One year of Quarantine

Paul: [00:00:00] hey Howard.

Howard: [00:00:00] Hi, Paul,

Paul: [00:00:02] Long time. No talk.

Howard: [00:00:03] that's been a number of weeks. The world has changed a little.

Paul: [00:00:08] Yeah, I heard stuff happened.  Things have things have changed. It's I'm not sure. I, wow. It feels like a good reset for now anyways, but it's yeah, it's a weird, it's a weird old world right now.

Howard: [00:00:19] It is, and I, I don't think it's going to change. So, so we need to, we need to stay active and exercise so that we can forget more about what's going to happen.

Paul: [00:00:28] It's crazy to imagine this. But it's a year, almost, almost a year since this whole quarantine, how are we going to lock down?

We were talking before we started recording that. We were swapping text messages and notes more than a year ago saying I can't quite believe anyone. No, one's noticing what's going on over with respect to this, this, this virus and its properties in China.

And you know, I joke that well it's because it was going to go on for another year or so. Why start paying attention any sooner than you have to, but the reality is this is now a year. And as you said, It's makes paying attention to your health or having paid attention to your health even more important, because this is probably one of the few things over which you have control in the face of something this large.

Howard: [00:01:16] right. And the consequences of not paying attention to your health have become OSA. Very evident. Right now, the number one cause of death. And we really don't know all the contributing factors, but we know many of them. And half of us out there are insulin resistant. Half of our kids are insulin resistant.

So it is time that we wake up and pay attention to those. Yes.

Paul: [00:01:43] Maybe a good place to start. And I, I sent this to you earlier today. I ran into a quiz that I think it was an an Irish sports medicine guy had put out and I just thought, you know what? This is a good way to sum up. In a really quick way, whether you know where we're at in terms of personal fitness, a year into quarantine, and it was markers like it was really short. It was just, I think, four items. Like how many times can you stand up and sit down from a chair in 30 seconds? And this is again, obviously graded by age.

How many pushups can you do? Without a break. Consecutively. And then one of the weirder ones, I think it was, how far can you travel on foot and 12 minutes? Which I like, just because it feels vaguely prehistoric. Like I can get just far enough to get me an antelope. And there was a fourth one that I forget, but,

Howard: [00:02:29] Standing on one

Paul: [00:02:30] Oh, yeah.

The standing on one leg arms folded across your chest eyes closed and you know, eight seconds was the target. And I, cause I had, I was talking to someone the other day, we were about like  sizing up their, how they felt about their fitness after a year of quarantine. And I wished I'd had this in front of me because it's a quick and dirty way of saying at least you're, you're  average.

Howard: [00:02:52] So as soon as you sent it, I did it with my son and. Yeah, well, like you, we went to the end, right? I'll squat for for 20 minutes. It, if I need to in truth, be told I can do 50 pushups. And I'm 57. So I'm doing okay. But I I've written got 60,000 words on these very things and he, he drilled it down into four, four, four simple tasks.

You're right. It's balance. It's resistance, strength, and it's aerobics. And it's so critical. I do the, I do the sitting lawn or chair squats in my office for people to test them. I do the balance and so many people fail and it starts in your forties and fifties for some people. So it's really important to have little simple tests like this.

Paul: [00:03:48] Oh, I'm I, I, I'm glad to hear you say that because for me, it's nice to be able to pull out a couple of quick things because I get this question a lot and I just usually just tag you into the conversation on Twitter and say it's Howard's problem. But you get this  question all the time. Like, how do I know.

Like, how do I know outside of blood markers or something some 10 K running time? How do I know that I've got some level after a year of quarantine that I've got some level of practice or maintaining some level of practical fitness, and at least this is one thing we can point people towards and say, here are some rough approximate markers.

And as you say, they really map in nicely to a lot of the things we've talked about and that you've written about many, many times about school, the importance of squatting, for example know the importance of a base level of. Of of aerobic fitness and this all seems to map really nicely and doing the thing that always surprises me.

And this was one of his claims was that he thought less than the age-related standards would be hit by less than 30% of Irish citizens. And I don't know if that's optimistic or pessimistic because I have a bad field, like it'd be worse here in the United States, but I don't know,

Howard: [00:04:52] That's an interesting thought. I, I'm not sure what the percentage is. You know, obviously my sample is biased based on what I'm seeing in the office. And our bubble I think will score very well on this. But it's interesting in that. You see this  about people who are worried about what their sleep score is, or they're trying out levels or very to map their blood sugar, but they're not doing balance resistance and, and aerobic training.

Certainly there's a tiny percentage that are however, so many people think that a low carb diet or a keto diet is going to. Cure

Paul: [00:05:40] right. Magic bullet.

Howard: [00:05:42] everything that ELLs them.

Paul: [00:05:43] Yeah. Yeah, yeah,

Howard: [00:05:45] and if their sleep score is good, then they're fine.

Paul: [00:05:48] Or if they have, or even in a  parallel universe, they have these strange pet favorite measures. Like I have a friend who's convinced that he can assess anyone's fitness. And he likes to brag about how much this has improved over the last year about by how many pull-ups they can do.

He said, that's the, that's the queen of all exercises right there that pull-ups, and he said, well, a year ago before his quarantine started, I could do two or three. And now I said, I can comfortably bang off 40 or 50.

And I said, wow, that's fantastic. And I S and this was just me being  a prick, but I said I said, how many do you think Alex Honnold could do. And out of titled, obviously as the this, this great free climber was in the Jimmy Chin's movie, free solo, which is outstanding. I saw a clip, actually. and he did, he, he did six and maybe half of a seventh. And as he said, it's just not practical for what I do. And that's the word that I keyed in on is that, and this goes to how you should I'm hope people have focused and spent their time during over the last 12 months, but it's on practical fitness because it's, what are you trying to accomplish in whatever your program has been over the last 12 months?

Is it fitness for some brace? Or is it fitness in terms of longevity or fitness? What, right. I mean, this is the key question and that's why I loved the Honolulu can do six and a half pull-ups thing. Right. Here's a guy who can do what? 3,200 feet climbing El Capitan without ropes. I mean, I I'm assuming the whole inability to do seven pull-ups did not get in the way.

Howard: [00:07:21] It's it's it's very interesting what people are trying to optimize for, or. That's assuming that they're thinking about what they're optimizing for to begin with. I mean, I don't see a situation where optimizing for pull-up strength when you're 57 years old matters. You know, yes. I think it's great that I can do a few and I could only do four or five John Bauman, who we've spoken to can bang out 50.

But I'm. Happier that I can squat bounce and run because I worry as we've talked about, I optimize for longevity. I'm not gonna win any more races. And, and the only race that I want to win is not being on a medication, not being on a cane, not being on a Walker and not falling and breaking a hip because I tripped over something.

That's it?

Paul: [00:08:15] Wow. It's we're, we're a cult of two, cause you've converted me on this one, but

Howard: [00:08:20] Yeah. Yeah.

Paul: [00:08:21] I do my best to evangelize for this particular cult. I'm not sure I was successful. I am, but no, I, I think when you it's optimizing for what is such an important question and. As I've talked to people who AF after spending a year and they built up a gym at home during quarantine and locked down, they have a Palatine and all these other things.

The single impression I walk away with more often than not is they don't actually know what they've been optimizing for over the last year. Right. And I see this over and over again. And I'm curious is, is that your sense too? That that's one of the problems here. It's great. People are buying these things because they're not going to gyms and they're doing this stuff, but I think they, it's still very misdirected because they don't know what it is they're optimizing for.

Howard: [00:09:07] Hey, you're a hundred percent correct. I've you know, as I posted this morning I climbed on my Peloton this morning to do a 90 minute zone to right. And I was, I was begging for people to

Paul: [00:09:22] Please just distract me please.

Howard: [00:09:24] And everyone's saying, Oh, you should use wifi. You should use this protect candidates. Use wifi because I'll be losing by 20 miles because I'm not letting my heart rate go above 125.

I'm not going to join a class and have someone screaming at me. And. You know, Peloton zone two is a FTP base. So it's not heart rate based. Yes, I could do it as a heart rate base, but still, I I'd rather just play my songs or read my book and do my thing. And as someone else chimed in and said, if you just change your cadence a little bit, according to the song, You'll be fine.

And I put on a playlist and at the end of the ride, there were two, four minute really beasts songs. So all of a sudden I'm up to 300 Watts and a heart rate of 107 days. So, so I got my top, I got my top line in.

Paul: [00:10:19] Yeah. That's and that's about all you and it's split all you need I mean, that's the, the 80 20 rule is very, very binding here.

Howard: [00:10:27] That was exactly what Dr. Sam Milan had said. So that has stuck in the back of my head.

Paul: [00:10:33] It's it's completely stuck in my head. So, so let's talk about what you're seeing. Are you seeing, and again, your sample is biased because people don't come to see you just to be social or maybe they do. I don't know.  But are you seeing any change in the types of injuries that people come in with?

Are you seeing more? And I mean, this was my, I've said this for a year now, but I'm now. Increasingly convinced I was wrong, but are you seeing more stress fracture is more over use injuries. Are you seeing more of anything or less of anything as, as this last 12 months changed anything in terms of the cross section of things you see?

Yeah.

Howard: [00:11:10] so as the pandemic. Progressed. Right. You know, when we first start started, we obviously sorrow the stress fractures from those of us who amped it up. But I also saw the weight gain and devastation and aches and pains because of all the people who stopped and locked up, things have started. To normalize, right?

The the word well or staying in and are never going to come out again. The school athletics travel teams have started with some restrictions, but they've started. So we're seeing our ACL tears, our shoulder dislocations again runners are getting back out there. I think a lot of runners Yeah, I've started to get back to quickly if they took some time off.

So I am seeing a fair number of stress factors. Not quite sure, but I'm seeing a ridiculous amount of frozen shoulder. I have no idea why it, it comes in. Yeah. It comes in spits and spurts. Whether it associates with COVID or not. I have no idea, but.

Paul: [00:12:19] Quickly explain exactly what that, what that is?

Howard: [00:12:22] So frozen shoulder is quite simple. It is a shoulder that is mechanically blocked. You can't move it as much as the other arm. So you can't, you can't raise it up. Not because of pain, there's actually a structural block because the. Capsular ligaments around your shoulder have thickened and shortened.

So there's less volume in the capsule and you have less motion. It's a very inflammatory condition. If we put a camera in a normal shoulder, it's a white, pristine environment. We put a camera inside, a frozen shoulder. It's red, it's angry. It's like a skin knee. And it associates and is more common with diabetics and poor metabolic health.

So we see a fair amount of it throughout the year, but there are times in a year when we just see more of it. It could be triggered by an injection. Like a bursitis, like someone who gets a a vaccine or an injection and the needle goes a little too far and hits the bursa in the shoulder.

It can set off a series of events and lead to a frozen shoulder. It's not the substance that was injected. It's the mechanics, right? It's a mechanistic cause So it's, it's a puzzling disease. It was brilliantly described by Codman back in 1934 who wrote all about it. And he actually said that that nothing that we do will help.

So just leave these people alone. And it's funny because we ran full circle with rows and shoulders and took a lot of them to the operating room, to manipulate them and operate on them and cut the capsule and do all sorts of things. And then we found out that just injecting about 20 CCS of sailing into them under, under ultrasound sound works extraordinarily well and almost everyone.

Paul: [00:14:12] Yeah, it's, I've run into multiple people. And I actually a couple in the last year that after having you run into people now and then, but all of a sudden in the last year I've run into multiple people and it's always this very no pun intended pain look that I just, I don't know what I did, but this has happened.

Howard: [00:14:30] It can be miserable. Know you, you see someone in your office and they're off the charts beside themselves, miserable. It's calcific tendonitis, right? Some calcium in there. If you see someone who's pretty miserable and they go to shake your hand and they hike their shoulder up and they can't move it.

And it's a frozen shoulder, it's an easy diagnosis to make. And now with the hydro dilation with, with the saline Injection so easily treated

Paul: [00:14:58] it's

Howard: [00:14:58] don't suffer with it.

Paul: [00:15:00] Yeah, well, I won't self, I won't self-inject either. It's interesting that it's popped up more during quarantine though. That's it? So did he, just out of curiosity, did the incidents of ACL's really drop off in the period?

Howard: [00:15:10] Oh, tremendously. When sports went away, a lot of ACL tears went. Went away. But then we had all the kids that we had booked for March and April and may. And we had to get them back and done. I mean, June, July and August. So those are some crazy months.

Paul: [00:15:31] Do you think? I I'm curious, I'm going to take us a somewhat related angle here, but it feels to me, and we've talked about this a lot. That there's lots of things that if we just leave them alone, they get to have a tendency to get better, or at least be less bothersome. And that this in some ways is a classic natural experiment because.

People had things go wrong and then we're forced to go away and wait, because that option wasn't available to them. Do you think we're going to discover that any particular therapies or treatments or interventions were less necessary because we've discovered that 12 months later, they actually didn't need the procedure that they were originally had prescribed and then couldn't have as a result of the, the pandemic.

Howard: [00:16:16] So,

Paul: [00:16:17] maybe not a good example, but

Howard: [00:16:19] no plenty of ACL's can't be treated without surgery. Hundred percent. You know, if you're an adult, you tear your ACL. Don't assume that you need to have it. Reconstructed. Everyone who wants the last Olympics, the last winter Olympics watched a female downhill racer ski without an ACL. So, but you know, you asked.

If we will learn if any injuries recover without our intervention. The problem is, is that we know these, we know about these injuries, right? We know that meniscus stairs don't require surgery. We know that a lot of rotator cuff tears and tennis elbow doesn't require surgery. These have all been studied with, with, with placebo controlled sham surgery trials.

So it's been proven over and over and over again.

Paul: [00:17:16] and it hasn't mattered.

Howard: [00:17:18] yet, right. So there are. Patients who I'm sure was scheduled for an arthroscopy for a meniscus tear in April, who, when it opened up again, found out that they didn't need the surgery. But I'm sure that that fact did not change their surgeons preference to operate on it.

Paul: [00:17:43] You know this. Yeah, no, no. It's right out of behavioral science motivated reasoning, right? I mean, you just find a reason to continue believing what you want to believe because the outcome is when you prefer, you're just too much too motivated to believe it. So you just continue reasoning in a way that supports you the basic objective, which is I want to do the procedure or I want to have the procedure done.

Right. So, yeah.

Howard: [00:18:03] you put your scope in someone's name and they got better, it has to be because you did something.

Paul: [00:18:09] If I put a scope in some wins and they got better, then that would be something, something to write home about. So, but anyways is it my sense, is that in general, I feel as if I see more people. Just doing stuff in general, that I've have a hunch that in five years we'll look back at some longitudinal data and this I'm not sure what specific data will we'll see it in, but it will see that there was a general societal uptick in fitness, granted, massive distribution, lots of people just never got out of the house.

They gained weight, they have joint issues. And what have you, but I have never seen so many people being active. In places that I'm usually all by myself. I say that somewhat resentful you a very entitled  way. As I do now, and that's completely ad hoc empiricism, I'm just selecting data based on what I see.

Not on any  systemic study, but I feel as if we're the, what has happened over the last 12 months has changed something. I don't know if it's sustainable, but I feel like something has changed. I don't know if that's your feeling as well.

Howard: [00:19:10] Yeah. You know, it's interesting if you remember our episode where I got stoned on a running trail for running too close,

Paul: [00:19:21] do. Yes.

Howard: [00:19:22] you had a story on it from the same, from the same episode. So they certainly, there's a plethora of people who are out in these parks and hiking on these trails and walking.

I don't know if it's a redistribution from doing other activities.

Paul: [00:19:37] Fair point.

Howard: [00:19:37] Right or they're out. But you're right. So I don't know what that they're not in shopping malls. So they're out on trails or they actually are trying to exercise

Paul: [00:19:51] Yeah, it's hard to know. I just, and I'm, I'm weirdly maybe optimistic this way, but I feels to me as if something has changed that there's an appetite for being more active. Again, maybe people don't have objective objective function, so it's not clear exactly what they're being. And we'll come back to this in some upcoming episodes, but it's not clear what they're optimizing and how they would know if they were optimizing successfully.

Anyway.

Howard: [00:20:13] I really hope you're I really hope you're right. You know, there've been a string of patients in the office over the last few months where if I help them draw, connect the dots. You see the light bulb go off. Right? So if I have someone who's hypertensive and you know, and I'm looking at a four month pregnant belly in, in a male and you know, abdominal obesity and they're on a statin and all I'll talk to them.

Did anyone ever mention metabolic syndrome? No. Didn't anyone ever mentioned. Insulin resistance. No, I'm not diabetic. No, you you're. You're going to be, you

Paul: [00:20:57] go here on the

Howard: [00:20:58] don't know it yet. And then they look at you correlate and you start to explain it. And I got to tell you, when you have the time between patients to sit there and chat with them, you'll convert a fair number of that.

So you. It's very satisfying, but you know, you sit through all these healthcare technology, startup events, right. Especially now with that new app clubhouse, right? All these people were changing the world. No, you're not you're, you may sell out to someone who's going to give you $30 million for your startup, but you're not changing anyone's health.

So I would love to see someone's scale to the point where they help people connect these dots.

Paul: [00:21:48] Yeah. And I just, I just, when you see and you see, I see it regularly, even on, on, on Twitter where people suddenly start making connections and realizing that while even in the context of this discussion about inquiry in your pandemic program, what are you optimizing for? And you, you say it all the time, but you know, longevity in your case that, that.

Even that comes across as a revelation to people that, Oh, there is an objective function here. It's not that I'm. I think people have the bad habit of believing I'm training to pass time. I'm training for a marathon I'm training, they're training for all these very transient reasons. And that's not, that's not sustainable because the marathon passes, the pandemic ends, right?

The, these things are all transient motivations, but if you're trading for longevity, right. Well you know,  mathematical sentence longevity never ends if you do it. Right. So,

Howard: [00:22:40] but that's true. That's what motivates me to get down to the basement and do it. Everyone thinks that we love every workout that we do, right. We don't, there are some runs that we need to do, right. Our head needs to be clear. There are some that we just love. We can't wait. To to get out, but there's someone we drag our ass out of bed.

We throw our shorts on and we go run because you know, I'm wanting to live longer. I want to be a father longer. It's going to be a messy world. And my kids judging by where they're at now are going to need a lot of help.

Paul: [00:23:16] I may have to carry a lot of ad loops home. Right. Do I exactly let's go into a topic. We don't spend a lot of time talking about, but probably should. And I'm sure you hear about a lot, but we've talked a lot about physical health, but it's. Physical health is so, so fraught in part because it's tied to mental health and one of the things, the real epidemic under the epidemic in many ways, and the stories are endless.

I mean, there was a piece in the wall street. Yeah. Journal last week about the, in CA in higher education students in colleges, but it's all over it at all ages, the effect this has had on mental health and mental health feeds directly. I'll say synergistically, but it's not nearly so charitable relationship into physical health.

And my sense is that mental health societaly is as fraught as I I've ever seen it.

Howard: [00:24:08] Yeah, I you're a hundred percent correct. People are frazzled, we're frazzled healthcare workers, frontline workers, people who've been locked up are poor kids. Right. And you know, they've really. Really suffered through this pant pandemic. And yeah.

Paul: [00:24:29] What do, I mean, what do you do with it? So you had someone come into your office and it's clear that they've got some physical problems and other things, but you get a sense in some form or another that maybe the problems aren't as really physical. It's more that there's a I lack energy. I'm not able to do these things, but all my blood tests are negative that maybe this has more to do with.

I mean, and this is a cliched example, but maybe it has more to do with some aspect of mental health, not specifically some syndrome that's causing me to be unable to do all these different things. Oh, well, Hey, have you, are you seeing that more of those kinds of cases and be, and I suppose more importantly you do with people like that.

Howard: [00:25:11] right. Great question. So yes, you absolutely see the first, as I explained to. Many patients recovery from anything injury surgery has an obvious physical component, but has a tremendous mental and psychological component. And for many people it's the mental and psychological aspects of the recovery that are most challenging to confront and deal with.

 The physical therapy is easy, but they just can't get over the hump with respect to their mental health. Now I'll also see people who they used to walk, they used to exercise. Bam came to pandemic. They got a little depressed and now they just can't muster enough effort to get outside.

If I don't think that they're, you know in need of medication if they're sidle, if they need urgent attention by a psychiatrist I'll try and work with them and I'll try and work with them in simple ways, like trying to get them to reset there, clock. Right. I want them to stare at the sun in the morning.

I want them to shut the, shut down the lights in the house at seven o'clock start to get back to her routine, right. You're not going to stay up all night and watch. TV. I didn't, I don't want you to look at a goal of exercising 150 minutes a week for 52 weeks a year. I want you to think of tomorrow.

I'm going to walk for 10 minutes. Just. One day, right? Chunk these goals, right. You know, we eat an elephant one bite at a time. So make these into really little achievable bites. A lot of times you can get through this with people who are just brought down by the overall stress and loneliness of the pen that the pandemic has really brought forth.

Otherwise, if I really think that someone is in trouble and I really can't get through to them, or I don't think that their physical issues are an actual problem. I will refer them to a professional for help. And I have done that quite a lot.

Paul: [00:27:32] Have you done it as you've seen more of it in the last year?

Howard: [00:27:35] I would say. Yes.

Paul: [00:27:37] Yeah. Yeah. I mean, my impression, again, it's, it's anecdotal, it's driven by people I know, or what people around me tell me, or what I see in, in, in reports, but is that. It's not, it is real, it's not just a convenient angle for a New York times or wall street journal story, but there is actually a, an epidemic under the epidemic and it's one that's, it's, it's darker and more insidious, and it's not solved by just telling someone as you just said get out there and go for.

Go for a run. I it's, it doesn't get addressed that way. And and that there's a tendency, I think, to feel like in particular with me, cause I'm  an idiot this way, but then everything gets solved. If I just, if I get a chance to go out and suffer for a while, I'll be fine. And that must work for other people too.

Right. And it doesn't, it just, it doesn't, and, and it can lead to some really bad places where people end up in these sleepless cycles and exhaustion. And then it just starts to all feed back on itself in an, in a horribly negative way. And, and then they disappear. I had a friend not too long ago, probably back in October who dropped off email and other things for awhile.

And I assumed they were up to things. And finally, about eight weeks later, six weeks later, I sent them an out and they sent me back one fairly quickly saying, well, I'm really glad you reached out. It's been a really rough time. I just  lost the plot here with. Things going on and unable to  cope with all this stuff.

And it turned out that reaching out was the right thing to do. And that's one of the things I encourage people to do all the time. Is that everyone, I don't know, maybe less so right now, but over the last year, everyone has been suffering and, and not the good  physical suffering you get from doing a 90 minute run.

It's the bad kind. Right. And reaching out and yeah. Even just recognizing that even the dude who honked at you at the traffic light, that pissed you off and you're thinking of reversing into them or something, this is not the time to go mad. Max, everybody's angry, everyone's on edge. And you know, the vaccine is one light at the end of the tunnel.

And so as our maybe a return to more normal working relationships or whatever, but it's a really, really fraught thing. And that people just don't, I don't think people accord each other enough Slack for it to realize how much of this is going on.

Howard: [00:29:57] I don't think we give each other enough Slack for anything anymore.

Paul: [00:30:00] well, that's fair

Howard: [00:30:01] Right. And I listen I've, you've learned some things about exercise and goals for me. And what I've learned from you is virtually zero news and My Twitter uses turned down tremendously.

Paul: [00:30:19] Glad I could help.

Howard: [00:30:21] I just can't take it.

Paul: [00:30:23] So , I feel like. It's been a dark year. It's been a really rough year in a lot of different ways for, I think almost everyone. We don't cut each other enough Slack, but I feel as if optimistically there were changes that people have made to their lives that maybe are sustainable.

If they managed to find out. An objective function for why they're doing it. I maybe I'm wrong about that, but I think that this mental health part of the pandemic is going to continue long after the pandemic is ended. I, I worry that it will. It's just, it just feels like it's, what's the line. Is this black dog that's out there for many people.

Howard: [00:30:59] yeah, I I'm afraid. You're right. Yeah. As I mentioned earlier, I think that we've lost the word well, For an extraordinarily long, long time. I think those that are on the fence if they have a friend network and a family network, then they're going to get through this. I think I wish somehow the narrative would change in that.

We would start to see a brighter picture at the end of this rainbow when people are ultimately vaccinated, right? I, no one is saying that or if they are, they're getting crushed on Twitter that it's gonna be okay if you're vaccinated right. To go out and hang out with vaccinated friends, hug people and have drinks and,

Paul: [00:31:50] I, and this has maybe a nice note to end on, but you, one of the, something you, I think it was tweeted or texted to me, but you said you had recently had as a frontline healthcare worker had had your first or second vaccine, I guess you've had both now. Right. And, and you were surprised, I think you said, and how emotional that was, right.

That go ahead. I want to put

Howard: [00:32:11] Yes. It was an incredibly emotional day to receive it. And I wasn't expecting it. I ran out of surgery. I ran downstairs rolled up my sleeve and they gave me it and I practically started crying. You're right. It was just such a relief. I volunteer as a vaccinator. Now I've been doing it two, three days and nights a week at a mass vaccination center in my County.

And I see it in everyone's faces. It's such a gift to be able to be part of this. It's really been wonderful. So some people are seeing that light at the end of the tunnel and that rainbow, but far too many are.

Paul: [00:32:52] My, my version of that just happened this week. And I was really surprised. I w a friend of mine had just gone to San San Diego down at the Petco park, the baseball stadium, where the Padres lose games. They they turned the parking lot into like a, well, I it's California, so we can't call it a mass vascular vaccination center.

We have to call it a super vaccination center, like, like super XL and It's it's the gigantic and this friend of mine and another friend's parents had we gone through on a separate occasion and I said, Oh, that's nice. And I hadn't really given it too much thought until the other day on Twitter a senior guy at CSU UC San Diego because they run their healthcare center.

Their hospital runs this super vaccination center. I think it was Chris long hers, but he he tweeted out a video, taken from an adjacent building, looking down in a time-lapse at the, at the super vaccination center. And I, that was my rainbow moment. When you see. The incredible 12 lines of cars flowing through tick, tick, tick, tick, all day long.

Every car has people in it getting vaccinated. They go to the next station. Someone watches them for allergic reaction. You think, you know what? This is gonna pass. We're gonna, we're gonna go through this. Right.

Howard: [00:34:03] Yup. Absolutely.

Paul: [00:34:05] I just took a time-lapse video to convince me.

Howard: [00:34:07] That's fantastic. I love it. I love being part of it.

Paul: [00:34:11] thanks, Howard.

Howard: [00:34:12] Thank you, Paul. .