stretch versus static stretching, would kind of be your standard, you know, try to touch your toes, and so there's not really any movement besides just that once at the joint. But we now know, as Dwayne was saying, that you can do both in your warm-ups, right? It's more about the parasympathetics or sympathetics than it is about, you know, the black or the white, which is dynamic or static. And so I almost, you know, for the last 10, 15 years of training for me, I've only been doing dynamic, and I slowly started getting away from that as I, you know, started to understand that, hey, static stretches are actually making me feel better and actually making me lift more with certain lifts. So that was something cool that he brought up. Yeah, and what he also alluded to was that the newer research now also shows that if you do static stretching and after a certain amount of time, the whatever the negative effects from that, I mean, they're counteracted and they're null at that point. But to your, what you just mentioned about, if the individual feels better, that is such a powerful thing. I remember attending a conference a number of years back where, you know, still foam rolling was a relatively new thing, and there were some debates of whether or not foam rolling improves performance. I mean, this is a extremely academic discussion. And one of the individuals was up there talking about how they did this study and foam rolling should have no benefit at all. And, you know, the argument was, okay, then why are we wasting time, right? Because again, time is extremely valuable when you're in a, for division one athlete, so really anybody, nowadays, time is extremely valuable. It's one of the most valuable resources we have. But what they didn't, and at the time, maybe I was too shy or I didn't think about this, is we don't account for the fact that one, almost every individual nowadays has some type of dysfunction, right? I won't say injury or pathology, but dysfunction. Like, you know, they're not moving, movement quality isn't that great because of just our posture and daily activities, what we're doing. Secondly, if you feel better, you are going to be, it's going back to that guard down. The physiologically, your body is going to be much more relaxed into getting into positions where you otherwise might be guarding and not letting your, your body adapt to different stresses, which we're going to touch on in a second. But that whole concept of you, your body is much more in a much better position when you're in a parasympathetic state to make changes to learn is something that really was my favorite thing to, and our discussion. Because, you know, a lot of times, like for me personally, when we're programming these mobility drills, these quote unquote, prehab drills, like for instance, let's just take a specific example for musculoskeletal sports medicine, something super, super, super common arguably the most common, is patella femoral pain syndrome, right? Most people who might be listening to this have heard of that term or went to the doctor and have this not specific knee pain, and some people say it's a garbage term and diagnosed with patella femoral pain syndrome, right? And what do we say for that? We say you have to do strengthening of like the part of your inside of the quads and a little bit of the glute muscles on the outside, the hip ab doctors, and so, and you know, and kind of retrain your body and how that patella the knee cat moves. Well, a really great exercise for that is something called the terminal knee extensions where you take a band, you put it on the back and do that. A great place to put that would be in the warmup phase. And again, as I mentioned, you're retraining the kneecap. Well, if you're in a sympathetic state and you're in a fight flight, your body's not going to make a lot of changes, it's not going to maybe those motor patterns aren't going to stick. So that's why it's so, so important to do that. You also mentioned you could do it towards the end of the workout, but I'm guilty of this myself. He programmed some of the, you know, ancillary stuff towards the end for myself, and sometimes like two days ago, I didn't feel great, I skipped it. You know, so, so, so, you know, we're in a world where, like he said, we're onto the next thing and so people are going to be less likely to do it, but speaking of, so anything else on that that you might have? Yeah, no, I was going to say, man, working out is very mental, right? Exercise is a mental sport. It's like any individual, it's like tennis for me, right? It's very mental. If you're on your game and you know you can make that shot, you're going to make that shot, right? So if I'm going to go in and deadlift with the L5 S1, I'm good up to like 250, but once I go to 260, right? It's only 10 pounds more. I could probably do it. You have this mental block. I don't know if you've ever gone through that, right? It's just like squats or whatever it might be. So, you know, I definitely agree with you. If you feel good, if it makes you feel good, if it's that placebo effect, that foam rolling, whatever it might be, go for it, right? And to your point about sympathetic or spare sympathy, I think it's so key, right? If there's one thing people can take away is understanding what sympathetic and parasympathetic are, right? Just google search, HRV, whatever you have to do to understand it and figure out the things that increase your sympathetic drive and increase your parasympathetic drive as well and try to reach that balance, try to figure out what you want to go in with, right? Do I just talk about, you know, when you're just starting out with working out, you really want to be in parasympathetics because, like you said, you can drive that change in your body and the patterns and then eventually once you're good enough, you can kind of just go straight into the sympathetic at those bigger lifts and train that central nervous system. But it's interesting, right? Because a lot of people do like crazy pre-workout before, or they think they need to be right before the workout, right? And you're driving your sympathetic through that. But then you're trying to do these mobility drills, right? So it's kind of counteractive, you know, in some sense. But you know, just having that thought process, I think, for people and individuals to understand will help them just appreciate the process a little bit more, I think, slow it down and really just have fun with it and enjoy it. I think at least for us, because we're nerds about it. But I love that. And it also reminds me, I think that that one episode of Peter T and when he had Beth Lewis on, I forget exactly what they were talking about. But I remember her saying that, you know, for some individuals in the warm-up, they just come to her and her thought is, I just have them lay on the floor and breathe, right? Yeah. And because they're so revved up throughout the day that they just need the time to kind of just shut it down a little bit, which is, again, that's the last thing you want to do prior to a workout where people are just like snorting stuff to get going. But that's important. And I also heard, you know, David Ote on a recent and his new podcast talk about that with one of the other coaches, but actually it's probably more than once. It's sometimes, depending on the individual, that's the first thing to do with the warm-up. And deep breathing is something that I have to do with the warm-up, too, because I'm always go-go-go-go-go. So yeah, I mean, I agree. But speaking of injuries, you know, patellar femoral pain, that kind of stuff, we won't necessarily talk about training modification for injuries, because we've touched on that before, and hopefully with a future guest, we will as well. But, you know, obviously, COVID has kind of shaken our world up tremendously. I mean, unfortunately, you know, some people, me, I'm psychotic, in a sense, have turned my entire gym every single day into something, my apartment into a gym. But, you know, you had some of these challenges about when your gym was closed. It's luckily open now. So, would you take away from modifications and maybe just recap for the individuals who still might not be comfortable going back to the gym? How can they modify their training regimen to continue, you know, training at home or just outside or whatever? Yeah, absolutely. So, I think first of all, I want to say, you know, for those listeners out there that may feel guilty, you shouldn't, because I, you know, I was in the same boat where I made excuses for myself almost, you know, going from training every day in the gym to when COVID restrictions came, and then I said, you know what, maybe I'll just use this time as a de-load phase, and I won't really do many squats or burpees or anything like that. I'll just stretch and do mobility drills and things like that, which are all great, great, dandy. But in the end, it's, okay, well, sure, when am I going to start running outside? When am I actually going to start, you know, getting this body weight workouts in? And for me, again, I'm very OCD in a way that I need the gym, I need the weights, but when that's not possible, you really need to look at yourself and say, all right, well, what else can I do? Right? Because this is important. And what Dewey's touched on is a minimum effective dose, right? Which is actually a lot less than what we would think, right? A lot of people think, in order for me to get gains, I probably have to go to the gym at least three to four times a week and do some, you know, heavy lifting. And that way, he says, no, actually, you can probably get away with just two, two days a week of like, strength training for 30 minutes. And then two days a week of cardio, let's say, for also 30 minutes. And you'll still see an improvement while your gains might not be, you know, they're in a month or two. It's still something, right? It's still moving. It's still, you know, getting your body and that blood flow and the lymphatics and everything, just kind of moving. And so any type of movement works, right? And we kind of split into two groups of people where, you know, those people who need data, right? And it will buy a mover an apple watch because they need something to track it. And if that's that type of person, that's completely fine, right? There's, as he says, there's nothing wrong with having your watch tell you, hey, get out and move. I think we all need that reminder. But then, you know, there's also this cam trying to figure out, hey, what are some things that I can buy, right? We see people going, quote, unquote, off the wall and get in, you know, getting like a wooden stick with gallons of water on either end and fill in the bench press. But you don't have to go that far, right? You can easily just, whenever there's, there's a commercial on, do some squats. The weather is okay. Go for a walk. That walk will turn into a jog. That jog will turn into a hike, see what other people are doing. But there's always a way to get moving. You just have to be honest with yourself, I think, because it's the biggest thing. Yeah. I really love, I mean, that, that story about people buying gal, I mean, that's intense. It seems like a lot more work. I think I would rather just find something on marketplace and try to buy old equipment. That just seems, but I love it. It's creative. You know, when people come to us with a very common complaint called tennis elbow, most people have heard that experience that and know somebody who's had it for rehab, tried and true method is, you know, we do these eccentric where you basically slower and you have to strengthen the muscles, right? You know this. We often, when people come to, we tell them to start super slow, grab a can of beans again. It's can of soup or something like that. So I mean, they're typically a pound or whatever, depending on how big cans that you're getting. But stuff like that. So one training modification is you talked about people just put books in a backpack. Most people have a backpack laying around. Most people have some books laying around or whatever. You could put anything and so you could modify load, right? Which is kind of weight. Another thing, another way you could modify load is by adding accommodating resistance. So for those who don't know what that means, it's like adding bands or chains to it, right? Chains are probably a little bit harder to come by. Bands super easy to get from Amazon or really anywhere else. Honestly, actually Dave and John Russen on their new podcast, the PPSEP and Free Performance Podcast, which is awesome. I recommend you guys go check that out. They had an episode all around accommodating resistance, which is super cool. They talked about how they program it and what that means and all that kind of stuff. Another thing that you could modify is volume, right? Which is typically, I mean, load plays into volume and tense, but also how many repetitions you do. So, you know, if today, you know, if you don't have a lot of weight, maybe instead of doing 10 reps, you could do 20 reps or 30 reps and like that. You have to be cautious of that as well because, you know, there can be detriment sets at some point for these things. Frequency is another one, right? You can train more times throughout the week for squats or rather than doing squats once, we could do it two or three times a week. So that's another one. Those are the easy ones. But some of the other ones, another one that he mentioned is called tempo, right? And that's how slow you go down and how slow you come up. Manipulating that variable can make an exercise much more challenging. And then lastly, I'll say, I'm sure I'm missing some stuff, but these are some of the ones that came in top of my mind is like exercise selection. So we're using bodyweight squats, which is a bilateral movement, right? I mean, you're doing like split squats. Excuse me, not split, but like even. But you could reduce the base of support, right? So you can do a split squat where you kind of like in a lunge position, right? And now it's more unilateral loading or single leg stance loading. You can completely remove the back leg up where you can elevate your back leg or people have seen pistol squats and those kinds of, you know, so now now you have a tremendous balance and stability component as well. And that makes it also you're putting all the load on one leg. So that makes it much more challenging. It's also quote unquote much more functional, if you will. So, so yeah, I mean, there's so many ways and you can do that for the upper extremity as well, right? Instead of doing pushups with two hands, you can do single leg, single arm pushups and you can modify all this stuff. Absolutely, absolutely. So there's so many ways to do it. And then, you know, again, but it all comes out into it. You got to figure out where starting point is and then you just add there. You don't jump. Like again, if you haven't trained in a while, you don't just the weather gets nice outside. It's 65 degrees. So I'm just going to go. You get in order for it. Yeah, I'm going to go on a seven mile hike because then you'll probably come see me in clinic and I mean, as much as you're doctor. That's right. That's right. No, I mean, I love seeing meeting new people, but you know, I want to meet you guys somewhere else. Hopefully we train together, but not in the clinic. So yeah, yeah, anything else you got on that? Dude, last thing here, if I may, because I think this is really important, is talk about squats, because I've definitely been guilty about telling people not, you know, earlier on, not having your knees over your, yeah, your knees over your toes. And I think a lot of people listening to this podcast probably still think that. And, you know, and so we need to de-mystify this myth that when you squat, you know, it was always taught that you're neat. You have to put the weight into your butt, back of your heels and midfoot, and then not have your knees cross over your toes. But now we know as, as DeWish talks about that, you know, that's actually not healthy for some people. We know as individuals, we all have different femur lengths and hip range of motions, and you know, our ball and socket joints work in different ways. And you know, for me, it's so bad now that when I squat, excuse me, when I squat, it's almost impossible for me now to even move my knees over my toes, right? Like, I have terrible dorsiflexion, and sure I've had a lot of ankle injuries from playing basketball and stuff, but, and that's something that I'm now training. But, you know, for me, with an extension pattern in my back, I like back squatting is probably not honestly the best thing for me at this point, you know, and my back pain has really resolved in the last month, especially with the workout program you gave me. So I go to a lot of front squats. And with front squats, you need that dorsiflexion and that ankle so that your, you know, knees can come over, and so you have proper leveling of that barbell, right? And in terms of center of gravity. So I really just wanted to mention that, what are your, what are your thoughts on that? Yeah, I know. Two things you mentioned, dorsiflexion and extension. Just explain what that means, both of those terms. Sure. So dorsiflexion is, you know, with your ankle, it's kind of bringing it up, right? So as if you've all ever gone to the doctor's office and we try to test your muscle strength and ankle, we'll say, all right, push down on a gas pedal, right? So that's plantar flexion. And then the opposite of that, bringing your ankles up would be dorsiflexion. So when you do your squat, you'll see that angle where if your knees kind of track over your toes, you're getting more of an acute angle between your ankle and your knee. And so that'd be more dorsiflexion extension pattern of the back, right? So we can have extension or, or, or flexion extension is when you see this lordotic curve in your lower back and textile and lordosis. It's kind of this concave curve in your back where, you know, you're, let's just say your belly would be sticking out and then your butt would be sticking out on the other end. And then flexion would be opposite where you kind of have a flatter back or more of a rounded back. So again, for me, I'm more extended, which I think is more the common pattern. And then my dorsiflexion is terrible because it's just that bad where my brain only knows how to squat back and not how my knees track over my toes at this point. Yeah, I love that. No, yeah, you lose an ankle mobility if you want to train it, right? It's, it's, you know, you use it or lose a type thing. But yeah, the extension pattern is we used to say it's kind of like the Donald Duck pelvis kind of like, you know, show that picture for most people thinking quickly, Google it. It's also like anterior pelvic tilt. Actually, Alex, Alex King, who is on here, not too long ago talked about that lower cross syndrome and that makes you more susceptible. So yeah, the squatting past the knees, I'm guilty of it. I talked about it on, on our, on the episode with dorsiflexion. Jesus made it. It's like, I haven't gotten sleep. You were there, but also dorsiflexion. Um, there's too many, there's too many, uh, these, yeah, these, these and sh ending and just confuse throwing me off my game. I apologize. Uh, with dorsiflexion and dorsiflexion that I might have, you know, I might have messed up some kids at the young age teaching them how to squat improperly. I think, you know, obviously we, I didn't know better and, and we were, I was guilty of this, but, uh, I also wonder if some of it, you know, I messed it up for myself. So I used to have a lot of issues with my knee at the time, you know, my right knee's kind of been one of my first injuries. And so to compensate for that, everything was heavy back, back, back, a lot of box squats, a lot of hip dominant squat patterns. And over time, some of my recent injuries have been issues with my back, like he mentioned, which is one of the reason I, I saw him out. And also, uh, issues with like femuracetabular impeachment or hip issues. And so, you know, it's, it's interesting. And it's just me speculating here, like how much could have this been self-imposed just because we didn't know any better. And so the one thing that I just want to add on is something he talked about is, you know, adapting to stress. And I'll give up my own personal anecdote is because I had this idea that, you know, for my knees, I shouldn't do this. Another thing that I wouldn't do is he, he programmed earlier on in, in, in our, in our, training, he programmed heels elevated front squat type stuff for me. And for those who don't know, sometimes people will see in the gym, you go, you, you throw some, some five pound plates underneath that your heels. And that allows you to compensate for the lack of dorsiflexion that you're talking about because it kind of gives you this artificial ankle mobility. And I was like, well, this is not good. I shouldn't be doing this, right? Because I have quote unquote bad knees. And he was like, just, you know, just trust me on this. It'll help. And, you know, just, because I told him I was like, hey, well, this bothers my knees. And he was like, you know, reduce the load and allow your body to adapt to it. And now this goes back to our very first point, bringing it full circle. Because I trusted him as my coach and I trusted what he had to say, I allow that to happen. And guess what, man? In a matter of time, I was pushing super heavy loads, you know, close to my previous maxes at a certain reps without any knee issues and much more vertical posture and stuff like that. And that was so awesome for me. And at that point, like, you know, and I've been, I was like, okay, I'm, I'm training with this guy. And, and, and this is why I enjoyed because I trust him. And in a lot of times, like, I feel like I know some things going on, but I always like to bounce off him because it gives me a new perspective. And obviously he does this 24-7, whereas I only dabble in it. And I'll have it, you know, I have a strong understanding of it. And I'm always trying to learn from him. But it's that it's the whole trusting, you know, and, and I let my body adapt to the stress of letting my knee go past my toes or also getting into deeper knee flexion. And that's not, you know, my knee isn't going to be destroyed and stuff like that. Are there sometimes where where it bothers me a little bit more short? Yeah. And you just got to also be able to understand that that's the other thing. I think people need to be able to appreciate what quote unquote discomfort is versus what true pain is. And at what point should you not let your body adapt to too much stress? Because I think we're also conditioned that pain is bad, pain is bad, pain is bad. And you must do everything to avoid pain at all times. But, you know, this is why having a guide, as you mentioned earlier, is so important. Who can tell you, okay, this is too much, this is not enough, but why that kind of stuff. So yeah, I mean, that's the last thing I'll say. And, and I know you got to get to bed. So I'm good. Yeah. Yeah. No, that's a great episode. So definitely, let's check out the full episode for this. Yeah. I couldn't agree more. Well, before we let you go, and I think we just want to make a quick announcement because we're going to change our format for how we're going to do these things. So why don't you tell the people of how we're going to switch after this episode and, you know, why maybe why we're doing that? Sure. So we're actually going to go kind of go to a three plus one format. So what that means is per month, we're going to give you three guests instead of our typical every other. So instead of getting two guests, we get three guests per month. And then in that last week, we'll be doing a lessons learned, but we're going to be recapping through those three previous guests. And so just by doing this, we thought there'd be more value by giving you more guests, more value, more information. And then what if, you know, for those of you guys that just love to listen to the lessons learned, you'll also get more content in that. And you know, we'll try to also keep those around, you know, probably 45 minutes or so, 45 minutes to an hour for those for those that like to listen to the shorter episodes. But yeah, that's going to be our new format moving forward. If you guys have any feedback, though whatsoever, please, please let us know. We're open a kind of hearing it here where we're still pilot testing kind of this podcast. We're still new to the game. So we'd we'd love to hear anything. Yeah. And they could reach us via social. So quickly drop that. And then our email is medredefined at gmail.com. So again, we'd love to hear feedback and any suggestions that you guys might have. And you know, whether good, bad or ugly, we consider it to be a gift. So let us know. All right, buddy. Get to sleep. Take care. We'll do. Well, guys, that's a wrap on the show. And hopefully that was informative for you. Before we end, don't forget to go hang out with my friend Aaron Wiseman over at Dr. Me first on your favorite podcast app. And before you sign off, please remember this important disclaimer that everything in the podcast is for educational purposes only. It does not cost you the practice of medicine, nor should it be construed as medical advice. No physician patient relationship is formed at anything discussed in this podcast does not represent the views of our employers. But if you enjoyed the show, please be sure to subscribe, review, and share it with anyone who you think will gain value from this as well. Until next time, thank you for listening.