Ep. 20 | Brian Pisula, MD, Emergency Medicine

Transcript

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- Welcome to another episode of What Brings You in Today.

- I'm Erika Bennett.

- And I'm Taylor Fisher.

- And we just wanna thank everyone for tuning in to the What Brings You In Today podcast. If you haven't already, please like and subscribe

- And if you have any questions or topics you would like to see us talk about, you can submit those at sgmc.org/podcast.

- Perfect. So today we're here with Brian Sula, MD with Emergency Medicine. So Dr. Sula, what brings you in today.

- I came in talk about some of the things that can bring people into the emergency department, as well as some of the things that people can do in their own lives every day to try to avoid having to come see us.

- Beautiful, beautiful. Before we get to those, tell us a little bit about your journey, your history, how you became a physician, and then how you landed here.

- Sure. So I grew up in rural central Wisconsin, more cows than people and ended up going to college in Madison and then went to medical school out in New York where I met my wife and we trained at UNC Chapel Hill in North Carolina. Practiced out there for a few years and then decided to move our way on down to Valdosta, Georgia. So we love it here. We like working, I love working in the emergency department. It's a great place to live and raise a family.

- So, fun fact, we may have more cows here than you do in Wisconsin. And I have indeed hit a pregnant cow before with my car on

- Like you hit a pregnant cow,

- Wrecked a car going 55 miles an hour. 'cause you can't see it on rural roads that don't have lights.

- Yeah.

- If they're black, they blend in.

- Yeah.

- With a road until about, you know, until you're just a few feet away, you can see the outline. And it was pregnant about to deliver. So I didn't just hit one cow. The owner did let us know I killed two cows. It was very sad, but luckily nobody was injured

- Except the cow. It's

- A fun story. I had to tell that story whenever it came because not many people have done that. So anyways. Very beautiful. And I could have landed in the emergency room luckily.

- But you didn't,

- Airbags were, were working. Yeah. So tell us about emergency medicine.

- So emergency medicine's a field where we can take care of anybody from the time that they're a baby to the time they're a hundred plus years old for virtually anything that they can come into the emergency department for. Most of the time people come in for acute complaints, something that is new today that's been bothering them, but sometimes people don't have good access to primary care, or even if they do, they've had a problem that's been going on for a while, say like back pain maybe for months and it's just gotten a lot worse today. And so they come into the ER to make sure that nothing worse is going on or just to get some relief from what they're going through.

- I feel like I've seen a lot of pictures with you holding babies.

- Yes. - Yes. Because we get a lot of good compliments and patient reviews from when you've treated their child, which you have. Yeah. Several

- Children. Yeah. I have four kids.

- Okay. - My oldest is nine and my youngest is four. We had four. Four and under at one point. 'cause we're those kind of people you

- And Dr. Sal Yeah.

- Can

- Be best friends. He was here earlier today, but yeah. All right. Healthy habits. The reason we asked you to be on this show is because you did a presentation for us about a year ago for our young professionals group, just kind of educating the public on how they can become healthier, live a little bit healthier lifestyle and why they would want to do that. Yeah. So get us started with that.

- Sure. So I think that, you know, the general theme of what I want to talk about today is that you have a lot more control over your health in most situations than many people realize. Generally, I tell patients that if you don't smoke, you don't drink alcohol to excess, you eat a relatively health diet, most of the time you exercise to a moderate intensity. And we'll talk about that a little bit more later. At least four to five times a week. Get a reasonable amount of sleep most nights. And you have some close social family connections and you avoid becoming overweight. It is very, very likely that you will live well into your eighties and in pretty good health. If you don't do those things or you let one or more of those domains start to break down, that's when we start to see people having really significant health problems at a much younger age than they ought to. So people in their forties having medical problems that we really ought not be seeing until you're into your sixties or seventies. And of course there are circumstances where people are just outright unlucky. Right. If you're, you know, a man in their twenties, I had this not that many years ago, a man who is only in his mid twenties, I diagnosed with stage four pancreatic cancer. Right. There's no way he's gonna marathon that away unfortunately. Right, right. He could do all the right things, but at the end of the day there are occasional situations, but that's rare. It's important to emphasize that what happened to him or those rare circumstances where somebody gets something like that. Many of those other medical problems were to some degree preventable when we're seeing people in their forties having things like heart attacks.

- You gave the healthy, or the analogy of the two Oreo

- Thing?

- Yes.

- Yeah.

- Tell us that.

- Yeah, so it was

- A sad, it was a sad story. Yeah. Story about an Oreo. Well you've already some stories about cows. It's sad if you like Oreos.

- Yeah, well 'cause Oreos are delicious and so they're like my, they're, I think they're one of those, the foods that's universally enjoyed, right? Yeah. Like most people really enjoy an Oreo cookie. And so the whole point of this is to just kind of emphasize that a lot of times when people are trying to lose weight and they're trying to eat healthily, they get into this mindset of, I have to be hungry. I have to be kind of starving myself when in reality they just need to make better food choices. And I kind of make the example of Oreo cookies versus apples. So each Oreo cookie has 70 calories roughly. So, and a serving size of Oreos is two Oreo cookies and that's about 140 calories. The thing is though, that's also the same as two medium sized apples. So if you were to visualize this, or you could do it in your own home, you can take two Oreo cookies and set them in a bowl and then you can get two medium sized apples and cut them up into slices and set them into another bowl and understand that clearly there's a lot more food in one bowl than the other bowl. But it's the same amount of energy, which is just all a calorie is is a unit in physics of energy. So there's the same amount of energy in both these bowls, but this bowl of apples I'm gonna be eating for probably 20 minutes. Right. And it's got fiber in it, it's gonna make me feel a lot more full. It's got some water in it, so it's gonna hydrate me as well. And so, and it's also got some nice sweetness to it, so maybe it'll kind of help with that craving too. Whereas the Oreo cookies, you're gonna eat those and you're just gonna want more. And it's very, I think rare for most of us to be able to just have two of those. I joke with people like doing a line of Oreos, right? Like you don't have two, you do like 12.

- I told you this was a sad story. Yeah.

- I

- Don't really like Oreos. Oh

- Well you could make it any example you want. So another good example I tell people is to just take your like favorite boxed snack food. Like what would be, do you have an example of like a, a boxed food that you enjoy or a snack

- Food you enjoy? Not much. Not much of a snacker.

- Yeah.

- Really.

- Well see, this is something you don't have to worry about then because these things don't appeal to

- You. You don't have to worry about this section. I like cereal. I guess cereal's

- A pretty good example too. 'cause cereals are deceptive and they're marketing, they'll mark themselves as being healthful when the vast majority of them aren't.

- I don't even try to eat the healthy ones. If I'm eating cereal, I just go for it. You might as well go for the the ones, you as kids

- Way it out. That's the thing I always tell people because then you'll see how little you get when you see the serving sides. Like most of us think a serving of cereal is a cereal bowl.

- Yes. It's like a cup.

- It, yeah, it's not a cereal bowl. It's like a third of that cereal

- Bowl.

- And so when you fill up that whole cereal bowl with fruity pebbles or something else like that, it, it's much closer to like four or 500 calories. Not the 130 or one 40 calories that's on the back of the box. And most people, I mean I don't expect most people to take a scale and weigh out their food, but sometimes it's informative to do that just once to visually see what, what does a serving of this actually look like? And is that how much I actually typically portion for myself. And when I'm thinking, oh, you know, I'm only having a light snack when I'm reality, perhaps you're having a lot more than a light snack.

- Yeah. So it's like switching out the foods for things that if you feel like you need to have more, you can have more of.

- Yes. Yeah. 'cause if you're, if you're hungry right, you're very likely to have difficulty being successful long term in a desire to lose weight or just kind

- Of over just like binge eat. Like Yeah.

- Yeah. Especially if you get into that weak spot where you've been doing good Yeah. But you've been hungry for weeks and then you have a bay where you just don't sleep enough. Or maybe work was super stressful or your kids are just being difficult today and all of a sudden you've eaten like a tub of ice cream and that's a, a kind of an effect. Like a relapse. Yeah. If you will. And so a lot of times avoiding being in that stage where you feel so deprived all the time is really important because you don't want to end up having a situation where you end up just undoing like everything you

- Did right.

- For two weeks by having one day where, and you really can do that where you just eat really aggressively

- On that day. This must have be been why your talk impacted me so much last time. 'cause I feel like you're talking to me.

- Yeah, well

- Get back out there. Yeah. As far as exercise, well first of all, still on the food I've heard before, like drinking water before you eat could be helpful because it just helps get, is that accurate or

- Yeah. Being hydrated or just in general If you're hungry, a good idea is like if you're hungry and you're not, you're trying, it's like not time for you to eat right now is to just have a large glass of water and see if that does anything that, that's one of those pieces of advice that can often seem very glib. But it really isn't. If you take a big, especially like a nice cold glass of water and drink that and give yourself like 30 minutes, a lot of times you'll find that that intense kind of hunger sensation that you just had actually fades off pretty easily. Especially if you want to add like some kind of flavoring or something to the water. Yeah. For some people that makes 'em feel like they're having something more. So like things like crystal light or meal, anything that's a sugar free option is gonna be a good thing. You can add,

- There's a protein, some type of protein, I don't, I can't remember what it's called, but I get it from the nutrition, you know, GNC type place. But it's one that you can mix with water instead of milk and it's very low calorie. And I have found that if I put that and do that in a water in the morning with like a light bar, I'm much like less likely to get hungry before lunch.

- Yep.

- So protein, what's the importance of protein in a diet?

- Yeah, so protein's your most important macronutrient for a lot of reasons. One is that it's the most satiating. So you'll hear me use this term a few times. So you want bang for buck, right? So if I'm going to eat, and we were just talking about this with apples, which actually don't have protein in them at all. But it's more of the visualization of how much food can you get and how full can you get for those amount of calories. So protein hands down is gonna make you feel the most full for the least amount of calories. So if you can have high protein density foods in all of your meals, you are much more likely to continue to feel full for an extended duration after you eat. Whereas if your meal is heavy in fats, so the least satiating. So even though carbs get a really bad wrap, fats actually fill you up the least for the most amount of calories.

- Hmm.

- So a really good example there would be peanut butter. So peanut butter is often kind of projected as being this super healthful food. There's nothing inherently wrong with peanut butter. I occasionally will eat peanut butter. It's just important to understand that peanut butter is really high calorie density. So two tablespoons of peanut butter, which again, if you measure out two table spoons of peanut butter, it's not as much as you're probably thinking it is, is 190 to 200 calories. It's most, it's main macronutrient is fat. And so you're unlikely to feel very full from eating two tablespoons of peanut butter. Whereas if you flip that and you say, what can I get for 190 calories that's got a lot of protein in it, you could get like two cups of cottage cheese for that and that would give you about 30 grams of protein. You get two cups of yogurt again for about the same, you know, if it's a light yogurt you could get about another, again 25 grams of protein and that's gonna fill you up for a lot

- Longer are nuts in general, like higher in fat.

- Okay. Nuts are just high fat density and they're gonna again be low

- Satie. But they're also marketed as being very healthy.

- Yes. So I will see people and that's the thing so we can tell. So

- You can't trust marketing?

- No. No. Okay. You gonna separate job. Definitely. You know, that's the thing. There's lots of, so, so this is America. I love America, I love capitalism. And the idea that that companies are gonna market themselves in a way that's gonna get people to buy their products. That's way our society works. I don't have a problem with that inherently, but people have to understand that lots of things are gonna be marketed to you from the best possible angle. Right.

- Okay.

- So for nuts for example, you know, I'll see people, you know, getting bags of un you know, unsalted almonds and I know that almost universally they're like, yeah, this is a good health snack. And every time I see that I'm like, that's a really high calorie density snack that doesn't really fill you up very much. Right. And if you get like a little bag of almonds and you, you know, just kind of munch on that throughout the day, that's actually probably way more calories than you think it is. And it's probably not doing a whole lot to make you actually feel full. You'd probably be a lot better off by just having like a meal that's got some decent protein in it. Like either, you know, a dairy based protein, chicken is a really good protein, eggs, fish products or great protein. Any of those things where you're gonna just be better served going for a proper meal.

- Are you big all the eater? 'cause your face right now is just so

- I, I eat but no, my face is like this because my next question, which we already know, you already know this, y'all already know this Celsius. What? Tell me

- Nothing wrong with it.

- Okay. Whew.

- Yeah, it's all just

- Because I see, first of all, I'm not the only one addicted to Celsius because I see everybody in this world like always have a Celsius. They really do give like a clear energy to me. Yeah. That's not like a Red Bull or whatever and it's low calorie. But I worry there's gotta be something like

- No

- Crazy in there. But they do market. Yeah. So they, the one, the reason I mentioned them is 'cause they're marketing is like live fit. Yep. You know, no artificial whatever, all these little things and you increases your metabolism. And so I did do a little research and like inherently if you have more energy, you know you're more likely to move and stuff. But it doesn't necessarily in and of

- Itself no.

- Provide those benefits.

- So it's kind of

- A weird marketing thing.

- Everything that they're listing there is, caffeine's

- Actually thought it was a good drink for you and I didn't realize it was an energy drink for like a couple weeks.

- Yeah. It's just, it's just an energy drink. The the they market, a lot of that is because they derive the caffeine from green tea. And so, which I don't know that it really matters where you're deriving caffeine is just a chemical. Okay. At the end of the day, you know, again things like Celsius, all the rest of 'em, it's important to emphasize that these aren't gonna be the thing that makes you

- Lose weight. Right? Yeah. Or anything else. It's not,

- It's just more of it's you and you wanna be careful with your caffeine consumption too. You don't really want to have, for most people about 400 milligrams of caffeine is pretty much what you should be having in a day. So that'd be like two Celsius in a day or like, you know, a big cup of coffee and a Celsius in a day. That, that's about it. And generally speaking, if you keep a normal schedule, you shouldn't drink caffeine after four o'clock in the afternoon. 'cause you should be trying to get to sleep at a reasonable hour. So if you're having, you know, caffeine late in the day, you might have trouble sleeping at night.

- Good segue. Sleep.

- Yes.

- I was just about to say my favorite snack is a banana. Is there anything negative about bananas?

- Yes. Yeah. The only thing in negative I'll table about bananas. Yeah. So, so not all fruits are super great for you. So some fruits are relatively similar to candy effectively. So

- Banana, that's why I like 'em so much. I guess they give you like a natural like high and then you like

- Yes. So bananas are one of those fruits that is really, really high and it's sugar content pretty low in its fiber content and it's actually high calorie density fruit. So if you were to pick like the fruits that are absolutely the best for you, it's gonna be the berries. So blackberries, raspberries, strawberries,

- I don't like them.

- Yeah. Those are the best. They're low calorie density. And

- There's though like, ugh, it's a texture thing. Bananas one of the only fruits I can

- Tolerate. Yeah. Yeah. And which again, it's totally fine if you, if you know what it is for. Yeah. But things like grapes are not, again, not super great. Yeah. Super high sugar content, not much in the way of fiber. And then a lot of your citrus fruits are me your, like your tropical fruits. So things like papaya, mango, and pineapple likewise fall into the category of really high sugar content. Relatively low fiber content.

- What about watermelon?

- Great.

- Lots of water.

- All the melons are actually pretty great to your, your cantaloupe watermelon. Okay. Again, you're looking for a fruit that has a lot of density for low calorie I feel like for a very long time. This is a concept that I wanna make sure I emphasize. For a long time I did not understand why, why are vegetables and fruits like quote unquote good for you? Like where does this come from? And for a long time and I think for a lot of people the idea is still, well you know, like you need your vitamins and minerals. Yeah. Like that's not it at all. That's not it. Even kind of, you can get all all that. See

- That's weird 'cause I, I do think you're, I do think you're getting like vitamins from your fruit.

- Yeah. I mean you do get some but that's like not the main reason not Okay. The main reason is satiety. It's the, it's food. You're getting lots of food for almost nothing. Gotcha. Right. So like when you think of like a salad, like why is a salad a good option? Because assuming that it's a actual decent salad where we've got like spinach or like, like dense leafy greens, we've got tomatoes, we've got, you know, cucumbers, peppers, onions, we've got all the good vegetables in there. Maybe we've put some baked or grilled chicken on there and then we use like a light vinegarette or a honey mustard and we're not putting a heavy fatty dressing on that. When you put that all on a scale, if you were to look at it, you can get this huge, huge quantity of food for very little in the way of calories. And it's gonna take you like 30 to 40 minutes to eat through that. That's why it's good for you. It's the same thing with like broccoli and cauliflower and all the big, what we call the confers vegetables, Brussels sprouts, they all kind of fall into that same family. You get a ton of food for very little in the way of calories and you also get a ton of fill for very little calories. And so I think a lot of it gets lost in the conversation in the United States about weight loss is it's, it should all just be about what can make you feel full and satisfied. Not like I'm starving give you good nutrition and keep you going.

- Is it, how much of it is mental like mind ever matter? Like you feel like if you're eating, you know, something that's smaller but more delicious. I mean like, like I know you really get full from that but you're not satisfied maybe in your 'cause you're like craving something

- Else. Yeah. So I think that you shouldn't ever, I'm not a big fan of restrictive diets that don't

- Allow you to eat. Yeah. That I do remember you talking about that too.

- Anything ever, you know like I think I've joked about like keto is one of my punching bags. I hate the keto diet. It first of all has no scientific evidence that it's superior to any other

- Form of calic. It does work. I did it for like two weeks and I definitely lost some weight but

- Yeah

- I did also then woo

- Yes.

- You know, killed it and gained it all that

- So whatever. Yeah. So that's what happens with keto more often than any other diet is. You're right. It is effective when people are on it. Because when you think about what keto does is it blocks you out from most carbohydrates.

- Yeah. - Which is going to be most of the snack foods, which then translates to most of those high calorie density foods that people eat. So yeah, of course if you say, oh I can't eat any of that and I'm just gonna be focused entirely on proteins, effectively yes you're going to lose weight because you're gonna be calorie restricting. Right. Is what you're actually doing. So the problem I have with it though is to say

- It's very hard to,

- I gonna eat sugar. I'm never gonna eat chips, I'm never gonna eat a piece of bread, I'm never gonna have a pancake. Like That's not very realistic for the rest of your life. And so I would much rather that people have a diet that says I can eat whatever I want. It's just, I choose most times, more often than not to have my diet be mostly vegetables, fruits, and high protein meats and dairy products. And I rarely enjoy things that are coming in boxes or bags like cookies, crackers, and cereals. I very rarely go out to eat fast food or sit in a restaurant and I rarely eat dessert items. If that's your general diet, you're almost certainly not gonna have a problem with weight

- Issues. Gotcha. And portion control is very important because portions we get served usually at restaurants are like huge, way bigger than what we're supposed to

- Have. Yeah. I think a good thing too, another good piece of advice I've heard is to ask yourself why you're eating something when you're eating it. Right. So our can, the emergency department people can sometimes be super grateful to us and we appreciate that. So we often are shower with baked goods all the time, like every day. And so it can be, you know, nine o'clock in the morning and there's a red velvet cake that's being sliced up and eaten. And people are like, do you want a piece? I'm like, absolutely not. I don't want a piece. It's not, 'cause I don't like red vet cake. I do. It's just, it's nine o'clock in the morning and I have no reason to be eating a piece of cake right now. And I think that that's part of what's happened. You're so smart. Like, but it's, but when you think about it, okay, so like for our, perhaps our That's so true. Like our older listeners. Okay. If you go back like 50, 60 years Right. Things like that just were not readily available 'cause we didn't have as many resources. Right. If we talked to our grandparents, right. Cakes, cookies, pies. These were things that were reserved for really special occasions. It's somebody's birthday, it's Thanksgiving, it's Christmas. You would never just get to have a cake for no reason in the middle of the day in like the 1950s, 1960s. It, it would be very odd to do that now. Those kind of items that were really have for a very long time been reserved for a special occasion where something sweet and fatty and it's meant to be a celebration has been like it's 9:00 AM on a Tuesday. Yeah. For no reason.

- We're at all convenient. We're celebr celebrating every day. We live a very, you know

- Yes - Pri privileged life in that we have access to so much more than you did back in the day. Right. Those people are like, which

- Is not good. It's 9:00 AM we have no idea what time it is. We've been here all night. Yes. We're just gonna eat some cake 'cause we're exhausted. I'm working the night shift. This is technically celebration celebrating. I made it through the emergency department.

- So it's wonderful that we have those resources, but it does come back to start to bite us in terms of our health. Because you will see if you, you can Google this online. Our life expectancy in the United States is falling. And it has been falling since about 2016 is when we started to actually have a decrease. Which means that our generation is at risk for being the first generation in American history. That's not gonna live as long as our parents did. Wow. And that makes no sense. Right. Because our medical treatments are much better. We smoke at much lower frequencies. Our rates of drinking are much lower, our cars are much safer. Despite what the media will tell you, our, our violent crime is the lowest it's been since the early 1970s. And so none of those things are that make any sense. We should have a higher life expectancy. And this is even before, even if you exclude out the opiate crisis. And then far before COVID-19, we still had a falling life expectancy. The only thing that accounts for that is obesity as well as the sedentary lifestyle.

- So let's talk about exercise real quick. Yeah. So we never talked about either. I know we gotta hit one days real quick. We don't have a lot of time. Importance of sleep with your health and then we'll go into exercise real

- Quick. Sure. Yeah. So sleep, I mean this is one I'm not great at. I mean, I try to get at minimum six hours of sleep a night. I think that most of the research indicates that there's almost nobody who can function on less than six hours a day. So there are people who say I can, there are some people who truly can, but the way I've heard it phrased is if you, the, the percentage of people that can function on less than six hours of night and of sleep and have optimal performance if rounded to a whole number is 0%.

- Okay.

- Now there are decimal, in other words, decimal points of percent of the population can function without any impairment at less than six hours. So pretty much all of us need six hours or more. You probably at about seven hours are good to go. Eight hours is probably unrealistic for most people and probably isn't required for

- Not for care Hope.

- Yeah.

- She likes 12 hours.

- Wow.

- And her apple watch proves

- It. Yeah. So,

- But it does, I mean there's a restorative aspect to sleep. It's not just, I mean, your body does stuff while you sleep that's imperative to your health.

- Of course. Yeah. I mean you'll die if you don't sleep. Yeah. Eventually. Yeah. It, it's required. We don't know exactly why.

- Yeah.

- But we do know that eventually sep sleep deprivation results and death at an extreme. So you do have to sleep. Your body absolutely needs it. It's also essential for weight loss by the way. So first of all, when you're sleeping, you're not eating. Second of all, it's important to recognize that when you rest, it allows your body to regrow and build muscle and kind of get everything back in line. So if you're not sleeping, the ability to like wake up and be ready to go, keep go and start to do workout and making good choices. Right. During the day, if you're sleep deprived, you're much more likely I can speak for myself much, much more likely to, to make bad choices. Like with my food

- Sugar.

- Yeah, yeah,

- Yeah. So it, it impacts a lot of things.

- Alright. Onto exercise real quick.

- Yep. - What do you, we haven't talked about exercise.

- Not yet.

- Okay. What do you recommend for, how do you, how do you tell get, encourage someone to get

- Sure.

- Moving?

- Well, so first of all, I'll tell you that exercise is one of the most important things you can do to prevent landing in the emergency department from a preventable illness. There is such a thing, a phrase, if you've heard of skinny fat before. I always bring this up because there is a fair body of literature that says that even if you are not overweight, if you are sedentary, you still have a significantly increased risk of mortality in other was dying at a younger age than people who exercise regularly. So just because somebody does not have a weight issue doesn't mean that they aren't higher risk from lack of physical activity. Second of all, the, the biggest single tip I can give somebody for exercise is if you can find something that you enjoy, you are going to stick with it. So if when you're heading off to do whatever it is your is and you are dreading it, you are gonna have a very high likelihood that you're gonna end up discontinuing that program. But if you can find something that, I love this, I'm so excited to go do this, be it, you know, for me, my very favorite thing is hiking. There's not a lot of hiking in South Georgia. But when I do get the opportunity to do that, that's one of those exercises that I don't feel like I'm exercising at all. Yeah. I like to go to CrossFit. My whole family goes to CrossFit winterville, we enjoy that because A, we do it together as a family. And B, it's kind of like a community. It's kinda like a church where you get together, you know, people, there's some accountability. If you don't show up, people text you, where are you? What's going on? Like are you okay? So that, that is nice. And then other people are kind of suffering along with you, which makes it a little bit more tolerable.

- That's, I go to Orangetheory and I feel the same way. I am like, oh my, if she can do it, I can do it. Yes. Like we gotta do it because it'll, I mean there's all ages, there's all fitness levels. Yes. I mean, I think a lot of times people are just like so hard on themselves that they down themselves into not having the confidence to go into a gym. Yeah. Having the confidence to go try a workout because they're just nervous about

- It. Yeah. Yeah. And I think that can be a barrier to going to a gym too. And so if that's you, I mean you don't have to go to a gym

- Yeah.

- To work out, you know, and a lot of times you can get exercise just in really bland, boring, every part day parts of your life.

- You - Can walk the stairs, walk right, or walk. Just walk. Yeah. Right. All the time. Like even if you don't need to be walking, like there's nothing to stop you from in the evening. Right. It's, it's summer in South Georgia, but like by seven o'clock, it's quite nice outside. So get out of your house and just go for like a one mile walk for no reason. You're not going anywhere. You can go at whatever pace you want to and then you can gradually increase that distance. If you have joint problems or knee problems, maybe a walk isn't a thing for you. You can get a stationary bicycle that you can even like sit in your chair and do like the little pedals. Ellipticals tend to be softer on the knees. If you have access to a community pool, you could do gentle laps in your pool. There's lots of options to get exercise. But if you find something that you don't hate while you're doing it and that you can take under your own power and decide to do it when you want to do it, I think you're much more likely to be successful in the long term. And then if you can find somebody to do it along with you.

- So yeah. That accountability aspect

- Aspect.

- Yeah.

- Walking your dog.

- Yes.

- My dog loves to walk.

- Yes. - I think my watch is also detected and exercise and I was doing some vigorous vacuuming. Yes. In the house.

- Yeah. Housework burns. Yep. Housework. Gardening. Clean.

- Clean up your housework.

- Yeah.

- Yard work, definitely. My husband makes me go do yard work with him sometimes. So

- Yeah, it can be a really good exercise. We call that. It's like the terms called neat, it's non-exercise, calorie burning basically. And so that's just things like Exactly describing, you know, housework, cooking, being up and moving around. Right. The real dangers when you're just sitting

- All day. Well and think about like DoorDash and you think about, you know, how you can get your groceries delivered now and so many things that you used to have to get out and be more active. And it's some catered to you like

- It's - Probably gonna get worse before it gets better.

- Oh yeah.

- In our society.

- Well you have to remember, society has changed a lot and our bodies don't evolve quickly like that. So very briefly, like this is a kind of cool thing to think about as well. So fat, our body's ability to store fat is life saving. Right? Right. This is a function that our body has evolved and maintained. And all mammals carry this ability, which is when you have the opportunity to eat, especially high calorie density foods, your brain is going to reward you for eating that because it is preparing for a time of starvation. So it's trying to keep you alive. So for many humans, billions of humans still today, this is still the case where they don't have adequate food all the time. And so tell sometimes they're gonna be in a starvation state. And so our bodies are evolved to encourage us to eat lots when they, we can. That's why foods like cookies and cakes, things that are really high fat and high sugar, high sweetness. Why they taste so good to us is 'cause we're evolved to find, yes, this is a good thing, store extra fat because our body is preparing for that starvation to come. The problem is that now in a very advanced country like the United States, that time of starvation never arrives. So we never end up burning all of that energy that we've stored onto our body. And yet that mechanism that encourages us to eat those foods is not gonna go away. So until we learn

- To, so how do we, how do I get rid of that mechanism? You can't.

- I'm gonna, it's built. It's built into you. So once you recognize that, that's a

- Thing, right? You're more aware of more

- Make better decision decisions. Cogniti of Yeah.

- Yeah. Well when we were talking about sleep, I found this meme that it reminded me too, it says pro tip, the longer you sleep, the less of the day there is to endure.

- Yes.

- A little morbid. But it made, it made me

- Think about that when you said that's the less time there is to eat. I was like, oh my gosh. Unless you're a sleep walker.

- Yeah. Oh yeah. Unless you're, yeah, that'd be really bad.

- I have a friend who has slept walk. I don't think she's eaten, but she did try to bake something.

- Wow. Did did it work out?

- No, no, her, her mom, she was in college. Luckily her mom stopped her. But it was from stress. Stress induced sleepwalking. Oh yeah. Yeah.

- All right. Real quick, we don't have much time, but craziest thing you ever treated or seen in the er?

- Oh God. Oh boy. Let's see. Podcast.

- Appropriate. Yeah. I should have asked you that before so you could have been prepared.

- Probably when I was in medical school we had a, a bus full of, I think they were Mennonites that crashed off of the highway and so it was like over a hundred Mennonites came into the emergency department. Oh my God. In all of like the traditional garb and everything and the whole ER was completely filled. It really weird. Yeah,

- That sounds like a episode of Grey's Anatomy. We were also talking about Grey's Anatomy earlier. That might have

- Happened on Grey's Anatomy at some point. I do remember some, some Amish on Grey's Anatomy.

- Yeah.

- Yeah. But non Mennonites.

- Alright, well listen, we could talk all day, but we do have to wrap it up. Care hopes telling us that. So we will have to have you back on later on. Perfect. Talk more. But go ahead Taylor. Hit 'em with the last question.

- Okay. So we've talked so much about eating. We like to ask our guests what your favorite meal is to eat here. I

- Feel like I already know what it is.

- And the spice or in the cafeteria.

- My favorite meal here at

- The hospital? Yes. That,

- Well, I'll be honest, I rarely get food from the cafeteria, but when I do, I usually hit up the salad bar and just absolutely pack full. A big salad with the grilled chicken on top. That's usually what

- I go for. Figured you were gonna say salad. Yeah, they do have a really good salad bar though. 'cause you can make it puts everything you can get that variety that you were talking about. Yeah. All this

- Stuff. Yeah.

- So shout out to our food services for giving us good food. Good and healthy food.

- Yeah. That's my favorite by far.

- They also have comfort food, but it's a good, keep it balanced. They lot of comfort food. Keep it balanced.

- They do.

- Alright, well thank you Doctor

- Priscilla for joining us today.

- My pleasure. Yes.

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