Josh Appel
Full Transcript

Back to Episode

Kelly: [0:00:04] Hey everyone, I’m Dr. Kelly Starrett.

Juliet: [0:00:06] And I’m Juliet Starrett.

Kelly: [0:00:08] And you’re listening to The Ready State Podcast.

[music]

Kelly: [0:00:16] This episode of The Ready State Podcast is brought to you by our friends at LMNT.

Juliet: [00:00:21] So we just went on a big family trip to Norway and Germany where we did a ton of hiking.

Kelly: [00:00:25] I would describe it as a hiking vacation.

Juliet: [00:00:26] It was a hiking vacation. We hiked eight out of the 10 days we were gone.

Kelly: [00:00:30] Ask our 15-year-old.

Juliet: [00:00:32] Yeah. And one of the things we relied on to survive these huge hikes, and I’m talking we hiked between 10 and 14 miles a day, was LMNT. And our kids did as well.

Kelly: [00:00:42] Yeah, these packets are easy to pack and then you’re not worried about sugar, you’re not worried about carbohydrate. We made sandwiches and things on the road, but having that nutrition, hydration part separated, was great. And I mean what a difference. I am a sweater, I’m a svister.

Juliet: [00:01:03] And also, we came into it being totally jet lagged and probably a little bit dehydrated, so to just hit the ground doing these huge hikes and know that we could just be replenishing ourselves with LMNT was really cool.

Kelly: [00:01:15] Not to mention, a little bit of Nordic sauna that happened and you’ve got to replace those electrolytes after the sauna.

Juliet: [00:01:19] So as you guys all know, we literally drink LMNT every day. Right now, if you order through our link, you get a free sample pack with all of LMNT’s flavors. Go to drinklmnt.com/trs.

Juliet: [00:01:33] This episode of The Ready State Podcast is also brought to you by our friends at Vitruvian.

Kelly: [00:01:38] Vitruvian was an interesting thing that came. I saw it on the internet, I saw some of my athlete friends using it. And imagine a force plate that has a couple cables. And traditionally when I see those things, I’m like it’s not serious because I can’t put enough heavy load in it and it just is kind of a one trick pony. However, this thing kicked my butt. You can deadlift over 400 pounds on it, you can be eccentric only loading on it. And what I really liked about it, it’s very quick to set up. Our kids loved it.

Juliet: [00:02:07] Yeah. And for my part, one of the things I loved about it, it’s not only quick to set up, it’s really small and really easy to store, so it’s not some gigantic piece of gym equipment that takes over our entire living room.

Kelly: [00:02:18] I tried to leave it out inside the garage for many weeks and you’d be like, “Hey, could you fold that up?” And you do, you just fold that up and it slides away. A straight bar comes with it, you can put crazy handles on it. I sometimes leave it up and one of the things that we discovered, Georgia’s boyfriend liked to get a pump on, it has a pump setting. The pump plus blood flow restriction, the most ripping pump you’ve ever had. This thing is so cool.

Juliet: [00:02:43] If you want to learn more about the Vitruvian, go to thereadystate.com/Vitruvian. 

Juliet: [00:02:49] On this episode of The Ready State Podcast, we are stoked to welcome Josh Appel. Josh is an emergency medicine physician and chief of emergency medicine at the Southern Arizona VA. He is a former Air Force Air Rescue Specialist, a PJ who deployed on the rescue recovery missions for Operation Red Wings, including lone survivor Michael Luttrell and Lt. Michael Murphy. Working with the Murphy family, Josh founded the Memorial Day Murph Tradition. Josh is a husband, a father of three active girls, a teacher, mentor, and a wellness evangelist.

Kelly: [00:00:00] I first met Josh officially when we went out to work with his pararescue squadron, who was really thinking about strength and conditioning for the first time. And then like two Cheerios in a big bowl of milk, we found each other.

Juliet: [00:03:36] Yeah, one of the things I loved about this conversation was hearing more about his creation of the Memorial Day Murph tradition. I mean the origin story of that, I had actually forgotten that he was the one who really popularized it, and then obviously it’s taken off and tens of thousands of people do it every Memorial Day and it’s a really cool tradition that started with Josh.

Kelly: [00:03:54] And we didn’t talk about this, but Josh and I have been collaborating with off the books projects for a long time. One of them was that we used H-Wave sort of off brand in the emergency room to treat snake bite wounds. Suddenly, he was like, hey, what if we dilute this venom. I mean Josh is cutting edge in all things. He’s a tremendous, tremendous human being. We’re thrilled to introduce you and the greater Ready State community to our amazing friend, Josh Appel. 

Juliet: [00:04:23] What is the good word, Josh? Welcome to The Ready State Podcast.

Josh Appel: [00:04:27] Good morning, you two. Fantastic, as usual. Happy to see you guys. Excited to talk to y’all. We’re going to solve some problems.

Juliet: [00:04:35] And I just want to give an early shoutout to your vintage San Francisco CrossFit T-shirt which I think probably has real value now given that it is vintage and no longer in production.

Kelly: [00:04:47] Tens of dollars.

Juliet: [00:04:48] It’s worth tens of dollars on eBay. 

Josh Appel: [00:04:51] Amazing. And it’s probably the last of the boys’ husky as well.

Juliet: [00:04:55] So we obviously have met before and know you well, but I’m going to go ahead and let you tell everyone listening to this the backstory of how the Josh and the Starretts became connected as humans.

Josh Appel: [00:05:08] Yeah. Well, I think it was recently after Becoming A Supple Leopard came out and Kelly was making the rounds and came out to Davis-Monthan to talk to our pararescue team. I was the flight surgeon. I had been a PJ for 12 years under the old school system, where if you got injured, they gave you a bottle of 800 Motrins, a bag of ice, and said come back in three days and get back to it. And Kelly came in and really blew our mind. I think that was probably the first time I ever heard the word mobility. I always said stretching. And then it’s funny because you get that first taste of Kelly and you’re like is this guy completely crazy or have I been missing all of this.

Juliet: [00:06:00] And the answer to that question is yes, Josh.

Josh Appel: [00:06:02] Yes, of course. Because I think that was about 11 years ago. I can give you an 11-year testimonial in search of Becoming A Supple Leopard. It’s in my daily routine. I can’t say I’ve ever been pain free in those 11 years but knowing how to diagnose and how to treat myself was probably one of the best gifts I’ve ever got. So thank you, Kelly, for that. I certainly would not be where I am today without your guidance. So thanks for that.

Kelly: [00:06:39] Well, everyone, Josh is actually memorialized in our 60 Minutes piece, believe it or not. We were back out there, that’s right.

Juliet: [00:06:45] Yeah, that was cool. Well, interesting too because you’re a physician and I think people think that physicians are all knowing about all things.

Josh Appel: [00:06:55] That’s true.

Juliet: [00:06:55] And I find it so interesting that you were already a working and well-trained physician at that time and you’re like, wait, whoa, I just learned how to take care of my body in a way that I did not learn in medical school. 

Josh Appel: [00:07:06] Right. When you say it’s like the service manual for your body, it’s such an appropriate statement, and it fits and everybody should be able to take care of themselves on a basic level and I think really that’s where missing people are missing these days. And you don’t have to be a physician to understand Becoming A Supple Leopard, but it helps. And that’s where I think you guys nailed it with the new book because it breaks it down, anybody can follow it. I read it and I’m like this is the secret sauce, this is how we get people doing this stuff.

Kelly: [00:07:41] Josh, you were a user, you’re a PJ, went to med school. We’ll talk about that funny intersection right on the border of PJ, med school I think is interesting. Become senior flight surgeon, the man. Then you transition. Each one of these transitions is an order of magnitude. Now tell us what you’re doing now. And the reason this is relevant in this conversation is because you see the challenges being on the pointy tip of the spear, the user, and the person in charge of the system. So tell us what you’re doing now for work and I think that’ll set up the framework for some of this nuance that we could all benefit from.

Josh Appel: [00:08:20] So now I am the chief of emergency medicine at the Southern Arizona VA. About five years ago I was presented an opportunity to run the emergency department at the VA, and this was about the time when the Phoenix VA was getting all the bad press. People were dying because they weren’t able to get in to see the physicians at the VA. And in typical Josh fashion I said somebody should do something about that. And then this opportunity presented itself and I said, well, I can complain about it or I can do something about it, and it’s really given me an awesome opportunity to get involved and see what’s going on at the VA and how it works. 

I guess I should give the disclaimer that the guests on The Ready State Podcast do not necessarily represent those of the VA or the government in general. So I am no spokesperson. I am not a paid spokesperson for the VA. I’m a guy that works there. But they really have done some great things over the last few years. Congress has helped. They’ve stepped in, they’ve passed some bills, The Care Act, the PACT Act, that said hey, if we can’t get to see you in 30 days, you have the opportunity to go out into the community and get the care you need. And I thought that was fantastic. We should be competing for veterans’ business. You shouldn’t have to go there because it’s your only option. But what we found was that people were going to the community and the community was saying, hey, we can’t see you for 90 days, and so patients were coming back to the VA. And so I’ve been a part of that and it’s been really interesting to watch and see how it’s developing. And I think the VA has a great model. 

I think there’s certainly still work that needs to be done. It’s what’s called a capitated system. Maybe getting in the weeds here, but the VA is paid per person, not so much a fee for service model, which is great because then they’re incentivized to create healthy people, not just treat them when they become complex medical problems. So they’re invested in making sure people are healthy. And so they’ve come out with some great programs. The Whole Health Program; there’s dietary guidance, there’s all kinds of resources for veterans to try and keep them healthy. And I think they stumble a little bit because each VA is a little bit different. But on a national level, the pieces are there that really could have a benefit. And the question is how do you turn that into a national program because it is expensive and your limitations are of course that you’ve run out of resources.

Kelly: [00:11:05] You’re catching veterans now theoretically potentially after service. You had that benefit of being in pararescue, which you should define for us in a second. But let’s say that you’re in the Air Force, you’re going around rescuing people and doing gnarly, heroic rescue, then you’re in charge of the care. When you look back, is there any sense of continuity of care? Because sometimes you can see things in leadership at the end of the tunnel that you could not have anticipated at the front of the tunnel. And is there a feedback mechanism for you to say, hey, let’s really pay attention to this much earlier? Because I feel like sometimes Juliet and I work with young athletes who just lop off their arm and it grows back the next day and they can do whatever they want. And I’m like you don’t understand, we’ve seen the end of your athletic career; we think we can extend it and prevent a lot of harm if you do these things. And we have that benefit of seeing both ends of the spectrum here. Have you had the same experience?

Josh Appel: [00:12:07] No. What really happens is that you’re active duty or you’re serving and they’re still… I retired in 2020 so I’ve been out for a while, but I imagine it’s still a similar mindset, is that you don’t want to be broke; you want to keep going. Especially with pararescue, these high-speed career fields. You just want to keep going and so you kind of bury things, which is probably a lot like the young athletes. You just drive on. And then you get out and you say okay, now I need to start taking care of myself, which is what happened to me. I ignored it for so long and then I got out and I was like okay, now it’s time for me to start working on this stuff. And so I don’t know how you square that circle with saying hey, this is important to do now. Part of it is fear of losing the ability to do your job. And I think we’ve made great strides in the military, pararescue and-

Kelly: [00:13:13] The Air Force particularly.

Josh Appel: [00:13:14] Right. The whole Guardian Angel weapons system, when I was going through and I was a PJ or pararescue specialist. So for those that don’t know, Air Force Pararescue is the combat search and rescue component of the Air Force. They were born in World War II but really got their name in Vietnam when they would rescue downed pilots going down the helicopter and the force penetrator. And have been involved with just about every high-level high rescue mission since Vietnam. So it’s a high demand, high stress environment where people work. And when I went through, it was you get injured, you come off, you try and work through it, but if you can’t you go and see the flight surgeon who gives you a bottle of Motrin and a bag of ice and says come back in three weeks. And I think starting back when we met Kelly this was kind of when we had the transition and pararescue became its own career field with some other battlefield airmen career field. And then it was designated its own weapons system and with that weapons system, it created a maintenance program. Somebody, I don’t know who it was, came up with the great line, “Guardian Angels, the only weapons system without maintenance program.”

Kelly: [00:14:32] Love it.

Josh Appel: [00:14:33] And so with that came all of the funds and some of the training. And so now there’s physician therapists, there’s chiropractors, there’s sports medicine physicians, all helping keep this weapons systems up and running.

 Juliet: [00:14:45] Okay so I have to ask as someone who doesn’t totally understand all the military language. By weapons system, do you mean a bunch of humans who are doing things and they themselves are the weapons system? Is that what you mean?

Josh Appel: [00:14:59] Yeah, that’s a great question. I can understand why it’s confusing. So most weapons systems are considered aircraft or tanks, a piece of machinery that needs maintenance. You’ve got all the maintenance crews that work on the jets and the tanks. But we’ve got a designation for the Guardian Angel Weapons System, and so we got the maintenance program to go along with it.

Juliet: [00:15:23] That makes sense. That’s interesting.

Kelly: [00:15:24] I don’t know if I completely understood that nuance. But I know I understood what you were saying. It’s really funny that that’s finally how we wrapped our heads around understanding that this is a finite resource that some of our most veteran, experienced PJs were not able to deploy, do their jobs because their back hurts.

Juliet: [00:15:47] Right. It would go without saying that you would maintain the jet, but it’s took a second to be like, wait a second, we actually have to maintain the humans in the same way.

Kelly: [00:15:58] We saw that throughout the Armed Forces where people started assigning a number to the training. So Josh, we have $1.7 million invested in your training and so that’s why we should keep you in the field. I love that we basically made humans numbers and systems, and we’re like okay, now we can do the right thing for the right reasons, which is great.

Juliet: [00:16:20] Okay, so I would love to just rewind a bit on your career. And I have 50 questions about what you’re currently doing at the VA and what you’re seeing, which I’d like to get to in a little bit. But before we do that, I’d like to rewind a little bit. And thank you for the explanation about what a pararescue person does because I’m not sure most people actually know that. But tell us a little bit about your career. Did you join the Air Force and then go to medical school, was it the other way around? And then I would like to tee you up to give a detailed background of a particular famous rescue that you were involved in and tell everybody that story as well.

Josh Appel: [00:16:55] Okay. Sure. So you guys know me fairly well but I tend to do things the hard way. So I decided late in my college career that I wanted to go to medical school and hadn’t really failed at anything so I was pretty confident that I would just apply and get into medical school. But it turns out you need things like good grades and high MCAT scores and some life experience to get into medical school. And so I didn’t get in and I found myself kind of wandering and wondering what I was going to do with my life. And then I just stumbled across this thing called pararescue.

Kelly: [00:17:34] Wow.

Josh Appel: [00:17:35] And this was before the internet. This was in the early 90s. And I got this brochure that had a picture of this guy in this maroon beret looking all tough. And it said skydiving and scuba diving and shooting guns and emergency medicine. And I was like that sounds cool, sign me up. And I had no idea what I was getting myself into.

Kelly: [00:17:58] Josh, meet the pipeline.

Josh Appel: [00:18:00] I know, right? After graduating from college premed, I enlisted in the Air Force, much to the chagrin of my parents. That was an interesting conversation because usually you go to college and then you join the military, you become an officer, the frontline leaders. But I wanted to be in pararescue because they were frontline guys, they were the guys doing the job. And I like to make the distinction that it was in the early 90s and so there was not a lot going on. The world was fairly stable. And so admittedly, I went in and I joined pararescue because I thought it would be cool and it would be a great experience. 

But once I got into it, just like any of the Special Operations jobs, there’s a selection which has about a 90 percent detrition rate and they just basically torture you for 12 weeks to include a lot of waterwork, a lot of breath holding exercise and just learning to be comfortable in uncomfortable situations because it’s expensive, it takes a lot of money to send someone through the pararescue pipeline and they want to make sure that you can handle yourself under pressure because you will be sent into some high stress situations. And through that, I learned and just really came to appreciate the sacrifice of others, the teamwork of others, and the things that people have done before me that I didn’t know about when I signed up to be this cool guy in a maroon beret on the cover of a pararescue poster. And so with that, I think I matured into somebody that really enjoyed serving others. So it was probably my first foray into service. And it stuck with me and it’s continued throughout my life. There’s been a backbone of service which continues at the VA.

Kelly: [00:19:55] Did you like the medicine part? It’s one thing to if I’m wrong, correct me here, but one of the things that happens out of pararescue is that you haves so much advanced military medical training, like ER medicine, isn’t that part of the genesis of the whole physician’s assistant program, that we realized we had people who weren’t even doctors but literally could prescribe, handle car accidents that happen with airplanes in wars. I mean this is the first big dose of medical training that you had and you liked it. Or you were so far into the pipeline that you couldn’t not like it. 

Josh Appel: [00:20:34] So that was part of what drew me to pararescue because it’s combat search and rescue, whereas SEALS are more search and destroy. I really liked that aspect of it, of going in and helping people, rescuing down pilots or whatever. And pararescue does a lot of civilian work as well and so all of the high-risk rescues in Alaska or high angle rescues done in Arizona or anywhere long distance, out to sea rescues, pararescue is usually involved because they have the greatest capability. But underlying all of that is the medical treatment that you learn, the medical skills that you have because it doesn’t do you any good if you get somebody and then you can’t treat them. so that was really what brought me to pararescue. All that other stuff sounded fun but it was the underlying medicine that drew me to it. 

Juliet: [00:21:25] And then after you do the pararescue training you go to medical school but you’re still in the Air Force? Is that how that worked out?

Josh Appel: [00:21:32] Me personally? You talking about me specifically? Because like I said, I tend to do thing the hard way. So like I said, I did a stint of active duty and then decided that I really wanted to be a doctor still. It gave me five years to reflect on my life and what I wanted to do and I was grateful for the experience in active duty, but realized that I still want to be a doctor. So I gained a little maturity and some focus. And so I got out of active duty and went to a reserve pararescue team and went back to school. I went to the University of Arizona and then ultimately got into medical school at the University of Arizona and that’s where I went.

Kelly: [00:22:14] Just pause here for a second. Your 21-year-old self-applied to med school. Your 26-year-old self who’s been around the block once, actually has some skills, how asymmetrical was your preparation to the other students? They must have thought you were just an alien who also knew how to work in a team and wasn’t freaked out by blood and could handle not sleeping for three days at a time. I mean it must have been really a shock that you’re like, wow, I think every doctor could really stand to do this before she became a physician. 

Josh Appel: [00:22:44] Yeah. I remember the first couple of weeks sitting in class, looking around, just giggling to myself that they’re teaching me to be a doctor. Because I had just such an appreciation for the effort that it takes to get in. And some of my classmates, they’re right out of college, they’re these young kids. Some of them probably hadn’t even seen blood before. They’re just academically very smart and very driven and step wise they’re like high school, college, med school, residency. But I brought in experience and I brought a different mindset to it that I wouldn’t trade. I tell people if I could go back in time and get into medical school or not get into medical school, I tell people not getting into medical school is probably the best thing that ever happened to me.

 Juliet: [00:23:29] I have to tell you a quick story that I think will probably resonate with you being a slightly older graduate student, but before Kelly went to PT school, he had to take some units to finish up some undergraduate units in order to be able to actually go to PT school. And one of the classes he had to take was a speech class that he took at City College of San Francisco. And obviously Kelly is good at speech, as one can imagine. And at that time, he was like 27 years old, and he gets into this class with actual 18-year-olds, which is even funnier now that we think we have an 18year old daughter. And he had to take this speech class. And kids are terrified of giving this two-minute speech and people are so afraid of public speaking. And Kelly had to check this box. But that was a really weird experience for him being an adult student and having to go through this thing with a bunch of children.

Kelly: [00:24:22] I had that organic chemistry class and that woman’s like—the girl—you live with a woman? And then-

Juliet: [00:24:35] Kelly’s like, wow, I’m already 100 years old.

Kelly: [00:24:37] I think I was in PT school and people hadn’t voted yet.

Juliet: [00:24:40] They were going to do their first voting.

Josh Appel: [00:24:43] I was in the same boat.

Juliet: [00:24:44] Two questions here: First of all, what is the craziest thing you did in pararescue training that a civilian person like me would be like wow, that’s crazy, number one? And then number two, I do want to tee you up again to tell the story about Marcus Luttrell. Kelly and I obviously know the entire thing, start to finish, and are consumers of all of it. But my guess is many of our listeners have no idea who Marcus Luttrell even is. 

Josh Appel: [00:25:10] Yeah. Okay. Craziest thing. I don’t know if I can pick out a crazy thing.

Juliet: [00:25:17] Are you guys jumping off of that high dive that’s five times bigger than the Olympic high dive? What are you doing that’s insane because there has to be some things?

Josh Appel: [00:25:25] That’s funny that you mentioned that because that was more of a summer job than an actual pararescue training. I did that before pararescue. I was actually a high diver in a circus, a German circus, but that’s probably for another podcast.

Juliet: [00:25:38] Kelly just died.

Kelly: [00:25:39] No, I know that. Dude, the depths of Josh you guys. Josh is the guy who finally convinced me to start making my own kombucha. Josh is- 

Juliet: [00:25:49] That’s true. We thank you for that. Wow. Forget about the pararescue class. German high diver?

Josh Appel: [00:25:58] Let me go back to the pararescue thing. So we have, I don’t know if they still do it, but hell night, like they do where they really try and get people to question their motivation. And so it’s just 24 hours of torture. But we did this thing called bobbing, which I know you guys are probably familiar with, but this is the pararescue version of it where you actually take scuba tanks, the twin 80 scuba tanks that are filled with lead shot and you put those on your back and an 18-pound weight vest and your fins and you swim or you walk backwards down into the deep end of the pool and then you bob. So you jump up, you swim up, you take a breath and then you sink back down. And then you have to take your fins off and you put them on your hands so then you can push and you can pull down and break the surface. So I’m like five foot seven on a good day. So I’m really struggling. And with the fatigue and everything. I’m not getting to the surface. And so I miss a breath and then I’m like trying to stay calm because you’re strapped to a bunch of weights and you’re lacking oxygen. And so second time I push up I really push and I really pull and I almost, almost break the surface of the water.

Kelly: [00:27:21] The glass surface.

Josh Appel: [00:27:23] And so I’m looking down the line. We’re all on a line and I see people bailing out, pulling off their safety strap and just quitting and I’m like I am not quitting. And so I tried again. And so this is my third breath and I’m already fatigued. And there is a pool. This was in the middle of the night. And so there was a pool light that I was looking at and I’m like, well, I know there’s people watching me and so I’m not going to quit. And so I just sat down and looked at the light and literally went to the light. Your peripheral vision when you become oxygen deprived starts to narrow and it literally was like turning off an old-fashioned TV. It got smaller and then I was out. And then the next thing I know, I’m getting slapped in the face on the side of the pool. “Appel, Appel, you know where you are?” I’m like, “Hooyah, Sergeant.” Because that’s how you answer everybody, “Hooyah, Sergeant.” “Do you know where you are?” “Hooyah, Sergeant.” “You want to quit?” “Negative, Sergeant.” “All right, get back in the pool.” “Hooyah, Sergeant.” I got back in the pool and luckily, I was able to get a breath and then we ended the exercise. But that was always one of my favorite stories.

Juliet: [00:28:33] So you shallow water black out, you get slapped awake, and then you’re strapped back onto the heavy weights and put back into the pool. That’s amazing.

Kelly: [00:28:41] So couple things. One is that you’re only my second friend who’s drowned in a pool. And what I’ll say is we were approached to do a TV show a minute ago and they were like, hey, here’s the premise: You take all these world class athletes and then we’re going to see if you can break them and we’re going to take them to do these crazy things. And I was like I don’t think you understand how this works. There is no off button. In fact, the premise is that you’re going to see injuries and people will die and drown. It’s because at some point you’re so tired and you’re so willful there’s no mental off button. You just go until literally you can’t go. I’m like have you ever see the woman rolling through the finish line of the marathon or the triathlon. She’s rolling and she can’t walk and she’s pooed herself and she’s like, I’m going to finish. I was like, do you want a TV show of that? And they were like oh, good point. There’s no off button. There you go. Apparently, there is an off button but it’s called your brain. That is a perfect tee up.

Josh Appel: [00:29:44] The thing about it is if you just relax, it was such a calming experience. You get past the hunger for air and the gulping and you just kind of go with it. The CO2 build up-

Juliet: [00:30:04] That’s definitely one way to look at it, Josh. 

Kelly: [00:30:07] I’m trying to keep up with Juliet on the bike and I’m in pain and what I think to myself is this is my life now. This is just how it is and I’m going to just suffer. That must be the same thing. This is my life now. I’m at the bottom of the pool. This is Josh. I hope someone tells my mom. I’m out. Bye.

Juliet: [00:30:23] Josh Appel. Out. 

Juliet: [00:30:27] Hey Ready State listeners, if you like what you’re hearing, please subscribe and leave a review on iTunes to help others find our show. 

Juliet: [00:30:33] This episode of The Ready State Podcast is also brought to you by our friends at Momentous.

Kelly: [00:30:37] We just went on vacation. You’ve heard us talk about the Juliet stack. That’s what this is. When you go, you always bring single serve protein packs because grams.

Juliet: [00:30:48] Grams.

Kelly: [00:30:48] You love a sleep pack because we find that our sleep as we’ve gotten older gets highly disrupted. And then you take collagen, collagen shot.

Juliet: [00:30:55] Yeah, and just having all three of those things with me on all of my trips in single servings, single use packets, is so awesome. I mean in the old days I literally used to be scooping protein powder in a Ziploc bag. And I couldn’t tell the difference between my collagen and my protein powder. And I would just give up on any nighttime supplement because it was too complicated to pack little pill packs. So having these three things on board every time I travel has really changed the game for me. And if you open my carryon bag, it’s like it explodes out with collagen and sleep packs and it’s just so easy to pack little pockets and bags every time I travel and I feel so much better.

Kelly: [00:31:31] Yeah. We did a lot of loading and what was nice was putting that collagen shot in and then loading our feet. That was fantastic.

Juliet: [00:31:37] Yeah, if you want to check it out, go to livemomentous.com/trs and use code trs for 20 percent off your first purchase.

Juliet: [00:31:47] This episode of The Ready State Podcast is also brought to you by our friends at YETI. And what we want to talk to you about today is our favorite summer YETI product and that is the Yonder Bottle.

Kelly: [00:31:58] We just traveled and we’ve been begging YETI for a long time can you please make us a light, backpacking, shatterproof, great poly bottle that isn’t a metal bottle because I don’t have a lot of volume, I don’t drink water. So this thing starts to become like five pounds of insulated steel and I don’t want to take that. Backpacking, straight up in Norway with this liter and a half bottle, was killer. 

Juliet: [00:32:27] Yeah, and I mean it is made of 50 percent recycled plastic and is super easy and lightweight to travel and we’ve used it in outdoor pursuits like rafting and backpacking but also just on everyday trips where you have to put an empty bottle on your backpack before you go through TSA. This thing is awesome to travel with.

Kelly: [00:32:44] Yeah. It’s my favorite travel bottle for sure. I’ve been throwing it in my kayak, I can clip it on to stuff. The Yonder solves a big problem for us. 

Juliet: [00:32:52] Huge fans of this. If you want to go and check out the Yonder bottle and maybe pick up one, go to thereadystate.com/yeti.

Kelly: [00:33:00] So you end up going to med school and then you have a little break, I think. And then you end up going back to Afghanistan on a little break from med school. Is that right? Do I have that right?

Josh Appel: [00:33:13] Summer vacation. Yeah, it is. And I should have never been there. So I started med school in August of 2001 and I loved being a PJ and I loved medicine. And so I was a reserve PJ when I got into medical school. and I had this dilemma: I’m like do I quit being a PJ and just focus on medical school or can I do both? And I decided that I was single at the time and I don’t think I even owned a house plant. So I said I’m going to stay in the reserves, I’m going to be a PJ and go to med school. I’m going to work my way through med school. That was right at the end of my enlistment. So I reenlisted September 9, 2001.

Juliet: [00:34:03] Wow. What timing.

Josh Appel: [00:34:05] Yeah. Isn’t that great? What could go wrong? So that was a Sunday, I believe. And I was at my military training, I raised my hand and swore my oath to the Constitution. And then September 11 happened. And then everybody that was old enough – right now it’s been so long that people don’t remember it—but people were angry. And I was like let’s go, let’s do this. And so I was ready to quit med school and go back and just be a fulltime PJ. I had a skillset to anticipate what’s going to be needed relatively shortly and I’d been training for this for a long time and it was time to go to work. We ended up getting activated and sent to Turkey because at the time we were protecting the no fly zone over Iraq. And so this was early on before Afghanistan had even kicked off and we got activated. 

And this really speaks to pararescue and the brotherhood it creates, my teammates realized how hard I had worked to get into med school and they came to me in a team meeting and they were like why don’t you stay back, stay in school, train up the other PJs, and send them over, and just stay in school. And I’ll never forget that because that meant more deployments for them, time away from their family and that was their sacrifice for me. And that really struck a chord with me and I didn’t like that feeling where I felt like somebody else was picking up my slack. And so 2005, I was graduating from med school May 13, and we got activated again, this time to Afghanistan in 2005. It was going down pretty good there in Afghanistan. And I said I graduate May 13, I’m available May 15 because my folks were coming out to visit. And so I volunteered to go to Afghanistan right after medical school, again, as an enlisted PJ. And so I had a special nametag made up that said Master Sergeant Josh Appel, MD and it really confused people. 

And so I ended up in Afghanistan in 2005 for my summer vacation between med school graduation and the beginning of my internship. And so I was in Kandahar and I walked over to the military hospital and I said, “Hey, I’m a doctor, can I help out?” And nobody checked any… I guess they just took my word for it, saw my nametag, it said MD. Sure, come in, right. And so it was amazing because I really got really the only experience that you can only get as a war time physician. Some of the most brutal conditions that a physician can find themselves in. And that was really a good introduction to my military, into my medical career. And so I did the rotation, I was packing up my stuff. I had packed up all of my gear and we were ready to go. It was June 28 and I was supposed to start my internship the first week of July. So cutting it a little close. So I’m packing up all of my gear-

Kelly: [00:37:29] Let me just pause for a second. Where is your internship and how is working as a physician in a war zone not an internship? You get no credit for that? People were like oh, look, you had a little side hustle, that’s cute.

Josh Appel: [00:37:42] So my internship was at the University of Arizona. And the intern serves two purposes. One is learning how to be a doctor. The other is doing all of the crappy scut work for all the other doctors in the hospital is kind of how you learn how to be a doctor, is that trial by fire. And so, yeah, I was getting the experience, but the hospital wasn’t getting the indentured servitude that the intern provides. And so like I said, I’m packing up my gear, my head is already back in Arizona, and I’m thinking about my internship and picturing something somewhere between Scrubs and ER, those TV shows, when I get this call on the radio that hey, we need all rescue personnel to the command center. And I walk in and I can tell right away that something has gone horribly wrong. You can just feel the tension in the air. And we got briefed that a military helicopter had just been shot down and there were 16 people on board and we don’t know the status of them and we need to go now. So I pulled all my gear out of the storage unit and got it on, got my head back in the game, and we flew up north to Bagram Air Force Base. We were briefed there that the 16 on board the helicopter were all presumed dead. They had been struck by a rocket propelled grenade. But that they had been searching for a four man SEAL team that was still missing and that it was out job to go find them. And that was the first I had heard of Operation Red Wings and that was the mission that Marcus Luttrell and Mike Murphy and his teammates were on. 

And so we searched and we searched and didn’t find anything for a couple of days. And then on the second of July we got a note that was hand delivered by a village elder to one of the Marine fire bases and it was from one of the SEAL team members, Marcus Luttrell, that said he was alive and he was being cared for in this village but that he needed medical attention and the Taliban were closing in. And so we launched on that mission that picked him up that night. And I won’t go in all the details but I was the pararescue team leader on that mission and we flew in to enemy territory and got him out. And then he told us the fate of all his teammates, that they had all been killed and he was in fact the lone survivor of that mission. But he told us where his teammates were located. And in the movie, they never mention this, one of the things I really didn’t like about the movie, but on the Fourth of July we went back in and that’s when we recovered Michael Murphy and Danny Dietz. There was another teammate, Matt Axelson, who was recovered a few days later. But on the Fourth of July, that was the mission where I really thought we were going to be killed. They knew we were coming, they knew where the bodies were, we had just snatched the lone survivor from under their noses, and that’s when I really felt like we were going to be shot down. I often thought about Pat Tillman and how that was a tragic story. This was before we knew what happened but along that same line, the Air Force PJ team whatever goes in and after rescuing, Navy SEAL gets shot down and killed on the Fourth of July. I thought it would have made a good movie but I didn’t want to star in that one.

Juliet: [00:41:17] So just in case people haven’t heard, this whole event was made into a movie starred by Mark Wahlberg called Lone Survivor, which we actually just randomly rewatched with our kids because we had mentioned something about it to our kids. And maybe it was because we had just spoken to you and knew we were going to podcast with you.

Kelly: [00:41:34] And Murphy just happened.

Juliet: [00:41:35] So we actually watched it with our kids because we were like you need to know about this. Did you overall feel good about the way that story was told? I mean I think I did vaguely know about you guys going in after but other than that missing piece of the story, which is a pretty big missing piece, but how did you feel about the movie?

Josh Appel: [00:41:56] I had mixed feelings about the movie. Peter Berg did a great job with the team stuff, with the SEAL team. Really that’s the important part. So overall, I thought it was a great movie, it was a great depiction. All of the action scenes, all of the wounds that the teammates incurred were actually from the autopsy reports, so that was all really true to life. And Marcus was on scene advisor and he literally threatened Peter Berg, he said, “If you make my guys look stupid, I’ll kill you.” So that may have been some of the motivation.

Kelly: [00:42:33] Fair enough. That’s fair. 

Josh Appel: [00:42:34] The rescue portion, the part that depicts my role, was a little cheesy. But it’s not about me, it’s about the team, and I think they did a great job with the team stuff. My biggest pet peeve is that if you watch, the guy that plays me in the movie, walks out of the helicopter and he’s got this big shiny carabiner on his sit harness right in front of his junk. And I’m like why would you put a big shiny object where people are shooting at you to highlight that area? Not something I would do.

Juliet: [00:43:08] Those little details.

Kelly: [00:43:10] Super reasonable.

Josh Appel: [00:43:10] If you watch it again, look for the big, shiny carabiner and you’re like why would you do that?

Kelly: [00:43:15] To highlight your manhood.

Juliet: [00:43:16] Obviously, we’ve been part of the CrossFit community basically since the very beginning and know that the famous workout that is done by tens of thousands of people-

Kelly: [00:43:27] I just saw a Murph Badge at the airport yesterday.

Juliet: [00:43:30] Is in honor of Mike Murphy who died during that mission. Tell us a little maybe for people who’ve never heard of it and what that is and what’s that about and why people do it on Memorial Day and so forth.

Josh Appel: [00:43:41] So when I started my internship, I was excited that we had done the mission and glad that we got Marcus back but-

Kelly: [00:43:51] Did you have any time to process that whole thing?

Juliet: [00:43:55] Yeah, did you just get on a plane and you’re like now I’m in my scrubs?

Josh Appel: [00:44:00] Now I’m back. Arizona. Yeah. a good way to avoid things is jump into an 80 hour a week medical internship. No real processing. So when I’m stressed, I tend to just dive in and do stuff so it actually worked out okay for me until it didn’t and then it worked through it. But it seemed like the thing to do. But I remember just having because all of his teammates were killed plus 16 people on the helicopter were killed. It was such a sense of loss. It seemed like it was kind of for nothing. And that was when I started doing CrossFit. It was actually 2006 when I started doing CrossFit to augment my jujitsu stuff and really liked it. 

And then I was in Albany, New York at the time and in 2006, 2007 there was maybe a handful of Hero WODs and I remember looking up at the wall and seeing Murph. And I was like I wonder if that’s the same Murph that I recovered. And sure enough it was. And I did some research and so I told Jason Ackerman, who was the owner of Albany CrossFit, “Hey, we should do something on Memorial Day.” And we did a Hero WOD workout. And I remember the shirt said “Our Pain for Their Sacrifice.” And I did Murph; other people did other Hero WODs. It was awesome; just the feeling. Memorial Day for me would always end up being drunk and depressed but I felt like I did something. I actually put forth some effort and thought about not just Mike Murphy and those guys but everybody who had paid the ultimate sacrifice and allowed us this day of remembrance and allowed us to have a barbecue and drink beer and not go to work. And so that really resonated with me and I thought that this should be something that everybody does. 

And so the next year I had the entire box do Murph and it was awesome. Just the synergy, the teamwork, it created the tribalism where everybody’s pulling for each other, it was awesome. And then we ended up moving back to Arizona after my residency and I thought it would be a good thing to have as a national fundraiser, at least as a national event, and that’s when I reached out to Mike Murphy’s dad, Dan, and I said, “Hey, I’ve got this idea, this Memorial Day event, it’s called Memorial Day Murph.” And I remember talking to Dan Murphy and he’s like, “So you want to charge people to work out at their own gym and do Mike’s workout?” I was like, “Yes.” He said, “Good luck with that.” Because nobody was really doing that. There was Fight Gone Bad or Barbells for Boobs or something. But it was kind of a new paradigm with fundraisers where you do your own, do it wherever. 

And that was the start of it, nothing but a Facebook page and a directory of CrossFit boxes. It’s where it got its start and just took off. We had 2,700 people the first year and then the next year we had 10,000. And Angie and I had just had twins or she had just had twins. But we had newborn twins and a two-year-old and we’re stuffing these T-shirts into envelopes for days on end. And she said, “We are not going to do this again.” And so that’s when we handed it off to the guys at Forged. And Mike, who was an ex-SEAL himself was a teammate of Mike Murphy’s. So it just blended well. And they have now taken over the general fundraiser. But the Memorial Murph tradition has certainly expanded well beyond CrossFit. People in police academies and fire academies and Boy Scouts, everywhere, people are doing it all over. So it has been amazing for me to watch and just an honor to be part of it.

Juliet: [00:48:05] So cool.

Kelly: [00:48:06] I don’t think enough people know the whole story. I love that. Thank you, Josh. That’s amazing. If we shift gears here for a second, emotional gears, you are suddenly a physician, you’re going through this traditional physicianship, you’re still attached to this pararescue wing. What places do you start to realize maybe the Guardian Angels aren’t quite on board yet as a fighting system? Are you able to come in and think differently about what you’re doing because you have this different perspective? I mean pararescue has been around for a minute, as you say, how does that change what you do in you day job, knowing that aspect of it and how do you take what you’re learning in your day job and change your pararescue experience?

Josh Appel: [00:48:54] That’s a multitiered question. What was that middle part again?

Kelly: [00:49:00] You’ve come through looking at the care and feeding of people from a medical perspective. For me, I remember the moment where I was like I’m just putting out fires and I’m wondering if there’s something I can do to prevent fires. Do you ever have that experience as a physician? Because that’s really different. I can not know anything about Juliet, Juliet comes to my table, I get Juliet sorted, out of pain, less pain, functional again, kick her back out into the world. But then after I see Juliet ten times, huh, what’s going on with Juliet? Is there something I can do to prevent this or change the system? Do you feel like there’s any agency there or do you start to become aware of that?

Josh Appel: [00:49:40] So this brings us back to when you and I met. Until we met, I had never thought about that. As the flight surgeon, my job was to get folks back to their job. Mostly it’s the paperwork and some recommendations on training on what to do. But until you and I crossed paths and you came out for that first seminar, there was no root cause analysis. It was all reactionary. It was all I got this, how do I get better? None of it as proactive. And I think we’re having that same revelation with healthcare in general now. Healthcare now is so reactionary. But how do we put out the fires or how do we prevent the fires because right now we’re just putting out fires and we’re getting paid to put out fires.

Kelly: [00:50:34] So much the DNA of our work has come from me… We just did this on another podcast working with the Navy, but so much of the DNA of understanding the realities of what people are asked to do with their bodies and we can’t have these perfect situations and scenarios, so how do we get 100 percent out of 50 percent? If we can only assume 50 percent of the thing, let’s make sure we’re getting the full 50 percent. And even, we made a thousand videos of a top down setup of how most people set up when you pick something up and then we started really looking at Olympic lifting, and oh, they’re all doing bottom up set ups. And I remember I asked you all what’s your number one problem. You’re like guys tweak their backs getting the litter out of the helicopter. And I remember being in the helicopter and being like you can’t stand up in this helicopter. And everyone was like, no. And we had to show people how to organize the best of their ability to get into the most robust positions from a full weird squat, grabbing a litter. And those ideas of saying what can we control, how do we optimize for the best positions in the worst positions, those were such important lessons for me, even though you thought I was there for you. I was learning a lot at the same time. But it really was. You guys didn’t have barbells. You had just gotten some early stuff. Guys were just thinking differently about it. 

Josh Appel: [00:51:52] Yeah. Right. And it’s not so much how do you lift in that awkward situation but how do you set your back up with what you’re doing in the gym or what you’re doing in your daily routine because I don’t have to tell you, but just lifting the litter doesn’t cause the problem, it exposes the problem.

Kelly: [00:52:09] That’s right.

Josh Appel: [00:52:10] I think I got that from you, by the way. See, I’m plagiarizing in real time.

Juliet: [00:52:15] So you touched on this a little bit and this may be a podcast in and of itself, but do you think the approach to medicine being reactionary, do you think that is starting to change from a philosophical standpoint? I mean it’s so ingrained in how our current medical system is set up. And if so, in what ways is it changing, who’s changing it, is it still just .01 percent of physicians like you and some other forward thinking physicians that are thinking this way? Are you still in the extreme minority or do you think there’s starting to be a bit of a change in philosophy and maybe starting to rethink how we’re doing this thing that is our medical system?

Josh Appel: [00:52:57] Short answer: yes. I think I’m still probably a one percent but not a .1 percent. So there’s optimism there. I think I see glimpses into the future that are promising. I tend to be an optimist. I think after trying everything else, we will do what’s right. I think if we give people the opportunity and the information, they will make the right choices. And then I read something about bed rot and I’m not so sure I have the optimism anymore. Bed rot. That’s an actual thing that goes against everything that… Anyway. Kids.

Juliet: [00:53:33] It sounds terrible. If my timeline is correct, you started your current role at the VA like five minutes before the COVID pandemic hit? Am I right on that?

Josh Appel: [00:53:44] No, it was more than five; it was at least fifteen. No, I had settled in. Let me come back to that, but I wanted to finish-

Juliet: [00:53:52] Sorry. Totally interrupted you.

Josh Appel: [00:53:53] My optimism for healthcare. So I think, like I said, the VA is a good model. I think if we can dial that in, like the capitated system where people are paid per patient and not per service, I think that helps with the motivation because unfortunately things are often motivated by money. And the VA is doing a lot of things in that sense like trying to be proactive. And there are physicians out there that are doing that. I know Julie Foucher is one of those forward thinking physicians. I’ve got a buddy of mine who’s running a men’s health clinic here in Tucson who is actually my PJ teammate on the rescue mission which is a funny story.

Kelly: [00:54:40] Amazing. 

Josh Appel: [00:54:42] Yeah, he was a trained cardiothoracic surgeon and saw all of the reactionary stuff and was like I’m going to skip all of this stuff and try and get people before they need to have their valves replaced or before they need their bypass graft. So he’s aggressively treating cholesterol, he’s aggressively treating things before they become problems. And I think that’s really where we need to go, it’s just building the model that gets us there. And I think when I become surgeon general, that may be something I tackle. 

Juliet: [00:55:14] Yes. Is that an ambition?

Josh Appel: [00:55:15] No, it’s more of a joke because I’m not even sure what the surgeon general does other than has a cool hat.

Juliet: [00:55:22] Cool title.

Kelly: [00:55:23] Chasing cool hats has gotten you into trouble.

Josh Appel: [00:55:27] I know. I hear you.

Juliet: [00:55:28] It sounded like, yeah, again, I don’t have the timeline perfectly in my head, but you obviously were running this huge organization during the middle of a worldwide-

Kelly: [00:55:39] Head of the ER department.

Juliet: [00:55:40] Yeah, head of the ER. And again, I think this could be an entire podcast in and of itself, but give us a little Reader’s Digest version of what was that like for you on the ground?

Josh Appel: [00:55:51] Yeah, it was really interesting and it really tested my leadership skills because clearly I’m not one to shy away from challenges and I looked at COVID as a challenge. And I was like, yeah, this is go time, let’s do what we can, let’s help people. We’re the emergency department, let’s protect ourselves, but let’s get in there and do stuff. And I charged up that hill and I realized that I was kind of up there by myself. And then I left some people behind because some people were a little more apprehensive than I was and that was good for me personally to realize that not everybody’s coming from the same perspective. But I think COVID was challenging in a number of ways and it was trying to keep people safe and being able to adjust on the fly. And really, those are two things that my training has helped me with. But things were not moving quickly. 

And so in the emergency department we tend to jump in and do what we can based on the information we have and then adjust as things come in. And I think what COVID really exposed is that we were not getting those updates and we were not able to flex real time when data changed and when we got more knowledge about stuff, so we were lagging. And this is America in general or healthcare in general dealing with COVID as things changed, I felt like we weren’t quite as flexible as we could have been. But really the takeaway message I got from COVID was don’t be fat and unhealthy, right? Talk about preventing fires. Now that we are a couple years with some data, we can see, we can dissect it and backtrack it and see who really was the vulnerable with COVID, and those were people who were overweight and underlying medical conditions.

Juliet: [00:57:53] So it’s super interesting you say that because I think that started to become obvious pretty early on. And I don’t know if it was how the media handled it or it was out of an abundance of sensitivity for certain groups but it’s interesting because nobody really did or does talk about that, at least in public settings. And I was always so shocked. I mean I think there were always a few small voices.

Kelly: [00:58:19] Maybe we were too close to the fire.

Juliet: [00:58:20] The broader mainstream media, people almost felt like they couldn’t say people who were overweight and unhealthy were the ones dying. They felt like they couldn’t say that because it would offend people or it was somehow-

Kelly: [00:58:37] Too late.

Juliet: [00:58:38] Too late. I don’t know. But I did think and do still think it’s a very weird thing. That you’ve even said it out loud is unusual, I think. Why do you think that it is?

Josh Appel: [00:58:47] I don’t know. I have thoughts but they’re not helpful. 

Kelly: [00:58:55] Ozempic and Ivermectin, that’s really a great stack.

Josh Appel: [00:58:59] I don’t know. We had data pretty early on. The things that were being done, there’s no logical explanation to me for it. As gym owners, you guys got shut down. You were part of the solution and your business was shut down because it was nonessential. I don’t know anything that would have been more essential than a place where you can go-

Juliet: [00:59:22] Yeah, that slayed us on a deep and existential level. I was like, well, I’m at Costco right now with a billion people buying huge bags of Doritos and that’s essential. But my gym, which is large and aerated with garage doors, is not essential.

Kelly: [00:59:40] With some of the healthiest people in the community.

Juliet: [00:59:40] Yeah, it was really hard for me to square that.

Kelly: [00:59:43] We learned that also people need community and people did not do well when we put them out of their friendship groups and their coping strategy groups. I mean I think what’s interesting to sum a little bit of what I think you’re both saying is having connected the dots on this experiment we ran that was thrust upon us and looking at the interventions downstream of that, now we’re just back on the phones, back on the alcohol, back on the whatever it is.

Juliet: [01:00:13] Yeah. You’d think there’d be some national push saying okay, we got the data in from a pretty large experiment that.

Kelly: [01:00:20] We lost a lot of people.

Juliet: [01:00:21] Yeah, we lost a lot of people and that was a horrible thing for families and communities and hello, we need to focus a lot more attention on this thing which is people’s actual health and rethinking our medical system so it’s not just reactionary. It’s deep but it seems like we just went back to, okay, well, let’s just have everybody doing their thing. 

Josh Appel: [01:00:44] I call it a teachable moment. We have a huge teachable moment right now and we’re squandering it. Again, back to that surgeon general thing, are we not going to learn any lessons from this?

Kelly: [01:00:55] It’s tough. It’s tough from the top down. I think that’s one of the things that I recognized standing in front of the senior Army medical leadership one time, that trying to change a tanker mid drive, it takes a long time to make change. It’s a lot easier working with a unit, seeing how the Air Force and the pararescue for example went out and hired and hired incredible coaches. I’m talking about Justin Schwinn, who is genius, running the high-performance program there, being able to act nimbly at a community level, and that’s really what each squadron is, a community level, versus a national level, it’s just much harder, even a global level. That’s why I think Juliet and I, one of the reasons I think with Built to Move, we really looked at hey, this trillion dollar experiment we’ve been running in fitness hasn’t served our communities. In fact, it’s failed us. And we maybe focusing on the wrong level of organizational change. And we really felt like the household, the dyad, the people who live together, that was really the only functional unit that mattered, the team at that level.

Juliet: [01:02:03] Fact. 

Kelly: [01:02:03] Fact.

Juliet: [01:02:04] I do have a couple other questions. Obviously, COVID must have been a huge part of your experience in the ER in recent years, but what else are you seeing? Are you seeing trends, changes, anything big about what’s going on with people’s health writ large as you see it in the ER? And then I do have one more other specific question but I’ll let you take that one.

Kelly: [01:02:24] We just don’t have heads of ER departments on our podcast.

Juliet: [01:02:27] What’s going on in there?

Kelly: [01:02:28] What are you seeing?

Josh Appel: [01:02:29] Well, lucky for me, people are still doing stupid things, so I have pretty good job security. People are still riding motorcycles and juggling chainsaws. Anyway, in the VA I see a lot of downstream effects, even more than when I’m working at the trauma center at the university. 

Kelly: [01:02:54] Is it like KV, ketoacidosis, you’re just seeing that people are mismanaging their health?

Josh Appel: [01:03:00] Right. That’s a lot of it. And they come to us. So we’re kind of a social safety net. I love that about emergency medicine. We’ll see anybody for anything. And sometimes that gets abused. But we’re definitely the social safety net of the community. And I think we try and fight that and our corporate leaders try and fight that, but when you don’t have anything else, that’s the place you go. And I love the fact that I never have to check insurance or are you qualified. In my ED, I’m treating you, I don’t care. But just the effects of the long-term abuse that we do to ourselves. And I think our generation is probably the first ones that will really start turning it around. But I see a lot of the older folks that have smoked and not had the best diets and diabetes. But I think it’s our generation that’s going to turn it around and then our kids that are going to be the mutants that… I’m curious to see, I know your girls are a number of years ahead of ours, but what this generation’s going to turn out to be, all of the information and all of the stuff they know about health and durability, how that’s going to work out. 

Kelly: [01:04:15] Whatever. We invented Doritos, our generation.

Josh Appel: [01:04:20] TV dinners and Doritos, all of that stuff. We got rid of the family garden. That’s not us. That’s our parents. 

Kelly: [01:04:30] It happened to us. I feel like Doritos happened to me. Is that fair, Lisa?

Juliet: [01:04:35] Yeah, I mean we’re actually going to have Dan Buettner, the author of The Blue Zones. I don’t know if you’re familiar with his work but he’s going to be on the podcast. And we’ve spent a lot of time thinking and learning from him about what it is those communities all do to produce a ton of sedentarians. And of course, it’s all the most basic stuff, including and maybe most prime strong human connection and connection with your immediate family. And so hopefully our kids will start to get on that program a little bit and change some things.

Kelly: [01:05:06] Josh, besides being bit by a snake or cutting my arm off to come see you, are you on the socials, can people follow you if they wanted to know more about your adventures?

Josh Appel: [01:05:17] Yeah. If you like what you’re hearing, I’m on LinkedIn. If you don’t like what you’re hearing, I’m on Twitter as well.

Juliet: [01:05:26] Kelly was trying to get to the end. I can’t let you leave without one more question.

Kelly: [01:05:30] Sorry. 

Juliet: [01:05:31] I’m sorry, but Kelly and I are obsessed with Ozempic and all Ozempic-y things. So I just wanted to get your thoughts and opinions on it.

Josh Appel: [01:05:41] So as an ER doc, I don’t really have a lot of interaction with it. It just feels like the latest shortcut. Just do the work.

Kelly: [01:05:50] Really powerful tool, if we can get people to lose 25 percent of their weight, decrease your fatty liver, that’s really a first step intervention that maybe is better than gastric bypass.

Juliet: [01:06:05] Interesting.

Kelly: [01:06:07] We’ve seen some friends taking let’s just say Mexican off brand Ozempic and working in ERs and seeing people who have had negative downstream consequences from taking suspect generic Ozempic.

Josh Appel: [01:06:20] Well, as with anything, it has a purpose. I think it has moved beyond its purpose and I think the people that need it are now having a difficult time getting it. But it absolutely can help, but I think the majority of people using it should probably just do the work.

Juliet: [01:06:37] Well, I feel like we may have to bring you back for a Josh Appel part two because I feel like there were a lot of subjects we didn’t get to cover like raising kids and standing desks at schools and more on longevity and durability and fermented tea. I mean there’s a lot that we didn’t have a chance to cover in this episode so I hope sometime later this year we can bring you back for Josh Appel talks to the Starretts part two.

Josh Appel: [01:07:05] That would be awesome. I do want to pitch my idea; I think it would be epic. Hose flavored water. A little packet.

Juliet: [01:07:13] Yeah, 1970s summers.

Josh Appel: [01:07:15] Yeah, you pour the packet in and then you drink the water and it tastes like a rubber hose.

Kelly: [01:07:21] Wow.

Juliet: [01:07:21] That is a key part of creating a 1970s summer for your kids, which I am a fan of. 

Josh Appel: [01:07:25] It would be a niche market, of course.

Kelly: [01:07:28] It comes in a three pack with a Chia Pet.

Juliet: [01:07:30] But there also needs to be a three pack with a Tang flavored-

Kelly: [01:07:35] You’re not wrong, that’s kind of genius.

Josh Appel: [01:07:38] I was thinking we could put an attachment to your water bottles that was actually the end of a hose so you get that metal taste.

Juliet: [01:07:45] And somehow some kind of technology that there’s four different temperatures that hit your mouth because the first part of the hose has been in the sun so that water’s kind of warm, and then it starts getting colder. I’m so with you. You and I have obviously been having the same thoughts.

Kelly: [01:08:02] I had heat not stroke, I had some pretty sun exposure problems as a kid and I remember being on the clay tennis ports drinking from that orange hose they use to spray down the tennis courts and feeling like I’m going to pass out and kind of nauseas and then hitting that full warm hose. You guys have positive associations running around. I still had to ride my bike home and I remember pulling under a tree and passing out.

Juliet: [01:08:32] Yeah, but I mean everyone’s doing all this formal resilience training now and I think if we just locked our kids outside, made them stay outside for 12 hours in the summer and were like drink from the house, forage for food, good luck to you, we wouldn’t need so much resilience training.

Kelly: [01:08:48] Josh, tell us where you are. Can we follow you?

Juliet: [01:08:51] LinkedIn. Twitter.

Kelly: [01:08:52] And your hose water?

Josh Appel: [01:08:52] Yeah, LinkedIn, I think I’m just Josh Appel. I think I may have seven followers.

Juliet: [01:08:59] Hopefully this podcast will get you up to 12.

Josh Appel: [01:09:03] Not really big on the socials but I’m here for you guys whenever.

Kelly: [01:09:05] From dad girl to dad girl thank you so much for… Girl dad, not dad girl. Girl dad to girl dad. Thank so much for joining us. Always appreciate your friendship and your candor and your view on this. And thanks for sharing your experience with our TRS family.

Josh Appel: [01:09:21] Awesome. Love you guys. We’ll see you.

Juliet: [01:09:23] Thanks Josh.

Kelly: [01:09:23] Thanks Josh.

[music]

Kelly: [01:09:29] Thank you for listening to The Ready State Podcast. If you like what you’re hearing, check out all our episodes here or at thereadystate.com. And be sure to subscribe or leave a review on iTunes to help others find our show. 

Juliet: [01:10:40] Check us out and follow us on Facebook, Instagram, and Twitter @thereadystate.

Kelly: [01:09:45] Until next time, cheers everyone. 

Back to Episode