Keeping Your Marbles : Cliff Arceneaux
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Guest: Cliff Arceneaux
Release Date: 2/6/2023
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Steve Washuta: Welcome to Trulyfit. Welcome to the Trulyfit podcast where we interview experts in fitness and health to expand our wisdom and wealth. I am your host Steve Washuta, co-founder of Trulyfit and author of Fitness Business 101. On today’s episode, we review keeping your marbles with the author. Cliff Arsenault cliff is a 20-year full-time physician assistant.
Right now he specializes in geriatrics, he became very intrigued with cognitive decline working in this geriatric area. And between his anecdotal research and time, and between his actual scientific research, he developed a book called Keeping your marbles and Cliff and I go over a lot of the insights and information he has in that book today about cognitive decline, how to potentially stave off cognitive decline, or help your clients do that if you’re a personal trainer who works with the adult senior population was a great conversation
with no further ado, here’s cliff and I discussing cognitive decline and his book, keeping your marbles. Cliff, thank you so much for joining the trulyfit podcast, why don’t you give my listeners and the audience a background on who you are and what you do in the health and medical space?
Cliff Arceneaux: Sure, and it’s a pleasure to be here. Thank you for having me. I am a Physician Associate also called an official physician assistant. I like the title that I can use in Spanish, which is associated medical, not that I speak. So. I really think that sounds cool. But I’m a physician assistant for the since 2006.
Cliff Arceneaux: I actually have a fitness background. I worked in different gold’s gyms and different personal trainer, arenas and then transition that into healthcare, getting into physical therapy as a tech, and just really liked the medicine side. And taking care of people that really kind of fit that the idea that I just, you know, you get that thing in the back of your head that says, You know what, you know, I’m supposed to be helping people.
Cliff Arceneaux: And so I’ve been trying to honor that. And the medicine really spoke to me. So I went back to school, been working as a full as a full-time physician assistant, again since 2006. Worked in cardiology worked in different internal medicine, places worked in the prison system for a short time. But the last 10 years have been working with geriatrics and that’s really where I think I found my niche, or niche, whichever part of the country you’re from. And it’s just been really rewarding. Breeding, treating grandmas and grandpas and cute little folks like that.
Cliff Arceneaux: And the medicine is different. You cannot treat a person who’s 85 the same, you would treat someone who’s 45 or even 65. And I have a handful of people over the age of 100. And that is a true honor to be able to take care of somebody who’s in that age range. And in the ones I have right now with that kind of good 100. Right. But everybody would like to be you know, they got some arthritis, but I don’t blame him at that age, but they all still have all their smarts with them. And so it’s been a, it’s just been a privilege,
Steve Washuta: I think it’s to be able to work it’s an important thing to do to work in that niche or niche of Geriatrics as far as personal training is concerned. That’s who I prefer to work with. And I think one reason why is because you can call selfishly, you’ve learned so much, because you’re talking about people who’ve lived a full life.
So you’re getting the full spectrum of what they’re dealing with now what they’ve dealt with in the past, you can kind of look at their entire health history to see where they are now. And that that helps you as somebody who is in the medical and health space kind of understand the inevitability for lack of a better term of what somebody is going to enter into later on their life.
Oh, yeah. And the perspective you get when you have somebody who is 8590 95. There, they don’t tend to money grab about the past. And honestly, they’re not too stressed out about the future, they really got that whole Zen moment to moment.
Here we are, we’re doing this now. And we’re doing this now. And now we’re gonna do this. And their life gets in a good way it gets simplified, right in that, you know, when a good way that you know, we’re just going to do this and we’re going to hang out, we’re going to enjoy this moment.
And then we’re going to do something else later on. And we’re going to enjoy that moment. And for me, that has been one of the greatest things to learn and be reminded and reminded of working with the population, good things
Steve Washuta: where they do all those happiness studies. You can poke holes in all of them, but most of them come up with the somewhat between the mid-30s and the mid-50s People are actually the unhappiest in life and that could be because you have maybe kids at that point you have a lot of financial stressors.
If you’re balancing sending let’s say kids to college and you have assets and you’re thinking about retirement, maybe you’re second-guessing your career choices, but typically when you get into that retirement age there’s another sort of like second Life of happiness where people consider like you said, maybe because you have less things on your plate.
Cliff Arceneaux: Right? Yeah. And there’s what they call the sandwich generation right now, right where you are, you’re raising kids on the one hand, but then you’re having to take care of this happy old person, or you’ve gotten a mom or grandma in the other bedroom, and you get your kids in this bedroom, and then you’re having to juggle taking care of both of those.
Cliff Arceneaux: And that is stressful. And that’s one of the and we’re all terrified of being that old person who’s a burden on their family. And that’s one of the reasons I wrote the my book is to give people hope. And, and the idea that we don’t have a great imagination. I’ve heard this from a couple other people, and I still think we don’t have a great imagination towards being a healthy old person.
Cliff Arceneaux: Right? We, as a nation, collectively, if you talk with, you know, you stopped 10 people on the street, you’re probably going to get a bunch of people who are like, Well, I hope I die. At age, you know, 30 or someplace like that, right? Where were they? They don’t want to be that broken down old person. And nobody does. But very rarely do you have that person who that’s their goal, to be the healthy.
Cliff Arceneaux: Grandpa, Grandma, I, my wife sent me that video, it’s been out a couple of years now. It’s that German company, I don’t even know what they’re selling. But it’s that grandpa who starts working out with a kettlebell every day, and you find out the end of it, he goes, you go through a whole season. Basically, he’s lifting his kettlebell, so that he can pick his granddaughter up and help her put the star on the Christmas tree. Oh, I was just a puddle.
Cliff Arceneaux: Because I want to be, I want to be the healthy grandfather, who can pick his kids up who can get down on the floor and wrestle with them. And who can do all those things. But in order to be that healthy grandparent, you have to be the healthy parent, and you have to be you have to do, there’s just things you have to do consistently, to get to that grandparent who can pick the kid up with, you know, and put in a bid to start the Christmas. Yeah,
Steve Washuta: I echo those thoughts. And and I think the thing that’s also missing sometimes, and we talked about this a lot on the podcast is Why do you want to have the most money when you’re the least capable of using it. So people focus on saving up their money for their entire lives have a 401 K retirement, but they don’t look at their body, like they look at their bank account.
And they slowly let their bodies slip away, or maybe even their mind, which we’re going to get into now. So they’re not practicing good, good health for their mind and body only for their bank account. They get to be 70. They can’t wait to take that trip to Rome. But guess what, they have type two diabetes, they have to get their foot cut off. They are starting to become dementia there. They forget half of their bags and luggage. And that trip to Rome doesn’t seem as fun anymore.
Cliff Arceneaux: Yeah, and I that has been that’s another thing that you learn when you start working with older population is people who do put off their whole entire life and personal and also their health, just like you’re saying, I have far too many heartbreaking stories of yeah, they finally retired and they get to enjoy their retirement for two months, three months.
Cliff Arceneaux: Sometimes that, of course. And then their retirement is they finally sit down on the easy chair and just kick back and just, I don’t know what they’re just gonna sit, watch daytime TV. No wonder they have a stroke after that. Because that’s one of the things I tell all my patients and just quit watching TV.
Cliff Arceneaux: That’s just terrible for it. Not and especially the 24-hour news channels don’t know whichever one you whether it’s going to the right or to the left, just turn them all off. And that’s better for everybody better for the nation better for everybody.
Steve Washuta: So as a PA who now works in geriatrics, you’re seeing this, let’s call it cognitive decline in a lot of your patients, what is kind of the first step or some of the first signs that you typically see in patients?
Cliff Arceneaux: Well, everyone’s going to have those what they call senior moments or brain farts or whatever they want to call it. And that is going to be normal. As we get older as you just get a head full of stuff. I heard one person say in an interview, the your librarian has to go and search through more shelves in order to find the materials and that makes sense.
Cliff Arceneaux: And everyone’s gonna have that every once in a while you’re gonna get go into the room and like, what am I doing in here? And that’s normal, right? The joke that we tell is this if you are if you’re still remembering that you forget that you’re doing okay, it’s when you’re forgetting that you forget and that’s when you’re having more problems.
Cliff Arceneaux: But so we’re all gonna have those little senior moments. And that’s, that can be typical, but when you’re getting hold day full of them, right? When it’s really starting to compromise what you’re trying to do when you go into the room and don’t remember so you go back and then you come back in and I still don’t come back and still I still remember I used my mother in law as a good sample, she was diagnosed with dementia very early.
Cliff Arceneaux: You know, she didn’t make it to her group didn’t make it to 70. Right. So when your mid-60s, she’s really starting to fall apart. But if you go back in time, which is what happens, right? You, you look backward on their life, when she was in her mid, or late 40s, early 50s, she was keeping the books for her husband’s job, she was homeschooling your kids.
Cliff Arceneaux: And then all of a sudden, she couldn’t come up with the big elaborate lesson plans like she used to, he couldn’t keep all the books balanced and and then she just starts to slowly you know, this kind of world starts getting smaller and smaller, and you withdraw more and more. And that’s one of the problems that people with cognitive decline have, you get into conversations with people. And you notice that when I can’t remember their name anymore, I can’t remember their name anymore.
Cliff Arceneaux: And, oh, I have this funny joke. And I just forgot the punch line again. Okay, what does that mean, when we restart and interactions get really difficult, right? In and embarrassing. So people will start to withdraw, which is one of the worst things that we can do for general health, but also specifically for your brain health and your emotional health. And I’m also a big believer, there’s not a difference in between your brain health and your emotional health and your physical health.
Cliff Arceneaux: And I think that’s one of the reasons when people are trying to prevent cognitive decline and trying to prevent and treat dementia, they’re going at it as a one dimensional, we’re just going to do this one thing, and it’s going to work. And that does not work, we know that to be absolutely certain. You have to come at it from a bunch of different angles in order to have any sort of hope, reading this thing.
Cliff Arceneaux: So as you are a younger person. And as I get older, the definition younger changes, right? But start hitting that middle age, you can start to really have these, like I’m having now, where you have, I always love it. I love that when it when it happens when I’m talking about especially with new people talking about memory loss, I blanked out. But that happens to everybody.
Cliff Arceneaux: But if I get to the point where all of a sudden, I just can’t do any of us like this anymore, because I’m like, oh, anyways, and then you know, puppies are good, you know, and you’re struggling to find the words, then you’re really starting to have a problem. Now the bad news is, you could be starting to have a problem.
Cliff Arceneaux: And and family members are really good with this, when people are starting to ask you, Hey, are you sure you’re doing okay? And as men, typically Aereo typically, we do tend to ignore things slightly during the plenty of women who are in denial as well. But you know, it’s, you really have to kind of pay attention to things. But when you’re in those beginning stages, one of the reasons I wrote the book is that that’s when your brain is most amenable, most, the best time to start treating the brain correctly is doing the body correctly.
Cliff Arceneaux: For Well, I was gonna say decades, but for hundreds of years, right? We thought of the brain as this little black box attached to the body. And you know, it didn’t really matter what was going on down here the brain was, you know, just perfectly preserved and not attached. We know that to do not to be true. If you’re treating everything down here badly, chances are up here is mess too. So, if you’re smoking all the time, now’s a wonderful time to stop yesterday would have been better for you to stop it.
Cliff Arceneaux: You know, stopping today is really, really good. But again, it’s not just affecting your heart and your lungs, it’s affecting everywhere that blood goes right. And that affects your brain. Same thing if you are overdoing it on the alcohol. And there’s actually some, you know, I didn’t include it in the book, because I think kind of the jury’s still out. But there’s still some things where maybe we don’t have a safe alcohol limit. Like we used to think that we did write us think one glass of wine a day, it was good for the brain.
Cliff Arceneaux: And now maybe not, we don’t know, I didn’t put it in the book. I don’t want to put these little throw these things out and make it more confusing. The whole point of the book called Keeping your marbles Henson is to provide hope, and to give people a sense of direction as to what can happen. So if you find yourself where you are forgetting more often, where you’re getting up and you’re trying to do like a talk that you’ve done forever, or you’re trying to do a job that you’ve been doing for decades and you’re like okay, what’s the next step picking up my mother law again, because I can do that because we loved her.
Cliff Arceneaux: And but she had this really fast decline. She used to be just an outrageously Great Southern cook right now obviously southern cook because that requires huge amounts of butter and other things that we all know are going to be exactly healthy, but she was a great and fantastic cook, right? So put some butter fry it and then it’s gonna be great.
Cliff Arceneaux: But she got to where her meals got little less complex and named To the point where she was just like, couldn’t sequence write, recipe she’s been doing for decades, suddenly, she can’t remember the next step. And we get so overwhelmed and gets lost in the middle of a cooking process.
Cliff Arceneaux: And just even looking at the recipe and just the idea gathering all that, if you find yourself where you’re just looking at something where you made, this used to be easy, and now you feel like you just bought the new Lego set may last the instructions, and you’re just staring at it, like, I don’t know what to do next, then it’s time to really start to buy my book and to really to start looking at things to do to increase your overall health, because is the overall health, there are some specific things you can do with your brain.
Cliff Arceneaux: But as an adult, it’s radical stuff, like getting a good night’s sleep, it’s amazing, the data on sleep, dealing with your stress, for me, when I’m writing the book, we all kind of know that exercise is good for us in the world know that, you know, eating certain way can be really helpful. But for me, the the the literature and the research on meditation was the more relevant story for me. And the more exciting because you would have these people who would start meditating, right.
Cliff Arceneaux: And it’s not the they don’t have to get the you know, get the smoke, you know, and do the little sensor, the incense burning and everything, you don’t have to get the gongs or the little chiming bowls, though, if somebody you know, I want one of those for my birthday, so this in July, but you don’t have to do that 10 minutes, just trying to organize your thoughts, just trying to that mental exercise of noticing that you’re, you’re getting distracted. So you’d come back to breath, and I’m getting distracted.
Cliff Arceneaux: Again, their brain scans would improve. Right, the brains get bigger, especially the hippocampus. And the hippocampus is one of those things that we can do. So if I’m getting ahead of myself, but I get excited about this stuff. If you so my typical workup for when a person would come into the office, you do a brain scan, make sure it’s not brain tumor, right? Because we’re going to treat that differently.
Cliff Arceneaux: And there’s some other things you know, so you make sure that it’s not like your thyroid is in the toilet or anything like that. And then one of the things you can do is there’s the brain looks a certain way on MRI, depending on what type of cognitive climate, right. So if you have Alzheimer’s, your hippocampus, which is the center of emotion, and helps with your memory, obviously, it looks kind of shriveled up.
Cliff Arceneaux: Or if there’s big, other big holes in the brain or something like that, then you had a stroke or frontal temporal lobe dementia, or all the other flavors. But it on these brain scans, you’d have people who just meditate, right? Just sit there, chill out for 10 minutes, not even 30 minutes, nothing, nothing super aggressive.
Cliff Arceneaux: And their brain scans would show that their brains would actually increase in size, the hippocampus would actually get healthier, getting bigger, we don’t have a pill in western medicine that can do that. Right? If they did, man, it’d be a blockbuster and everybody flying off the shelves, right. And we don’t even have supplements that can do that.
Cliff Arceneaux: We have some supplements that can help. And I do put an have a supplements chapter in my book. I didn’t, I almost didn’t put it in there. Because supplements are supplemental, right, you’re not going to be able to fix the problem by taking handful of pills. And I write about in the book, I talk about a lot because I have this guy had this patient for years. And he just broke my heart. Every time I saw him he was a young guy he had just bare he was he may have been late 50s, early 60s. And he was just declining very fast. Had a family
Cliff Arceneaux: should have been prime in life. But his he just can’t. He’s just losing it where he’s just can’t keep up with work anymore. He’s, he can’t do that. Just simple little tasks like arithmetic and just you know, help the kids with homework. Can’t do it anymore. Having trouble holding on to his emotions, right? Because as I talked about, if you have a different type of different if you have stopped me if I’m going if I’m no, you’re fine. I’m not quitting when I quit making sense.
Cliff Arceneaux: So with the emotions part, and I’ll get back to that, because this goes back back into the meditation part which goes back into the brain recovering. So you have let’s say you have 80,000 neurons that help you control your depression and anxiety, right? Probably more than that, but I’m really bad at math, which is why I went in medicine.
Cliff Arceneaux: So at 80,000 neurons and they, they start out and they depending on what is what type what flavor of dementia that you have, or even Parkinson’s one of the other things that cognitive decline, which is why I put that in the title, you go from 80,000 Then you get on 8000 Okay, well, you can still kind of keep it together, but you’re having some trouble. And then you’re gonna go down to 800. Right? Maybe you’re good at and that’s bad.
Cliff Arceneaux: And then you really have trouble focusing and controlling your emotions, right? Just physically, right? Not not even just the horror of what’s happening to you. But you just physically can’t control the depression anxiety, because you’ve got the job of 80 neurons trying to do the job of 8000 or 80,000 neurons. And you’re just, you just can’t keep up with your depression and your anxiety. So this was part of this guy’s problem.
Cliff Arceneaux: And he’s taking a page, and I’ve had more than one patient who do this, here’s my page of supplements, right? Some of them are good, you know, B, 12, vitamin D tumeric, can you get some other things that are going to be good? And then you got some other things like the ground of jellyfish and other things like that, that are just, okay, whatever.
Cliff Arceneaux: And they don’t work. This problem, right? So, it people always asking me about, well, we got this pill on TV, and they gotten more pills on TV, because people were terrified of losing their memory. And if they really did work, right, if they really did stop cognitive decline code, you know, there would be parades. Right? The the, you know, there wouldn’t be this little Facebook ad that pops up, it would be, you know, your doctor would be handling, it would be this huge deal. But also
Steve Washuta: only be one not something that also only be one, there wouldn’t be any Yeah. 15. If we found one that work, you wouldn’t keep seeking one out.
Cliff Arceneaux: Yeah, yeah. So aren’t gonna get it done. So but you need a multi-pronged attack to get to it just like you would do if your brain with a body that’s unhealthy, right, you’re not going to come up as a, as a, as a person who’s trying to get some broken down old wreck of a person, right? They have done a push-up in year, they haven’t even you know, they can barely get up off the floor, or they can’t get them off the floor.
Cliff Arceneaux: So you’re not going to sign them up for an Ironman, right? You’re not gonna say, well, cross fits for you, right, here you go. So they just break themselves on the first. We tried that once they don’t, we tried to go from zero to 60, and we signed up. Before we had kids on topic. We’re like, well, we we think we’re fit, we can sign up for a free CrossFit class, we were rent, right 10 Min, we can move for days afterward.
Cliff Arceneaux: So you can’t do that you can’t just jump in and attack that one thing, like the exercise portion, which is important. That’s not going to fix the problem. And you can’t just go zero to 60 on that same thing. You’ve got to address the problems that are going to be in the diet, you’re going to address the problems that are that come from when you don’t move the body. When you don’t deal with your stress. When you don’t get a good night’s sleep those four things you can address. Hope body gets healthy when the whole body gets healthier. The brain is gonna get healthier.
Steve Washuta: Yeah, I love that you talked about it’s a full body, you know, sort of correlated issue and that you have to look at your health. You have to look at maybe your toxin, alcohol consumption, smoking things of this nature. It’s not just, you know, typically, one would expect if they ask somebody, Hey, what are ways to stave off dementia that someone would say, here’s some brain drills, here’s some supplements, and then just continue to do this right? Rather than saying,
Now listen, we need to address this from a form sort of more, I guess you would call it another term that is bad now, nowadays, but like a holistic perspective, right? We need to look at the full body, see what’s going on day to day, make sure your sleep is there, make sure you do proper nutrition, make sure we’re exercising.
And then I’m sure also what you could add to it. I’m sure there are some sort of cognitive brain rules that are advantageous for one right? Even if it’s simply you working on a day-to-day basis and challenging yourself as opposed to you just staring at a TV screen all day.
Cliff Arceneaux: Oh, absolutely. Yeah, as I say, I say it as a joke. But I also mean, just staring at the TV, it just it, I really do think it makes you dumber, right. And it because you’re not engaged. If you can learn a new skill, learn because this year my one of my my resolutions for this year, is I’m going to finally learn how to play the harmonica, right? I’ve been wanting to Santa Monica has never, not that.
Cliff Arceneaux: And that’s not like playing the concert piano but in art, but I’m going to carve out that five to 10 minutes. So that maybe next Christmas, I can play some at night or you know, on the harmonica. So that’s really simple, but that’s a new skill. I’m going to force brain connections, right? I’m going to spark up the brain. It’s gonna keep me engaged, it’s gonna keep me interested. And so the little things like that.
Cliff Arceneaux: And again, when you have someone who is starting to have some some temporal super to do some cognitive problems. They withdraw and their world gets really really small in a bad way. And then we talked about the simplicity that happens when you get to a certain age because you know life is easier but your your perspective DivX is better, right? Because getting older, and a lot of ways is not easier, right your body, especially if you haven’t taken care of it doesn’t work like you really want it to.
Cliff Arceneaux: But the perspective of these ladies who are 100 and 100, plus, whose bodies don’t work like they really want them to, but they’re okay with it because they’re pretty happy. So, but they stay engaged, they stay around people, you learn something new. I was talking with my wife earlier, it’s not just do the crossword puzzle every single day, because they used to think that would work.
Cliff Arceneaux: But then they realized, it could just be you’re doing the crossword puzzle every day, because you can still do the crossword puzzle every day, if you’re really having cognitive decline, you’re staring at the crossword. And and I’m not good at crosswords, right, it’s actually one of the things I’m starting to work on. And so I’m staring at and like da, you know, I almost feel good, right. And if you’re always like that, but I will learn it and I’ll pick it up.
Cliff Arceneaux: And I’m doing all these other things to help with my brain. Just like when I was learning how to do the Wordle, this year, right? If I start doing that, there’s a rhythm to it, there’s a way to figure that out. And your brain will figure that out. And then your brain can do it, you can teach your teach an old dog new tricks, you need to keep teaching your old brain new tricks, because it will keep it going all and not gonna make the joke.
Cliff Arceneaux: With all my patients, all the bits and pieces of you that still work, we need them still work, right. So we need to keep them excellent exercise, we need to keep them going. And that goes for your brain, all the bits and pieces of your brain that are still working. Well, let’s flex those, let’s get those moving, let’s try something new. Let’s get excited about things.
Cliff Arceneaux: And let’s have some hope, which again, is the main thing I wrote the book for. It’s not an exhaustive, I mean, it’s pretty, it’s pretty small. It’s a pretty small little book, and a big chunk of this as the bibliography so that people would, mostly my family would understand that it’s a it’s not just a bunch of stuff I made up.
Cliff Arceneaux: But let’s have this idea that this can work that the things can go in that positive mindset can also carry you through a whole bunch of problems, right? It’s not just going to be the thing that fixes you. But if you go into it, like this is not gonna work. We’ll try but there’s no way it’s gonna work. Of course, it’s not gonna work.
Steve Washuta: I worked with a lot of Yeah, so I worked a lot of Parkinson’s patients, I just want to add to something you just said. And then, you know, older, older clients going through dementia, but the Parkinson’s patients, especially in in small group classes, and the whole class was really designed around for lack of a better term, almost like a Simon Says, type of situation, right?
It was never the same exercise, it wasn’t like we were sitting down and saying you’re gonna do eight repetitions of bicep curls with these weights, there was always a cognitive challenge.
So it was I would be standing up in front of the classroom, I would take two steps to my left one step forward, and then do a motion with my arms, they would follow that we would go to the boxing bag they would have on boxing gloves, I would throw out a combo 123 Slip three.
They would have to repeat that combo, always making sure I was challenging them from a psychological mental perspective, right cognitive perspective, and a physical perspective. I think that’s important for personal trainers, majority of my listeners should understand is that you know, it’s not just about keeping their bodies healthy as well, although it is it’s a big part of it.
But you don’t want to just sit them down at machines and have them press away and do the same exercise every time they come in and talk to them.
You want to challenge them even if you you see and feel and hear the frustration. Like you just said they might forget what you just said they might withdrawal they might feel embarrassed because that seems to be the emotion that comes out that I see when they do forget us embarrassment but we have to fight through that and continue to help them by challenging them not wearing kid gloves.
Cliff Arceneaux: Oh, yeah, yeah, I mean, do you the the studies on exercise on old people not just for cognitive decline, but the ability to take somebody what am I a study that was really really good. Study one, right? But so it’s but they took the old broken down guy in the back of the nursing home, right had cognitive decline, the whole thing. Basically, you went from a self total care patient and to do everything for him, you know, rolling them over cleaning them up, he was the diaper, change the diaper, do the whole thing.
Cliff Arceneaux: And they just started working with therapy and everything and just got him up where he could roll around in the bed and then he could stand up and he went from somebody who was just, you know, he was screaming down towards the end. And he got to where he could walk by himself. Maybe with a roll Walker, you know, that still counts in my book, right? Especially bill from bed bound to someone who can push the wall and then use a cane.
Cliff Arceneaux: Got someone who so you had somebody who suddenly his quality of life greatly increases now, his brain had been damaged quite a bit by whatever the ravages of what that particular pathophysiology that was hurting him was So he didn’t get his brain back, right? But it kept getting worse, right? It SLOW THE HECK down.
Cliff Arceneaux: And he went from to was just an accident waiting to happen in someone that, you know, could easily be forgotten in the back of the nursing home to someone who could come up with meals and sit and at least be around people in would, just by working with him, right, by doing the little bit of, you know, all the little bit broken bits and pieces of him that were still working. They worked on it, they kept a move, and they kept it and he was able to gain muscle mass.
Cliff Arceneaux: And he was able to get stronger now, was he doing CrossFit? No, was he banging out? No Knuckle Push-ups are doing burpees now. But we’re that’s not the goal. Right? The goal was for him to be a functional person again. And that was achievable, which is why I also talked about the brain to a certain amount can heal. We know that now. Right? But it’s got its limits.
Cliff Arceneaux: And so when you do start to notice these problems creeping in with your memory, the sooner you can jump on it, the better, right, because your brain can feel some of this damage, but it might not be able to heal all of it. So have these patients who we want to guys have talked about in the back of the book, pretty bad memory, still new people, because still, but you know, he just needs you know, it’s time to eat, he can’t cook for himself, he can’t get his own meals together.
Cliff Arceneaux: And he just needs help in queueing. And he got to where he was just so he turned he he attacked the exercise portion, right, he’s riding his bike for hours, he’s young, and he’s feeling better, he’s eating better to clean up the diet. He’s sleeping better, because if, as you know, if you start exercising, your body will sleep better, right? And it helps to get the little hamster off the wheel in a good way, right? And you can rest easier.
Cliff Arceneaux: And that is amazing. And so but his memory really didn’t get that much better. And so I tell that story in the book to show that, but it might not get better. But if we can’t keep you from getting worse, right? Oh, that’s good. Now you have some hope. The pills that we have right now for memory. And I talked about this book, even the new ones that are coming out, you’re looking at slowing the progression of the slowing the rate of decline.
Cliff Arceneaux: To them, that is a win. Right, not stopping the decline, right? The two main drugs that we use to treat dementia in this country and everywhere is AirSep or dinette, Brazil and mantiene. Right. And what they do is they take somebody whose memory is starting to curve down, and they’re starting that slide. And they try to create a plateau. And they try to hold that plateau.
Cliff Arceneaux: Or even their own literature says six months, maybe two years. Right? So your typical Alzheimer’s patient, you’ve got like an eight year from diagnosis to morbidity to their death, you got about eight years in so you got a drug which might last two years. Right? Just slow the symptoms down, right? Same thing with the new ones that are coming out those slow the rate of decline, underlying pathophysiology, their underlying underlying forest fire as torching the brain still raging on, they can’t do anything about that with the pills, but they’ll slow that rate of decline down.
Cliff Arceneaux: And so that’s how I pitch it to it started pitching it to my patients is and that’s how I pitch to people. Now, you can take the standard medical practice, and they actually did the finger study, which I think is funny because the Danish study for somehow the word anyways, I don’t know how they got it to be finger, but it’s easy to remember. They take people and they do the standard medical treatment, right.
Cliff Arceneaux: And they put that to the control arm. And then they get the multidisciplinary diet exercise, you know, the all the things that we talked about in the book, and the only thing really seems to work. And so you got this multidisciplinary thing versus that one dimensional, here’s your pills, and just try to control your blood pressure, you know. And of course, at the end of the study, people on the standard medical decline get worse. So we didn’t really get that the people who are on this multidisciplinary thing, at worst, get worse slower.
Cliff Arceneaux: Most of them stay where they’re at, and a lot of them get better. Right. So to me that is very exciting, because for two things. Number one, we’re going to get better, which when I really started digging into this and I talked about in the book.
You know I’ve been working started digging around in this about five years ago, four or five years ago. Probably at least four years ago, because working with old people can be very, very rewarding.
Cliff Arceneaux: You can So be very, very depressing, right? People who declined, if people who do everything right, and you’re doing your best and you’re doing they’re doing their best according to the medical model that we’re taught in, and they still decline, and they still get sick and they still die.
So I was really struggling with that. So I really started looking at other things that would work and which is why I came in all these lifestyle changes. Both for me and for my patients.
Cliff Arceneaux: And so I pitched it to him. Look, I can put you on all the pills. And and you will continue to get worse, you might get worse, slower, but you will get worse. Or I called him a guinea pig group, right? And I told him, you’re gonna be the guinea pig group. We’re gonna try this radical stuff out, I’m gonna want you to eat broccoli, oh, no, I’m gonna, I’m gonna want you to stop eating bacon. And I had a guy who custom me out and like, cussed out the whole staff.
Cliff Arceneaux: Because we want him to stop eating bacon. And just crazy stuff like that, like, you know, control your stress levels, you know. Do all this, you know, get a good night’s sleep and exercise and eat some some good food for you. And you might still get worse. Or you might do just as well, just as bad as the people on the pills. Right? Or you might get better.
Cliff Arceneaux: So there’s actually there was hope in getting them to take a walk, and getting them to get a good night’s sleep naturally, without having to nuke them with some sort of sleep aid, getting them to control their sleep stress levels. Just the main four things, right, I would write it down on those sheet of paper called the memory protocol. If for some people, it was just like, yes, we’re going to do this.
Cliff Arceneaux: And when that people would dive into it, again, the same that they would either quit getting worse, or they would get better. And I had the what I call the poster boy. He was one of the first ones who just he and his wife jumped on top of it. Did they do everything? 100% correctly? No, they did not. Were they the ideal paragon of diet and exercise. Certainly not a diet, but they they cleaned up a lot. And they exercise on a regular basis.
Cliff Arceneaux: And he did any got better night’s sleep, and were actually able to pull them off some of his other medications, which was really cool. And hey, guess what, the less medications you’re on, the less side effects you have. Often you get some spare money in your pocket, right? Because you’re not having to fill it out for the pills. And as your body gets healthier you use you need less medicine, and you actually get healthier.
Cliff Arceneaux: And he got a lot of his life back for several years, was able to go out and do things again, go travel and then like be going back to church and go back to you know, and do all these things. Whereas if we adjust, well, I’m gonna move these pills around. and I can probably adjust the dose and I’ll put you up on the maximum dose of this one.
Cliff Arceneaux: And be careful because this one’s gonna give you diarrhea, and this other one’s gonna give you constipation, and you just hope that they cancel each other out. And that’s the best you can do. Right? Which is the truth, right? The Donepezil causes diarrhea and the momentum causes constipation. So if you get them at the same time, you just kind of hope that the equal out.
Cliff Arceneaux: So yay, who wants to sign up for that? Or is it you can eat some broccoli, and take a walk. And he did get better? It was really good. Now, he still has some permanent brain damage. Right? Because it’s been a while it had some strokes. So we had some deficits that never really got better. But he got better. Yeah. And he was able to do it a
Steve Washuta: lot. It’s important to you know, from the, you know, to take sort of a zoom out approach from the provider. Or from the personal trainer or the coach. You know, when a provider says take the pill, you’ll be fine. See, see in five weeks, there isn’t a level of care there. Number one, the patient thinks this is a this is a fixable problem, right?
Whenever someone gives you a utopian solution run away because there are no utopian solutions, right? So and number two is there’s not a lot of investment there. From our perspective, you know, you’re a personal trainer. I’m working with someone I can’t control what they do outside of that one hour a day at work with them.
But I know that if I show them my care. and I’m telling them what to do, and that every time they come in, I’m putting in energy and effort to try to help them that eventually there’s a better chance that they’re also going to help themselves so if that makes sense, right?
They see that I’m that I’m trying to help them and they go you know what, I’m spending the money in time someone else is making the concerted effort to help me I am going to serve out that bacon for broccoli. I am going to make sure that I get to bed two hours earlier, I am going to make sure that I you know maybe pick the book up instead of pick the TV remote up,
And then you can start those chain of events that ends up being the potential fix or maybe not but it’s still worthwhile, right for that person to give them a chance to potentially heal their brain or to stave off the the sort of the rapid cognitive decline and slow it down so that they have you know, five more years with their grandkids.
Cliff Arceneaux: Yes, yeah. There is with the genetic component of it. To the APO e4 Gene, if you have that one, you have a highly increased likelihood of developing dementia. Right? And that’s bad. Now, and if you get both right one from each parent, then your risk goes from super high to almost a certainty, right?
But thanks to our friend, epigenetics, right, which is what you will wear. The genes are turned off and on by different things that we do different things that you’re exposed to.
Cliff Arceneaux: You can activate those genes, or you can activate them. I don’t know if that’s the right word, but I’m going to use it from now on and activate them. Where you can have somebody who like with my my mother-in-law, she was diagnosed, let’s say around 65. Right. I think she just hit Medicare.
Cliff Arceneaux: Let’s say we were able to push her diagnosis off. Maybe we couldn’t get rid of it. Maybe I don’t know. But just sick. We’ll just say. But let’s give her five more years, right? 10 more years. Let’s give her 15 more years, right before she starts. So it’s 65. Really bad problem.Let’s push that off to eight. Right? How much more life did she have? Right? My kids were young, they were like 1012 years old,
Cliff Arceneaux: they would actually know who their grandmother was as a real person, as opposed to someone that they had to be? Right. How much better would that be? Now maybe we couldn’t get rid of it entirely. Maybe we couldn’t. Maybe we were just pushing it down the road. But that’s okay. Right. The alternative is to is to have it all is to her is what happened.
Cliff Arceneaux: Now, I didn’t know all this stuff. When she first started getting sick. She was one of the reasons I started studying all this. And all my other patients in my own family, my dad’s had a couple of strokes. And we’ve got I had an aunt who’s had dementia for decades.
All of us know somebody who’s had problems with dementia, one of the different flavors of dementia, if not the bad one like Alzheimer’s or, or even with, with your Parkinson’s patients, you can have some talk cognitive decline with the Parkinson’s.
Cliff Arceneaux: And so all of us get touched by this. But what I really wanted with one of the reasons I wrote the book is to give people hope with the idea that you can’t put the hope in, in your doctor’s office, right?
You have to take a large amount of ownership for what’s going on with you and with your brain and really be your own advocate for what’s going to happen here. Because yeah, as I said, it may be we can’t cure it. Okay, maybe we can’t get rid of it. But we we can slow it down until the magic cure happens.
Cliff Arceneaux: Fantastic. Or maybe you just have a brain that’s a little creaky for 1015 years. And then maybe something else takes you out when you’re 85. That’d be cool with me too. But right now, this. The only thing that really has been shown to work is, like you say is moving the body is eating good food getting rest and controlling your stress. And it’s not super well, I shouldn’t say on the face of it. It doesn’t sound super radical.
Cliff Arceneaux: But for a lot of people, even myself 20 years ago would have seemed super radical, right? But it’s really, but the perspective of taking 30 pills a day to try and control your symptoms, versus, you know, not eating mac and cheese or not. We’re not eating mac and cheese at all right? Certainly not eating like I used to, I used to be like around 260 270 pounds.
Cliff Arceneaux: So you need the whole box of macaroni and cheese and when sitting, right? That’s not healthy, right? But how many people do that? Right a lot, because they sell a lot of boxes of mac and cheese right? In every single grocery store. So plenty of people are eating that stuff. And it’s full of stuff that’s going to hurt your brain hurt your body, right? clog up your arteries.
Cliff Arceneaux: There’s such a vascular component to dementia that anything that’s really going to clog your arteries and hurt your heart. It’s going to clog your brain even with patient zero, right. Dr. Alzheimer, right the German physician who first recognized the symptoms and classified them as a disease he they did the autopsy in the poor lady’s brain. And you notice that the brain was full of plaque.
Cliff Arceneaux: The arteries were just clogged. So anything that’s gonna that we all and we joke about like the quadruple cheese bacon cheeseburger and like oh, I feel my arteries hard enough to eat it haha.
Well guess what tough guy your arteries really are hardening in his not in the chances of you having that big friend Fred Sanford heart attack and taking you out like that. It’s pretty low. I talked about in the beginning. Look, that’s what my grandfather wanted to do.
Cliff Arceneaux: Right. He wanted to have that big heart attack and just die when he was still pretty young and healthy. Didn’t he clogged up the arm? are two reasons brain fog up the arteries and its heart became that sickle man.
Cliff Arceneaux: So we have to take ownership and really start taking care of ourselves with that hope with that imagination, that we can get better, that we don’t have to be that down old man that we can be, or broken on a woman that we can have that we can be that grandpa who picks up the little girl, you know, that’d be a really.
Cliff Arceneaux: But that strong, vital, old person who can be a help to your family instead of being a burden, right? Who can give wisdom to your grandkids? Right? Who can sit there and, and, or to your great grandkids? Right? We’re missing that in our country, part of how we’ve set up our life. But also part of the fact that we’re our own people are really, really sick. So a generation of healthy old people, I think, would be marvelous. And very,
Steve Washuta: I think it’s coming everybody, you know, being in the fitness industry, I see there, there’s a change, it’s, let’s say, my mother’s generation, my mother was born in the 50s.
My father as well, early 50s. Exercise was not really normal towards the latter half of your life, you know, when you got done playing sports. And it was it was more rare. Like if you were to take 10 or 15 of their friends and put them in a room and say how many of you exercise on a regular basis.
The ones who had money did certainly but the blue collar people did not exercise were in now you’re even seeing blue collar people in their 40s and 50s, and 60s, exercising, and it could be small things like taking walks with their family around the block.
And it could be things like CrossFit and and or they have a peloton in their house and all these other things. So like, you know, chalk it up to marketing, but guess what it’s it is helping people overall.
And I think that, you know, what goes on talked about is. If you’re doing something, you’re not doing something else. Let me explain that. It’s not just the walk that’s healthy. It’s the fact that if you weren’t walking. You probably grabbed a bowl of ice cream and sat on the couch. Right? So it’s like the alternative to those things that you’re otherwise doing.
And I think that’s, that’s something that people don’t think about a lot. It’s like, oh, well, what is walking going to do? For me, I’m going to burn 200 calories. It’s like, well, it’s not it’s not the total caloric expenditure of the walk. It’s the fact that you’re outside in nature, you’re not thinking about other things. You’re calming your stress levels down.
In addition to that, what are you not doing right? You’re not on your iPhone, eating that whole bag of chips. You didn’t even notice because you were scrolling through videos. And before you know it 20 minutes went past the chips are gone. You did nothing but stare at a phone. So I think that’s a that’s a big portion of it.
Cliff Arceneaux: Oh, absolutely. I couldn’t agree more. We talked about that with diet too. If you are eating the broccoli, we’ll pick on broccoli, because it’s a good one. It’s something that everybody can agree on as something is healthy, maybe not something that everybody likes. But you can fix a way that makes it tasty, right? Without cheddar cheese soup.
Cliff Arceneaux: But if you’re eating a bowl of broccoli or something like that, you’re not eating the ice cream, right? You’re not, you know, the 46 ounce, ribeye steak, you know, or something like that. Because you’re crowding out all those. That is what that’s what worked for me and my wife, my wife was a chemistry. She was a Weight Watchers leader. She was we don’t have I’m not going to talk bad about Weight Watchers.
Cliff Arceneaux: But and we lost a bunch of weight. But that’s a very highly processed food type of diet and you don’t and you eat that stuff. And so we both lost a bunch of weight on that. And but I still myself, I still had high blood pressure, I still had high cholesterol. My blood sugars were cruising into the diabetic range, even though I was smaller.
Cliff Arceneaux: But like I was saying, you went from eating the whole box and mac and cheese to the to know just a quarter of the box mac and cheese. That’s not, you know, yeah, it’s better. But I’m still eating unhealthy food, when we really started when we really started to trade out. More adding more and more plants into our diet, which is really the secret sauce to the whole thing. And crowding out a lot of the bad things and adding more and more plants into there. We got better my blood pressure did. It’s totally normal.
Cliff Arceneaux: Now. My blood sugar is totally normal now. And the cholesterol is gorgeous, right? All my biomarkers and everything are so much better just because we kept eating more and more real food. And we and we did it by crowding out the bad stuff and just adding more and more good stuff. So you don’t have to be a paragon of magical eating right.
Cliff Arceneaux: But like a doctor I like to follow and read his books, talks about you know, you flip the plate, right. And I talked about that with my own patients down here in the south. Everyone knows what a median three is right? You go to a restaurant and it’s a it’s usually cafeteria and they get the ice cream scoop out right? And you get a scoop of whatever the mystery meat is. And then he gets smaller ice cream scoops of the three vegetables, right?
Cliff Arceneaux: So turn that around, get the big ice cream scoops of the sides of the vegetables, and then maybe the small ice cream scoop of the of the of the meat of the potted meat or whatever it is, right? The mystery meat that you can serve with ice cream scoop. But hey, if you do that, it’s a good step in the right direction.
Cliff Arceneaux: And you’re starting to load up on all the phytonutrients and all the other big multisyllabic words, right? That you get when you eat fresh fruits and fresh vegetables, and things and healthy fiber and things like that. Your body appreciates it. That is not even going into the quasi mystical world that we’re learning about with a gut biome and all that which is really fascinating.
Cliff Arceneaux: And as a practitioner, I don’t really know quite how to use it except for the fact that just eat more fiber, and all sudden your gut gets happier. And you will literally you can literally get happier with happier gut bacteria. That can impact your brain as well, because the prep the depression, and so intricately fingers crossed was realized that from no consuming. They’re just tied together in a way that’s really hard to tell which comes first, right? You losing your memory, and that’s making you depressed or you’re depressed.
Cliff Arceneaux: And so then now you’re starting to lose your memory. We can’t really tell yet. But we know, I’m sure you know. And your clients know, if you exercise your depression and anxiety you get better, right. When your depression and your better, your perspective on your memory loss gets better and your memory loss can actually get better people with with high levels of depression, their memory loss is worse.
I had a patient use her a lot. She had so we everyone thought she had dementia her her family, I had my I was like the behave like your typical dementia patients.
Cliff Arceneaux: So we sent her out gotta do that really long memory tests, like three hours worth of just IQ testing. It’s exhausting, but it’s exhaustive. And she was just super duper depressed.
She started to do some things to help her depression. We didn’t have to give her some antidepressants for a little while. When you’re when you have a broken leg, a crutch is really really useful. Right?
So that helped her kind of prop her up so that she could get motivated enough to do some stuff to help yourself.
Cliff Arceneaux: And guess what, as the depression got better, the brain overall the fog was lifting, the gears were flowing, memory got better, is really pretty cool. So the exercise portion to kind of help control which is why I say it’s not all of it. You can’t just do just the exercise portion. And ignore everything else like Jim fix, right? The guy guy who created the jogging face craze in the 1980s. And his idea was you could just jog aerobic exercise or everything.
Cliff Arceneaux: Right? You still eat terrible, but I can talk and I can take care of and so he did. And of course, what did he do, he had a heart attack and died. Wow. So you can’t just narrow in to decide the thing that’s gonna work. I have to do a treat the whole person. I agree with you the holistic is kind of overused and kind of icky word right now. But the idea that it’s a treat all of you. In order to fix all of you, I think that’s the best way.
Cliff Arceneaux: And it’s not just going to be good for your brain, right. Like I said, even with myself, the things I’m doing helped me keep my marbles. Which is why I called the book that. But my blood pressure is better. I’m healthier, right? Did I lose weight? Yeah, it did I get stronger, yes. But I’m also just healthier. So when I was shooting for health, instead of just weight loss. Then I actually got healthy and then the weight loss became much much easier,
Steve Washuta: I’m sure if you might echo my thoughts and feel free to add to this. But you know, one of the hardest parts about working with patients who are going into dementia or already have some sort of cognitive decline is watching their partners because. There are partners who do not have that cognitive decline, you know, unfortunately, have to be and I don’t like to use this term lightly. But babysitters have a sword.
And they have to sit there and they have to be by their side the whole time. And it’s very difficult, and their lives are impacted by it. So it’s even more of a reason why people should really care about their long-term health both physically but also mentally and their cognitive decline and fighting it because you’re gonna put that potentially that burden on your partner down the road.
Now, again, not saying that this is all someone’s fault, and that we can always stave it off. Right. We know that this is sometimes genetic. We know that it could be inevitable. But anything you can do to fight that is also in turn potentially helping your partner.
Cliff Arceneaux: Absolutely the rates of burnout. Depression disease, when you when you are the caretaker, or just astronomically higher than the average person, right? Because you’re dealing with having to your loved one is declining. And you got that horror. And then you’re the only person who’s going to who feels like you’ve got to take care of them.
Cliff Arceneaux: And so you’ve got the burden of taking care of yourself, you got it is an awful, awful job. So yeah, so if you want to take care of your partner, if you want to take care of your kids, the most least the most least. You know, I’m saying the least selfish and the most helpful, that’s a better way of saying the best thing you can do would be to take care of
Steve Washuta: the oxygen mask. Right, put your oxygen mask on first before you put your partner on.
Cliff Arceneaux: Right, absolutely. Going back to the genetics thing, there were there are studies that have shown that if your partner gets dementia, the risk of you, you they’re over here, they have dementia. You’re not genetic. Well, hopefully, we’re in the south. But the chance things, right of being related to them are probably small. I’m in I’ve been living in Alabama, which is a lovely state.
Cliff Arceneaux: But you know, we have certain stereotypes, but but if if your partner has dementia, your risk, the caretaker, not genetically linked to them, is like over 300%. Right, the chances of you getting it are much, much higher. Why because you’re both eating Holbox, macaroni and cheese at the same time. right, you’re both not eating, you’re both, you’re both exercise, we’re both not exercising, you’re both eating that bowl of ice cream, right? Both just sitting, same lifestyle.
Cliff Arceneaux: And so your risk, so all that all that Metabolic Fire that that is lit in you is also lit inside your partner and their brain is getting torched. At the same time. A lot of couples that, you know, they’re both on that same road, they’re both starting to both, and for a while. This person will have you know, their deficits will be over here. And these other so they’ll make a whole human being for a while, right. But eventually, the all the wheels fall off, and they can’t pull it together anymore.
Cliff Arceneaux: So taking care of yourself, and making changes that both of you can do. And if you’re the caretaker, I’ve seen this a lot too. Well, that’s I don’t want to eat their food. I want to keep eating my whole box and mac and cheese. That’s not gonna work, right. So that’s a whole another dynamic and relationships and stuff. That’s a whole different podcast,
Steve Washuta: give me a second book for you.
Cliff Arceneaux: There you go. That would be great. If I figure that part out, that’d be that’d be great. But the idea is, again. We all think it’s selfish to take care of herself, but it’s actually one of the least selfish things that we can do.
Cliff Arceneaux: Because then you can actually take care of everyone else in your life. If, like you’re saying the oxygen mask thing, I think that’s really important for people to grasp that especially if you’re in that sandwich generation. Like we were talking about near the beginning, where you don’t have time you’ve got little kids and you’ve got and you do have grandma in the in the upstairs bedroom, and then there’s they’re not doing well.
Cliff Arceneaux: And you know, the last thing you want to carve out time for is take care of yourself because you’ve got to take care of me. You don’t take care of yourself, then and your wheels fall off, then the whole thing collapses.
Steve Washuta: Cliff This has been so informative and great information. I want to give my audience directives on where they can find your book. Where they can reach out to you personally if they have any questions. If you have a website, a social media handles anywhere where they can find you cliff.
Cliff Arceneaux: Sure, the name of the book is keeping your marbles. It’s a field guide for preventing and treating cognitive decline. As it’s a it’s a very light read on purpose. I tried to dump talk about the science but I do try to make it as approachable as possible. Try to find the humor in it as much as possible. The whole thing is not for you to feel like you’ve read it now. You have a PhD in neuro psychology.
Cliff Arceneaux: It’s for you to have that hope that idea that this is possible that this is something that can work.
The website is www dot keeping your marbles dot info I O or when we’re keeping your marbles and then social media presence.
We’ve got a Facebook page. Keeping your marbles and then it’s also one for keep your marbles and got both. T hat’s a whole another that’s a how not to do a social media launch. Well again, that’s a whole another podcast. But you could reach out there.
Cliff Arceneaux: My Instagram is just Cliff a 74 because I haven’t created that other thing again because I’ve been I wrote this book when I’m working full time and being a dad and a bunch of other stuff. But I really felt like this was information that needed to get out there. So the main thing if you just get to the website. www dot keeping your info Of course the book is on Amazon or all the major booksellers you can also find it there.
Steve Washuta : I will put all the links in the descriptions of the podcast below. I will also link it every single time I put up some sort of graphic on my social media accounts. Cliff , thank you so much for joining the truth of podcast.
Cliff Arceneaux: Oh, absolutely had a blast. Thank you so much for having
Steve Washuta: Thanks for joining us on the Trulyfit podcast. Please subscribe, rate, and review on your listening platform. Feel free to email us as we’d love to hear from you.
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