The Wellness Blueprint: With Dr. Caleb Davis
Welcome to The Wellness Blueprint with Dr. Caleb Davis, where we uncover the secrets to living a long, active, and pain-free life. Hosted by Dr. Caleb Davis, an orthopedic surgeon and fitness enthusiast, this podcast is your ultimate guide to musculoskeletal health, injury prevention, and wellness.
Dr. Davis combines his expertise as a shoulder and elbow specialist with a passion for empowering people to take charge of their health. From deep dives into cutting-edge restorative medicine to practical tips on avoiding surgery and optimizing recovery, The Wellness Blueprint offers valuable insights for anyone seeking to preserve their body and thrive at every stage of life.
Join us each week for professional guidance, fascinating medical discussions, and actionable strategies that help you move better, feel stronger, and stay functional for years to come. Whether you're an athlete, a weekend warrior, or someone looking to age gracefully, The Wellness Blueprint provides the tools to design a healthier you.
The Wellness Blueprint: With Dr. Caleb Davis
Episode 9: Beating Winter Blues: SAD Solutions & Joe Rogan: "Video Games Make Better Surgeons"
Joe Rogan discussed on his podcast how video games can improve surgical skills.
As the Weather grows colder, Seasonal Affective Disorder is on the rise!
Ever wondered how the lack of sunlight can turn those winter blues into something more severe? Nicole and Dr. Caleb Davis share their own battles with Seasonal Affective Disorder (SAD) and the surprising effects of geography on mood. Drawing from personal stories in sunny Orlando and the chilling winters of Rochester, this episode highlights strategies to keep the winter gloom at bay, from light therapy to the simple joy of an early morning walk.
Fractured Facts Spoiler alert: the mysterious "funny bone" isn't what you think, and it's not funny when it acts up!
Beyond the winter blues, we explore how modern medicine gets a fun twist from the world of video gaming. Imagine surgeons honing their skills with the dexterity you develop playing your favorite games. We discuss studies that link video game prowess to fewer surgical errors and faster performance, a topic that even caught the attention of Joe Rogan and Elon Musk. It's not just about games; we delve into the rigorous worlds of music and surgery, examining the common thread of discipline and skill enhancement through unconventional means.
And if you've ever pondered the quirks of surgical life, we've got you covered! From managing bathroom breaks during marathon surgeries to the precise art of orthopedic practices, we pull back the curtain on what truly happens in the operating room. We also touch on medical jargon that sounds ominous but is usually good news. With a hearty dose of gratitude, we thank you, our listeners, for your feedback, questions, and shared moments. We're here to make you smile, think, and maybe even learn a thing or two along the way.
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Hey everybody and welcome back to the podcast. We're really excited to be back. I'm back again with my very favorite co-host, nicole Davis. Welcome back, nicole.
Speaker 3:Thank you, dr Big K.
Speaker 2:Thanks for being here. We are going to do something a little bit different with the episode today. We had a couple small topics that we wanted to cover and not really go into exhaustive detail with a deep dive into certain subjects. We had some really fun and interesting questions that we had from family, friends and fans that we wanted to discuss as well. So you'll have a little bit of a hodgepodge of topics in today's episode.
Speaker 3:Love a good hodgepodge.
Speaker 2:Nothing better than a good hodgepodge, that's right.
Speaker 4:The information shared on this podcast is intended for educational and entertainment purposes only. The content of this podcast should not be considered medical advice, nor is it a substitute for professional consultation with a qualified physician. The views on this podcast do not necessarily represent the views of Dr Davis's Medical Practice Group. If you have health concerns or conditions, it is recommended that you seek the advice of your own physician, who knows your medical history and can offer you personalized recommendations.
Speaker 2:One of the topics I really had hoped to cover today is seasonal affective disorder, which, handily enough, the acronym is SAD S-A-D, and that's exactly how you feel when you have SAD.
Speaker 3:That's true.
Speaker 2:Although.
Speaker 3:I shouldn't be smiling.
Speaker 2:Sorry, this is serious, that's right. One of our biggest and most vocal fans, dr Ken Embry, actually asked me pretty early on in the life of the podcast to cover this. So, dr Embry, here we go.
Speaker 3:This one's for you.
Speaker 2:Nicole, tell me a little bit about seasonal affective disorder.
Speaker 3:All right. Well, it's a type of depression that's linked to the seasonal changes, so most commonly it's going to occur in the winter months with less sunlight. In a lot of ways, it'll affect people. Uh, and what happened just now with our time change? So, for those states and cities that actually pay attention to the, um, the fallback, yeah, the fallback fallback for the what people call the normal time zone.
Speaker 2:Right.
Speaker 3:Yeah, I don't like the normal time zone Personally. It's a. We're based in central time where we are, and I guess we're kind of right on the border, so that means that the sun actually sets by 530pm central time.
Speaker 2:Yeah, it's getting pretty dark pretty quick over where we are. We are in Kentucky and, with the time just having fallen back, I am definitely noticing a big shift, and a lot of people have brought it up to me and a lot of people have complained, and so that's how I knew time to cover the topic.
Speaker 3:Right, well, I mean, people are just getting out of work by then.
Speaker 2:And I can tell you I still have memories of this when I worked as a bank teller in college and I would drive there in the morning when it was dark, work all day and then drive home and rush hour in the dark. That got to me pretty quick.
Speaker 3:Yeah Well, so I don't know. I can mention that seasonal affective disorder is something that's affected me and other members of my household. So I know, you know, I take it kind of seriously. I start to dread early November a little bit, knowing that this time zone change is going to happen, and so this year I decided to attempt to combat it by actually going to bed earlier and waking up earlier when the sun's first light hits, because otherwise, for the past 30 plus years, I've just known misery for the past 30 plus years I've just known misery.
Speaker 2:So let's go ahead and get a little bit more into the details and we can talk about a little bit how you can address seasonal affective disorder.
Speaker 3:Sure sure. Yeah, I kind of just skipped right past that.
Speaker 2:Yeah, as usual, you're trying to jump ahead and show how smart you are.
Speaker 3:Well, you know, you can't hide it, can't hide it.
Speaker 2:No, when you're as brilliant as Nicole, you can't cover it up. So it's estimated that about five to 6% of United States adults have seasonal affective disorder and up to potentially even 20% of adults has a feel some sort of, maybe minor, depression. When the the time starts to shorten them, we start to lose daylight, but maybe not quite meeting the threshold of a diagnosis.
Speaker 3:Yeah, I think. I think some people call it the winter blues, right.
Speaker 2:Yeah, I've heard that. I've heard it called the winter blues and I think a lot of people experience that. So what people may not know is that geography actually affects it fairly dramatically. Nicole and I, both having grown up in Orlando, Florida, don't really experience seasons that much.
Speaker 3:I'm sorry, what are seasons?
Speaker 2:Yeah, exactly hey, there's just summer, right well, when we lived in florida, but you know. But you also lived in rochester, new york for college, so I think you know exactly what seasons are that was a real rough night.
Speaker 3:My mother tried to warn me and I should have listened to her I bet your sad kicked in pretty hard when you were there. Yeah, I think it was more like ssad super, super, sad, super sad so Super sad.
Speaker 2:So there's actually a study showing that for every degree that you go more north, you have a 1% increase of incidence of SAD. I bet the people at the North Pole and Alaska have it real, real bad when they don't have sunlight for months at a time.
Speaker 3:Well see, if we had moved to Alaska, I would have just said goodbye and flown to Hawaii for the whole winter.
Speaker 2:You know, when Nicole and I were looking for my first job out of residency and fellowship, she actually asked me to apply for a job at Anchorage, which I looked and it was kind of appealing because I love the mountains, I love being outdoors. And I said, well, what about the long winters? And Nicole said, well, what about the long winters? And Nicole said it's a direct flight to Honolulu for a five hour flight direct from Anchorage. I was like, oh, so I'm just going to have to stay at work. And she's like, yeah, yeah, pretty much.
Speaker 2:Yeah, thanks for volunteering me. There's actually a huge disparity in men versus women who are affected by SAD. You're actually four times more likely to be affected if you're a woman than a man. Now, I'm not sure why that is. None of my research would indicate why women would be normally more affected than this, but that's definitely something that's played out in multiple areas. When I read about this, typically starting in young adulthood between the ages of 18 and 30, is when people will normally see their first manifestation of SAD, and it gets a little less common as you age, so there is actually some instances of people aging out of it.
Speaker 3:As we know, symptoms can include low mood, excessive sleepiness and then increased appetite, especially for carbs, and then a drop in energy. So really, you're just describing bears.
Speaker 2:You know, I actually read a study on this that said that there was an evolutionary theory that there was like, well, we'll just sleep more and eat more and just try to sleep through the winter. So maybe it is sort of a physiologic function that no longer serves a purpose. Yeah, but you know, sometimes I feel like I could just eat a big pile of pancakes and curl up in a blanket.
Speaker 3:What about beets though?
Speaker 2:Bears, beets, bass, star galactica. Yes, sir, you got it.
Speaker 3:This is why we're married by the way that National Air Galactica yes sir, you got it. This is why we're married by the way.
Speaker 2:That's the only reason, only reason. Okay, you don't even like the office that much.
Speaker 3:I do like the office. I just can't marathon it the way you know you can.
Speaker 2:Go hard or go home the other thing that we see now. If you go back and look at our sleep episodes, you'll hear us talking about how hormone levels are attributed to circadian rhythms and how that might affect your sleep if you're having inconsistent sleep.
Speaker 3:Can we pause for just a second and remind people what circadian rhythms are?
Speaker 2:Yeah, real quick. Circadian rhythms just have to do with the natural rise and fall of different hormones that are associated with sleep. So think cortisol, think melatonin, think serotonin and dopamine, all of these different hormones. But most people are thinking about melatonin rising in the evening to make you sleep and cortisol falling in the evening to make you sleep, and then cortisol rises again as you wake, and this is often affected dramatically by light, the way the light hits your eyes and how the way, more importantly, the light stops hitting your eyes in the evening, and so if you're not getting enough sunlight, you're actually never becoming fully awake. There are even people who advocate that the first thing you should do when you get up out of bed is see sunlight immediately, because it stimulates the drop of the melatonin, the rise in the cortisol, which in this case, is a good rise in cortisol that helps stimulate you so you're not so tired during the day.
Speaker 3:Yeah, and I can definitely attest to that, just in my own personal experience. We sleep with blackout curtains and if you leave for work, it's still 8 am or later and those curtains are still pulled shut. I could just sleep until noon or later. I need to have them open to see the light.
Speaker 2:And that sunlight actually will stimulate you to wake up.
Speaker 2:Think of it as the opposite of blue light blocking glasses that I recommend people wear at night to help be the opposite of stimulating. Think of it that you need that stimulation to boost your circadian rhythm in such a way that you're going to be stimulated to wake up. So if you can imagine, let's say, your normal person wakes up at eight o'clock and then goes to bed at midnight, let's just kind of throw out those numbers. If the sun is now setting at five o'clock at night and you're going to be awake for another seven hours, that's a very large portion of your waking day that is not exposed to sunlight anymore. And now that the sun is coming up much, much earlier, most people aren't going to be getting up earlier to see the sun when they first wake up. So a lot of people are just going to be experiencing the sunlight while they're driving in their car. A lot of people have sunglasses on when they're driving and then they go to work, stay in work in a building all day and then never see the sun at all.
Speaker 3:Yeah, Especially hospital workers.
Speaker 2:I I very rarely understand how little sunlight you guys see, until I go visit you and I'm like guys see, until I go visit you and I'm like, oh, this is just a big box, yeah, so no windows in the operating room, a big bright fluorescent lights though, but not UV. Uh, no windows in any of my exam rooms, although I've seen some doctor's offices where they have it windows in the exam rooms. There is technically a window in my office and I spend very little time in my office. I'm seeing patients all the time and running around, so I spend very little time in my office. I'm seeing patients all the time and running around, so I get very little sunlight in my line of line of work.
Speaker 3:But you still. You'd look like a vampire, even if you did get sunlight. I think you had a nickname in college called pale kale, didn't you?
Speaker 2:There was one person who called me that. Thanks for bringing that up. So you may think, if the if the problem is you don't have enough sunlight, what's the answer? What can you do to treat this more, more light, right?
Speaker 2:yeah so some people actually there's. There's a market for this where people sell uv lights just to get under uh, just to expose yourself to more uv light during the day or at night. If you're going to be home and the sunlight is already gone, you can just expose yourself to uv light. That will help stimulate more of that wakefulness, more of that vitamin d production, and these might all help contribute to alleviating some of the symptoms of sad so by uv light are you talking about sunlight lamps?
Speaker 2:yeah, things like sunlight, sunlight lamps okay, that's right.
Speaker 3:That's exactly right. I I used those in Rochester, new York.
Speaker 2:Yeah, Nicole actually had experience with doing this exact thing and did it help.
Speaker 3:No, Well, like I said, I had super SAD, so I think I just needed to be in Florida.
Speaker 2:Yeah, what if your doctor wrote your prescription saying go to Florida? Do you think insurance would pay for it?
Speaker 3:Well, I know you would, as you do.
Speaker 2:So of the listed treatments for SAD, light therapy is one of them, Exercise is another. Getting regular exercise, preferably outdoors, has shown to help decrease the symptoms of SAD Again, that being sluggishness, depression, sleepiness, low mood, low productivity all these things.
Speaker 3:To be clear with exercise you're talking about even just taking a walk.
Speaker 2:Oh yeah, it can be anything. We're not talking specifically about cardio versus strength training here. We just mean moving around more, and it's preferred to get outside, preferably in the morning when the light is coming up and you're getting more light exposure. That's probably going to be your best bet. Back to that thing cognitive behavioral therapy that we talked about. Some people have also shown that that, in addition to some of the other treatments, can also help alleviate some of the severe symptoms of SAD. Some of the less talked about treatments are just vitamin D supplementation. If you have a vitamin D deficiency, this is helpful. I don't know that this is going to be the answer to it, but most people in the United States, or at least a very large portion of them, do have a vitamin D deficiency, so it's probably never going to hurt you to supplement vitamin D, unless you have some sort of hyper vitamin D disorder, which is pretty uncommon. It's probably a better, a good bet for you to supplement vitamin D pretty regularly. In my book.
Speaker 3:Yeah, especially if you're a vampire known as Dr Big Guy.
Speaker 2:I think just stop spreading rumors. There are people who are going to be at more increased risk of getting SAD People with low vitamin D levels, people who have a history of mood disorders, people with conditions like bipolar disorder. They all have a higher risk of developing SAD and, interestingly enough, people who are in more densely populated urban areas are also more likely to get it. I think people in these settings are probably more likely to be it. I think people are in these settings are probably more likely to be indoors more often, where people who are in rural settings are probably more likely to do more outdoor work, thus exposing them to more sunlight. So let's talk about a little bit of the stuff that we've done since the time change Right.
Speaker 3:All right.
Speaker 2:Yeah, so we've actually implemented quite a few of these things we talked about, when we have started going to bed around nine or 10 o'clock at night sometimes nine o'clock, if I can really convince Nicole that it's good for her health, and she'll listen to me on occasion and we'll get up at five and five in the morning now and go for a walk, like just as the sun's coming up. We're there, we're ready to greet the day, we're getting that sunlight exposure. We're not wearing our sunglasses, so we're getting some, some exercise. We're getting some companionship. You know, we're doing that mindfulness. We're not looking at our phones and we're uh communicating with, uh with each other and having good community and, um, we're being uh grateful. We're talking about what we're grateful for the day, and all of these things are things we talked about on our mental health episode too.
Speaker 3:Yeah, it's been been. It's definitely been helpful for me, because then I feel like, okay, I have a purpose and a reason to get up in the morning, whereas in the winter months I tend to be a little bit more like, oh, it's cold, I don't want to get up. I don't, I don't want to do this, and you know that's not a great place to start your day. Every day is a gift. You shouldn't, you shouldn't wake up and be thinking that if you are, then, then there's something deeper going on there.
Speaker 2:Yeah, and I'll be curious to see if we can keep it up when it gets real, real cold, cause there's something about getting up in the cold and walking out in the cold when you don't have to necessarily get up that early.
Speaker 3:Okay, but I know the trick for me.
Speaker 2:What's the trick for you?
Speaker 3:It's's, it's just tell me that we're in iceland, and then I'll go do it yeah, because when it's iceland you don't care.
Speaker 2:It could be right. It could literally be freezing rain and you'll go out into I will go out into it and I will smile I think you'll figure out pretty quick.
Speaker 2:It's not iceland, although where we are, we are surrounded by nature. Even though we're in the middle of a town, there's like wild turkeys and foxes and coyotes near our house, yeah yeah, so you could almost be convinced you're out in nature. I can say that I've really, really enjoyed going to bed earlier, getting up earlier, doing these walks, spending time with my wife, and it just really uplifts me for the whole day and really lifts my spirits for the whole day and I can feel a very tangible, measurable difference when I do it versus when I don't do it. Well, here's something to lift your spirits. It's time for Fractured Facts, one of my favorite segments of the show, where we talk about orthopedic trivia knowledge. Nicole, can you tell me where the funny bone is located?
Speaker 3:Hmm, well, I think I'm going to have to go with right here.
Speaker 2:Yeah, that's pretty close. Can you tell me what the funny bone is?
Speaker 3:Well, I know it's not actually very funny. I know every time I hit it I'm pretty much shouting things I shouldn't and crying, and so I think it's a very cruel twist of fate that we call it the funny bone. Why do we call it the funny bone?
Speaker 2:It's a very cruel twist of fate that we call it the funny bone. Why do we call it the funny bone? Well, I'll get to that, but first I want to tell you that the funny bone isn't actually a bone at all and it's actually a nerve that runs near a bone and it's just in a sensitive spot that, just for some reason, people can bump all the time. It's actually called the ulnar nerve and it runs just on the inside part of your elbow.
Speaker 3:It runs right along here on the inside part what we call the medial elbow between the medial epicondyle and the olecranon.
Speaker 2:Ah, what is the olecranon is that? Is that the same thing as the weenus? Nicole, this is a family-friendly show it's. It's a child's word yeah, children used to call that the weenus and I became. I had to become a doctor to realize that there's no such thing as that.
Speaker 3:That's ridiculous hey, man, you've got the funny bone, okay, yeah yeah.
Speaker 2:So I don't know if any of you knew this, but when I was a child and nicole still is a child people said the loose flap of skin on the back of your elbow was called the weenus, and I believed them. Well, now I can tell you as an orthopedic surgeon it's not true. It's not called that at all. But this bony bump right here is called the olecranon and that's part of your part of your ulna as it meets up and articulates with your elbow what does articulates mean?
Speaker 3:is it like articulating a sermon, like what's going on?
Speaker 2:no, articulate just means two, two bones joining together as a joint that move.
Speaker 3:Oh, okay, like a hinge, a hinge, yeah, why not call it?
Speaker 4:a hinging, then I don't know, wait, don't look at me like that.
Speaker 3:That was such a judgmental. Look right there.
Speaker 2:It was like, devoid of all compassion, I've got a lot to judge you for. So the ulnar nerve is interesting because it is a motor and sensory nerve. It gives sensation to essentially all of the pinky and half of the ring finger. So sometimes people will notice that if they lean on their elbow on their armchair too long or sometimes when they're driving with their arm propped up on the window, one and a half of their fingers will go numb and sometimes a little bit of numbness in the palm and the forearm as well. But it gives off multiple motor branches to the FCU, which stands for flexor carpi ulnaris muscle, and there's a lot of different muscles in the hand that it gives sense, a motor that it gives motor control to as well.
Speaker 3:Yeah, and apparently if you have a consistent issue with it, you might have cubital tunnel syndrome.
Speaker 2:Yeah, just like there's carpal tunnel syndrome in the wrist, you can also have compression of the ulnar nerve at the elbow, causing what they call cubital tunnel syndrome, just like Nicole said, and that can cause chronic paresthesias or numbness in the fingers that we just talked about.
Speaker 3:Yeah, and let me just say from personal experience you don't really understand how much you use your elbow until it's really painful to bend it, and then you realize you use your elbow until it's really painful to bend it, and then you realize you use your elbow for basically everything.
Speaker 2:Yeah, the interesting thing I was gonna say the funny thing, the interesting thing about the ulnar nerve is that it gets tighter as you flex your elbow up.
Speaker 2:It puts it on stretch and can make it worse. So a lot of times you're holding it in flexion like some people may even notice that they're texting on their phone and they're flexing and holding up to their face that they'll have older nerve paresthesias. Most people don't know it, but when we sleep we tend to bend our elbows, even though it's not a conscious decision, and that can cause more stress on the nerve while we're sleeping too, which is why a lot of people wake up first thing in the morning with that numb and tingly feeling. The reason they call it the funny bone is twofold. One is just when you bump that nerve really, really hard, it feels funny. The other is that the bone that's running next to is called the humorous bone, and so I think there's sort of a double play on words is why it's called the funny bone. Nicole, if you don't have anything else to add, we'll go ahead and get back to the show.
Speaker 3:Let's do it.
Speaker 2:So I'm always looking for fun topics to cover that are popping up in pop culture, and I just happened to find the jackpot when Elon Musk showed up on Joe Rogan's podcast recently and they were talking about video games and how they correlate with surgical skills. So I just had to sit down with Nicole and talk about this.
Speaker 1:Yeah, super stoked about this actually I was reading this study about surgeons, where they found that surgeons who regularly play video games make less errors.
Speaker 5:Well, video games require manual dexterity.
Speaker 1:Yeah.
Speaker 5:So it makes sense.
Speaker 1:Completely makes sense.
Speaker 5:Actually, if somebody was like I have very good video games, I'd say their surgical skill is going to be very good, because in order to be good at video games, any kind of fast reaction video games Look at this fast reaction video games.
Speaker 1:Look at this 32% fewer errors, 24% faster and scored 26% better overall than their non-player colleagues.
Speaker 2:Oh I believe that for sure.
Speaker 1:That's incredible.
Speaker 2:This is something that I've actually sort of touted for years, because I'm familiar with the study that they're talking about when it talks about correlation of video games and surgical skills. So it was actually really fun to hear about it on one of the biggest podcasts in the country, or, I should say, the world.
Speaker 1:Well, you should be required in medical school to play video games, don't you think?
Speaker 5:If somebody is like top, a top ranked video game player, and they say they're a surgeon, I'd be like plus plus one plus two.
Speaker 2:Well, there you go. Elon Musk says, says if you're good at video games, you're probably going to be a good surgeon. He'll trust you. I mean, they were just having so much fun with that, they were so enthusiastic about it, so it was just really a lot of fun for me to get to see that. Uh, because you know, obviously I've played video games for most of my life and I actually do think that it's contributed and, um, I feel like I can finally be like hey mom, like it wasn't a complete waste of time.
Speaker 3:Yeah, yeah, I mean it does take a lot of skill to play video games and play them well. Uh, I do not play them well. The only game I can kind of play well is mario kart.
Speaker 2:I was gonna say I think you're pretty good at mario kart, thank you thank you, I appreciate that, but pretty much nothing else type of thing.
Speaker 1:Oh, top rank for sure, but this isn't even top rank.
Speaker 5:This is just people play well, your manual dexterity has to be extremely high so you're looking at things on the screen, you've got, you're reacting and you know, sometimes you've got like 10 milliseconds to react yes um and um, and so if somebody's got uh incredible reaction times, manual dexterity, they're obviously going to be a good surgeon imagine if there was a course that you could take that course would promote.
Speaker 1:You would be 26, 26, better yeah.
Speaker 2:So they're kind of hitting like the same things that we talked about already, like they're just sort of emphasizing it, although I will have to say that the study that rogan is talking about here, it wasn't actually looking what surgeons were doing in real life surgery. It was a surgery simulator. So it's not exactly correlative to like these are better surgeons having better outcomes on real patients. You can't really measure that truly because there's not a great way to say how many errors did these have? Like when it's a simulation, you're like that was an error, that was an error, that was an error. That's not so clear, cut and dry, so to speak, in surgery maybe it's like every 70 hours of skyrim that you've played.
Speaker 2:That means you get like plus one on your patient score outcomes yeah, you know, I don't think Skyrim is probably not a great example because in my humble opinion, it doesn't require as much dexterity. Reaction time okay, what?
Speaker 3:what are your? What are your go-to video games for?
Speaker 2:well, well, dexterity, back in the day when I played a lot of video games which I don't actually don't play anymore, which maybe I need to dust that off yeah, maybe you do the skills.
Speaker 3:Come on. Now you're cheating your patience, that's right.
Speaker 2:My patients would like me to play more video games. Um, my big go-to game was halo 3. That was when I was like really in my prime in college and I was playing competitively. You hush your mouth. You better respect my surgical skills. That's right. I was in my halo prime and halo 3.
Speaker 3:I was actually pretty competitive I'm gonna have to ask our friend wesley if this is true, to corroborate the story well, wesley's not very good at halo, but I will give you that wesley's better at call of duty.
Speaker 2:So these fast, fast reaction times, like these multiplayer games that require a lot of fast reaction times, especially when you're playing against other humans uh, that those are the ones. I think that test your um reaction times a little bit more and probably correlate. Um, anything that's involving you having to use multiple sticks, multiple buttons all at the same time with both your hands to make you a little bit more ambidextrous, I think would probably correlate.
Speaker 3:Now I don't have any real data to back that up, but that's sort of my assumption well, um, I remember you tell me years ago, when you were in medical school, that there was a interventional radiology. They kind of have like a video game, like simulator. Uh, am I making this up?
Speaker 2:is a lot of subspecialties in medicine have this sort of thing. Uh, we don't use it that much in orthopedics at least I didn't in training but we have arthroscopic surgery where we're using a camera and we're doing things inside of a joint on a computer screen.
Speaker 3:Isn't it like backwards? You explained it to me once.
Speaker 2:Sometimes it can be confusing the orientation of where the camera is and where the shoulder is. So if I'm, for example, I'm using shoulder as an example because I use that's mostly what I do is I do a lot of shoulder surgery. If I'm putting the camera in the back of the shoulder, then I'm looking at structures in the front of the shoulder, but like I'm behind the patient, or I could be putting the camera in front of the shoulder and then I'm in front of the patient, so all of a sudden the camera is sort of mirrored, a mirror image of what you're expecting. Or if you put the camera in the side of the shoulder, it's all of a sudden, it's all disoriented and your range, your reference range, is different. Some people do arthroscopic surgery with the patient on their side, so instead of everything being oriented vertically, it's oriented horizontally, and so then you're in a whole different terms of when you do what we call lateral arthroscopy. Then the camera orientation is completely different.
Speaker 3:Wow, that sounds complicated.
Speaker 2:It is complicated. I mean it's surgery for a reason that sounds complicated. It is complicated, I mean it's surgery for a reason. But I think that the ability to change on the fly and adapt on the fly makes you a better and quicker learner. What Rogan and Musk didn't mention in this episode is that there's other studies that looked at ability to pick up on new surgical concepts quickly in surgical learners. So they looked at. There was a couple of studies that looked at non-surgical residents and surgical residents, meaning that they were in residency training to be surgeons, and those who had more video game experience or played regularly were able to pick up on new concepts more quickly. So that was some other studies that I looked at once I watched this episode.
Speaker 3:Okay, well, I know that at least the way it's depicted, uh, on tv shows that those in the military might have some background with video games. Like maybe the military kind of promote like a tries to grab, grab those guys and gals who are super good at video games and be like hey, you want to do our vr drone stuff? Wouldn't that be cool? Is that real or did I make that up?
Speaker 2:man, I have no idea. I don't know, I I don't work for the CIA. I have no idea.
Speaker 3:This was in a TV show we watched, though.
Speaker 2:What was it?
Speaker 3:I don't know. I've watched a lot of TV in my life.
Speaker 2:The other thing that just piqued my interest is because Nicole and I are both musicians, classically trained musicians. I was curious to see if there's any studies showing that if you had a background in music that you might be a better surgeon just because there's a lot of fine motor control, a lot of manual dexterity, small motions that I thought might be that could correlate. The data on this is not as robust as the video game data, believe it or not. The studies aren't that well designed, but the longer short of it is that the small studies did suggest that if you had a musical background you may be more apt to pick up surgical concepts more quickly.
Speaker 3:Well, I know that just in our personal lives. We know a lot of musicians who have since gone into medicine.
Speaker 2:That's very true. I think there's something about masochism. I think there's something about masochism and hating yourself that makes you either a musician or a doctor. I think there's something about masochism and hating yourself.
Speaker 3:That makes you either a musician or a doctor. You're like, yeah, all I want to do all day is critique myself and get better and spend hours a day shut in a room working on my skill.
Speaker 2:That's what I was thinking about yeah. Sitting in a practice room for six hours a day and practicing the cello or studying for 10 hours a day, and working 80 to 100 hours a week as a resident.
Speaker 3:And either way, you have some sort of mentor whether it's your primary musician teacher or your attending who's yelling at you and telling you you're doing it wrong and you go back and back for more.
Speaker 2:There's always someone yelling at you, telling you you're doing it wrong.
Speaker 1:Everyone would have to take that course. Sure, why would you want a surgeon that's less prepared?
Speaker 5:You would say hey, bob did you take this course.
Speaker 1:You didn't take this course, don't you understand? This course makes you 26% better. You would have to take it. Everyone should have to play video games if you want to be a surgeon.
Speaker 2:Well, I love seeing Rogan get so animated on like, oh man, they got to take the simulation like they got to play video games. If you're 26% better at surgery, it was. It was amusing for me to watch. I don't think that probably correlates. Honestly, if you took every single surgical resident and told them to play video games, I don't think it would necessarily mean you will be 26% better at surgery. We have to remember that this study was looking specifically at a surgical simulation which takes out. It takes out a lot of critical thinking because you it's a fixed set of variables. All of the unknowns and the pressure of surgery are not there. It's not real. It's not real life and death. There's all of these unknown variables that could change in a video simulation isn't going to do Um, but is it kind of like playing the game of operation from when you're a little?
Speaker 2:bit more advanced than that. It's a little bit more technically advanced than that and we do practice. All the time. We practice on cadavers, all the time we're doing real-life surgery and practicing.
Speaker 3:In case you didn't know, cadaver is a deceased person who has donated their body to science.
Speaker 2:Correct. So, as a surgeon, when we're learning, we will often try out procedures and approaches where we're trying to get to a certain part of the body safely in the prescribed way. We practice on dead people because no one can get hurt, but you're dealing with real human anatomy and you're dealing with practicing dexterity in an applied way.
Speaker 3:I feel like it's important to say that the deceased person has given their consent. Yes, you're not like digging up graves.
Speaker 2:no, it's that was the old way yeah, in the ancient history of medical school and doctors that's how they got cadavers was to dig them up out of graves and practice on them, which is not the way things are done anymore, fortunately. I think we're getting off a little bit of a tangent. I think the message here is that it's really fun to see that video games are getting their due here and like they're showing that there actually is some value to it and you can actually get some benefits from video games. I think obviously video games come with challenging territory too, where they can suck you in and actually cause social problems. So I would encourage people not to just take up video games because you think it's going to make you more manually, have have better manual dexterity. But I do think that it can offer some benefits and, just like I said, if it helps you relax and unwind and decompress, I think it's a great thing to do.
Speaker 5:Well, I think it certainly would be a very good test to see if somebody can't play video games well, Because you've got to move both hands simultaneously, You've got to react to something very fast on screen, and if your keystrokes or your mouse clicks or whatever are wrong, then you lose the game. So if somebody has a good rank in video games, I would say that their manual necessarily their manual dexterity must be extremely good.
Speaker 1:Well, it's so hard. Their fine motor skills have to be excellent. If you think about StarCraft or any game like Quake, any game where a lot of people are playing. To rise to the top, you have to be exceptional period as a human being. There has to be something exceptional about you.
Speaker 3:Something that Musk said about using both hands simultaneously. That reminds me of musicians.
Speaker 2:Piano players yeah, especially.
Speaker 3:I mean if there's a piano player who can sight read music, not aurally but like just visually.
Speaker 2:All right, you know what. You're always calling me out on being too technical.
Speaker 3:You're getting too technical here in the music world.
Speaker 2:Sorry, no one's going to know what aural sight reading is or what sight reading is Okay.
Speaker 3:Yeah, break that down for us.
Speaker 2:Well, sight reading just means that you put a piece of music up on the stand and you've never looked at it before, and then you play it as best you can. That's what sight reading means.
Speaker 3:Means you've never looked at it, never heard it, brand new, fresh to your, to your eye and aural sight reading would be you hear a piece of music and, without looking at a physical piece of music written out, you're able to play it based on what you hear audibly. So I'm I'm making the claim that if a pianist is out there can look at a piece of music and immediately play it.
Speaker 2:Then that's in fingers, yeah.
Speaker 3:Like doing the double dexterity stuff, then that would be really impressive and that would also be along the lines of what Elon Musk is talking about with video games.
Speaker 2:We need to find some all-star champion Starcraft, call of Duty, halo. Player from Korea who's a pianist.
Speaker 3:I'm sure they're out there.
Speaker 2:Yeah, I'm not singling out Korea for any reason. It just seems like they're all really good at video games.
Speaker 3:I was also going to throw in there, if I may, about children. If there are any tiger moms out there who are like, ah yes, my child should play video games and train at it intensely so that they may one day become a surgeon, that might be a little bit challenging, as we're finding more and more data about how screen times and video games can affect children adversely as well as positively in some ways. But yeah, just use your best judgment and just know Caleb's mom that it wasn't all for nothing.
Speaker 2:You know, yeah, I think that's a good. It's a good way to wrap it up because there are problems with overuse of video games and they can cause cognitive behavioral problems in children, especially those under you know, those who are not teenagers yet. So it's a good way to wrap it up. But I just, I just had a really fun with this segment. I really enjoyed watching it. So after the mental health episode, we made the commitment that we were going to do a short, dedicated segment to being grateful, just because we think it has so many mental health benefits. So, nicole, why don't you go ahead and start us off with your gratefulness today?
Speaker 3:Sure, well, actually I really enjoy the fact, and I'm grateful, that our city built sidewalks in our neighborhood, because that's one thing that I've always said was sort of lacking about our neighborhood. I love our neighborhood, but it feels very dangerous to walk in uh, at times, especially around bends, when people can't see. And so they they started building sidewalks and I think it's great. I see people using them all the time. They got it done relatively quickly and I'm looking forward to using it for many years to come.
Speaker 2:Today.
Speaker 2:I'm very grateful and wanted to give a shout out to all the listeners of the podcast.
Speaker 2:I know that's a little bit cliche and self-serving, but honestly, People, when they come up to me and tell me how much they're enjoying the show and things that they've been able to take and learn from it and how it's affected their lives, is really touching, really means a lot to me. And those who have come with a critical feedback and said, ah, this isn't really good and this isn't really working. I really appreciate you all because I want to make this a really good product that's really good and helpful to people. I want you to be critical and I want you to tell me when things aren't quite right or when the ways that they could be better. And it takes courage to do that and I really appreciate that. And we're going to cover some questions later on in the episode and I really appreciate people who come to me with questions that I can share and discuss on the episode too. So just thank you all so much for listening. Thank you so much for your feedback.
Speaker 3:It means the world to me. Hey, dr Big Guy. Yeah, I think we should call this segment Ask a Doc, or maybe what Up Doc.
Speaker 2:Oh for the questions.
Speaker 3:Yeah.
Speaker 2:Yeah, what up Doc?
Speaker 3:I mean it's kind of pulling it.
Speaker 2:Yeah, yeah, no, I kind of like that.
Speaker 3:Can I crunch a carrot while we do it?
Speaker 2:If I tell you not to, you're going to do it anyway.
Speaker 3:So let's go ahead and get into some of the questions that we've heard over the last few weeks. All right, so, dr Big Guy, everybody wants to know when you're in those very long surgeries, what do you do if you have to go to the bathroom?
Speaker 2:You know, this comes up sometimes, unfortunately, as long as nothing comes out.
Speaker 2:The short answer is I just try my best to hold it and sometimes, if I know I'm going to be operating a lot in the day, contrary to my advice to everybody, I don't always drink a lot of water, so that I try not to run into this problem of having to go to the bathroom. When you're in a really stressful situation or if you're really concentrating, you'll find that a lot of times you just aren't paying attention to the need to go to the bathroom. So when it was really difficult for me was when I was a med student and I had nothing but time to think about how much I had to go to the bathroom.
Speaker 3:Were you holding like a retractor open?
Speaker 2:Yeah, you're holding a retractor in surgery and you're just watching the surgeon operate.
Speaker 3:You'll find that when you're operating that sometimes you don't even think about it once you're getting into the groove of things. I really hope that the majority of people listening are not attempting to operate without the proper clinical supervision, though?
Speaker 2:Yeah, that'd be pretty tough. They don't let you into the operating room without credentials.
Speaker 3:Yeah.
Speaker 2:You know I make every attempt to go to the bathroom before every single surgery, just in case that I feel the need to go. But I will say I have been in a 10-hour surgery and I did not leave to go to the bathroom that whole time. It's a matter of pride among surgeons to not go out and scrub out to go to the bathroom. So in the surgical community if you had to leave to go to the bathroom you were considered weak, at least in residency, and you were made fun of relentlessly.
Speaker 3:I feel very badly for people who have bladder incontinence, perhaps older individuals or pregnant individuals.
Speaker 2:Yeah, I can imagine being pregnant as a surgeon would be pretty difficult and I know many women who have operated while pregnant and they're able to do it. You know there's always jokes about putting in a catheter while you're in surgery or something along those lines, and there's the jokes about adult diapers. I've never seen anyone actually do it, Um, but I will you know if they were doing it.
Speaker 2:I think that I diaper. No, I guess I wouldn't know. But the catheter I think I would know, I think I would. But we, I mean we joke about it. But if you absolutely have to, if it's going to be an emergency, a lot of times you can you can leave the operating room and go to the bathroom and come back, but you just have to re-scrub, re-gown, go through this whole thing. And if the patient is in critical condition during some key portion of the procedure, where things are very tenuous or serious and have to have and they can't take time away from the the doctor can't take time away from that situation. You can't go, you have to, you have to stay. So there and there are some rules on there has to be a doctor in the room and certain operating rooms. So whether that be an anesthesiologist versus the surgeon, I mean there's different rules different hospitals.
Speaker 3:But I can tell you I don't know that I've ever left the operating room to go to the bathroom. What about if you were a lowly med student or resident and you had a horrible stomach virus?
Speaker 2:There's probably some stories you don't want to hear about. Yep, actually, again, as the this whole, like I'm a surgeon and I'm tough, I'm not going to. Like I'm not going to cave under the pressure. I actually knew a general surgeon he was the chief surgeon, chief resident surgeon on the service and he had a stomach virus, uh, and he came in. He'd be in surgery, he would scrub out to go throw up, clean up again and then come back and that's the culture that used to exist in surgical fields. Like you don't leave for anything. Uh, it's softened up a bit. Since COVID, as you can imagine, people have been like yeah, you're sick, stay home, it's, it's, it's actually softened up the culture, but there's pretty extreme stories of people doing things like that.
Speaker 3:Yeah, surgeons are some pretty extreme people.
Speaker 2:They sure can be. I'm not saying I recommend that, by the way, if you Surgeons are some pretty extreme people, they sure can be. I'm not saying I recommend that, by the way, if you have a stomach flu. I think you should probably cancel your surgeries for the day, all right.
Speaker 3:Well, along that line, you talked a little bit about scrubbing in, so I want to understand better something I think you've referred to as the sterile field. I hear you complain a lot when we're watching medical dramas and somebody is maybe putting on their own mask after they've put on their their gloves, and you seem upset by that.
Speaker 2:Yeah, that's well. It just doesn't make any sense. You know it doesn't. I try not to get worked up about it, but it doesn't make any sense. So if you have scrubbed your fingers to your elbows, you know you've taken a scrub brush with soap and it's all and you're all clean. Or there's sanitizing solutions that we use as well. That's not necessarily soap, but it's a sanitizing solution. Your hands and arms are clean and you put on your mask, they're they're no longer clean. Or if you're wearing sterile gloves and you touch your mask, you're no longer sterile. So it's. It's just not a appropriate attention to detail.
Speaker 3:So who puts on your mask for you?
Speaker 2:Well, I put on the mask before I go in the room, before I scrub. I have seen actually I was just watching ER, the old, the old show, er and there was a scene where Carter, kind of the main protagonist, med student, although he's a resident at this point, scrubs in and someone does come and tie his mask behind his head for him, which which could be a thing too. He did not put the mask on himself, which was really good attention to detail. And that show probably one of the most realistic medical shows I've ever seen. So they do a pretty good job of the detail. But I always have my cap and my mask on before I scrub in and then I go into the operating room.
Speaker 3:Okay, then Well, is there like a dedicated person who scratches your nose for you?
Speaker 2:Yeah, that's called the orthopedic sales rep. No, if you have to scratch your nose, you can't. I mean you can't. I don't think I would ever put anyone through that, having to do that. But I will say that if I get a sweaty brow I will have someone dab me.
Speaker 3:Like dab.
Speaker 2:No, just take a towel and put it on my forehead to wipe up the sweat, because you can't really do that on your own either. I mean, there's a way you can do it, but it's just better to have someone else do it.
Speaker 3:I would scratch your nose for you.
Speaker 2:That's because you love me. That's true love. Right there I do yeah. Yeah, I haven't asked anyone else to do it, I just try to tough it, tough it out, just like that's the surgeon way.
Speaker 3:Well, I've also heard you talk about, regale me with many stories of your surgeries and generally you talk about how you have a field where you're allowed to move and what I imagine is this giant man who essentially is a t-rex uh, where you kind of go in the t-rex mode and you like can't move your hands, like like above your chin or below your chest or something yeah, you're close.
Speaker 2:so kind of the general rule of thumb is that you keep your hands not going above your chest and not below your waist and you sort of keep them in this zone so you don't reach down and touch something that's not sterile. Or you don't reach up and touch something that's not sterile and then also you're further away from your breathing, even though it is covered by a mask of bacteria that's coming out of your nose and your mouth.
Speaker 3:So we're just going to call that the T-Rex zone that's coming out of your nose and your mouth.
Speaker 2:So we're just going to call that the t-rex zone. Well, you do sort of have to stand like this, or even like I'll even find myself sometimes, when I'm not in the operating room, like just sort of holding my hands here because it's it's instinct to not let them hang when you're operating.
Speaker 3:So, yeah, I mean that that that is a thing well, we had another great question from a young lady and she was asking do you actually have to break any bones while you're in surgery? Yeah, this one.
Speaker 2:I've gotten a lot before and my understanding is that there's probably medical TV shows out there that are depicting orthopedic surgeons literally just like grabbing bones and snapping them or things like that. That doesn't really happen. That doesn't really happen. What I will say is more reminiscent to that is when a person breaks their arm and say the let's say, the forearm. The bones are like this and then they fall off and are displaced and angulated and I'll have them go into sedation. I'm literally pulling on the bones and putting them back into place and putting a cast on them. That's more reminiscent of what that looks like. Although the bones are already broken, I'm just setting the bone and putting a cast on that. It looks like, although the bone's already broken, I'm just setting the bone and putting a cast on. It can look kind of appalling when you do it.
Speaker 3:In fact, I get a lot of like oohs and ahs and like when I do it, when people are watching Interesting.
Speaker 2:But when we're talking about bones that have, say, healed in the wrong position, that's something we call a malunion. And when we go into surgery to correct the malunion meaning we need to break the bone and put it into a better position it's done much more precisely than just snapping the bone in half. It's usually done with a combination of power saws and chisels to break away that bone in a very precise manner. If you were just to grab it and snap it, it could. I mean, imagine a piece of broken glass it shatters in all directions, right, it's not at all controlled. And then you're dealing with a much bigger problem. Sometimes you have partial healing, called a non-union, where it hasn't healed all the way and it's just lots of scar tissue. And then that's probably the little bit less precise where we're just sort of pulling away this sort of poor quality bone and just cutting it away. But it's never really a snap.
Speaker 3:I have a question about some of your terminology. Should I, as a layperson, ever be offended if an orthopedic surgeon says I have a poor quality bone and or if my bone is unremarkable?
Speaker 2:That's a great question. I remember when you first saw an x-ray report of something of yours that said unremarkable study, and unremarkable is what you want to be in medicine. If you're remarkable, that means like, oh hey, let's talk about this. Or if a doctor ever calls in a bunch of other students and says, hey, come, look at this, that's a bad sign. So no, you want to be unremarkable. When we're talking about poor quality bone, sometimes we're talking about osteoporosis, people with osteoporosis who have low bone density. Sometimes we're talking about this what we call a fibrous non-union, where the type of tissue that your body is using to fill in a fracture is not ideal, and I don't want to go into too much detail because there's different ways to describe this type of tissue and different terminologies for how the bone doesn't heal, and I don't want to get too much into the nitty gritty, but that's sometimes what we're referring to. It's not personal. Sometimes you're just your body's just not making the right stuff.
Speaker 3:So another question, interesting question we got was have you as a surgeon, or have you ever known a surgeon to leave a tool behind in the wound? Maybe it gets closed in there like a sponge or something.
Speaker 2:Yeah, that's a great question. I think that's also been depicted in television a lot and personally, no, I've never left anything in the wound, and we've become very, very innovative on ways to make sure that we don't leave anything in the wound. So all of the surgical sponges we use to help soak up blood and fluid and other things, they all have little metallic thread inside it so that if there were something to be left behind, you could get an x-ray and see it. So it's not just a cloth that doesn't show up on x-ray that's actually pretty cool that's pretty cool.
Speaker 2:More importantly, though, we actually have a very complicated counting system where, anytime a package of sponges gets opened up, they have to be counted very meticulously by the staff two people counting back and forth, confirming that they agree that, yes, I opened up 10 sponges. The other person's like yes, 10 sponges. At the end of the surgery, both sets of people count. To make sure that all the sponges are accounted for Same, for any needle that was opened, any suture needle that were opened, there has to be an equal and agreed upon count. Some systems are so elaborate that there's even a QR code on every single sponge and they get scanned and put in this slot to make sure that they're absolutely accounted for.
Speaker 3:I feel like you have to be in a rich hospital for that.
Speaker 2:Yeah, I mean, it's becoming really what drives it is. A lot of times it's regulation. The government says, okay, this is the new standard and you have to do this, but there's a big system in place for this. So personally, I've never lost anything in the wound, but it does still happen to people even with this system in place. But you can feel a little bit rest assured that there is a system in place to make sure it doesn't happen.
Speaker 2:So, just as a quick summary and wrap up of the episode, we talked about seasonal affective disorder and some of the strategies that you can use to try to battle it and lower the severity of your symptoms. Get early light exposure, get outside, do some exercise, maybe supplement with some vitamin D, maybe a little bit of cognitive behavioral therapy and, if you absolutely have to, you can see your primary care doctor or a psychiatrist and discuss possibility of doing a serotonin reuptake inhibitor. We also talked about video games and how they can make you a better surgeon. So get out there and get on your Xbox and PlayStation or PC if you're that guy.
Speaker 3:Or a Nintendo Switch.
Speaker 2:Or a Nintendo Switch Sorry, I forgot about the Mario Kart and we answered some of your questions from the audience on the life of the doctor and some of the strange idiosyncrasies that we have to deal with, so keep those questions coming. If you can think of something that you would like asked, I would love to hear and we'd love to get back to you on it, as always. Thank you so much for tuning in, nicole. Thanks for being here with me. I love doing this podcast with you.
Speaker 3:Back at you, Doc with me.
Speaker 2:I love doing this podcast with you. Back at you, doc, and remember be happy, be humble and be healthy. We'll see you next week.
