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Scot: So we just did our photo shoot for the podcast. How do you feel? You feel like a model?

Troy: I really don't. I'm really nervous about how these are actually going to look. I know Chloe said several times that I looked awkward, so I think that was probably the theme of the photo shoot.

Scot: Yeah, I've heard that myself a few times. Here's the thing. At one point, I think I wanted to be a model. I thought it'd be fun to be a model and then I realized . . .

Troy: Are you being serious right now?

Scot: I'm being serious. Yeah, when I was younger, right? And then I realized that I've never taken a good photograph in my life, so I don't know how I'm going to do this for a job. And it's hard. When we were out there, I mean just, "Okay. Just act natural." Well . . .

Troy: Yeah, what's natural?

Scot: I've never felt natural.

Troy: Exactly.

Scot: All right, Dr. Alex Pastuszak is back here on the "Men's Health" podcast. Good to have you. How are you doing?

Dr. Pastuszak: Awesome. Awesome, guys.

Troy: That's some vigorous applause.

Scot: Well, we're excited to have him. You're just a little jealous. I've never applauded for you like that.

Troy: I've never gotten applause.

Scot: I'm sorry.

Troy: I know. I don't know what to make of this.

Scot: Before we get to the topic, Dr. Pastuszak, I was just curious. One of the things that we talk about a lot here on our podcast are, you know, the things that all men should really kind of concentrate on to make sure that their health is going to remain good now and in the future. Those are activity, nutrition, managing stress, sleep, taking care of those nagging health issues.

So one of the things we want to do on the podcast is find out how different people work activity into their life. And we're not talking exercise, although it could be. We're just talking activity, getting up, moving around. So you look like a fairly fit individual, so you must find a way to work activity in your life.

Dr. Pastuszak: Absolutely. First of all, I'm a doctor because I can be active. I purposely do not engage in a desk job because it's increasingly difficult to be active in a desk job. Although you can do it. You can do it. And on days when I'm pushing paper, I will still get up, you know, at least once an hour and take a walk, go to the bathroom. I will spend five minutes every couple of hours walking around.

Exercise is obviously a huge thing for a guy like me who doesn't have much time on his hands. I do it before I get to work, because after work, I'm tired. I'm ready to go home, you know?

Scot: Just don't even want to deal with it. What do you do other than just kind of moving around?

Dr. Pastuszak: Well, in the fittest state in the country, or what I think is the fittest state in the country?

Scot: Yeah, sure looks like it, right?

Troy: I think we're top five, yeah. We're pretty good.

Scot: Every time I have friends from out of town, they're like, "Is everybody here fit and beautiful?" What is it you like to do to keep active?

Dr. Pastuszak: Troy and I were just talking, you know, it's a perfect winter to do some trail running, snowshoeing, skiing, snowboarding. Those are all high on both our lists. I mean, anything to get out of the house. This morning, I shoveled all the snow. I woke up at 3:30 in the morning so I could get on the bike and then I could shovel snow for an hour and that was my fitness today.

Scot: And that's an interesting thought too. When you reframe it not exercise but activity, then all of a sudden shoveling snow becomes an actual legitimate thing that you can do for your health because you're getting that heart beating.

Troy: Yeah. I think that's great how you mentioned that. And at the risk of quoting someone who I'm going to sound weird quoting, but I heard Matthew McConaughey say he just tries to work up a sweat every day. I don't know what exactly that means, but I think it kind of falls into that category. If you're out shoveling snow, if you're snowshoeing, you're skiing, whatever it is, that diversity of activities, you're working up a sweat. You're getting exercise. It doesn't have to be a very regimented routine thing.

Dr. Pastuszak: And I think, Troy, just to speak to that for a second, you know, you don't have to be exercising for 60 minutes a day to get the benefits. And we've seen the studies. We've read the newspaper articles on it. I mean, working up the sweat, getting your heart rate up for a few minutes a day keeps the doctor away.

Troy: Exactly. And that's what I love that you mentioned that because, you know, I think we're both talking about studies here. We've seen where just 30 minutes three times a week, there's incredible value in that, just getting to that point. So if you're not getting a lot, starting there is just a great starting point and then building from there.

Scot: Let's go ahead and get to the topic today that we brought Dr. Pastuszak in for. We're going to talk about testicle pain. What does it mean when the boys are hurting? Have you ever had testicle pain before, Dr. Madsen? Is that an unusual question to ask?

Troy: Again, in the interest of being in full disclosure on this show, I have had testicle pain.

Scot: Have you? Oh, see, I never have and I thought . . .

Troy: This is bringing back traumatic memories of my youth. I remember second grade. I'm not going to name the guy's full name, but his first name was Monty.

Dr. Pastuszak: Full Monty?

Scot: He sounds like a bully.

Troy: I am not joking. He was a bully. And he wore cowboy boots, and being a young, scrawny, nerdy kid in second grade, another kid held me while Monty . . .

Scot: Oh, no.

Troy: Yeah.

Scot: No.

Troy: I am not joking. And the memory of this is so painful. So yes, the answer to your question is I have experienced testicle pain and that's a very painful memory.

Scot: I would imagine that there are two different types. There's the kind that Dr. Madsen's describing, and then I guess where I was thinking of going, but we should talk about this one too, was just for no apparent reason, all of a sudden, things start hurting.

Troy: Oh, yeah, there was clearly a cause to my testicular pain.

Scot: His name was Monty.

Troy: His name was Monty and his cowboy boots.

Scot: I did a little research and, Dr. Pastuszak, it looks like there's a ton of things that could lead to just unexplained testicle pain. There's a list on here. Diabetic neuropathy. Is that how you pronounce that?

Dr. Pastuszak: That would be nerve pain.

Scot: Yeah? Gangrene, I didn't know that was still a thing in the world. Kidney stone, mumps, scrotal masses. I mean, the list goes on and on. So let's talk about Dr. Madsen's type of pain. Is there anything . . . after an event like that or you fall on the bicycle, or you do something, is that a time you should be concerned?

Dr. Pastuszak: So I think that is a perfect question to distinguish the type of testicle pain that you go to the ER for and get worked up right away. So, I don't know if Troy went to the ER, but I might have, having been a urologist at this point, although in second grade I probably wasn't thinking about it.

Scot: Right. You probably didn't want to tell anybody because that was a little humiliating.

Troy: Well, here's the other piece of the story. My dad is a pediatrician, so I was hurting and it was extremely embarrassing, but I did tell him. Yeah, I mean, it was one of the things . . . Alex is going to talk more about what we think about in that scenario. He's the only pediatrician in town, so I'm not going to rush off to someone else. So I told him. And I'm sure he was thinking about this as I was experiencing this pain. You know, everything turned out all right. But yeah, there are definitely some things we think about here.

Dr. Pastuszak: And it's really important for people to know that the sudden onset of testicular pain, be it from a boot or just suddenly waking up or noticing acute onset bad testicular pain, is a reason to go get it checked out right away.

And the reason I say that is, you know, the sort of most ominous thing or worst thing that can happen is testicular torsion or testicular trauma where your testicle, say, by getting kicked in it with a boot will get split open, and that needs to be fixed.

Or in the case of torsion, that's when the testicle twists around itself on its blood supply. And what a lot of guys don't know is that that blood supply comes in all the way from high up in the abdomen and it can twist on itself, and that pain is you not having enough blood flow to your testicle and that's a surgical emergency.

Scot: And that can just come on. I can wake up one morning and have that happen.

Dr. Pastuszak: Yes.

Scot: There doesn't need to be anything that's caused that torsion.

Dr. Pastuszak: No. I mean, there are people who are predisposed to it, but there are . . . and so, it happens more often in young men or boys, but there are adults who get it.

Troy: Yeah. And in terms of what I'm thinking about in the ER, that's the number one thing on my mind. And I think when I hear testicular pain in the emergency department, number one thing I'm thinking is, "Okay, I need to rule out a testicular torsion."

And obviously, there are a lot of other things that cause this as well, but that's probably the most common reason I see someone in the emergency department. Someone wakes up, they're experiencing testicular pain, or they've had some sort of trauma. And that's the next thing on my mind, is we need to rule this out quickly, potentially call urology down here pretty quick.

Scot: All right. So takeaway number one, if it's sudden onset testicular pain, go to the ER. Do something about it immediately.

Dr. Pastuszak: I would say yes.

Scot: What about this kind of slow build testicular pain? What could that possibly mean? Which one of these 86 things that I saw on this list . . . and that's an exaggeration, but there are quite a few . . . could it be?

Dr. Pastuszak: There's about 20. No, the good thing about those types of testicular pain is you have time to figure it out, for the most part. You know, the only one where you'd kind of want to get on top of it pretty quickly at that point would really be sort of an infection or other cause that you need to treat or it's going to get worse quickly.

A lot of the other causes of testicular pain besides infection can be due to problems with the pelvic floor, problems with your prostate, other things that can take actually quite a bit of time to diagnose and treat, but generally will get better over time.

Scot: Are there some common ones for men 25 to 35 then?

Dr. Pastuszak: So again, it's just a lot of these have to do with reproductive issues. So sometimes you can have a dilation in the veins that drain the testicles. That's called a varicocele. That can cause gradual onset but persistent and worsening testicular pain.

You know, there are kidney stones which can occur in young men. That can radiate down to the testicles and cause testicular pain.

You know, young guys are at increased risk for testis cancer. Now, I will tell you that testis cancer usually does not cause testicular pain, but guys have a very firm testicle. But sometimes it can cause discomfort.

And then stuff like, you know, if you've had a vasectomy, you're at increased risk for some pain afterwards, and several others. But those tend to occur in older men.

Troy: And speaking of testicular cancer, I know growing up I would hear, you know, "You really should perform a testicular self-examination every month in the shower, kind of warm shower, feeling around for any lumps or bumps or anything unusual." I'm curious what your thoughts are on that, if you recommend it, if that's kind of gone out of vogue with maybe some of the other recommendations against doing too much screening for things. What are your thoughts there?

Dr. Pastuszak: So I'm going to take the risk of nerding out for just a second on this.

Scot: Please do.

Troy: I'm not nerding out. I'm all for it. Go for it.

Dr. Pastuszak: So, you know, the recommendation for testicular self-examination is . . . the U.S. Preventive Services Task Force actually recommends against it for reasons that we as urologists don't completely understand. That being said, it is the cheapest, i.e., zero cost. Let me say that again. Zero cost to feel your testicles in the shower once a month.

Scot: And also, most convenient because you don't have to go to a doctor to have them do it, right?

Dr. Pastuszak: Exactly. Yeah, least embarrassing, you know?

Scot: Yeah, sure. All of that.

Troy: If your dad's a pediatrician, you don't have to talk to him about that.

Scot: Yeah, no kidding.

Troy: Which was insult to injury in my case.

Dr. Pastuszak: And you learn what your testicles feel like, right? So then the more you do it, the more you realize, "Well, this is normal. I've felt this for the past 10 months," versus, "Oh, this is a new lump."

Because a lot of guys feel their testicles, they expect them to be like little eggs and they have all kinds of lumps and bumps on them, but that's just the normal anatomy.

So going back to my point, it is absolutely the cheapest way to detect a potential problem with your testicle and go see somebody like me to really tell you, "Is this good, i.e., no problem ,or do you have a problem?"

Scot: Yeah, I liked that you give us the ability to do some troubleshooting, if you will, on our own. So I've never had pain, but I did detect a lump one time. And we can talk about that in I think a different episode, but essentially detected the lump, went to my primary care doctor, told them about it, they did an ultrasound on it, found out everything was fine.

Troy: And I guess speaking of testicular pain, do you expect pain with testicular cancer because that's . . . one of the things I see in the ER is people who have pain and they're not concerned about a torsion. It's been slow, but they're really concerned about cancer.

Dr. Pastuszak: I would say the minority of guys with testicular cancer actually come in with pain. They come in with discomfort once that cancer has actually gotten fairly large. But a small testicular cancer will almost always be a painless lump.

Scot: All right. So on the podcast, we like to, you know, think of things in terms of worry level and action levels. So, the worry levels being right now, over the horizon, or way off in the distance, when it comes to testicular pain, immediate pain, right now?

Dr. Pastuszak: Right now, worry level, high.

Scot: Okay, sounds good. Critical. And then as far as testicular pain that's taken a while to develop, worry level? Probably, right now, you've got a little bit of time to kind of figure it out, but you should go do something about it.

Dr. Pastuszak: Absolutely. From the doctor standpoint you have time, but if it persists, check it out.

Troy: And in those cases, do you recommend just going to your primary care doctor or getting directly into a urologist?

Dr. Pastuszak: Troy, great question. I think it really depends on how bad the pain is, but almost always if you go see your primary doc and it's not an infection, then they'll send you over to the urologist.

Troy: Okay. So you can potentially skip a step, get in to see urology. They can do the full evaluation and give you the answer rather than going through several steps?

Dr. Pastuszak: Absolutely.

ER or Not: Passed Out for No Reason

Scot: All right. Time for "ER or Not?" where we throw a scenario to Dr. Troy Madsen, who's an emergency room physician, whether you should go to the ER or not for something. Play along at home. You're just kind of minding your own business and passed out for seemingly no reason. Next thing you know, you're waking up and there are people around you going, "Yeah, you passed out." ER or not?

Troy: See, now you're hitting close to home, Scot.

Scot: You pass out for no reason?

Troy: No, but I did pass out once for no reason and it created so much drama. I was in Washington, D.C., went to the Holocaust Museum and my wife and I were at the cafe there and she described what happened, but essentially my face just went blank and I went face down on the table. I woke up with people around me. I got transported by ambulance to the George Washington University emergency department. It was the last thing I wanted to do in Washington, D.C. I was so embarrassed.

Scot: And what's it like when an emergency room doc ends up in an emergency room?

Troy: We could do a podcast on that itself. It was awful. I mean, they were wonderful there. They did a great job, but it was so surreal to be on the other side, sitting in the back of an ambulance, going through the streets of D.C., and then being in the George Washington emergency department.

Scot: So I know you well enough that you were analyzing at that point whether or not you really needed to go to the ER.

Troy: Oh, I was telling everyone I didn't need to go to the ER. They had me sitting in a wheelchair there. I couldn't stand up because I felt so weak. They checked my blood pressure and it was like 80 systolic over 40, really low. And I said, "Well, I'm a runner. It's just low." That's incredibly low. And I was trying to tell them I could go. If I could have gotten up and walked away, I would have, but I couldn't. My wife and then this nurse who were there said, "No, you're going to the ER."

Scot: So it sounded like if you pass out for seemingly no reason you go to the ER.

Troy: That's what's tough. You know, the challenge is, like in my scenario, I went to the ER, I had a bunch of testing done, and everything was fine. In 95% of cases I see like this in young healthy people, that's the case. But then there's that 5% of the time that maybe something is wrong.

So in the ER, you're going to get an EKG done. You might get some blood work done. In a really severe case or more concerning scenario, you might get an echocardiogram done where they look at your heart. These are all things they did for me at the ER and everything was fine. And in my mind, I thought, "Everything's going to be fine. I'm going to walk out of here and I'll be okay." And that's what happened.

But it's those 5% of times where they pick up an abnormal heart rhythm or something structurally wrong. That's the reason to go to an ER.

And these are the cases you worry about. You hear about the young healthy athletes who just drop dead, you know, in marathons or athletic events or training. That's what you worry about, that there's some sort of undiagnosed, underlying heart rhythm that then just out of the blue manifests itself. Then they go into ventricular tachycardia, which is just a crazy fast heart rate, and they pass out for that reason. That's what we're looking for.

So, my advice would be if you're passing out, definitely if it's happening more than once, but even out of the blue, at least go to an urgent care to get an EKG done. They can pick up on a lot of these abnormal things there, but they very well may send you to the ER to get some more testing done.

Scot: All right. So 95% of the time, if you're a young, healthy person, probably not a big deal, but that 5% of the time does make it worth going to an urgent care if this does happen to you.

Troy: Exactly.

Are You a Maximizer or Satiscficer?

Scot: All right. Troy, I've got a question for you. What kind of person are you? I'm going to give you two different scenarios and I want you to identify. So do you agonize over details when you're working on a project and you do a lot of research because you're afraid of missing out on the best way to do something, or are you more of a less-research-based kind of person and find yourself saying a lot, "I'm good with that"? You know, you want to make progress and you're like, "That's a good enough decision." Which one are you?

Troy: I'm probably a good enough decision.

Scot: You're the good enough decision.

Troy: I am. I don't know. I was going to let you answer that question based on your experience in working with me with podcasting, but as you know, I kind of just show up here and wing it. Hopefully, that doesn't show too much in the quality of our broadcast here.

Scot: Actually, it's interesting because I think I'm exactly the opposite. I'm taking a Master's program right now. When I write a paper, I've got to find the best angle. Like, this paper has got to just blow people away. And I'm terrified of not finding that best angle, so I will start down the path of numerous different ideas and abandon them because I think, "Oh, wait, this one will be better."

So actually, this was an article I read in "The New York Times" and it's called "It's Never Going to Be Perfect, So Just Get It Done." And the guy's name is Tim Herrera that wrote this and I just really responded to this article because of my personality type. So he talks about the concept of MFD, which is a mostly fine decision, which I love.

Troy: Where are you going with this?

Scot: It's not perfect, but it's something that would make you say, "I'm good with that."

Troy: I like it.

Scot: And the two different types of people I described he calls maximizers . . . I'm a maximizer and you're a satisficer. I guess kind of satisfactory enough and . . .

Troy: It's good enough.

Scot: Yeah, right? So maximizers spend a lot of time looking at all the options because they're afraid of missing the best one. Satisficers make quick decisions based on less research and get things done.

And here's where I'm going with this. Talking about mental health, research has shown that satisficers are more satisfied with their decisions at the end of the day than maximizers are. So I agonize over this decision, but at the end of the day, you're happy. I'm not. I'm never happy. Satisficers also experience less stress during the project and they get it done, which is something that maximizers sometimes never do, and that's where the satisfaction lies.

Troy: That's interesting. But I think it's hard just to classify a person as one or the other because there probably are times in various things that I've done where I'm more of a maximizer. You know, maybe more when I'm doing research stuff, I may be more of the maximizer side, but then there's part of me with that same research project that's a satisficer. With papers I'm writing, I'm like, "Let's just get this done. Let's get it submitted. It's not going to be perfect, but we can revise."

I think possibly we all have different tasks we approach maybe differently, depending on whatever training we've had in that area or depending on, I guess, what we're trying to accomplish there or what the expectations are.

But it's interesting, like you said, that they did find that that whole satisficer approach, like, "Hey, let's just get this done. Let's make it happen," that that tends to lead to more satisfaction in general.

Scot: So, for me, what it really resonates with is sometimes just getting it done is the important thing because you can eventually go back and make it better, right? And it comes back to this business concept of the minimal viable product. You've got to get that thing out there and into the real world and then you can start making the adjustments. Me, I want it to get in the real world perfectly.

And this article, this really resonated with me. The author quotes a guy named Dr. Alex Lickerman in a "Psychology Today" article where he said, "At some point, we must remind ourselves any changes we make to a creation no longer make it better, but just different and sometimes worse." And I experience this.

"Recognizing that inflection point, the point at which continuing to rework a work reaches the law of diminishing returns, is one of the hardest skills to learn, but is also one of the most necessary." So this all comes back to mental health, happiness, less stress. And this was just kind of a little breakthrough for me. So I really enjoyed this article, and I hope that it helps somebody else.

Troy: Well, sometimes when I think about tasks that to me just seem monumental, I think about the Transcontinental Railroad. This is one of the greatest . . .

Scot: Sure you do. Don't we all?

Troy: It's the first thing that comes to mind. But at the time, this was one of the greatest accomplishments in human history, to have a railroad from coast to coast, but these guys were satisficers. They were just like, "Just get it done." They weren't worried about quality. They were like, "Just lay track and make this thing happen." And then they met up at Promontory Point. We just celebrated the 150th anniversary of that. But that's what they did. And the whole idea was "We can go back and make this better later." And in doing that, they accomplished it. It was a huge accomplishment.

Scot: And the other thing they learned that this article does talk about too is if it's a monumental task, you've just got to break it up in little segments too. That's another key to happiness, is don't look at it as "How am I ever going to accomplish monumental . . . this needs to be perfect." It's to break it up in a small segment. So, I hope that helps somebody.

Just Going to Leave This Here...

Just Going to Leave This Here. It's our opportunity to just talk about whatever it happens to be on our mind. Could be health related. Odds are it's probably not. Just Going to Leave This Here. Troy, why don't you go ahead and start?

Troy: I'm just going to leave this here. I just listened to an audiobook recently that was really cool. And basically, this book talked about getting to the moon, and obviously a lot of this has come up. It's been the 50th anniversary of the moon landing, but you would think getting to the moon, the planning for this, you'd think, "Okay, let's fly a rocket up. Let's land it there. Then let's fly it back." But it wasn't that simple.

Scot: Oh, I'm sorry. You thought it would be that simple?

Troy: Well, you know, you think you'd just fly there and you'd land it and then you'd take it off and fly it back.

Scot: No, you don't.

Troy: You can't. I mean, you can't back a rocket up and land it bottom-down on the moon and just miss all the moon rocks and then just shoot it straight back up. This was really challenging.

But this one guy had this idea of creating . . . he called it a lunar orbit. And then while one piece of the rocket is orbiting the moon, you have your other piece that essentially breaks off and lands on the moon and then launches back. And it was just this novel idea, but to me it was really cool to just listen to this whole process, this guy sort of bucking the trends within NASA to try and get people to listen to him. Like, "Hey, this is how we're going to do it." And that's what they did.

And it really kind of inspired me like, "Hey, sometimes just the simplest idea or looking at things in a different way can make all the difference." And that really was the key to us getting to the moon.

Scot: I don't know. To me, it seems like it's not the obvious thing. Like you said, the obvious thing would be just to, "Can you just . . ." But now you've got to get creative and solve that problem.

Troy: Well, that was the whole proposal.

Scot: You're a blazing trail. You have no idea how to approach it.

Troy: Exactly. I mean, the obvious thing was, "Let's take a 50-foot rocket and somehow back it up on the moon and land it bottom-down and just shoot it straight back."

Scot: Beep, beep, beep. "Watch out, guys."

Troy: "Watch out below." It was . . .

Scot: What was the show? It was an audiobook.

Troy: It's an audiobook called "The Man Who Knew the Way to the Moon." I believe that's the title. It's on Audible. It's one they produced, so they offer every month, you can download a couple of books without using any credits. And it was one they offered this month. I think otherwise it's probably pretty inexpensive relative to their other audiobooks.

Scot: So you recommend it?

Troy: I do. It was fun to listen to. It was really cool, yeah.

Scot: So Troy talks about rocket science. I talk about urinals. I'm just going to leave this here. Cell phones and urinals? No, don't do that.

Troy: So while you're urinating, using your phone or what?

Scot: No. I was in the bathroom at the urinal and then some guy comes in talking on his cell phone and just holding it on his shoulder and he's just there. Just don't do that, please.

Troy: So he was actively talking, like trying to balance it on his shoulder and not drop it in the urinal?

Scot: Yeah. So I don't know if he was stressing about it. I was. So now I'm stressing about two things. One, I don't need you talking next to me while I . . .

Troy: I've decided the next time someone comes and is talking on a phone in the restroom on their cell phone, I'm going to make some really loud bathroom noises just so there is no question to whoever they're talking to that they're in the restroom talking to then. I'm just going to start doing it just to . . .

Scot: Perfect. I am too.

Troy: And it's the appropriate place to do it. I'm in a restroom.

Scot: If you can't make fart noises in a restroom, where else can you make them?

Troy: I know. I mean, it's all fair game.