The Biggest Health Lie We Keep Telling Ourselves

[00:00:04] Welcome everybody to another episode of the The Health Movement. My name is Derek, I'm your host, certified personal trainer and teacher of over 20 years. I have another awesome guest with us today, but before I introduce him, well, I just want to reiterate that I'm not a doctor. So before you go changing any programming or anything like that, please check with your physician.

[00:00:24] With us today, we have Dr. Ryan Green, who's the Director of Behavioral Health in the Department of Gastroenterology, Hepatology and Nutrition at the Cleveland Clinic. Thank you, Dr. Loop. I appreciate you being on here with us. Hey, no problem. And, you know, you made the comment about, like, make sure you consult your doctor. And I'm a psychologist, so I can't write prescriptions. So people should always talk to their doctor.

[00:00:52] That's a good thing. Yes, definitely, definitely. Well, I feel bad because there's a lot of, like, throughout the years doing this, there's been a lot of good information people have put out there, and I don't want people to be like, all right, that's perfect for me, because it's different for everybody. Oh, yeah.

[00:01:10] What have you found, I guess, just kind of diving into it, when working with people in these areas? What are the different problems that people have, and how do you get them to understand that there is no one-size-fits-all solution to whatever they might be dealing with? Sure. You know, and that's, like, one of those things that I'm really, really passionate about is that personalized treatment, that every one human being is an individual.

[00:01:35] And even in the area that I work in, which is gastroenterology, so I work with a lot of patients who have, like, inflammatory bowel disease, for example, or IBS, or even upper GI disorders, like GERD. It is not the same for every one person who experiences it. So even, like, look at, like, what we consider kind of, like, a quote-unquote biological disease, like inflammatory bowel disease.

[00:02:00] I tell patients all the time, look, if we're talking about a Crohn's disease, in the future, I imagine we're going to be talking about 50 different Crohn's diseases, because you start talking to people about their journey getting there, and there's, like, this one group of people who have always had kind of, like, IBS-T-type symptoms, something major happens, and then they developed IBD, which is inflammatory bowel disease.

[00:02:23] There's another group who, you know, it's like my mom had it, my dad had it, my uncle had it, my grandma had it, and you're like, those are two different, they present the same, but they're two different ways of getting there. And so everybody's treatment should look the exact same. Everybody's life is different, right? The stressors you have in your life and your diet, your background, and it's even getting even crazier now.

[00:02:46] Like, when we start looking at, like, the gut microbiome, you go all the way back to, what was your mom eating before you were conceived, and how much time did you spend outside as a kiddo? And it's just, that's how granular it gets when you start talking about the functioning of a human being. That, it's got to be incredibly difficult for you to kind of solve that puzzle for everybody.

[00:03:10] That takes a good amount of time and a lot of background knowledge, and then the patient themselves has to be knowledgeable. And, I mean, you asked me what I ate, I actually wrote everything down today, but, like, there are definitely days where, like, I couldn't tell you what I had for breakfast. Sure. And that might be vital information for you to help them out. Sure. Well, and this is why I work as part of a team, too. My whole special, like, everything I've done since, my career started, I was a paramedic first.

[00:03:39] I was a 911 paramedic. Oh, wow. For about 12 years. And I saw firsthand, like, the effects of lifestyle and how people were living. You know, we'd walk into the house of someone who happened to have diabetes and they were taking their medications, doing, you know, what their doctor was telling them to do from a medication standpoint. But then their pantry was full of Oreos and Coca-Cola. There's empty beer bottles on the counter. There's an overflowing ashtray. There's a stack of bills for medical care.

[00:04:09] And you're like, it doesn't matter how good the medications are. We're never going to unmedicate this lifestyle. And so I went back and became a health psychologist. And what I found worked when I was going through grad school and I built teams even in grad school was really doing integrated care where you are in the office with the physician and, like, maybe even a dietician, nursing staff, PTs, whoever we can get as part of that team.

[00:04:35] And when you work that way and talk as a team, you get so much more done because we're all coming at it from our own angles. Right. And the physician has all this testing and they have all of this medical background I'm going after. Like, what does this person's life look like from a behavioral standpoint, psychological standpoint? And then our dietician staff, what are they eating and what is their diet look like? And if you got a PT, how much are they moving and everything else?

[00:05:02] And you really get a better picture of what human beings are doing that. And then we have to all work at it together because the understanding of even medicine and illness now is that this is not just this, like, siloed biological thing that everything is affecting everything. So even stress, it changes the physiology and anatomy of a human being's body. Can we talk more about stress?

[00:05:29] And I know that is a very broad discussion. But in terms of how you see stress manifesting in people's physical issues, what sort of things are generally seen when somebody is living a stressful life? Well, there's a problem with stress, too, right? Is that, like, we're all told, like, don't get stressed, which is the worst thing you can say to someone ever. Don't be stressed. Don't worry. Just stop worrying.

[00:05:59] Oh, okay. That's brilliant. Never thought of that one. Which I had to do a lot of that education at first with, like, a lot of my physician colleagues. It's like, I understand you're telling people stress is affecting their medical condition, but stop saying it that way. We have to keep people fooling with stress as opposed to get rid of your stress.

[00:06:20] And I think that's kind of been a shift even in, like, the mental health, behavioral health fields is a shift over from, like, let's do stress management to how do we live with the stress that is part of life. Right? Because a lot of the times the problem comes from fighting with the stress. I don't want to be stressed. And now I'm more stressed about being stressed. Stress. And when you have stress, we can see the changes in the body. You look at, like, the endothelial cells that line the blood vessels.

[00:06:50] They become inflamed. The tight junctions in the gut open up and allow more things to pass into the inner lining of the gut. And so you're looking at this and going, then stress is not just a psychological phenomenon. It's something we all encounter in life. There's no way not to. We've created a world where the lion never walks out of the room, basically, because we always have bills. We always have another thing we have to do at work. Right? Have to take kids to the soccer games or whatever it is.

[00:07:20] And so we have to learn to not fight with the stress as much and then work with the body to bring the body down a little bit. I love that you said that, too. And I started writing down, like, all right, how do you manage stress? And then you immediately went into, no, like, we have to figure out how to live with stress. And I'll talk to some people, you know, that I'm trying to help with make, you know, physical changes, eat better, start working out, that sort of thing. They're like, but I can't do it now.

[00:07:48] I have to wait until things calm down. Like, will you please tell me when that's going to happen? Because it's never going to. I usually say, all right, well, tell me in the last year, when has, when has it not been stressful? And they're like, well, it always is. I'm like, well, okay. So that's life. We need to accept that and then learn how to make it, like, how to live with that stress. So I love that you said that. I hear the same thing all the time. And I say the same thing.

[00:08:15] It's like, have you ever reached a time in your life where it's just been like, nah, it's, ah, there's nothing going on. There's nothing at all for me to worry about whatsoever. I'm completely calm. I make this joke with patients all the time. It's like, look, I've been working with people in one way or another for going on, like, 25 years. No one has ever walked into my office and gone, you know what the problem is, is I don't have enough heart in my life. I need some more heart. Right? We all, that's life. Life is hard.

[00:08:45] And our brain can make it even harder by predicting. And then it'll talk us out of doing things that are helpful to us. You know, and we have to start there, too. That, like, in your world, right? It is not your fault that you belong to a species that until about 150 years ago, movement was not optional. Yeah. And so we developed a brain that goes, why don't you lay down? Because that was more useful in that world.

[00:09:13] And now you never have to get off the couch if you don't want to. You really don't. And it's funny when people say, like, oh, I don't have the energy to work out. And it's like, well, you don't have the energy to work out because you don't work out. But, like, you have to build that momentum. And it's people fight with you about, I just don't have the motivation. And what, 5%, 10% of the time you truly have motivation? It's momentum. You've got to force yourself to get started.

[00:09:41] And then it's easy, you know, because once you get going, once you get moving, it's, you know, it's like starting a book. How often does it sit on the nightstand? But the second you pick it up, you read for an hour and you don't even realize it's gone by. So it's, I mean, so how, what are, do you have suggestions for people that, you know, are having trouble living with stress, things they can do? And I know this is a generic sort of situation. Sure. There's a ton of things we can be doing.

[00:10:09] And most of us know the things that are good for us, right? And most of the things that are good for us will help with stress. Physical activity is a great one. It is probably the least prescribed antidepressant and anxiolytic, so anti-anxiety medication, we have. And it's just as effective if you look at, like, some of the old studies on, like, depression. It was just as effective as Prozac for low to moderate depression.

[00:10:34] And it's like, so why is that not, like, our first thing we're prescribing is get up and, like, let's start walking and doing things. And it is hard for a lot of people. And sometimes we got to meet people where they're at and start, like, real, real slow. So when I'm working with someone who's completely deconditioned, right, and who isn't moving at all, it's like, let's get up and I want you to walk to your kitchen two more times today. Just get up and go walk into the kitchen twice.

[00:11:02] And I'm going to talk to you about it next week. And we're going to see how that went. And then maybe the week after we're going to walk out to the mailbox and start building on this and start building momentum. And then trying it in the first place, right? Like, if people are important to them, most people don't want to be healthy just to be healthy. It's like, why do you want to be healthy? I want to be with my kids longer. I want to see my grandkids. I want to do.

[00:11:25] It's like, OK, are you willing then to get off this couch to go kitchen for, like, if it possibly brings you more time with your grandkids? But then, you know, the other things we're doing to help people with stress, stress does respond very well to, like, coming down takes time. So it may even just be taking small breaks throughout the day to push back from your desk and take three breaths and check in with yourself, right?

[00:11:53] And just and then figuring out how to get you to do more of the things you enjoy. So you have some protection there against the stress that is in life. So that finding the why and understanding the simple looking at what were the biggest things that people could do to help increase not only their life span, but the quality of the life.

[00:12:16] And in one of the studies I had looked at, I can't remember the name of it, but it took it said, you know, if a 40 year old man, woman, whoever it happens to be starts working out three days a week and does it consistently begins building muscle, does that whole routine. On average, they added seven years to their life. And I don't know how accurate that was or how many different studies there were or the control or anything like that. But doing the math out, I broke it down to the rep.

[00:12:46] You added almost three minutes to your life for every rep that you took, which is it's a lot easier when you can, you know, put a number on it like that. You know, every time you get up and walk into the kitchen, you're adding a minute, you're adding two minutes. But it's also it compounds because then you're building these habits. And maybe the kitchen might not be the best thing always if you're going into the pantry and grabbing the Oreos that are stacked there.

[00:13:15] But, you know, I think they stack one on top of the other where you start to develop these habits. They do. And the same thing on the nutrition side, right? It's like, no, let's meet people where they're at. I just had a conversation with one of the bigger companies that's out there that's making like plant-based food and stuff like that. And I was like, the problem is you can't like just grab people and go, look, you don't need to be on this plant-based diet. You have to meet them where they're at, right? And be like, look, right now you're eating McDonald's and KFC.

[00:13:45] What if we started putting like a little bit of like, where can we start with you? Like, what is something you're willing to even go toward? Is it a blueberry? I have worked literally with patients where their assignment was eat one blueberry this next week. And once they got over it, because there's also a lot of fear of food in like the GI space and stuff. Oh, yeah. They started rolling with it and it just like took off on itself. And nobody eats one blueberry.

[00:14:13] You know, once they have one, you know they're having more. So that's a great way to go about it. Just get them started. Build that momentum. Yeah. And we just have to meet people where they're at, right? And I know that we want to get them there. And it's so hard, I think, when we want so badly to help people. To not jump into that and be like, look. And it's like, no, let's start where you're at.

[00:14:40] And let me get you to move just this much so we can get you moving towards this bigger goal. I remember talking with somebody who they would eat a sleeve of cookies, you know, almost every day, if not every day. And they're not giving up a sleeve of cookies right away. I'm like, all right, why don't you have three-fourths of a sleeve? Let's work on cutting it back to that. And then eventually, you know, and I think people get stuck with the fact that it's a long game.

[00:15:08] You know, you're not going to get the result tomorrow. But if you build the small little adjustments two, three, four, five years down the line, you're going to be a completely different person than you are today. And it's tough. We love the instant gratification as much as possible. But it's a long life. And if you can see that longevity piece in it, it makes it a lot easier. Sure.

[00:15:34] In terms of working with teams, how did that get developed? How was that when you started that? Because that's not the normal model. No. The model came out of primary care in pediatrics. Pediatrics are always better than the adult world. I mean, our world, you know, it always feels so bad for the kiddos. Like they get to like 19, 20 years old and they leave like the room with like the balloons and all that stuff and get dropped into the white sterile room.

[00:16:05] That's why I stayed with my pediatrician until I was like 22. He's like, Derek, I think it's time to get an adult doctor. I'm like, all right, fine. All right. That's what you said. Right. But yeah. And so we started doing it in primary care where I would just and I changed the way we were doing it a little bit, too. When I was in graduate school, I worked in this federally qualified health care center where we were doing like we had an office and the doctor could kind of send them over to the psychologist and stuff.

[00:16:34] And, you know, as a paramedic, I was like, I don't want to sit in an office all day and just wait. I want to go like sit out there with everybody and like cut it up and talk in like you just found that if you do that, you can listen to these things and start interjecting. Like the doc comes on there. I can't get this guy to quit smoking. I don't know what I'm going to do. And it's like, hey, do you mind if I go in and start talking to him and see what I can do? And they're like, oh, what's psychology going to do? It's like that behavior change is kind of like our gig. That's what we do. And so we started doing that.

[00:17:03] And then it got moved over. I got moved into like some specialty clinics and we started, I started doing it with like pulmonology and cardiology. I went off for my internship, which is kind of like residency for psychologists at the University of Florida Hospital. Started working with the pain team there and then got very involved in the transplant team. And we just kept building these things. And then I got hired at the Cleveland Clinic. They were, they had posted they were looking for a pain clinic. And they're like, no, that'll work.

[00:17:33] Came over to the Cleveland Clinic and we reproduced it. Same thing there where I'd take my laptop and just go sit in the hall and listen and talk to the patients. Go in and just start talking to them. Introduce myself. Say, you know, I'm the GI psychologist here. We want to make sure we're taking care of you as a whole. And patients loved it. Oh, absolutely. And it just started building and building and building to the point now where we do work very closely with like even our pelvic floor PTs.

[00:18:01] You know, our, my dieticians. We have two dieticians that are directly part of our team who I work with very closely. I always make the joke with them that they're my boss and they have to tell me what I need to get patients to do before I can get them to do it. And the same thing even with like the, you know, physical training staff and stuff, any of the gyms and whatnot. I love working with like the people that are involved in movement. One of my favorite things to do was to work with PT when they would call me up and be like, Dr. Loop, we can't get this guy up. And I'd be like, okay, here we go.

[00:18:31] Let's try to see what we can do. So, um, so what, oh, sorry, go ahead. No, no, go ahead. I was just going to say a lot of, you know, you're, you're changing people's behaviors and habits. What's the process look like when, when someone needs to change your behavior in timeframe? And how do you, how do you go about doing that? It depends on the behavior. Um, you know, there are patients, it won't, it depends on the person and how deeply embedded it is. Yeah.

[00:19:00] People, people do things because they work. Right. And this includes even like our thoughts. If you're looking at thoughts as behaviors and our stories about ourselves, at some point that story worked for that person. And so it may be really, really well ingrained. Um, you start thinking about like people that are carrying around negative beliefs about themselves. Right. If I come out of a really chaotic environment, that's kind of abusive and stuff. And I develop a story about myself that I'm trash.

[00:19:28] That makes the world make sense. And so now I don't have to worry about why you, I don't wonder why people hit me or like, don't want me around. It's, oh, I'm trash. And so that behavior of like them putting that into it and seeing through those lenses is going to be really, really hard to put down. Some of the other ones, though, like you start working on like diet, some of the dietary changes, like that patient I was just talking about with the blueberry.

[00:19:55] Once she saw that it wasn't as scary as she thought it was because she was really scared that the blueberry was going to spur on her GI symptoms and she was going to spiral out of control. That, you know, those behaviors may not take as long to change. And so it really just depends on what the person's doing and. You know how well this has been working for them. The other thing is that I always say is that people want to regress back to the things they were doing before.

[00:20:24] So I never discharge people. Right. They're always I'm always part of their team and in the background waiting. So even if we get things going, this person's now doing some relaxation practice or meditation practice. They're, you know, feeling better about themselves. Physical symptoms are better. I'm just OK. Look, I am so happy that things are working for you and you are doing so much better. We've done so much work on your diet and everything else. Go forth. Go live your life.

[00:20:51] Just know I am here in case there is something else that comes up. And if they start regressing back, we can catch it and go, wait a minute, what were those skills we were working on? And how do we get you back into that place you were where you were feeling better? And do you look at triggers and things that might have caused them to regress? Of course. Yeah. And a lot of times that that is stressors from life or in the case of like some of the other disorder,

[00:21:18] like inflammatory bowel disease, they may just have a flare of it that we can't really account for why that's happened. But the gut, like most things, is affected by everything you are, everything you've ever done, everything that you experience. Right. So if life is throwing you all these things, you stop sleeping. You know, diet slips back a little bit. But you maybe like you go to a party and have like a like one too many. It affects the gut. It affects the whole body.

[00:21:48] And that can kind of start this slide backwards. And so we do have to look at those things. And we have to even practice some forgiveness of ourselves. Like I was doing so good and people beat themselves up. And it's like, is that getting us where we need to be? I see that like it's there that we want to jump into that beating ourselves up. But what do we need to do to get you back over here? And so it really depends. That's been a recurring theme with a lot of guests is getting to the point where you can be nice to yourself,

[00:22:18] which is not always an easy thing to do. We are our worst critics. And, you know, I think back to even like my athletic career and I can remember every negative play on like if I should have caught the ball or I missed a shot that I shouldn't have missed. And I don't remember the the all the good that you do, you know, or that I do. So it's it's it's tough.

[00:22:44] But giving yourself a break is is definitely OK in the necessity. It's hard because we're tribal creatures, right? We come out of these tribal like backgrounds is like you go back to like prehistoric man. And it wasn't as useful to like acknowledge our good behavior was much more useful to develop our brain that monitor bad behavior. So we didn't get kicked out of our tribe because if you live on the Serengeti and you get kicked out of the tribe, things are going to go bad. Yeah.

[00:23:13] And so we develop even like a part of our brain called the facial fusel form area. Its only purpose is to see your face and try to figure out what are the emotions you're having about me. And so we have this terrible self monitoring talk and we see the negative over the positive. Like I think I saw a study last one I saw was like four to one because the negatives what evolutionarily if we missed the negative, we died. If we missed the positive, there was more of a chance we were going to see it again.

[00:23:43] So if you missed a bear is a bad thing. But if I missed the blueberry bush, you know, chances are I'll find food somewhere else. And so it's hard. And I think that part a lot of what I do with people even is trying to get them to understand that a lot of this is not your fault. This is just the way our brain works. Your brain's going to predict the worst case scenario. And thank God it locks for our front doors.

[00:24:10] However, we have to see that as a tool and figure out how to see it while it's happening. So I can go, is this the tool I need to use right now? Or do I need to just see that as a thought and practice some skills like even some mindfulness skills of just observing it going back and forth? And seeing that self compassion. You know, one of the self compassion exercises I do with people frequently is I'll go make them get a picture of themselves when they were little and go, go ahead. Say you're a loser to that kiddo. Right? Yeah.

[00:24:39] It's hard to do when you're looking at a kid. Yeah. And it's the same person. There's something I saw where it's like I do what I do for two people. The person I was when I was eight and the person I'm going to be when I'm 80. And you want to make them proud. And obviously, yeah, if you showed yourself, picture yourself when you're eight, you're probably not going to be too harsh. That's a good strategy. I like that.

[00:25:06] One thing I've noticed, and maybe you can speak definitely better on this, but the brain kind of notices the things you focus on. So if all you have are negative thoughts in your mind, you're going to notice all the negatives that you have. And the thing, we're not perfect. We're going to make mistakes throughout the course of a day. But it doesn't mean it's a bad thing. It doesn't mean that you failed or whatever you want.

[00:25:34] And I think back to I teach during the school year and I paint houses during the summer. And I got to tell you, once I start by, I'd be like, oh. And then I look at the lines on the ceiling. I'm like, I didn't paint that. And you see like the previous colors bleeding onto the ceiling. So my mind was so in tune to all of that. And it's just I feel like that's the way the mind works with the negatives. Sure.

[00:25:59] Well, I mean, you know, it's this whole idea within the nervous system is use it or lose it. Right. And so if we start using a track and we get better at using it and using it and using it, it becomes more automatic to us. And so this is why some of those thoughts just start popping up. And man, we will be mean to ourselves. We will be meaner to ourselves than we ever would anybody else. Yeah. And that's hard because once you start, once that cycle starts, it can get very, very ingrained.

[00:26:27] And we start using it a lot to make the world make sense a lot of times as well. So what I'm sure there are definitely patients that it's tough seeing their struggles. What are some of the success stories? And definitely, you know, obviously don't use names or anything. But I'm sure you've seen some incredible transformations throughout the years, too. Sure. Yeah. Yeah.

[00:26:53] We've seen, you know, a ton of like, you know, it was really interesting. I don't know why my mind went here, but we had a couple of patients that came out of this. Right. Like right post COVID. COVID was such an interesting time working with the population I work with because a lot of those patients did not see the lockdowns is a bad thing. It was all of a sudden like now I'm safe. Right. I don't know. No one's going to ask me to go out to a restaurant. No one's going to ask me to go out. I don't have to worry about restrooms anymore.

[00:27:23] I don't need to do it. And like life shut way down. And then afterwards, there was lots of questions when we were starting to open back up about, especially for the patients who had Crohn's disease and ulcerative colitis, because their medications make them immunosuppressed. They wanted to know, like, were they at higher risk? And we didn't know the answer. I don't know. Right. And so a lot of those people stayed very, very shut down for a very, very long time, including up to even today.

[00:27:51] And I remember working with one patient who was very, very, very depressed because one of the things that will happen out of that. Right. Is like once you cut off all your social, your socialization, you cut out like the exercise and stuff, all of those things that we're doing will further depression. That's like creating a incubator for depression. Became very, very depressed. Wasn't able to go to school. Wasn't able to go to work. Wasn't able to do really anything. And we and we ended up work.

[00:28:20] I worked with him for about a year and a half, which is much longer than I normally work with people. But by the time we were done in a lot of this, like it was very slow. Like, OK, can we even just go out to the car and sit out in the car today? I want to see if you can do that. And if we can have success there, maybe we can push a little bit further. And a lot of doing that finding of the why. Why do we want to do this in the first place?

[00:28:45] And by the end, he had gotten to the point where he was able to start working. He had dropped the idea of going back to school, became like a realtor and stuff. But he was starting to do that again. But it took a lot of even like a self-acceptance of he had to be able to go into like even meetings with clients, right? And be able to say, I have to excuse myself to use a restroom where before he refused to do that because he was so embarrassed of it.

[00:29:13] Didn't want to have to say those things. Didn't want to have to acknowledge that. And so that was a big success story for us. Um, we've done like several things, even with, um, like our digital, we've, I was part of a team that developed a whole digital arm of what we're doing too. That's out there. Um, a digital like platform in, you know, we published a lot of data, even out of that showing that we were reducing symptoms dramatically by working with this whole model of like,

[00:29:43] how do we do some behavioral or psychological intervention? How do we do some dietary intervention and then oversee it with your physician, making sure the medication pieces are there. Um, but yeah, we've had, you know, the other story that came up in my head when we're talking about like success stories, even, and this is going to sound crazy because it wasn't, doesn't sound like a true, like health success. This was a woman that was dying of pancreatic cancer in the hospital.

[00:30:10] Um, and when I kept, when I went up to see her, she kept getting, she was very, very much on the thought of, I can't be mom anymore. Right. I'm in a hospital bed. They've told me I'm probably never going to go home. I'm going to be admitted until like I die. I just can't be mom. Um, and we talked, we spent a lot of time talking about what does that even mean to be mom? Like, what does mom do? What is, what do you do when you're at home that makes you mom? And she started talking about like making dinner for her boys and stuff like that.

[00:30:38] And I remember, um, you know, walked into her room this one day after we had that conversation, she had a big grin on her face and I was like, what is going on? What are you, what is happening? She's like, I found out I could order pizza and be mom. So she was sitting in the bed ordering pizza and sending it to her husband and her two kids. And that was how she found meaning and value and was being mom. Right. But it changed her outlook on everything because then she found out she could be part of this whole thing.

[00:31:06] The kids would call and say, you know, my backpack ripped. All right. I'm Amazoning you a backpack. Yeah. She could still be mom from the bed, even though she wasn't. And then there was a lot of talk even of like, she was also very stuck on this idea of like, she didn't want to be a burden in like, tell people when she needed something. Um, and it would, that drives away. She, she was much, much happier, um, at the very, like towards the end as she was able

[00:31:33] to spend more time with her family without trying to guard herself from telling them about how bad she felt. And she was much more, felt much more involved in their lives. And I'm sure her family probably felt much more involved in her life and they, they were much happier. I would imagine being that much more involved. I I've noticed a theme here where it keeps coming back to identity, um, and how people identify themselves.

[00:32:00] And that seems to kind of root a lot of the issues that people have. Um, and then maybe once that identity shifts, maybe they see themselves as a mother who bakes cookies and does all this sort of stuff. And that is no longer an option. Um, so they have to reinvent that identity. Um, that I imagine is, is kind of a difficult thing to work through, especially if you've,

[00:32:27] you've worked your whole life and that, and then you're that mother and you're, I don't know how old this individual was, but I, I imagine you do something 10, 15 years. Then that identity shifts all of a sudden and it takes some time. Sure. Yeah. Human beings, we, you know, we love to label ourselves and we become very much the content of our lives as opposed to like this thing. That's all of it. Right. Um, and I, men are especially bad at this. We read each other. It's like, what do you do?

[00:32:57] I'm a physical therapist. I'm a psychologist. It's like, okay, what if that wasn't there? Um, and that comes up all the time. Like there, so if you look at like a disease, like inflammatory bowel disease, there was traditionally two ages where the diagnosis popped up the most. The first one was 19, 20 years old where kiddos were transitioning out, going to college, tends to be a pretty stressful time to start your like adult life and get launched. The second one though was right around 60 to 65.

[00:33:27] Um, and the thought there was that there was a loss of identity for a lot of people who had been working their whole lives and now they're retiring. Right. And for a lot of people, that's really, really difficult. Like if I'm not, I don't know, in my case, a psychologist, then what am I? Right. And unless we spend time building out these things and it's especially hard if like there's like patterns of behavior, like workaholic type patterns of behavior where people invest

[00:33:54] so much in their job, um, that. I can't do it. I'm going to, I'm going to be very nervous. I'll tell you that much. I think because I have three months, uh, maybe it's not hitting me yet, but I also, I know the people who are helping me, I trust and they, they've gotten there themselves. Um, it's kind of like asking, I love my mom, but I'm not going to ask her for mechanic advice on my car. So it'd be like asking her and she tells me what to do.

[00:34:23] I'd be like, uh, but if, you know, I go to the mechanic and he tells me what to do, I'm going to be like, okay, that's the plan. That's what I need to do. Um, love you, Mark. Don't worry. Well, and that ties it back to that whole individualized thing, right? Because you, you could listen to like every podcast in the whole world. You could read all these books, but it's not the same as like you saying, I have a team I trust who are working with me, who know me and are trying to get me to this goal. Yeah. It's, uh, yeah.

[00:34:51] So it's that whole identity pieces is big, is big. Yeah. Um, wow. I didn't, 40 minutes went by pretty quickly there, Steven. I know you probably had a long day and I don't want to keep you any longer, but, um, are there, is there a piece of advice that you could give to any of the listeners here that you think might be helpful?

[00:35:16] I think, um, you know, the hardest thing for us to do is to try to create balance in our lives and to try to work with who we are and what, what human beings are. Or it, I, the one piece of advice that I always have for people is, you know, like try to figure out where you can do something for help and don't be afraid to ask your team for help.

[00:35:45] Um, and teams don't necessarily have to even be like these, like huge things like doctors and stuff like that. They can be like, ask your friends for help. It's so, and stuff like that and how they're going to go. And I don't want to look weak and I don't want to, you know, all these other things that come up for people and it stops us from getting to where we need to be. And so I really do encourage people to like kind of catch that and do whatever they can

[00:36:08] to try to work with their body to get them to at least start moving towards health. I love that. And I, uh, asking people for help, I think is one of the most sincere, um, expressions of how much you actually care about that person. If I'm going to ask you for help, I care about you and I trust you. Um, so if anybody asks me for help, that's very flattering.

[00:36:36] Um, so yeah, I think that's great advice. Well, thank you so much, Steven, for hopping on with me. I appreciate you taking the time. Yeah, this was fun. Thank you to all the listeners. Um, Steven, how can people get in touch with you if they want to reach out? Um, probably the best way, you know, I was thinking about that. I was like, I don't know, I'm going to answer this anymore because I'm not really on social media so much. Um, it's on LinkedIn, right? I did find you on there. I sent a request earlier. LinkedIn or my Cleveland Clinic site.

[00:37:05] Um, the Cleveland Clinic site. If you go to Cleveland Clinic and you can search providers, you can search for me. There's a video of me up there talking about what I do. Um, and there's some contact information up there. Okay. Awesome. If people have further, I, they'd want to reach out to me. I'm always happy to talk. Well, thank you, Steven. I appreciate you taking the time. Yeah, not a problem. Um, yeah, not a problem. Yeah.