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Scott Benner 0:00
Hello Friends, I want to welcome you to Episode 700 of the Juicebox Podcast that is more talking than even I thought I could do.

On today's show, I'll be speaking with Chad, he is the father of a child with type one diabetes. He's also an orthopedic surgeon. It's completely possible that this is the longest episode that I've ever published. I'm not sure I probably should have looked into it before I recorded this. But anyway, it feels like it's the longest one. I'm getting into that into that territory. And like you think we could do a three hour podcast maybe one day, we'll see. While you're listening, don't forget to take breaks so you can rest. I'm just kidding. Don't forget while you're listening, that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. You know, if you're a US resident who has type one diabetes, or is the caregiver of someone with type one in just a few minutes, you can help people with type one by taking a short survey AT T one D exchange.org. Forward slash juice box. You can do it right there from your sofa. It will not take long. This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juice box. Today's extravaganza is also brought to you by Omni pod makers of the Omni pod dash and the Omni pod five, you may be eligible for a free 30 day trial, the dash and so much more that I have yet to tell you about. You'll find out of course at Omni pod.com forward slash juicebox or by listening to the ACT later in the episode.

Chad Zooker, M.D. 2:14
My name is Chad Zooker. I am a board certified orthopedic surgeon in Baltimore. And I specialize in sports medicine. And for surgical purposes, that means I do a lot of knee and shoulder arthroscopy. So think of ACL reconstructions, meniscus surgery, rotator cuff surgery. And in my non surgical, professional world, I see a lot of everything. So treating all manner of orthopedic injuries from broken bones to strains and sprains of joints and muscles. knees, shoulders, some backs, ankles, elbows, hands and fingers. Pretty much. If you can jam it, sprain it, tear it, break it, I can at least get you started. And if it's a little bit out of my typical expertise for treatment, I work in a larger practice that has several specialists that love the non knees and non shoulders that I like to treat.

Scott Benner 3:15
Right? Well, here's the real secret. I have a question about origins arrest. That's the only reason I let you on the show. Sure.

Chad Zooker, M.D. 3:23
You just treat me like everybody else. I know Scott, don't worry.

Scott Benner 3:26
Oh, Chad, hey, it's good to see you at the grocery store. How are you? The kids are good they are my knee is how often how many times a week.

Chad Zooker, M.D. 3:35
It's it's funny that so it's three, four times a week easy. And I'll usually on the weekend, you'll collect a few texts, a few messages. And Monday morning, I email my secretary I say hey, you know, here's so and so friend, can we get them in to see me today? Such insights needs an x ray. And if Monday morning comes and I'm not sending that email, I start to wonder like, Am I losing my touch here? Like nobody reached out to me in the last few days?

Scott Benner 3:59
I don't have my friend. So it's interesting, you bring this up, because I don't know if you've ever heard Adam on the show. He's a pediatrician, but he's also a very good friend of mine. And when I have questions about my kids, I shudder to say i i text them. And as I'm doing it, I'm horrified with myself. You don't I mean, like because I know he's a person. He has a life. You know, and you're like, hey, just real quick, is there a stomach bug going around right now? You know,

Chad Zooker, M.D. 4:29
it's uh, you gotta if you especially in a town like we call it small tomorrow, because a lot of us are born here raised here and never leave. And if you are not comfortable with that idea that you're just going to be intermingled with one degree of separation for the rest of your professional career then you can't you gotta leave you can't practice you have to be there. And honestly, I really don't mind I think very few people are have a problem with kind of boundaries or when they should text or call and instead of like You know, if you had sent me that message two hours ago, during the office day, I could have taken care of this easy. But now you're turning to me at nine o'clock at night when I'll help you with it. But I really there's not much I can do, you know, remotely right

Scott Benner 5:12
now. Yeah, I have to tell you, I love there's is there's nothing not to love about the office calling you to schedule an appointment, instead of you having to call the office scheduling, Dr. Needleman said that I should call you and get your son in like, and it feels like, ah, whatever leaf, you know,

Chad Zooker, M.D. 5:30
it's, you know, for me, I get a text, I'd say no problem, you know, let me have someone call you, I cut and paste it to the email. And it's 10 seconds of my effort, and then they get a call directly. And then they feel like they're getting the VIP treatment. So you know, why not? It's good for business, it's good for patient care, it helps direct where people need to get to quicker. So it's really, it's not as much a bother as you think. And usually, if it's somebody I'm close to, there's a handful of friends that I consider really good friends. They never take advantage of it. And they know that it doesn't matter. They could text me too in the morning, I'm never gonna get upset, but there's, you know, not the 98% that could probably use a little bit of thought before they, you know, send a non urgent text at like 10 o'clock at night when there's not much we can do about it. And I'm an orthopod, you know, we're not dealing with life and death. So

Scott Benner 6:21
Chad, do you know that happens to me in a different way,

Chad Zooker, M.D. 6:25
I believe in knowing what you do. And I just gotta, I gotta say, it's amazing what you've created here. Oh, thank you. And I can tell you as a, you know, I look at your podcast and the Facebook group. And just the way that you are willing to give up your time and look at people's curves and say, talk to me about your bagels, and it still feels like it's not a medical professional, it's not a somebody running a business, it still feels like you're a dad who you know, happens to know a little bit more about this than the newbie in the cloud. And you just want to help and I just, you know, as a doctor, I appreciate it. As a dad, I appreciate it. And I can't get through an interview with you and not give you some major credit for what you've created here. And I imagine the trade off is you get these, you know, urgent, quote unquote, messages about a blood sugar about a Dexcom curve, like what do I do with this?

Scott Benner 7:23
I don't mind the messages when they come at 230 in the morning, and I sent in that style of like, one line, one question, new text, next question. And it's, you know, it comes to the messenger, and it's like, boom, boom, my wife's like, what is that? I'm like, a lady in the Philippines does not understand her blood sugar. And like, I guess she didn't understand the timezones, either. And you know, but that's pretty much it. Although, while we were getting ready this morning, and you were getting your microphone together, I was talking to a woman named Julia and Canada about her kids blood sugar through a text at the same time. But yeah, I don't mind. It's funny, I don't mind. But there's a moment where it gets overwhelming and I just can't answer and then that actually feels that that gives me a guilty feeling. Like if like to leave something on answer, it makes me feel it's not a good feeling. Let's just say, I relate to that very well. Yeah. Well, at the end of this episode, I'm gonna ask you a question about each of my children, and I'm gonna get some, I'm gonna get some free advice from you, what do you think

Chad Zooker, M.D. 8:27
I am, you are on the spot, you get bumped right up to the VIP list. And you can always whether it's for you, your kids, any orthopedic questions, you get the special VIP treatment?

Scott Benner 8:38
Well, we'll save that for the end. What made you want to come on the show?

Chad Zooker, M.D. 8:42
So I was flooding through the Facebook group one night, and you put a post, I think I just good timing. And you had put up this post saying, I'm looking for some medical folks in different specialties and trying to put together a series of episodes that tie in where type one, you know, spills into things that aren't just directly endocrine related. And I as a, as a super fan of the show, my wife and I are just, you know, huge fans of what you're doing. And I was like, oh my god, this is like, I've been trying to find an angle where I could be useful and helpful to get on juicebox. Here it is. And, and I think I soon as you posted that message, I had put together an email within 510 minutes, threw my CV in there and fired it off. And I was surprised at how quickly you responded that you know, the sound great. Yeah. I'll send you a link and we'll schedule is like wow, that was that was too easy. Yeah.

Scott Benner 9:38
Well, Chad, it's because you send an email that was like you were trying to get a job with me. So I this guy really wants to be on the podcast. See I whether it's wanting to be on the podcast or wanting to take care of diabetes, I find desire to be really important. Yeah, you know, so Yeah, I ended up telling people when I talked to them a lot, you can tell that they're going to be okay one day with diabetes, because they want to be. And I know that's like a, it's a weird thing to parse out. Because you could just sit there and think, you know, I really want this to go well, but there's a difference between just wanting it to go well, and being willing to put in effort in places where you have no comfort, and to hear information that you have no relation to, and to force yourself like you're in school to sit down and make sense of it and to give it time. You know, maybe not completely connected to that idea. But one of the one of the things I hear back from people so much that breaks my heart, and kind of two different ways, is I know the answers are in the podcast, I don't have time to listen to the podcast. And it makes me feel like, well, you don't have time not to listen to the podcast, because the reason you feel like you don't have time right now, is because you're overwhelmed. Partially, partially because you're overwhelmed by diabetes. Like, what if we just carved out time ignored some other things, learned more about how insulin works made your life easier and see if that wouldn't free up some of your your headspace, you know, but it's a weird leap for people to make when they're like, I got three kids like, When am I gonna listen to a podcast? I was like, Well,

Chad Zooker, M.D. 11:21
I don't know, when you figure it out. Yeah. It's funny that you mentioned that because so my wife and I were, you know, we're coming up to the morning of the interview. And I said, you know, let's just get our like, I want to get all the facts straight. I'm thinking like, how did we hear about the podcast? And we're talking about and I think, literally, so when, when our son was diagnosed, we were in the hospital, in that initial admission, and, you know, she was sifting through everything she could find online. And I think she came across the maybe some old posts from Arden's day. And she connected that to the podcast. And she's not a podcast person, but she knows I am. And so like, probably within two days of diagnosis, she's telling me about this Juicebox Podcast, and me being a big dummy and not listening, because I'm so sort of focused in on trying to figure out diabetes. Because as a doctor, we're not really trained to treat diabetes, believe it or not, that I'm saying, Yeah, it sounds interesting, I don't know, like, great, and just kept putting it in the back of my head until maybe, you know, three, four, or five months later, I listen to some episodes, I'm like, wow, this is perfect. This is like exactly what anybody needs explained in very direct and easy to understand terms. And if you pay attention to the pro tips, and if you start digging in on some of the episodes that are more technical, you'll get it and you got to practice and it takes time. But you know, she was listening from probably the first night of diagnosis, figuring out how to use you even how to use a podcast app. And she's already got it figured out within 24 hours. And, and I'm just sort of, like, I got this, I got this, and I don't got this until I started to listen and really, you know, put the effort in to learn it. Because it's like any other skill, you can, you know, can't really perfect diabetes, but you can get better at it. If you practice.

Scott Benner 13:11
Well, there's also a there's quite a leap to make in your head too. I mean, all this has just happened to your child, it's happening to you in a different way. And I mean, what you're supposed to expect that podcast is gonna help you like, I mean, really, when you think about a cast, you think a True Crime, Comedy, you know, actors talking to their friends. It's not like you're like, oh, yeah, that must be where the secret to my problem is.

Chad Zooker, M.D. 13:35
Right? Yeah. But you know, sometimes if you pay attention, and if you have say, wow, look at how many people are getting really good results. It's not just they love it, because it's relatable. They're, they're actually changing their outcomes. There's a value here. And that's why, you know, this, your podcasts in particular is one that stands out as being entertaining, and it's pointing at times, and sometimes you just want to listen to someone's story, because then you don't feel like you're the only one. And then you tune into you and Jenny, and you're like, oh, so fat and protein do have an effect. And I actually could maybe try to quantify that if I start looking at the data right in front of my face, from the Dexcom. And from what I know, in terms of the nutritional content of whatever they're eating, and, you know, playing around with some of these things like the Warsaw method and some of the other trips, tricks, tips and techniques that that we can do.

Scott Benner 14:31
So no, I agree. It's, I mean, I'm, I'm incredibly proud of the podcast and I think it's a great blend of a lot of different things. And I'm happy when anybody finds something in it, that it's valuable to them. I think the whole thing is valuable. Like I genuinely believe if you just listen to this show, like just either started now and you know, listened forward or went back and dug through the pro tips and that kind of stuff and then continue to listen or some people Well, bless them go back to the beginning and just listen straight through. I think it's an A once in the fives.

Chad Zooker, M.D. 15:06
I think it's Yeah, everything you need is there. The toolbox is right there. You just got to get familiar with all the tools in it and start using them.

Scott Benner 15:13
Yeah, no kidding. All right. Well, how about I'm sorry, are we saying was your son or daughter,

Chad Zooker, M.D. 15:18
so as my son, so you know, the origin story of so our son and so Zach is he just turned 12. He's literally, you know, even a week at the age of 12. Right now, seven years old, and first grade, oddly enough, is,

Scott Benner 15:35
was he on a school trip to a science lab, and he was bitten by a radioactive packet of sugar is that when

Chad Zooker, M.D. 15:40
he wishes he wishes, I wish those origin stories are more fun. So so but there's, you know, everybody has their little quirks to their story. So we were in first grade, and we had moved schools completely no reason related to type one, to start first grade, his, within a week or two, he made a good new friend who turns out that his friend has type one, the teacher has type one. And we put together an assembly and they're teaching the whole school about type one diabetes and how it's not contagious and what the Dexcom does. And two weeks after the assembly, we're at the movies. And for anyone who doesn't know our son, he is like, he's the he's the kid that won't share anything, because he doesn't want to, like, you know, your mouth to touch his water. You know, we're not sharing snacks or barely sharing popcorn, so we smuggle in our water bottles. And he finishes his water, he finishes my water, he finishes my wastewater, he actually started drinking his sister's water. And he said to us, I think I have type one, you know, just matter of factly just because it was fresh in his mind, and I'm completely blowing this off, like, you just had this assembly like, you know, I don't think so. And my wife was like, you know, had much better intuition and said, Well, you know, this was Sunday night. So Monday morning, we call the pediatrician, she makes an appointment. It's just mostly we love our pediatrician. He's, he's great. Why not go see the doc and see. And so Tuesday morning, they're at the pediatrician, I'm at work and I get a call from him from the from the pediatrician saying, Zachary has diabetes. Three words. And, like in that moment, it's, it's like the time standstill and stops for a second. And you, you get that gut punch where you've like, you know, no clue what's up and down. And I think within it seemed like 10 minutes, but it was probably three seconds, I replied back. Okay, what do we do next? And flipping like, you know, into my surgeon mode, here's a problem, how do we fix it? What's torn? How do we fix it? What's broken? How do we fix it? And, and so he said, you know, you know, I'm gonna send you, I'm gonna send him to the hospital to this hospital. And, and then, you know, my wife called me and it's all a blur. And we go to the hospital, and his, his diet, buddy from his class, with the family, whole family shows up at the end of the school day. So this was, maybe mid morning, we're in the hospital. And I'm over there by three, four o'clock, and his buddy walks in with their family, we call them our died, our diabetes Sherpas. And you know, so they're, they've already become pretty close friends, but they're best friends at this point now. And we're, that's it, you know, he's his little buddy is up in the hospital bed with him. And they're showing each other how to check finger six. And I think because of the fact that we actually here, we got to give him the credit to be kind of proactive and say, I think I have this, we diagnosed pretty early, we were out of the hospital and 24 hours, I think, and he was back in school by the end of the week, where we have a very supportive nursing staff and he was the seventh type one in the school between the upper middle and lower school at that time.

Scott Benner 19:05
Well, I've it's a really touching and lovely story. And what I took from it is that your wife trust the kids more than you. But

Chad Zooker, M.D. 19:12
I think I think that goes without saying that in all things. And it's funny that, you know, my medical degree, stops at the door in our house. Even for orthopedic issues, nobody's listening to me and any good sound medical advice once I'm in the house, but, but she knew and she, she's amazing. And she's gonna hear this episode, and she knows how amazing she is. But she pretty much runs the daytime affairs, and she's managing all of the decision making remotely with the, you know, between texts. And we love our school system or our school and our school nurse, but COVID gave us an opportunity to go completely solo on this and we we haven't been in the nurse's suite for two years, two and a half years now. And she manages most of it data That

Scott Benner 20:00
feedback at school now.

Chad Zooker, M.D. 20:02
Yeah, so we're very lucky that the school we're at here has been in person almost entirely since the beginning of the pandemic, and they've made some, their testing once a week, everybody in the school, they've been very, it's just a good sense of community. So there was no question that everybody's going to wear a mask in school. And they had very little remote only time during the initial pandemic. And then for the last two school years, they've been in person the whole time, and my wife that happens to be a physician assistant, which you'd also think might prepare us for handling, you know, managing a medical diagnosis. But you know, she has been amazing and taking the reins of doing most of the day to day management and working with me, but spending more time working with with our son now instead of in the office, but I'm looking forward to having her back in the office more frequently and in the operating room. Because I'm always looking for more help.

Scott Benner 21:02
Can I Can I ask you to expand on that a little bit? Like, what's it like? So I would imagine being a doctor and your wife, your wife, being a physician's assistant, you have that? I'm kind of going through this right now. My mom is ill, she's older and she's ill, and somebody gave me some great advice to not look too far ahead. Just kind of tackle the problem in front of you keep going. And I was surprised in the first weeks of in the first weeks of my mom's illness, she's I guess I'm going to talk about this here chat. Okay, hold on a second. That's, that's okay. Let me set her

Chad Zooker, M.D. 21:39
but I'm sorry. I'm sorry to hear that. She's not doing well. Yeah,

Scott Benner 21:42
she's she's doing actually oddly, well, hold on a sec. Okay, the whole thing. So, going back about six months, my mom is fine. I'm, she's 79 years old. She lives by herself. She uses a walker to help her get around. But, you know, two or three days a week gets on a community bus goes to the gym, you know what I mean? Like, you know, this whole thing. I go and drive her to a cardiac appointment one day, it's just a regular appointment, where they look at her pacemaker, which he's had for, you know, 20 years maybe. And I didn't notice anything different about her. You don't I mean, I picked her up, I took her down, she got out of the car, she walked into the building the whole day, when as I expected it to 12 hours later, my brother calls me in the middle of the night and says, I'm taking mom to the emergency room. Alright, and I was like, why? What's wrong because she's has incredible stomach pain. And she can't go to the bathroom and something's wrong. So it's COVID. And my brother has to sit in the parking lot for seven hours while my mom sits in pain in her nightgown, in the emergency room by herself. And my brother, finally, I wake up in the morning, and I say to him, how's it going? He goes, she's not in yet. And I said, You got to get her somewhere else, man. So he scooped her up, took her to a different hospital. There. She waited a couple more hours but got in. And they quickly diagnosed my mom with a UTI kept her for a couple of days gave her some antibiotics sent her home. Well, she continued to struggle. And a week or so later, we had our back at the emergency room, where this time they did some imaging again, as they did the first time. And you know said oh, well, this is just you know, the, the residual the, the UTI will drain her bladder and send her home, she'll be fine. They do that. And a week later, my mom is still in trouble. But now she's declining. And I'm going to tell you that I've never really experienced anything like this. But it was like watching someone turn a light dimmer down kind of quickly. Like my mom went from that lady who I described at the beginning to sitting in a chair and not being able to stand up being weak, having a hard time keeping your eyes open like this whole thing. So I get her back to another er, and this time in the ER, I pressed them. I was like, Look, if you're gonna make her wait, you have to give her a Foley catheter and drain her bladder. They drained her bladder and took out 2000 cc's of urine. Wow, even I know that's a lot. It's a soda bottle full of liquid. Yeah. And luckily, I got them to drain her first because this time they scanned her when her bladder wasn't full so they could see the cancer. All right. And so my mom had a large mass the size of a large grapefruit near her ovary. She was you know, still with that news took two days to get her out of the ER into the hospital. And they started you know, working on ROP for a plan. And I felt like the oncology OB that she was you know that she But was assigned. I felt like he wasn't really interested in doing surgery on my mom. He said he was. But then everything he did kind of indicated that he wasn't like he. I can't say for sure. But I feel like he was going to slow walk her into the ground, if that makes sense. Yeah, I understand. Okay. And so we're watching it happen over weeks. And one day, I'm just in my car driving back and forth from the hospital to sere. And I had this realization.

It's not NGOs that don't understand diabetes. I've gone on this thought for so many years that how could it be possible that we create all these endocrinologist that don't understand how to help people with type one diabetes? How do they not understand this thing? How do they not know how to talk to people how to and then I went, Oh, God, it might just be doctors. Like, and I was. And then I thought, How is it possible I get on this podcast and tell people all the time, take control of your health. Don't listen to that's good enough, or you're in range or whatever. Like, I literally fell into the same trap that I watched people do because it was now suddenly cancer and not diabetes. Like I felt like all the things I knew I didn't know. And then when I just took the things that I know about type one and how to how to go through the healthcare system and manage things and understand things and just apply them to my mom. Boom. Since then, my mom has had surgery. They cleared away all the cancer. They gave her a full hysterectomy. They found a little more cancer that was kind of intertwined in a hernia that she had they fixed her hernia. She's in rehab now. And getting ready to see the doctor two weeks post post op, but not the doctor that saw her at the hospital. Right? My neighbor's son grew up to be this is crazy. I guess this is why I'm telling you this. My neighbor son grew up to be an orthopedic surgeon. And I know he's a good one because at a pretty prestigious hospital on the East Coast. When there was one opening, he got it. Right. And I texted him. And he said, Oh, when I was in medical school, I had a friend who became a an oncology OB, he texted her, she texted her as her mentor. And three days later, my mom was being seen by the mentor who said, I take this right out, you don't worry about it. There you go, just like that. And it wasn't until I started treating my mom's illness, the way I treat Ardens diabetes, that anything happened. I genuinely think my mom's dead today, if I didn't think why am I listening to them?

Chad Zooker, M.D. 27:47
All the things you say advocate for yourself. You got the toolbox. It's your toolbox. You built it and you just had to tweak the tools for a different, you know, a different project.

Scott Benner 27:57
Yeah, I felt stupid at first Chad, I felt like I was walking around with the toolbox in my hand going. I don't understand why I can't work this out. You know, that's

Chad Zooker, M.D. 28:05
deep. But yeah, but first of all, you shouldn't because, you know, you've said this many times. You're not a medical expert. And even if you were you could, I am I'm a doctor I got it, I got a diploma somewhere buried in my basement. That proves it. But I wasn't prepared to treat the type one diabetes, either as a doctor, let alone as a parent. So you're different when you're the family when you're the patient. It's it's it's different. It's okay to that's not have clear thought and mind when you tackle, you know, in that first few hours of learning a diagnosis.

Scott Benner 28:42
Yeah. Well, Chad, you're very good at this because I told that story just to get you to this spot. So

Chad Zooker, M.D. 28:48
you're good at something in medical school, when you know so you go through two years of learning everything in the books and you're you just buried in exams. And then after two years, alright, let's go see some patients. Let's go to the wards. And one of our doctors, one of the mentors came in and he, you know, he basically had this. He came in dressed as an old man, he was a makeup, he really looked like we couldn't tell who he was. And the whole, some of his little spiel that day was talk to patients like they're regular people who have no understanding of anything medical. Even if that patient is a doctor, always talk in the most simplest basic terms, not because people are stupid and don't understand you. But at that moment, they can't process everything. And if you don't keep it simple, and explain it in a concise and clear way that that you know, they understand. There's no chance that any of that information is going to get through and even if you are very simple and concise and explaining things when someone's been hit with a ton of bricks over their head like your mom diagnosis like a cancer diagnosis like a type one diagnosis, maybe 10% 24 St gets through, you know, it's like the goalie is pretty good that first day and not letting much through into your brain to process so, it I've always taken that to heart and you know, I, I never speak in and I can you know act like I'm a dumb bone doctor that's our little joke we like to say that we're strong as an ox and half as smart in orthopedics, but I always try and explain things on a very basic level to patients to make sure they get it because you know, even though I'm not dealing in life and death in my practice, it's still a big deal to talk about surgery to somebody and recommend something like that or trying to encourage of physical therapy program or something that may take six months to recover and you need a patient on board to believe you. Will they got to put the work in to actually get there.

Scott Benner 30:50
Yeah, it doesn't matter what the ailment is, and you shouldn't you know, I know you're joking, but you know your art your art is as valuable as anyone else's.

G vo Capo pen has no visible needle, and it's a premixed autoinjector of glucagon for treatment of very low blood sugar. In adults and kids with diabetes ages two and above. Find out more go to Jeeva glucagon.com forward slash juicebox G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit G voc glucagon.com/risk. If you've heard about the diabetes pro tips, and you'd like to find them here in the podcast, they begin at Episode 210, where they're available at juicebox podcast.com. And at diabetes pro tip.com. I'd also like to remind you to take the survey AT T one D exchange.org. Forward slash juicebox. Before we get back Chad, I'd like to tell you about the Omni pod. Here's what it is. It's a tubeless insulin pump. Actually, my daughter has been wearing it on the pod every day since she was four years old, and she's about to turn 18 I think you might enjoy it as well. Here are your options, you go to Omni pod.com forward slash juicebox. When you get there, you can see if you're eligible for a free 30 day trial of the Omni pod dash. You can also find out more about on the pods algorithm based offering the Omni pod five. If you have a Dexcom G six, and the Omni pod five, they talk to each other and make insulin decisions. Let's say you're interested in the Omni pod five, but it's not covered by your insurance yet. And you think well I'll just wait then you don't have to, you could actually get started with the Omni pod Dash. And then when it's covered by your insurance switch effortlessly to the on the pod five. That's something that on the pod calls the Omni pod promise, they promise that you can I forget how they say it. Maybe I should know this while making me. Don't you think? I have it right here. Let me just read it. I'll pretend like I'm, I'm just gonna read it ready. There's no need to wait for the next big thing. Because with the Omni pod promise, you can upgrade to Omni pods latest technologies for no additional cost as soon as they're available to you and covered by insurance terms and conditions apply of course, and you can find out more details@omnipod.com forward slash juicebox which just means if you're not eligible for the five yet, but you want it you can get the dash now and just switch when your eligibility happens. The Omni pod is a terrific device it is to Bliss and you can wear it to bathe or shower or swim. You don't have to take it off for sports or other activities. If you know what I mean adults, you'll always be getting your insulin just the way you're supposed to on the pod.com forward slash juice box for full safety risk and information and Omni pod promises terms and conditions. You can also visit omnipod.com forward slash juice box. Now let's get back to Chad. We have a lot more to talk about.

I want you to talk a little bit about to medical professionals or parents and the diagnosis comes. I mean everybody feels completely unprepared but I would think most lay people would assume you'd be alright. But it's no different for you is it?

Chad Zooker, M.D. 34:46
No, it's I mean it's it's so easy to answer that question. There's not even a qualifier or we were halfway ready. Now. It's you're not ready in medical school. I didn't learn much more helix there either, you know, so this is a lot on the job training for how we manage his type one and just trying to understand the nuances of his body. The changes with now that he's 12 And he's, you know, he is taller than me now, I'm not a small person. He's almost six feet tall at age 12. And he's playing lacrosse at the club level, and he's playing basketball. And it's awesome to watch him because he is intense when he plays. He's the kid who wants to run sprints at the end. And he wants to beat everybody at the sprints and the coaches yelling at the team saying how is this defenseman beating you guys at sprints? So, trying to manage, you know, shifts in blood sugar when he's going 110% in a practice, let alone a game. And trying to figure out, you know, where we're going to put the Dexcom where we're gonna put, you know, we had a tournament this weekend, I took a kitchen Tupperware and I hid his phone in the back of the goal. So I could pick up a reading while he's on the field. You know, so yeah, so you're just not prepared for any of

Scott Benner 36:05
it? Well, what would you say? I'm sorry to cut you off. I mean,

Chad Zooker, M.D. 36:09
now, just so you just yeah, it, you know, I, my last treatment of diabetes as a doctor was as a resident writing a sliding scale for inpatients with NPH insulin on a sliding scale that none of us would use today.

Scott Benner 36:23
Well, as you say, that the woman I was talking to when we started this episode is in Canada, and she showed me some stuff. And like I said, I answered, I said, You comma, Canada, question mark. And she goes, Yes, I'm in Canada. So she's not using, you know, regular and mph, but they still have her on us using a sliding scale. She's like, I can't figure out what's going on. I'm like, Well, you're not using enough insulin for the meals. And I mean, I think your basil is too weak, but I can't tell because of what's happening. Like you have to you have to get a carb ratio, you know, to try to get this closer. But nobody's even talking to her about it. So it still does happen in place. It's not I mean, it's not maybe the whole of Canada. But there's there's some provinces that that are just like, there's some states, I'm talking to a woman, man, a young mom in Arizona right now, too. And they got her kid on a sliding scale to right, just jumps up and down all day long, but was so what did you What was the first thing? I mean, what were the first couple of things like how did the building blocks go together? So it started to make sense.

Chad Zooker, M.D. 37:28
So I mean, I'm, I'm a, I'm a surgeon, I think concretely, I'm a fixer. I also like to think of the give me a problem, don't tell me how to fix it, give me a problem. And let me figure it out. So we start figuring out, you know, cart counts and start realizing quickly, hey, it's a lot easier to weigh stuff than to try and count anything. So we get in that mindset of, we're going to use a kitchen scale for everything. And starting to figure out how we respond to certain foods and listening to the podcast was super helpful, talking to our, our Sherpa, or diabetes Sherpas that from his diabetes family that were helping us. Really, my wife was amazing. Like, you know, from day one, we knew we wanted x calm, and we wanted a pump. And it wasn't like, you know, maybe in a little bit. She had the rep was in the hospital, meeting us from Dexcom. And we had a Dexcom on him in less than a month. And we had a pump by three months. And that was mostly her pushing, because she knew that those tools, were going to make it easier for us to manage. And we're going to give us more peace of mind to not keep doing the 2am finger sticks, sending him to school and not having to worry that he's going to drop low during a gym class because we could watch it remotely. So understanding and getting those tools to work for us. And then you know, when I see people complaining about Dexcom and I can tell you 80% of our sensors fail early. We bought stock index com simply on the fact that we kept replacing 80% of our sensors and they were still making such such margins and revenues. I said if they're making a profit replacing so much of their stock, you know so much of their product. I got to own that company before before they you know they get any more expensive. So that's

Scott Benner 39:15
that's funny, but let me tell you that might have been flawed thinking because I don't think Well, I don't know the last time art and sensor didn't last 10 days. I can't think of whatever happening once like hers goes right up till it shuts off works perfectly.

Chad Zooker, M.D. 39:29
It's we get seven to eight. I think what I mean, I mean our son is really lean. He's he's stretched out lean. So I think a lot of it has to do with that. But understanding hydration that is like the Top 10 Top 10 troubleshooting steps you take before anything else makes a huge difference. Just understanding how it works. So when people are so befuddled by the difference between their finger stick and their Dexcom and sometimes if I have the time I'll maybe type out a nice explanation to try and help out but you know Understanding how the technology the trends learning that you follow the trends, not the absolute number. So piece by piece. That's that's how you put it together. And then it's the way I looked at it is every opportunity to Bolus basil change its data, it's an experiment. He eats a pizza, and you know, his sugars go too high, we go too low, you learn from the data. And you adapt. So, you know, it's, we're changing Bezos, probably every two to three days, just because he goes through a growth spurt. And just when you get it locked in, it changes on you. And rather than getting frustrated and saying, Well, maybe it's pumps not working, maybe you know, the insulin went bad. We say, well, probably all those things that are pretty consistently reliable, they're fine. And it's the fact that he's going through a growth spurt again, that we need to make some adjustments and not be afraid to not just change his basil by a little bit. But by, I'd like to go by a percentage. So we'll dial it in by 10% or 20% shift at a time, rather than just going up point oh, five or point one, like we used to do in the early days of being really, really slow and careful about it.

Scott Benner 41:09
I have to tell you, like hearing you say all that, it just warms my whole chest up. I'm so happy. It should

Chad Zooker, M.D. 41:15
Yeah, well, it's your fault. It's your fault completely in a good way.

Scott Benner 41:19
I just and it makes me Well, it used to make me sad. I used to think, Oh, well, some people are gonna get it and some people aren't. Right. And even when you're listening, you might think well, okay, great. Chad understands Chad went to medical school, he's obviously has an ability to understand this. I don't have that ability. But I don't think that's the case. I don't think that I've put it, it's in this podcast, in terms that I feel like are accessible to everybody. And yes, and your desire to do it. I really don't want that to come off as like insulting, but you have to want to do it, you have to like it's it's like anything else. It's like, it's how my son learned how to like deadlift, 525 pounds, he didn't just start at 525. You know, he, he started at a lower number. He dedicated himself to it. And he kept going until he accomplished step by step by step, diabetes, the same thing. It's, it's no different than any other thing. That's, that's difficult. You start you take small bites, you figure it out, you keep you keep goals, attainable, you don't look too far down the road, like I was talking about with my with my mom, like, you know, like you just do what needs to be done today. And you don't worry too much about tomorrow. Sometimes you don't worry too much about this afternoon, you know, you just you do what needs to be done right now. And eventually, through experience, both good and bad, positive and negative, you just sort of come out the other end. It's just like your rebirth and you're like, Oh, I understand diabetes. Now. Like I know how to use this sense on I know not to stare at this blood sugar all day and go this is the pumps fault. Like I have a note waiting for me right now that says I switched to an insulin pump. And this was a huge mistake. And and I was like, alright, Mike, you know, and it's my my, my kids a one C rolling daily a one C was like seven now it's seven and a half. And so I see that. And I realized what the person saying is, look, I moved to a pump and my kids average a one C daily is gone up what I what I saw was your average a one C was already too high by point and a half in my estimation. And so which indicates to me that your your settings were already not close enough. They were just you were okay with them. For some reason, maybe the doctor told you who cares why, like you were okay with a 781 C. And which means you're not using enough basil, in my estimation just blindly. And you know, you probably don't understand how to bolster your meals correctly. And now suddenly you move to a pump where they were probably the doctor probably gave you even even weaker Basal rates because they were like, We don't want you to get low with I mean, I don't know how low you're getting if you're a one C seven, right? Like so. I mean, unless you're bouncing around like crazy. And I am going to answer that person at some point. And I'm going to tell them look, your basil is probably wrong. Show me your graph, they're going to show me a graph where I'm going to imagine I'm gonna see stability around the 150 160 range. And we're going to talk about getting their basil right, making sure they're, you know, don't check your Bolus. It's the same thing over and over again. And I used to get frustrated by it, because I would think it's in the podcast. And then I realized that it's, there's going to need to be a community aspect to this too. I can't just expect everybody to do what you and your wife did pick up the stupid podcast and listen through it like it was the tour of looking for answers, you know, so So

Chad Zooker, M.D. 44:51
I was terrified about the pump. You know, my wife was pushing like, we got approval and I'm thinking like, it's only two three months and I got this I know how to use a pen. I know I need as a dose shots, why do we need a pump? And I couldn't imagine going back, we had to go back on MDI for a couple of days, because we had a failed PDM. And we're waiting for the new one to be shipped out. And we were fine. We calculated we reverse calculated what the long acting was going to be. And we were we were great for a day. But there's no way I'd want to go back to MDI after living in the pump world and being able to change basals, you know, every couple of hours, if I feel like it, it's just having that control over the, you know, the outcomes. But I absolutely understand that hesitancy and it absolutely took us time to figure out how to make those settings work for us. And not just blindly trust the our endo who be loved, but, you know, they're doing their best in the moment. But that moment in a child is going to change in two days. So having the tools to make those adjustments is critical. Rather than railing on the endo for not, you know, making adjustments for you every two or three days. Just do it yourself. Yeah,

Scott Benner 46:07
no, I I. So I'm, Jenny and I are getting ready to in to two out 2022 Actually, I've dated this episode so much. You're you're not gonna have to wait for yours. So you're just gonna have to go up soon. I'm talking about my mom and all kinds of like time related stuff. I don't want to mess people up on too much. Perfect. Yeah, you tricked me into getting your your episode off center. But, but right now Jenny and I are, it's the end of the year 2021. Yep. And in 2021, we did variables, like we leaned pretty heavily into into talking about variables with Jenny this year. And next year, we're going to readdress the Pro Tip series, like we're going to do a deeper dive on the Pro Tip series itself. And that started out by me going online and asking people like, here's an episode, what questions do you have now still, after listening to this episode, like, let's make this episode better? You know, I love it. I love that idea of basically building a, you know, a compendium to it. And and so I'm looking, I'm watching people answer. And there's part of me that's like, Oh, God, like, there are more, there's more to say, which I knew, but it still broke my heart a little bit. Like I didn't get it all completely right the first time, but it is all off the top of my head. I know, do you find that hard to believe that the protests are off the top of my head and the top of hers?

Chad Zooker, M.D. 47:25
You know, understanding? I think if I didn't have some sense of how long you've been doing this, and Jenny has been doing this and the fact that you know that, that it is what Jenny lives and you live, you know, I can I could get that. But and I will say when I listened to the pro tips, I often get to the end of the episode, and I'm like, that was really good. But I wanted more. I wanted, you know, a little deeper dive because I feel like, as you start to understand it better, like as a newbie, I would, I would have to listen to the pro tip, you know, episode five times to get it. But now I'm like, I understood everything they just said. Give me chapter two of that same topic. Now I'm ready for, you know, protein 201. And for you know, basil, 305. Class,

Scott Benner 48:10
we're gonna try. So yeah, but my point was, is that as people are answering back, it helped me realize like, it's not that I didn't know. But I was like, well, there's so much more to talk about, for some people, for the people who want it. You know what I mean? Like, it's not going to be for everybody. I think there are some people who are happy with a seven, which I don't. I mean, listen, it's, it's not for me to judge, you know, I don't I don't care what you do. And, and maybe they're in a different situation. I even understand when people say I'm too busy to listen to it, like I get it, you know, but I was a little like, like, because I think those pro tip episodes are maybe, in my estimation, the most helpful thing that I've seen, it's available freely online for people about diabetes, right? And it's the

Chad Zooker, M.D. 48:57
best advice I could give any when people ask me when sometimes, you know, a new family is diagnosed and somebody connects us with them. It's not even like the first thing out of our mouth is do you know about the Juicebox Podcast now? Go, go sign up for it. Go find the episodes, start listening to the protests. It's not even the dump, don't pass, go don't collect $200 Start that first. And we could figure out the Dexcom and everything else later,

Scott Benner 49:20
you're gonna hear something crazy. I don't normally I listened. I'm not going to now or in the future to tell you guys how much the podcast is downloaded. But you know, I'm not gonna put a real number on it because it's kind of I know, that's weird. But that in the podcast world that's pretty proprietary information that I need for sure advertising and stuff like that. But the first episode of the Pro Tip series, that to 10 its newly diagnosed or starting over has been downloaded about 50,000 times. Wow. So

Chad Zooker, M.D. 49:53
that's, I mean, it's huge. But look, we got close to 5 million type one diabetics in the US and a lot more 10 times that type two, we need to get that downloaded, you know? Oh, no, no 50 million times.

Scott Benner 50:06
First of all, I agree. Yeah. And at the same time, I can tell you that I saw a, there's another diabetes podcast that last year celebrated. And I felt really good for the person, please don't get me wrong. Like, I'm not, I'm not holding one up against the other. But for the purposes of perspective, this person said, I had a really great first year with my diabetes podcast, I had over 4000 downloads, right in the year. And, I mean, it's like 1030 in the morning, and I haven't looked at my downloads. But if I don't have 4000 downloads today, something's going really wrong chat. I gotta get on it. You know what I mean? Like, it's, it's a, it's a scope thing. And I agree with you like, once you, once you have something that's going to help people your next job is to, is to scale it, you know, and yeah, and try to reach more people. But absolutely, and hopefully a percentage of them come away with something valuable. But you really did like, what's your kids? I want to say, can you say,

Chad Zooker, M.D. 51:01
We don't like to talk numbers. But I will, I will say that our best improvement came after, you know, as we were listening to everything we're learning in the podcast. And then the other thing is, is it really we're hitting a moving target with this kid and his growth, it's I don't know where he gets it from, because he's outpaced anyone in the family. And he's, and he's got more room to go from what I can tell. But, but we're happy with where he's at. And you know, and we try to focus in, I'd like to see time and range kind of become more of a standard, but even I use a onesie, when I screen my patients, and we're talking about how diabetes may or may not affect issues with their cup regarding surgery and bone healing and everything else. My first question is, you know, what was your last day one? See? Yeah. And type ones are spot on. They know the number, you know, they're, they're not my worry, my problem children, it's my type two patients who say, what's an A one C or, you know, they're coming back with some double digit number. And having, you know, far less of an insight into why that matters, or how that matters. My type one patients are on point almost universally with, with their management with their agency and understanding how it affects them. And, and it really doesn't get in the way of our treatment. Usually.

Scott Benner 52:27
Yeah, I agree with you about time and range for certain and I didn't mean to make you upset, or uncomfortable. But you did. You started to allude to a leap, but you didn't tell me what it was.

Chad Zooker, M.D. 52:37
To sorry, to you a leap,

Scott Benner 52:39
there was some leap where you moved up a percentage or a number just you just didn't say the number, that's all?

Chad Zooker, M.D. 52:45
Well, yeah, so without saying the number, I will say, but it was when we we started doing our own adjustments. It wasn't. I know when you saw it every three months. Yeah, that was the difference when we were making adjustments every week. Not every three months. Gotcha.

Scott Benner 52:59
Excellent. No, that's a I mean, to be honest, like most of this game is being comfortable enough with the insulin to make decisions on your own. It's pretty big.

Chad Zooker, M.D. 53:09
It's huge. And I always say and I met probably stole it from you, but I don't know. Insulin works low sugar works fast. So you know, what, what are you worried about? You can you can always you can always add a little more sugar to the to the recipe if you overdo it. But it's forever trying to drag down a stubborn high. Yeah, if you're not being aggressive.

Scott Benner 53:29
It's interesting, isn't it in so many aspects where people take the physical body out of the equation for some reason, they look at the, the insulin, but they don't think about the body. Like like you said earlier, like, you know, your son's needs, you know, they they greatly change fairly consistently and, and instead of saying, oh, you know, what was the thing somebody I saw somebody say the other day, it was something about like, Oh, what happened to my blood sugar? Is it because I put a red shirt on today. And I'm like, I mean, I get that's funny. And it is fun to be light hearted about it. But you also run the risk of telling new people that this thing is unknowable. And it's, it's not an unknowable, you know, you just have to know what to look for and, and staying flexible. Like that is such a big deal. Like it just is. I mean, listen, if you have a daughter, especially one who's of menstruating age, and you don't understand the be flexible part of diabetes, you're gonna have weeks that they go poorly.

Chad Zooker, M.D. 54:27
Yeah, I read what you know what you've done in how you've finally tried to figure out the changes with menstrual cycles and other people in the in the podcast group. And on the one hand, where, you know, we don't love being in this club that we're all in for type one, but we do sometimes say wow, managing his changes with growth and puberty are one thing but at least we're not trying to manage, you know, a monthly change and doubling a Basal with a menstrual cycle, which seems so hard to keep in range and to stay consistent and And hats off to the to the parents of women type one women and type one women out there who are, you know, at that, that extra burden of trying to keep that with a week to week, you know little doubling of Basal needs is just hard to fathom.

Scott Benner 55:21
It's like you're going for a walk and someone's like you should take a bag with 50 pounds or oxen it right? Wait, I wasn't walking up the mountain enough, you should definitely carry a bag or 50 pounds or oxidant that'll that'll really, you know, let's test you a little bit. You know, chat chat, I'm having a wonderful time talking to you. I've realized now I've taken you over the time. And I haven't asked you if you're okay with that. And

Chad Zooker, M.D. 55:43
I am and I blocked off. This is a rare treat for me because my Wednesdays are usually a really hectic office day. And I actually blocked off the whole morning, I don't have patients till the afternoon. So I'm happy to stay on longer. Or if you want to dig in on some orthopedic specific stuff, I'm more than happy to stay on.

Scott Benner 56:01
I'm completely touched. And what I was gonna say is, we have not yet covered any of the reasons why you asked to be on the podcast, and I'm looking at, I'm looking at my counter up here and we're like cresting an hour. And I was like when I've done it again, I just so specifically to your to your practice. I did find myself wondering when you're talking about type twos? I mean, is it just general health, that keeps people from healing or from not being injured? Or, you know, can you point specifically to diabetes impacts on joints and muscles and ligaments.

Chad Zooker, M.D. 56:38
So, you know, as I was doing a little prep work last night, I was looking at some research just to kind of freshen up things and numbers. There's some studies out there, they actually show a one C doesn't have an effect, if you just look at that single number as a risk factor for an infection after a knee replacement or a wound infection after a surgery. If I look as a whole, if I just take my gestalt of taking care of people now that I've been in practice 10 years. Type Two diabetics are a wide wide range of patients, because you have some that are barely type two that are have an elevated agency and are diet controlled, and you have some that are just poorly managed. They're on insulin already. And it's a slippery slope. In my mind, when you have type two diabetes and insulin, I feel like sometimes you're almost feeding the the resistance, because you're just pumping, your body's already pumped more insulin into the system. And that wasn't enough. So now we're adding extra outside insulin. And there's a lot of lifestyle issues related to activity, how much exercise we're getting, how active people's lifestyles are from work and nonwork. Diets are huge. I think as doctors, we are awful. Just god awful at understanding nutrition. And we don't teach we meaning we are not teaching any doctors, but nobody really gave me a great instruction on nutrition. And I've had an interest in it for my own personal health reasons and absolutely double down on it now that I'm trying to understand nutrition better for our son. So there's a whole host of things that I think make treating a type one and type two diabetic, really a different patient when you stratify risk, and you talk about you know, how was my diabetes going to affect my outcome, whether it's a fracture, a surgery, a sprain. And just to circle back because we've talked about spraying tear when we talk about the grade of tear so so when you sprain something, you stretch and or tear it. So a grade one sprain is a little stretch. But as we start to tear that structure that ligament, then you get into higher grade grade two, grade three. So also, you know, discussing terminology with patients and but yeah, so So diabetes affects things, but it doesn't have to, and I think it's greater than just your a one C or greater than just your, your, you know, fasting blood sugar. It's what are the factors in your life that have led to that point in time? And how are you managing your overall general health in terms of diet and exercise? That absolutely has got to be part of our discussion. When we talk about orthopedic injuries, it's not enough for me to fix you, and put the broken thing back together when you gotta get the function back into the system somehow, and that's going to take effort from you know, from the patient and from physical therapy and attitude and effort are the two things I can't give you. But I can actually put, you know, emphasize they're important. I have to

Scott Benner 59:46
say that I've been surprised through COVID that in a in a worldwide scenario where it became pretty obvious that your general health had a lot to do with you being able to fight COVID that, yeah, we didn't talk about it at all, like as a country or through medicine or social media, it just in general did not get spoken about very much. And to go back to what you said a minute ago, about you were specifically talking about type twos. And you said, you feel like sometimes it's a slippery slope using insulin, I felt like what you were saying was that sometimes people skip over the lifestyle factors that they have, that they could try to change and jump right to the insulin is and right. So you're skipping problem A and just addressing what problem a is a is, is adding to is that? Am I understanding? Yeah, yeah,

Chad Zooker, M.D. 1:00:41
it's, you know, insulin resistance your body, your body doesn't respond to insulin anymore. And we deal with this with type one. Also, sometimes when you've had sometimes long standing type one or maybe other lifestyle issues that are giving you some resistance, in addition to the fact that you don't make any to begin with. But yeah, the how do we improve our insulin resistance, and once again, I'm not a medical doctor, I'd say all the time to my patients, I'm a, I'm a glorified mechanic. But if I had a minor in any part of medicine, now it's diabetes. And now I understand type one and type 220 times better than I ever did. So insulin resistance, we can change that. So when somebody has type two, and we say, you know, you can, you can get rid of your type two, there's truth to that if we make modifications to our diet, and have less of a need for insulin in the foods we eat. And we also need to increase the sensitivity of our tissue, and what's one of the biggest tissue that's going to drive glucose out of your blood, it's our muscle. So if we make more and bigger muscles, now all of a sudden, our body is helping us to need that glucose to get out of the blood. And the if you look now, and you get a little nerdy on the science, there are regulated, there are receptors on our muscles for glucose, and insulin, helps to unlock that receptor key and the lock opens up glucose goes on the muscle. How do we get that? How do we get that door to open up more frequently and more doors to open? Well, you're gonna have to use that muscle and going for a walk is good. That's a good start. But what if we added some weightlifting to it also, then we start to really make some shifts here in the metabolism side of things. And if we also change, and I always talk to patients about weight loss, because it affects knee pain and arthritis, and, and I always say, we're going to work on our weight loss in the kitchen that's not in the gym, we're not going to chase a bad diet. So what are the dietary changes we're going to make that are going to help us and it's not a one size fits all. I mean, I mean, there's so many diets out there, and there's probably a diet that's perfect for every person on the planet, but it's not the same one. And I encourage a lot of trial and error. And we talk about low carb diets, and I've talked about Paleo diets with patients, and they get all hyped about keto and SR, let's talk about keto. And let's understand what that really means in terms of what your intake is going to be and how sustainable is that going to be for more than a few weeks or a month. And I spend a lot more time than I thought I ever would as a orthopod, who just likes to do surgery, talking about diet modifications, lifestyle changes, getting a proper exercise, I get patients that say, show me your squat, and let's squat down here and start making some form corrections. When people say it hurts when I squat, and I don't accept that if it hurts when you squat, you shouldn't squat. I say well, let's let's see why it hurts. And that's actually teach you how to do that better and get some physical therapy involved or a trainer involved. Yeah, it's huge. The lifestyle piece is is far better than I can do surgery wise for a lot of my patients.

Scott Benner 1:03:47
Well, I appreciate you bringing it up, because a lot of people don't want to talk about it, it's it now. Well, and you you you run the risk of offending people too. I think that I think it's important to say that, that you know, when you specifically talking about type twos, and insulin resistance, I'm not even talking about your your body makeup, you know, you could look thin, you could look heavy, and have type two diabetes, it, it doesn't matter, it's how your body's dealing with it. I think that what you said about just lifting heavier things. I mean, I'm I'm as far from a doctor as there could possibly be but it seems to me that we are basically like organisms that are machines, right? Like your your lifecycle is you you're born you grow to a to a size where you can be valuable to the clan, right. And that and that used to mean walking around lifting things carrying things and now it means making a podcast and sitting in this chair. And so your body very well may see your lifestyle as Oh, you know, I guess it's okay if we start aging out now because he's not helping the clan. You know, and so you have to go We'll make that somewhere else. Yeah,

Chad Zooker, M.D. 1:05:02
I mean, all the time, we talked about that the evolution of the human form the human body, we're living in a body that evolved 1000s of years ago to hunter gatherer. And there's really nothing, you know, our, our lifestyles changed. And now you don't have to go out and hunt, you know, a buffalo to survive off the meat, you can go to the corner of convenience store and Hunter bag of chips. So it's a problem with that we have this, you know, this calories all around us, and a lot less effort required to achieve them. And we earn our key by sitting in front of computer screens now. So, which I think is great. I mean, I am not lifting heavy boxes in a warehouse, I'd sit in on a stool and I stand up and walk around, and I stand still for hours, at a time doing surgery. But I have to fill my other time with lifting heavy things. And, you know, doing extra exercise and activity that takes advantage of the fact that my joints do move, and the muscles do move. And that's absolutely, it's a hard sell a little bit, even though it makes perfect sense if you explain it the right way. But it's hard, you got to do the work,

Scott Benner 1:06:13
he used the example of a person working in a warehouse person working in a warehouse that they're living, you know, working day is that they have to supplement it in their personal time with rest, you know, because they can't just go and they're normally you see, those people are in incredible shape, you know, because they're, they're basically exercising all day as part of their job. You just flip that around, if you're a person like me who sits around all day working, then when in your personal time, I need to move. But it's I mean, it's not rocket science, right? Like, we not really need a certain amount of, of movement, we need a certain amount of, of heavy weightlifting, whatever heavy is to you. Like you don't need to, you need to yank up 525 pounds, my kids trying to throw a baseball through a brick wall, you mean like you're just trying for your muscles to stay taut, active, little larger, so that you burn off your insulin, you're well and you manage your insulin well through your gen, he talks about all the time how people with good muscular skeletons, you know, man that they have lower insulin needs, usually, you know, and

Chad Zooker, M.D. 1:07:21
if you it makes sense if you understand the physiology involved, if you. So always, I always like to use these kind of make it simple analogies. But when we talk about I talked to people about exercise, and all they're doing is maybe running on a treadmill, or they're riding a bike, but they're not doing any weight training or stretching or yoga. So if you get on the bike today, and you ride the bike for 30 minutes, you burn calories for 30 minutes, your muscles work for 30 minutes, and that's good work. But as soon as you stop that ride, the factory is closed, the lights go off, the workers go home, and there's no more work being done. If I go lift weights for 30 minutes, I'm actually creating not in a bad way. But I'm creating some little micro tears, a little bit of damage going on. To use resistance, if I'm using, you know, a heavyweight and the muscle responds, by getting stronger by getting larger in terms of the muscle units by recruiting more muscle units to do work, that magic happens after I put the weight down and I walk away, and I go to sleep that night. And that, that that factory is still burning that third shift overnight when I lifted weights, so they're both important, but but they do different things. And you can keep your metabolism running, you know paths passively when you're not doing anything if you've done some resistance exercise as part of your overall you know, weekly repertoire of activity.

Scott Benner 1:08:46
Your your I just did a variable on I think exercise. Got I think I did I gotta be honest with you, Chad, this podcast is a blur to me sometimes, but where I remember Jenny talking about those exact things about the difference between resistance. And you know, and anaerobic. My son was just telling me about a teammate of his who's doing this thing now where he just puts his feet he stands up with his feet apart. And then he basically tries to rip the ground open with his legs, like interested in you know, he's pushing out with his feet. And my son's like, I watch him and he he's working harder than people who are throwing around 400 pounds. And yeah, and he's like, it's just he and the kid thinks he's getting stronger from it. You know, like, it's just,

Chad Zooker, M.D. 1:09:32
he's doing an isometric exercise. He's he's firing his, you know, his glutes, the muscles on the side of our hips, which don't get nearly enough love as they should. He's got to fire those muscles to spread the earth apart between between his feet, right? So there's something happening there even though if you're watching him, you know, you're like, wow, I was just filming like a weird tick tock or what's happening.

Scott Benner 1:09:55
My kids my kids like my God, he's like, he's sweating and like it's hard. You Am I making this up? And maybe you don't know isometric exercise developed by a man who got caught in a cabin in a, you know, lands like snow? What is it called when snow goes over a mountain? Avalanche, avalanche, and he stuck in there for like months, and he kept himself in amazing shape pushing on doorframes and things like that. Am I making that up?

Chad Zooker, M.D. 1:10:21
I don't know. But I like I mean, it sounds plausible. So

Scott Benner 1:10:25
like, let's pretend it's fact. And yeah,

Chad Zooker, M.D. 1:10:27
it's a that's exactly what I learned in an isometric muscle school. That sounds right. Yeah, that's crazy.

Scott Benner 1:10:31
Yeah, you can Google it on your own time, if you want. It's just how I heard it. That's really something I appreciate you talking about all this? Is there more? Is there anything else you want to talk about?

Chad Zooker, M.D. 1:10:42
Well, I mean, so I mean, I could talk about this topic for for days, because that's just I'm, I'm a geek when it comes to movement and the importance of it. And that's what I spend most of my day talking to patients about, you got to move more, you know, whether we're talking about your rotator cuff tendinitis that's shorter is achy from sitting in front of the computer too much, or we're trying to understand why sitting is bad for us and how we have to counterbalance it. But I think as a surgeon, one thing I also want to bring up because I see it come up not infrequently now is with surgery, and having surgery and our devices and our pumps and our index coms. And libre, and what have you, I think I'm always an advocate for that being part of your you know, that all stays on. And my or I almost, I don't usually lose my cool, but I got hot last week when I got an email about a type one patient coming up for a shoulder scope. And it was even like brought up like, are they going to be allowed to have their devices and it wasn't coming from. I'm not sure kind of who had put that idea in the patient's head, it might have been like a pre op exam. But I think that is such an easy tool for it to help us. So I was I always want patients to know, your doctor number one should be on your team. If you're certainly not advocating for you to keep all that stuff on and the O R, then you got to you got to be a little pushy. The anesthesia doctors I work with absolutely loved the technology because it makes their job way easier to have the ability to watch your blood sugar and not have to worry about it during surgery. And I think that that's something that, you know, I see a lot of people when they're having a procedure or surgery, they're always worried about that, but it seems like they're afraid to ask and that should absolutely be something you asked your your physician, your your surgeon, your anesthesia doctor, if you're in a hospital, if you're admitted to the hospital for whatever reason. Don't ever let anyone tell you you can't have your devices. And make us think and ask for a charge nurse and ask for a patient advocate. And if your doctor isn't, you know, writing an order to say patient may use their own pump or may use their own CGM, you know, then then be a little bit more pushy about it or wanting to say get another doctor. But

Scott Benner 1:13:06
yeah, what happens when the doctors keep pushing back like this is not apples to apples, but I'm speaking with three different people right now who have a TSH level. That indicates to me and anybody who really understands thyroid that they need a thyroid replacement hormone, right? But their doctors subscribe to the idea that if your TSH isn't over 10 then you don't get a thyroid replacement hormone. This one one is a kid who's falling asleep basically hair's falling out. We can't, like you know, doctors like oh no, TSH isn't high. It's not that another one's a woman I just started talking to this morning in Australia who's like, and she and she brought up this great point like the doctor shopping is expensive. Like, like, how many doctors do I need to go to before I hit one of those? Yeah, here it takes some Synthroid. You know what I mean? And what happens when you're advocating for yourself, but in the midst of advocating someone standing in front of you, who's holding the key going now, you can't come in? Like, like, what do you do?

Chad Zooker, M.D. 1:14:08
Yeah. Well, this is tough because you know, it's not fair or right, that you have sort of that mentality and you see this with what you mentioned with the TSH and treating thyroid, you see it with the loopers. When we get into those folks who have chosen to do a DIY DIY looping and their endos aren't supportive or sometimes when you know you're stuck maybe between geographically between a rough location or long distance between any providers and a direction and you're just trying to get supplies. So the number one you got to advocate for yourself and if you feel strongly enough that maybe your doctor is not pursuing the right avenues, it's always okay to go to another doctor. And I never discourage second opinions. I offer patients I say Let me you know, you won't offend me. Have you seen one of my partners in my group, I'll send you to someone else in town I trust at least let me help you find someone I know is, understands this problem well, so that you're not getting the opinion of someone that's not qualified. Any doctor who's afraid of a second opinion or fights back on it, that's, to me, that's a red flag. And it's sticky. When we deal with something like diabetes management where you know, you may not be able to just, you know, disconnect your doctor, and then worry about who's going to write your prescriptions when you need insulin, but it's okay to shop around or, or not so much going to 10 Different doctors, but, you know, you've put up the section of the website where you track kind of that kind of the good doctors, people like, the Facebook groups are great, you know, find the group in your area geographically, and who do you like and who's sympathetic to this problem, or, you know, who's got thyroid issues that's got an endo, that's really proactive. So you got to do a little bit of work here and be willing to maybe leave a doctor you really like for 99% of it, but the 1% is driving you crazy that they won't get behind.

Scott Benner 1:16:09
I worry, I worry about the problem associated with well thyroid and diabetes, where if your health is so far out of whack, that you can you can be there just a fraction of who you are physically and mentally. You know what I mean? And you're in you're like, you're like, Well, you got to fight you got to ask you how to go on, you're like, I can't lift my head up I, when my when my iron got really low. There was a moment where I was just there going, like, Look, if someone doesn't help me, I'm going to die. Like I can't get up and help myself now. And I think when your blood sugars are super low or super high or bouncing around, where you're, you know where your thyroid so whacked out of your skull that you can barely breathe walking upstairs or keep your eyes open. Like how do you fight in that situation? Like at what point do we expect somebody to know their job and not just look at the finger? Oh, it's in range. It's I know,

Chad Zooker, M.D. 1:16:59
it's it's tough. And I'm, you know, I am, I love my specialty. And I'm blessed to deal with. I love the musculoskeletal system and I can I'm comfortable fixing things. If something's broke, I fix it. It's torn, I reconstructed. You tear your ACL, I'll make you a new one. And that's such an easier kind of treatment tree to go through. And that's why I chose orthopedics because I didn't like medicine where all right, you got something wrong. Let's give you a pill. And let's wait a month and see if it works. And then it worked a little bit. Let's give you a double the dose. Well, let's try another pill. So I don't I like that concreteness of something's broke, I fix it.

Scott Benner 1:17:36
Don't get me wrong. I know there was there was no answer your question, but it I know, it needs to be asked. So the people listening can hear that? There's no answer to the question. Yeah,

Chad Zooker, M.D. 1:17:45
I think just just like this podcast emboldened you to take care of your diabetes and your day to day management. Use that set that same mindset of okay, so I think I'm doing okay, on the insulin and the diabetes in the blood sugar, the thyroid is where I'm not. So what am I going to have to do? I can't prescribe myself Synthroid. But I know that whomever is is taking care of this problem now is not the right guy for the job of the right guy for the job. So you're gonna have to do a little legwork, maybe, and maybe not physical, like get up and go to places but start asking people talk to your primary care physician and say, you know, who do you like not for diabetes? Just say, say, what do you do with your patients with hyperthyroid? Where are you sending them? Are you treating them yourself? A lot of primary care doctors take care of thyroid dysfunction, because it's so common. We talk about it in the context of diabetes all the time, because of the autoimmune issue, but there's a lot more people with thyroid issues that are not diabetic than our Yeah. So it doesn't just fall into the to the endos bucket, it falls into most primary care doctors and you know, and so being willing to just expand your thought process a little bit and maybe not, you know, filter everything through your Endo, because you trust them so much for type one, but maybe you need your endo for type one, and maybe you trust your PCP to manage your thyroid,

Scott Benner 1:19:14
I'm gonna tell you something. And then I'm gonna ask your questions I'm gonna let you out of here. So I just had this private conversation with somebody the other day, it's not important who it was or why it came up. And this is what I said, after watching diabetes for so long with my my daughter, after watching thyroid for so long with my wife, then with my daughter, and now my son who has Hashimotos and then watching my mom, go through her diagnosis and figure out that she has cancer and needs to have it removed and everything that comes along with it. What I've come to the conclusion is, yes, the system doesn't work properly. A lot of the times for people in these situations, but if you think the answer It is we'll fix the system, you're out of your mind. And you're about to waste your like, I'm not saying you shouldn't try to fix the system, go ahead, if you've got free time, go ahead and rail against the wind and try to make the world work a different way and etc. But just remember that people are the failing of the system, and the system is built on people. And so you can't fundamentally, like just look at how we're talking about diabetes, you can't, that's just one little idea. You can't fundamentally fix the world, you have to get in there and fight for yourself, there's no, you, you're still going to have your health problems. If the system's broke, you understanding the system's broke, isn't going to make your health problems go away. It's just an excuse. It's, it's well, I can't do this the system I live in Canada, they give us a sliding scale. My doctor, my doctor doesn't understand that my TSH might be four and I have symptoms. And if they gave me Synthroid, the symptoms would go away, my life would be better. It doesn't matter. Like I mean, it does. And in a perfect world, if I had a magic wand, I'd fix it for you. But that's not going to happen. And that's where you got to set your mind right and get to work. You either want to have success in your health, and you're willing to work on it by yourself, or you're going to have what I consider to be at this point. Now now that I've gone through it a bit of a childish attitude that there are magic people in the world who fix problems. It's just it's not how it goes, Man, there are there are regular people, and there are some people who help you with your health. But some of them are great. And some of them don't have all the information they need. And some of them were just really good at the book learning and wanted to make a bunch of money. Like you don't I mean, like you're gonna get a mixture of all these people, you spending time banging your head against the wall going, This isn't fair, or this isn't right, or it shouldn't be better. It that isn't going to help anything.

Chad Zooker, M.D. 1:21:57
I early in practice, I came to the realization, and I'm a doctor, I took an oath to do no harm. I am in this for helping people primarily and I'm blessed, I can make a nice living because I'm in a specialty that does well. But I'm not I'm not here, you know, just to cash out. And if you are medicines, the wrong the wrong place to be anyway. But you learn early on, you can't help everybody. But you can help those people who want to help themselves. And you start to really see the difference between somebody who really needs help wants help. And someone that is not going to do anything to help themselves. And it doesn't matter what you tell them what you prescribe them. And what you need to focus 80% of your effort is into that, you know, into those patients that you can help and not into the 20% that are never going to help themselves. Don't put 80% of your effort into the 20% that can't do anything for themselves or won't. And that's I'm not I don't want to sound harsh or callous, because I'm the doctor and I can just you know, either take my advice or leave it but I don't give people advice and spend my schedule is a wreck, I never stay on time. And it's because I spend time with each patient for what they need. And when I start to realize that someone isn't going to help themselves, I don't say Well, look, this isn't working, you can't come back, I'm not going to see anymore. I'll keep giving them the same set of recommendations, we'll have that talk again and again. But I'm going to bend over backwards for that patient that I really think needs, needs the extra help, and we'll take it and we'll run with it. You know, and you see it on the podcast, we still in the Facebook, when somebody puts a post up as a piece of cake blood sugar is 400 Ugh, diabetes sucks, help versus, you know, ate a piece of cake. Here's what I bolused. Here's my curve, you know, and gives you all this information is like you could tell they really want to understand where they could have been better, way more easier way more helpful for that person. And also for anyone else who comes after and sees that post. Wow, I have a similar situation. I can understand all the variables in this equation, versus I just want to complain about it but not do anything about it and said

Scott Benner 1:24:09
you don't need me to but I'll stand with your statement. Because very recently someone asked me, What are some of the leaps that I've made doing this thing that I do? Like where are some of my my learnings and you know, how did I kind of Vault forward and I said, I said one of them was the day that I recognized that I can't help everybody. You know that that was a big deal for me. Because you you get chained to I don't even know how to put it like, there. It's um, I think I've learned to talk about it like this, like in a class of 20 people. You might have four brilliant kids, you know, the kids in the middle might be pretty average there might be three or four at the end who are really struggling. And we seem to teach to the three struggling kids and It feels kind. But we don't talk about how that eliminates real success for the other 17, who could take more and jump forward with it. And I think it's the same thing as what you just said. And I just, I recognize that at some point like I can, I can put this information out there. Hopefully people can take it up on their own and use it if they can't, I'm willing to try everything. I mean, I've built a fairly fantastic Facebook group for you to go talk to each other. And it is unlike most Facebook groups, and that there's really very little bickering people aren't mean to each other. You know, like, it's, it's, it's, it's not censored. You know what I mean? Like people's posts don't get deleted, because you say something I don't like I don't give a crap. If you know, I don't agree with you, if it's your truth, it's good with me. But that I can't stand back with those three people, and die with them and not help the other 17. And that's what I figured out I was doing at one point as I was going down with the ship, instead of taking the life raft that was offered. And you know, there were other people who could have gotten the boat. And they chose not to. And there are times, and I know this doesn't sound great, but there are times that some of those people can't get into the boat, and I can't physically get them in either. And that's when you have to say, This is sad, but I don't think I can help that person. Like the thing I have to offer is not valuable to them at all. I've done my best to boil down and simplify everything I'm saying I think it is accessible to most people. You know, intellectually assessable is what I mean. And, and if it's not, this is the best I can do. Like I've offered you the best options that that are running out of my head and keeping in mind that I am not a structured person. Like if you've if you've ever listened to those protests, like just keep in mind, I get Jenny when I can get Jenny. She pops on in front of me. And I said to her, Hey, can we talk about insulin today? Hey, can we talk about MDI today? Let's talk about CGM. Today, I want to make it a prototype. Let's drill down on it. She's not prepared when I start talking. And I'm not either and you might think, well, you should be except I'm a guy. Like I'm one literally one person. I was looking at the charts yesterday for Apple podcasts in medicine. And I consistently chart at the top of medicine in the top 20 to 30. With podcasts that are actual businesses that have like, you know, business partners and marketing departments and producers and audio technicians and you know, money coming in like, right, I'm hanging with them. It's me, man. Like, like, it's the editing the setting up of the the interviews, how the interviews go, like, it's, it's, it's all on me, and I don't have like, I mean, listen, if you're listening, and you'd like to infuse a million dollars into the podcast, I'll hire people right away, trust me, and I think I could grow it and probably get your money back. But I otherwise I don't have that. You know. So

Chad Zooker, M.D. 1:28:03
that's why we that's why we like it, it is Jen, it's still genuinely, it's a dad talking about, you know, his experience. And I think that comes that comes across your intention is still pretty, pretty honest. And I don't think any of us begrudge you in this community. Any, you know, sponsorship, and any financial gains that may come as you grow this out, but it's still it's still, it's not coming from that place. It's coming from, I've learned some stuff, I think it'll help you, hey, if you want to dial in, it can help you to if you don't want it to now. That's okay. There's you know, 10s of 1000s of other people that are really digging this right now,

Scott Benner 1:28:43
I appreciate that. I don't feel badly about the about having advertisers. I mean, genuinely, I have, I have bills and children, and also my wife, I don't think, like try to imagine if my wife was married to a guy sitting in a room talking to a microphone and it didn't earn any money, don't you think she'd be like, oh, and but but the other side of it is I just couldn't do it. Like, I know, it's not for you guys to worry about. But I mean, I, I sat up here yesterday for the better part of 13 hours working on this podcast, you know, like I didn't like their leaves on my yard that need to be picked up. Other such things that I ignored to make sure that next week those episodes come out for you and that they're entertaining and provide quality for you. In different aspects of your life. It's a full time job. It really is. If I had help, it would still be a full time job. But anyway, the point is, is you don't leave people behind on purpose. It becomes circumstantial at some point. It's just there's nothing left for you to do. And hopefully and by the way, I it's not a hopeless situation. Because I have you know for the better for lack of a better term left people behind who six months later, come back and say, I wasn't in the right frame of mind back then. But I am now and I'm getting it. And so maybe just exposing them to it is a is a kindness, you know, in itself. So it's all you can cross my fingers.

Chad Zooker, M.D. 1:30:14
You help the ones you can help. And it's not. There's good doctors, as bad doctors as better doctors. Most of us get into this path with the willingness to want the burn to help people on on whatever level we can. And it's hard, the system is broken. It's frustrating, it's dealing with insurance companies, there's so many distractions in my day that have very little to do with helping patients that keep trying to edge in and you keep pushing out. But if I can get that spark, that patient clicks in the room, our eyes meet, I said something that made sense. And they actually come back a few months later, and they did it. And they're feeling better. They've lost weight, whatever it was, you know, that's it. That's That's what keeps you going. Because you realize that you're reaching somebody. So you're reaching lots of lots of somebody's but you get that feedback. And that just wants you to help another one help another one it you know, somebody's listening out there. Even if it's sifting through, you know, lots of people who aren't ready to help themselves to find the one that is, yeah,

Scott Benner 1:31:24
I listen, I wish there are times I wish I had a call yesterday for an hour with a new, an old sponsor that's coming back, right. And I'll be able to explain it better later. But I said to them in the meeting, like you have to understand the podcast exists because I want to help people. I'm taking your ad because I need your money to help those people. And I think that you have a genuinely valuable quality product here. Like I said, there are other people I could have taken this ad from and there are plenty of people have asked, but yours is I'm specifically comfortable taking your money. I said, but just keep in mind, like I will do my best to let people know about your product. And I hope they click to learn more. And if they want it, that's terrific. But don't make any mistake, I just need your money. So I can talk to these people and pay my bills. Like you'd never had a more honest business meeting than you'll have with me. And so and I said, you know, if you were just some like low carb, like, Bs, like thing of the month or something, and I get those emails all day long, I don't even answer them. I just delete them. Like I'm not gonna get involved in your, you know, your fly by night thing where you're trying to get rich real quick off of people like I don't, you should see the people that I that I gate from getting to you. It's trust me it's a it's a thing. But um, that's it to me, like I'm trying to help people and if I can I can I need money to do it. I mean, again, my my daughter said to me other day, she's like, don't you think one rich person listens? I was like, What do you think? You think someone's just gonna send a couple mil over here, so I don't have to take ads anymore. And she goes, maybe and I was like, Oh, all right. Well, I guess I would be okay.

Chad Zooker, M.D. 1:33:10
It just takes one. Yeah.

Scott Benner 1:33:12
She and I were laughing about it. But I was like, I don't think that's how it's gonna work. Sweetie. I was like, and I don't mind the ads. I'm an American, um, I'm down with, you know, consumerism and, and how this place works like I'm okay with with how this goes. I don't have any bad feelings about at all. So here's my next question. Arden we'll talk about my ankles hurt when she you know, my knees hurt my wrists hurt. You know, we've we've optimized Arden's health in every way that we can think of her her thyroid is amazingly maintained her blood sugar's are very well maintained. She takes you know, we even did a poop sample God she is going to one day listen to this and just be like you. My both of my kids did it to measure their gut biome, the other taking, you know, some pretty like strong probiotic stuff to like, balance their gut biome, like I've done everything I can do. Okay, right. And, and she'll still come up and be like, my wrist hurts. And she wants me to put my thumb in the top of her wrist like what feels like the joint between your hand and your your arm and my finger on the other side squeeze so that it's hard so that it almost creates a separation in the joint and then wiggle her hand back and forth. And when I do that, to me, my hand goes back and forth. When you do it to her, it clicks and pops and snaps in her wrist.

Chad Zooker, M.D. 1:34:35
Okay? But it hurts or it doesn't hurt. She

Scott Benner 1:34:39
She does not like it. And she's been by the way to a rheumatory specialist and she doesn't have arthritis.

Chad Zooker, M.D. 1:34:47
And she's had X rays of arrest at some point.

Scott Benner 1:34:49
I mean, I've chatted too long life. I don't I don't think of a risk no like I don't think he's ever had X rays like Could it just be like a, like a physical

Chad Zooker, M.D. 1:35:00
It can be has you ever heard of a wrist and she'd do any gymnastics or anything really wrist heavy in her past sports lives? No,

Scott Benner 1:35:07
but I can tell you as weird as that sounds, my wife has a similar thing in her wrist. It's not nearly as bad though.

Chad Zooker, M.D. 1:35:13
Okay. I mean, there's some there are some less common things congenital differences and how we're built and things will definitely get passed on from parent to child. The wrist is complicated I, I treat wrist basic stuff, I have two hands specialists in my group, anything weird that goes right to either of those two, because they are so honed in on all the little joints. And there's there's a joint between your two forearm bones right at the wrist, there's eight little bones in there, we call the carpals. And then you get into the base of the hand and every place two bones meet as a joint and an opportunity for something weird and unique to happen. So I generally tell patients to ignore clicking, I say we're mechanical animals, we move to like our car engine, so we should make noise. But when it's painful, and it's reproducible, so you can you can make that happen the same way every time. And if it's not happening on the other side, it's probably worth seeing, at least you know, somebody that's a hand and wrist specialist in your area, minimum gets some X rays, let them do some of the other special little exams that we do around the hand and wrist and dig in there. And if you know, if you're like us that deductible is met, you know, within two months into the new year. So getting an MRI or if there's any process to this club we're in getting an MRI is not can be a great way to look at some of those tiny little joints. And there are some there's a little thing called the TFCC. That's a like a little meniscus and part of your wrist. The diu J is the distal radioulnar joint, it's where those two forearm bones meet. There's some weird and unique things. And it's probably worth looking at if for no other reason than just to cross off a mechanical problem.

Scott Benner 1:36:56
She told me the other day they were playing volleyball in school and she bumped the ball with that, like that top of her forearm and she said a pain shot from her wrist right upper arm indoor, indoor neck.

Chad Zooker, M.D. 1:37:09
So it's Yes, I believe the pain went that far that way. But we don't have like a nerve that goes up uphill. Yeah, you could get a pinched nerve in your neck coming all the way down to that part of the risk for sure. But it sounds like whatever's going on here is right in that joint. So I don't think it's necessarily dangerous to keep playing, I think she can put weight on her hand and do push ups, planks and other things. Sometimes that's helpful. If she's not doing some forearm and wrist stretches or not doing any yoga, we could maybe use that as a way to pull her in to do some plank positions down dog some of those things that forced the wrist into a couple of different stretches than we get from regular activity. But it would probably be I would recommend seeing, you know, a hand doc in your area. And if we want to talk offline or email me, you know, location wise, I can see who I might know or what places I might like in a given region of the country where there's good hand,

Scott Benner 1:38:12
a FedEx box and senator to Baltimore. So it doesn't matter. We got

Chad Zooker, M.D. 1:38:15
to we got to, I've got two great partners in my group that are awesome. And we also have the Curtis National Hand Center in Baltimore. So we've got great hand hand care in Baltimore.

Scott Benner 1:38:24
My muscles like I'm not flexible, Arden's not like she's, you know, Arden likes incredibly hard rubs, like incredibly hard massage, like to the point where if you did to somebody else, they'd be like, my god, that's insane. You know, like, she's, she and I are both the kind of people who will lay on the floor and be like, can someone just walk on my back for a while, you know, please. But it's hard. That kind of stuff is difficult to pick through. So I appreciate your input on it. I really do. Anytime, anytime. Is there anything we didn't talk about yet? I can't believe there is. But

Chad Zooker, M.D. 1:38:55
I don't think because I did and I didn't work her in earlier, but I got to give a little shout out to to my daughter, who is she's 15. So we have two children. Our type one is 12. His sister is just absolutely amazing. And is a super advocate for all things type one and all things related to her brother, and they are incessantly teasing one another out of good natured ribbing that we all do in this house, but luckily, not any fist fighting. So I gotta I gotta throw a little little shout out to her because I didn't get a chance to work her in. Excellent.

Scott Benner 1:39:30
Well, I think everybody appreciates getting support. So that's really cool over to do. My kids are very similar with each other. So my wife's like, what are they doing? I'm like, they're just being brother and sister leave them alone.

Chad Zooker, M.D. 1:39:43
I told her early on, you know, because because we saw that our son was on a trajectory to be larger than average. I said, Be nice to him now, because I have a feeling he's going to be the biggest person in this house by the time he's done growing. And so now he's the tallest I still have at least 50 Plus pounds on him. But I think, you know, once I get him in the weight room, when he's a little older, he'll he'll easily surpass that me too.

Scott Benner 1:40:06
My son sent me a video of him doing a deadlift that was like five, like over 525. And I sent it to my friend. And he goes, Well, I guess you've told him the last thing you're ever gonna tell him? And I was like, yeah, so I think I think my kid could just grab me by the shoulders and toss me aside if he wanted to. So

Chad Zooker, M.D. 1:40:23
that's a little that's a legitimate, we talked about how much someone should lift if we're talking about a division one college level athlete, a multiplier of body weight is how we talk about those things. So he's deadlifting, more than twice his body weight. So, you know, that's, that's a very good you know, threshold that we want to be at or above when you when you talk about what it takes to be at a certain level of play.

Scott Benner 1:40:48
Yeah, he actually said to me that he's really thoughtful. Personally, he called me the other day he FaceTime that, by the way, kids don't call they always FaceTime doesn't matter if they're driving or walking. I'm like, you know, that other button if you just touched the picture, the anyway. So he's like, I don't need to lift more weight than I'm lifting. And I'm like, why he goes, it's stupid. He goes, what he's like, where's this going to end? And I was like, right? He goes, I'm gonna work more on flexibility to I mean, he's like, I'm gonna keep lifting where I'm lifting, but I want to work more on flexibility. I'm gonna look at that ISO stuff that my friends doing. And I was like, okay, he goes, I mean, he's, like, what's the point? If I deadlift 600 pounds, he's like, you know, at some point, that's not going to help he gets

Chad Zooker, M.D. 1:41:27
it gets into goal setting. So I also talk to patients, what do you like, why are you doing this, when we talk about what you're doing for exercise, his goal is to be a better baseball player to be better at his position at hitting and running. So he's not trying to deadlift, you know, in powerlifting competition, so he's kind of right. And he should work on his flexibility, because that's, that's the third piece of the puzzle, its movement, its strength and flexibility is that third leg that needs to be there, but um, so, so not not only, you know, reframing that discussion and say, Alright, so what are the what are the goals, we're going to set and then lifting accordingly with proper schemes and maybe resetting some of his rep schemes to be, you know, maintained, but also not reaching for higher and higher and risking injury or just deadlifting? You know, 600 to deadlift. 600. Yeah,

Scott Benner 1:42:18
that's it. He came to it on his own. I was like, I think you're right. And he's like, Alright, I gotta go. Okay.

Chad Zooker, M.D. 1:42:24
It almost sounds like he's becoming a mature young man. Yeah,

Scott Benner 1:42:26
he's just, he's just running it past me real quick. And I was happy. He had a good idea. He was looking for a little backup. And, and that was it. I will. I'm gonna let you get an idea. Yeah, give me one second. Hold on. I really appreciate you doing this. Thank you. You're welcome. A huge thank you to one of today's sponsors, G voc glucagon. Find out more about Chivo Capo pen at G voc glucagon.com. Ford slash juice box. You spell that? G v o KEGLUC. Ag o n.com. Forward slash juicebox. I'd also like to thank Omni pod makers of the Omni pod dash, the Omni pod promise and the Omni pod five. Learn more at Omni pod.com forward slash juice box. Don't forget to take that survey AT T one D exchange.org. Forward slash juice box.

Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.