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Episode #520 - Retirement Plan Live: Mature Marriage - Mark’s Story
Roger: To test or not to test, that is the question when it comes to medical testing. Is there such a thing as too much information? We're going to explore that and more on today's Retirement Answer Man show.
Hey there.
Welcome to the show. My name is Roger Whitney and this is the show dedicated to helping you not just survive retirement, but have the confidence because you're doing the work to lean in and rock retirement.
Big show today, big month. This is going to be a big month today on the show. We're going to talk with Bobby in our Bring It On segment on building energy with medical testing and how to do that in a healthy way.
Before that, though, we are going to launch this year's Retirement Plan Live case study with Mark and Mary. They are 50 somethings that have been married for less than a year and a half, and they're both bringing an adult child to the mix and their own resources to the mix, and they're just figuring out, how do we make this work when we're used to managing our own life without having to take into consideration somebody else's opinions?
This is going to be a really interesting case study.
Let me lay out the month for you. We're going to meet Mark today, hear his backstory and his aspirations and concerns about this new marriage later in life. Next week we're going to meet Mary and do the same thing so we can understand who they each are as an individual.
Then the week after that we're going to talk about their goals and then we'll talk about their resources the week after that.
The last week of this month, since it's a five-week month, we're going to have a discussion of how they manage cashflow since they have separate assets and they're not just going to put them all together, at least not at first. How do they manage cashflow or who pays for what when it comes to their joint life and perhaps expenses for the kids that they're bringing into the marriage.
Then February 1st, we're going to have them on live with you and me, and we're going to go through results show of sorts of, okay, how do we start to put this all together and what next steps should they take? You'll be able to ask questions and make comments and we will have them on live with us.
If you want to join us for that live show, you can go to livewithroger.com and register, and you can join us live on February 1st. That's a Thursday. We're going to do it at 7:00 PM and we'll be talking about this throughout the week.
In addition to that, we will be opening up enrollment for the Rock Retirement Club.
This session, we're starting a new program where when you join, we're going to walk you through a process so within 30 days, you can get to a feasible plan of record and answer those questions. Can I retire? How much can I spend? Et cetera. We're going to try to guide you through building your feasible plan of record.
You can check all that out at livewithroger.com.
Oh, that's a lot. With that said, let's get on to meeting Mark.
MEETING MARK
So now it's time to start the first segment where we are going to meet Mark from Mark and Mary and learn a little bit about his story. Next week we're going to meet Mary. Marky Mark, how are you doing?
Mark: I'm good, Roger. How are you?
Roger: Good, and obviously that's not your first name but I'm going to remember you by Marky Mark. I'm going to be singing a lot of those songs probably this month in my head.
So, I'm curious, what motivated you and Mary to raise your hand to do this case study? I'm always curious about that.
Mark: I've been listening to the podcast and I heard you talk about this topic and we've been married for just over a year living together for a year and a half and we're really struggling to see eye to eye on finances, both current state and future state. So, I thought I'd ask her if she was interested in doing it. I didn't think that she'd be interested at all in telling you the truth, but when I mentioned it to Mary, she jumped right on it. She thought it would be great.
Roger: She hadn't really listened to the show. So, she didn't really know who I was, if I recall.
Mark: That's exactly right. She's never listened to it. We’re, I'd say fairly different in terms of how we approach things. I'm as analytical probably as they come, and she's probably at the other end of the spectrum.
It's more sort of by feel and comfort level with less interest in looking at numbers.
Yeah, she's just, she's not a big fan of how I look at things, so we're learning how to get together on that.
Roger: Yeah, she and I have had some conversations and she seems very enthused about doing all this. I think she's motivated to want to get to some agreement on how we operate.
Which is wonderful.
Mark: Yeah, that's what I've learned since suggesting this tour and connecting with you here in the last few weeks.
Roger: That's really encouraging for both of you, that you both are all in on figuring this out. Even though you know there's some differences in how you operate.
Mark: We are, no question.
Roger: Yeah, that's wonderful.
So, tell me a little bit about yourself. How old are you?
Mark: I recently turned 57. I've been living out here in Oregon, 27, 28 years, grew up in the Northeast, went to college in the Northeast, worked the first seven or eight years of my career out there, and then through mergers and shutdowns and things like that, got the opportunity to move out here. I've been here ever since to have a bachelor's degree in an engineering field. I've worked for the same company in aerospace ever since graduation. I've really enjoyed it. It's been a really fortunate career. I get to work on a lot of exploration projects for NASA as a contractor and have done all sorts of neat exploration things. Then along with the exploration based at work, personally, I've kind of explored quite a bit to travel quite a bit to all the continents and a lot of countries and taking a lot of pictures of it, et cetera.
I have one son from my first marriage who's adopted. My first marriage lasted just about 20 years and then some number of years after that decided to try to reestablish a relationship and found Mary's kind of the new fashion way with internet.
Roger: Really? So, this is an internet match?
Mark: It is. There's more out there than you realize when you start talking to folks about it.
Roger: Oh, totally.
How long did it take you to figure out your profile picture?
Mark: Oh, boy.
Roger: It seems like it would be a weird thing. They even have movies about that.
What do I write? What do I put up on there? All that type of stuff.
Mark: I sort of made up my own mind on stuff. I don't look at a lot of other people's ideas for it. So yeah, I remember what it was. I don't. I don't exactly remember how I arrived at that. I've got a lot of pictures from adventures and things like that that I suspect it was.
I don't even remember what it was at this point.
Roger: So, adventure is, you've been to all continents, it sounds like you were either into photography, you've taken pictures on all, you're into photography a little bit. What drives that adventurous spirit? I'm just curious. Why do you need that in your life?
Mark: I mean, there's two things.
One is I feel like. We live in a period of history where it's just so accessible to go see all these amazing things around the world, and that's always energized me. Then I just think of the ideas of thinking of places to go, researching them. putting it together. You have a job; you have to plan pretty far in advance to map out the time. I just enjoy that whole process of discovering these places, trying to discover little nooks and crannies in various places, and then going there and actually doing it and taking tons of photos of it and then reminiscing about the whole thing.
So yeah, like I said, been to many places with my son, we went on a five-year stretch of international trips together that we just talk about all the time. There are so many memories there and just so many memories from all that. We're not done, right? You'll hear us talk about the intent to keep doing that, but I'm incredibly glad and have a lot of gratitude for doing so much of it already in life.
Roger: So, a friend of mine and I have a little mission to visit the least visited safe places in the world.
We had to qualify safe. So, you can get creative. Give me some ideas. It sounds like you said nooks and crannies. Give me a couple highlights.
Mark: Never thought of it that way. So, when you think about sort of out of the least visited Africa, obviously is a hard to find maybe safe nooks and crannies there, but I've jumped straight to Namibia as a safe place to go. It's a little more popular these days, but it's certainly not crowded.
My son and I, that's actually the first place we went on an international trip. We flew in there, we went to Bobo Campers by the airport, rented a four-wheel drive with a camper on the back and just headed out by ourselves, self-drive in Africa, driving on the opposite side of the road with a stick shift pickup truck. We just were able to get lost in the mountains in Africa and just pull off on the side of the road and sleep.
Roger: Very cool.
Mark: That would be one I'd jump to. If you want to go to Africa on a trip like that, that's where I'd start.
Roger: Okay, and so you're an engineer in aerospace, and the thing that came to mind when you said that, Mark, was that your mindset cares about how many decimal points you go out. When you get to spreadsheets.
Mark: It does. I had a chemistry teacher in high school, Mr. Woblowski, that taught us about the concept of significant figures, and I always remember that, so like when I look at numbers and stuff like that, I just look at how precise things are, and at work, I look at how precise people make some things that are, seemingly don't have to be that precise, but yeah.
Roger: So, give me that concept, I've not heard of that, I'm not a math geek.
Mark: Significant figures. It's sort of digits in a number that are important. So, like, 10, like if you have a decimal point that's like 1.5000, that's only two significant figures, because all that matters is the 1 and the 5.
Roger: So, it works in both sides of the decimal point. Okay, but I remember when we first met, you talked about it and Mary sort of laughed about it.
You were sort of, hey man, I got some pretty cool spreadsheets. You're like, you want me to send you these spreadsheets? You're proud of them. That's the vibe I got.
Mark: If and when you see it, it probably reminds you of the character in A Beautiful Mind with all the scribbles and all over the boards and stuff.
You can view it as a masterpiece. It's a Monte Carlo in Excel with all sorts of 10 or 12 variables to it. I like it. It's a good model. I consider it a plan of record. Most people are probably going to look at it and think it's gibberish.
Roger: So, yeah, but it works for you. So, you built a Monte Carlo engine or analyzed it in the Excel spreadsheet.
Mark: I did. I did. Yeah. It's a big file. Yeah. Yeah.
Roger: We're in the middle of updating some Excel planners internally, and they're not near as complicated as that because we use software for a lot of things, but Excel is really important. So, when you leave work, maybe you can just freelance and build us some Excel files. We want an Excel savant. We want that. That's a beautiful thing.
Mark: I taught spreadsheets in college. I don't know if you know this or not, but you might've heard of VisiCalc and all those things.
Roger: Oh yeah.
Mark: I had VisiCalc when I was in high school. I got a copy of it and learned it and all.
So, I've been sort of early generation spreadsheet guy and just everything you could do with them, it's a pretty remarkable tool if you're into that sort of thing, and I am a little bit.
Roger: Would it be fair to say, and I imagine in aerospace as well, it is relatively an exact science. Tolerances, if you're building something, you have to get to as perfect as you can.
Mark: Yeah, the types of programs I've worked on are sending spaceships off to other planets. We're sending astronauts to the moon, that's as precise as you could possibly have to get. There's no margin for error, and there's lots of numbers involved. I'm certainly used to it. I actually feel like folks I work with are more precise than me in a lot of cases, but yeah, there's no sort of sticking your thumb in the air and landing on Mars.
Roger: How do you think that skill set applies to retirement planning?
Mark: I think the ability to envision an outcome five or ten years in the future, and then put a plan in place to get there, and then do the analysis to underlie that and maybe trade out different options the thrust of it the whole concept of Looking at the endpoint and then developing a plan to get there.
It's kind of where I talk from travel I certainly do it at work. That's what we're trying to do right now with this because we're cramming a little bit here at the end to get to the retirement we want as soon as we can get there.
Roger: Yeah, and when we have the first conversation with the two of you together, we're going to get into okay, when do we want to retire and then what do we want in life?
But I think getting this background of who you are, because you two are still Mark and Mary, but separate, that you're trying to create as us, right? With separateness, with separate kids, and separate stories, different.
Now, when you met Mary, so I wanted to get that out, because I know you're very analytical, and you talked about your spreadsheet, I do want to see it, and we won't share it publicly, I don't think. It took a long time, I have no doubt, but I would love to see it because I have a lot of spreadsheet geeks in my life and I am not one, but I love to see the creativity.
When you met Mary and you met on the internet, did you click on her or did she click on you?
Mark: I clicked on her. I contacted her and she more or less said I don't go on dates without talking on the phone first. So yeah, she sorts of flipped it pretty quick on how she wanted things to go.
Roger: Why did you click on her?
Mark: I think she seems like a person that liked to get out and explore the world, I would say.
She's a dog person, which is important to us, and then she talked about books and stuff that she liked to read, which tells you it's a type of person that's pretty settled and comfortable and trying to remember the book she was reading at the time was The Soul of an Octopus, if I remember right.
Roger: I've heard of that. Did you guys tell me about that? Somebody told me about that book.
Mark: It wasn't me. I don't know if you mentioned it talking to her.
Roger: Maybe it was her, yeah.
Mark: She just seemed like a really thoughtful person and pretty willing to see what would happen. So yeah, she was willing to meet me somewhere for dinner shortly thereafter that she isn't usually willing to go. She said she still doesn't know why, doesn't know why she accepted that. But nonetheless, everything's clicked since then.
Roger: I was going to say, so you had the phone conversation, the screening call. What was it about her that affirmed your initial Impression from whatever website.
Mark: You know, the one moment that sticks out the most is when we went to dinner and then I asked her if she wanted to take a walk nearby.
So, we did and went for a walk and just talked the whole time. But towards the end of that, I asked her, what do you want a relationship to be like? Her answer was something just like this. That was literally to the word, which was great, right? I was comfortable too. At this stage in life, having someone that sort of wants the same things as you and moved in that direction pretty quickly. That was that. We had some challenges and things after that, but nonetheless, it all kept moving forward in a positive way.
Roger: So how long did you date for?
Mark: About a year? Yeah. About a year. Actually, asked her to marry me one full year later on that same walk. So, we kind of repeated the first date and in the middle of that we got engaged.
Roger: Then you moved in together first, right?
Mark: We did. We got married five months after we got engaged.
Roger: I've walked this journey with people before. You have two whole households set up. So how did you navigate that?
Mark: We swung big and bought a new house and both moved there. I was actually renting at the time we met. I didn't have a home. And she had a place that she rents out now. We swung big and All right. Bought a pretty nice place together and both moved there.
Roger: Speed can be a force. Now you've been married about 13 or 14 months, if I recall. That's right. I want to ask you about, what are some challenges you're facing? I also want to ask about some aspirations. So, let's start with the challenges first, and you mentioned some of that at the beginning.
Here we are. We're trying to merge these separate households and you went big got a house. So, it's our house. What are some of the challenges that you had to navigate over these last 12, 13 months?
Mark: I think early on sort of each of us being masters of our own domain and then figuring out how to be masters of each other's domain and understand. Day one, moving in, we ran into some things of that nature. So, we've had to learn how to work together and I think we've gotten there. I think Mary would tell you that I sort of got more of the way to set up the house from my perspective than she did. So that has been a lingering challenge for us.
I think on the financial side, Mary would tell you that she at times doesn't feel great about some of the financial ramifications of my earlier marriages that are still lingering and that bothers her at times.
Then I think we had never individually planned a lot about retirement, and now we come together, the picture looks pretty positive. So, trying to figure out how to put all of that together and start to focus on it more and just really understand our finances and how to put those together.
Roger: That's totally normal.
You're two separate individuals that had lived autonomously, and now you have this us in the middle. You're sort of in two different worlds mentally and psychologically, right? So that's totally normal. So, you know that I'm guessing you would know that, but it is.
What is your philosophy on creating us when it comes to finances now that this is a later in life marriage?
Mark: My philosophy on creating us was to merge everything right away. I viewed that as a way to sort of show trust and togetherness and be working together on finances to have similar visions to have some give and take, but what I've learned is that probably wasn't right, I think, because I believe that Mary was always used to having all her own finances and she's not as used to sort of working together on it and what that means.
She wants some independence the way she's always had it.
Roger: We'll hear from Mary next week, but she's never been married.
Mark: Correct. She's never been married. Always been autonomous and self-sufficient.
My first marriage, I probably sort of controlled the financial side a fair bit, and I thought that was fine, and I thought taking the same approach here was what I knew, but it's proven to be a challenge.
Roger: Okay. I'm trying to think, have you ever taken a personality test, like a Colby, or a DISC assessment, or something like that?
Mark: I have.
Roger: That might actually be fun to do, maybe I'll send you both one.
Mark: Yeah, well, the ENTJ or whatever that one is, I've definitely been.
Roger: ENTJ, see, I have to remember, but maybe we'll do that. When we have some of our conversations down the road, we approach things differently. Like I'm a quick start, right? I'm all in. Troy on my team and Nichole on my team, Troy, I know for sure, is a fact finder.
Right? One's really fast, one's really slow, and that can be really good or really bad, depending on how you interact.
Mark: Yeah.
Roger: Do you see yourself; I mean, it seems like you're a planner, and you're a project manager, and map things out very exactly. At least that's the spirit you articulated to me. Do you think that is part of some of the challenges on your end?
Mark: I think doing it analytically is part of the challenge, but I think we did so much together right from the start, buying a pretty nice house and et cetera, et cetera. I had made some predictions of what things would look like, and they weren't quite right, let's put it that way. Cash flow is a little bit tighter.
I think that's a big part of it is we've looked at this analytically and it's turned out a little different than that. So that makes it hard to regain trust in my approach.
Roger: I get that. And I was going to ask around, because I think of aerospace engineering, there’s an exactness to it, would be my impression. Travel, when you're doing that planning, there's still a lot of things. Your plane could get canceled. Do you think the randomness of life when it comes to personal finances is different than aerospace? I'm guessing you would, but can the engineering part apply? How much can it apply to it?
Mark: Well, the planning process and using numbers can apply to it.
But I think in aerospace, the type I does, there's a lot less uncertainty. Accounting for uncertainty and looking at things in terms of probability and where you have resiliency or margin is the term I use, as opposed to just expecting things to be spot on down the middle is a major difference.
Roger: You've articulated the challenge that you guys are facing and I'm sure it sounds like it because you started with that when we started talking is front and center and definitely in this realm.
What are your aspirations? Because that's the finance part, but there's a whole separate part of life. What are your aspirations for you and Mary?
Mark: To be able to get on the same page, right? So, this isn't a frequent point of contention and stress. To get on the same page that aligns to what we both want, and to be able to focus on all the positive things and what we get to do together as opposed to when we don't agree on things financially. That's the near term, is just to have an outcome that we both understand and can communicate in and use as a tool as we move forward in life and not constantly trying to figure it out.
Roger: You take this out of the mix. Are you two like, yes, we both want to do the same things. We have the same values. We want the same kind of life.
Mark: Definitely. We both know what great retirement looks like. For us, we know what a great life looks like between now and then as well. We share a lot of the same interests. We've adjusted a little bit here and there, but yeah, if you get to the point where, what does it look like in 10 years, we both tell you pretty much the same thing.
Roger: Marky Mark, thank you for sharing your perspective. I'm honored to be part of this journey, at least in this forum, and I think what you two are willing to do, and I had very pointed conversations.
Is this a form that you want to do this in? And you both started with, yes, we're comfortable, but we think it could help others that are going through similar things. So, I appreciate that. I want to make sure we honor that, and I'm excited to walk this journey with you. Thanks for sharing.
Mark: Sure thing, Roger. Thank you.
BRING IT ON WITH DR. BOBBY DUBOIS
Roger: All right. Welcome to the Bring It On segment where we are going to focus on energy and how we build and make sure we're healthy enough to actually rock retirement and to help us as always is Dr. Bobby Dubois. How are you doing, Bobby?
Dr. Bobby Dubois: I'm doing well.
Roger: Good.
Well, I want to make sure and there's always a disclaimer on this. We're talking about medical topics and you should always discuss this stuff with your doctor to have or not have screening tests. This is just exploration as to whether you should test or not and how to think about it in an organized way so you and your doctor can make the best decision for you.
This is a big topic for me, Bobby, as I've been doing a lot of testing recently.
Why is this important topic in the first place?
Dr. Bobby Dubois: Well, I think it's a really important topic because it's becoming more available. You can go online and without your doctor, order panels of hundreds of blood tests and arrange to have a whole-body MRI scan.
In the past, this was just the purview of you and your doctor together, and now it's much more consumers driven. So, because it's so common and you told and shared with me that you've actually done this, I thought it would be a good idea to talk about whether in fact this a good idea is or whether there's a reason to pause and perhaps not do these broad screening tests in asymptomatic folks.
Roger: I think this is a great topic because I've gone down this rabbit hole after reading that book. I'll live off, I try to be proactive about my life. I'm 56. I want to be healthy when I'm 70 or 80 and you and I on the show and other places have had discussions about this and you're right! Wow. I can do all these tests. Why wouldn't I? So, I'm excited to explore this because I've gone down this rabbit hole as I've shared some of mine with you.
Let's start with what are the reasons to do the tests.
Dr. Bobby Dubois: Well, at the very highest level, they're really compelling. It's like, well, I'll do all these tests and it's like an early warning detector. If I find something before, I'm ill, well, that's got to be good. Finding cancer early, finding heart disease early. It seems like it's a no brainer rather than waiting and finding it when you're really sick. So, at the highest level it makes perfect sense.
Roger: Yeah, I think more information is better and like when I frame, I've seen the journey with my mom and with my sister and other people in my life and in my practice of the discovery of say, cancer, which is sort of the big one we think about right, of it always seems to be discovered later, and then they just start treating aggressively. It's just me thinking as I've observed, this is like, well, if we could detect things earlier, it would give us more agency to try to take action. So, it seems logical to me that more information would be better.
Why might you think twice about this?
Dr. Bobby Dubois: That's the critical question. The positives are pretty clear. And folks just focus on that. And the companies that would like to make some money focus on that. They don't really give you a full sense of the downside.
I'll give you two answers. One is the kind of very high-level answer, and the other is the nerdy example.
Given that I'm seriously a nerd, I can't avoid the nerdy answer as well. So, the CDC has an ongoing task force called the U. S. Preventive Services Task Force, and they come out with recommendations of what type of screening tests folks should do, and in adults, it's really a tiny number. It's pap smears and mammograms and colonoscopies. Then if you're a smoker. the certain type of lung cancer screening.
That's it. They don't recommend routine PSA screening, ovarian cancer screening, grail cancer tests, large blood panels, total body MRI scans, routine treadmill tests for cardiac disease.
None of those they believe has evidence to support their use. So that's kind of the high level, what do the experts say, or at least one group of experts.
Then there's the nerdy explanation. I think it's important to do a little bit of statistics 101 and why screening tests may lead to problems.
Okay, so the first thing is kind of the pure statistical way these tests are evaluated.
So, the way most blood tests are determined are you take a hundred people, or a thousand people, or ten thousand people, and you say, well, the top five percent on this blood test, blood sugar, blood calcium, by definition, is abnormal and you will get a little positive flag. Or the low end of that range, you'll get a flag.
This would be true if we counted freckles on your body. Well, we took a thousand people, counted freckles. Well, some of you have more than 400. So, by definition, that's abnormal or positive, and some of you have zero. Well, that's got to be abnormal too. Or we were counting hair follicles, in my case, almost none, per inch on my head.
You'd say, okay, what's abnormal. It's a purely statistical determination, and if you do a bunch of tests, you are going to fit into that 5 percent category in one of them, or many of them.
That's the first thing, that you're going to be abnormal if you do enough tests, and then you have to figure out what to do with that.
Roger: Whatever happened to personalized medicine when they decoded the DNA or genes, I forget what it was, even the genome, whatever happened to bespoke testing based on, hey, if I happen to have a lot more freckles, that's just me and that's okay.
Is that just something that's still happening in the background? I remember everybody was excited about that.
Dr. Bobby Dubois: Well, there are algorithms to say, well, your blood test is this and your genetics are that, so therefore worry or don't worry. I think we're in somewhat of the infancy of that. I mean, probably the closest we get is cardiac risk prediction, where the Framingham Heart Study taught us that age and male gender and smoking and blah, blah, blah, and you come up with a personalized estimate.
For most blood tests, no, you just get your results and you have an asterisk or a red color, and you run with that. So that's the kind of statistical problem I am speaking of.
The other problem in many respects was probably a deeper problem, and this is the tests are not perfect.
If you think about a treadmill test exercise study for your heart, there actually is a gold standard. They're not just saying, well, 5 percent are of the top end or abnormal.
They actually take 100 people who have heart disease and run them on a treadmill and say, well, do 100 percent of those people have a positive treadmill result? The answer is no. You're lucky if it's maybe 70, 75 percent are positive. Now that's a problem for another day. We call that sensitivity. So even if you think somebody might have heart disease, the test may be wrong.
For today, it's the other side of the coin. Let's say we took 100 people we know don't have heart disease. Maybe they did an angiogram. Maybe we did some other fancy tests and you run them on a treadmill. What you would like to find is 100 percent of those people have a normal study.
Well, what you find is that you may end up with 20 or 25 percent of people who know absolutely don't have heart disease, but they might end up with a positive test.
Now you might say, well, why did we define the test? So, they would be positive. The problem is if we set it, so 0 percent of normal people are positive, then you're going to miss almost everybody who actually has heart disease. So, it's a very complicated process, but the bottom line is you're going to end up with a whole bunch of people who run on the treadmill, and they have what looks like a positive result, and lo and behold, they don't.
So, statistics are not in our favor. Either because you do enough tests, 5%, you know, you're going to pop into that one. Or you do a treadmill test or an MRI scan, and you're going to find something that often is meaningless. So that's the problem.
I'm a poster child. I can tell you a number of scenarios. where we went down rabbit holes with my doctor when I had an abnormal test, one of which was a treadmill test, and in my case, it wasn't screening, I was actually having some symptoms, but anyhow, that's again a topic for another day.
Roger: When I think of the CDC and their recommendation, part of it is the scientific evidence, but part of it I imagine too is economics, because this is talking about societal protocols that are what the standard is.
When I think of this, I care about that from a societal standpoint, and I think of this with retirement planning too, but ultimately, I just care about me, right? My health, and okay, if that's what they say, what should I be doing if I have the means and the intentionality to do it? That's what I always think of with medicine. A lot of it is about what's the best standard for monitoring health, but another part of it is just societally, what can we afford to do?
It's hard to parse those two.
Dr. Bobby Dubois: I think that's right. That's why I went to the nerdy example, because that has nothing to do with cost. It totally has to do with, you do enough tests, you're going to end up with a positive result.
We're about to get to, why is that a problem?
Roger: So, before we go there, because this is going to be fun because you gave me an example that I hadn't thought of when you and I talked privately. Isn't part of finding a negative result, whether it's positive, whether it's an error or not, isn't that a healthy exercise to prompt us to explore it and eliminate it?
Even though it happened to be something that wasn't an issue, isn't just that practice of, oh, this looks a little off. Let me go check it. That practice seems like that's a healthy thing to do regardless, even though it might send you down a lot of dry holes over time.
Dr. Bobby Dubois: We'll get into pursuing dry holes.
It's not risk free, but let's take an example where you do your blood tests and your cholesterol looks great. Hmm. Well, maybe I don't need to exercise as much as I thought, and maybe that smoking I was thinking about doing or giving up, I don't really need to. So, here's an example where you're falsely reassured that all is well when it's only a tiny piece of a much larger puzzle.
Roger: That's a great example. That's a great example. As I think of financially, oh, I make a lot of income right now and have money in the bank. So, you start to get a little lazy in how you spend money, and if you're not paying attention, all of a sudden, you're not in that position anymore because things have changed.
Dr. Bobby Dubois: Exactly.
Roger: I get that.
So, should we be concerned about false positive tests?
Dr. Bobby Dubois: Okay. So, let's assume that if you do enough tests, you might end up with a positive result. Now, we have to separate, is that a real positive, you really actually have something abnormal worth knowing about, or is it a false positive?
But let's just say you're going to have a bunch of positive tests. Now, let's just say part of your screening test was a PSA for your prostate, and that's not recommended, and it's not just the CDC. Lots and lots of groups have said routine PSA testing, which was considered a thing to do, should not be done.
Now, let's say it's positive. Let's say you're 50, 55 years old, and it's positive. You're going to end up visiting your friendly urologist in town, and friendly urologist will then examine you, and maybe he'll feel something on your prostate exam. That might lead to an ultrasound test, and then that could show, well, maybe we better stick some needles in there and do some biopsies, which is really no fun.
That biopsy could have complications associated with it. Infection, whatever. They may find that, oh, you have a little bit of something going on and you may now buy yourself some surgery and radiation therapy when in fact that really isn't a positive result to worry about.
The saying goes, if you live long enough as a man, you will die with prostate cancer, not from it. The problem is differentiating what will never hurt you from what will hurt you is a challenge, and so you may end up down a rabbit hole, which could be problematic.
Roger: Making that distinction, Bobby is, I would think pretty impossible of prostate cancer. Will it kill me or will it not?
Is it something I should act on? It seems like it's just a judgment call. I don't think it's binary. You can actually figure this out. I don't know.
Dr. Bobby Dubois: Well, depending upon what they found, if they actually do a biopsy of prostate cancer, there are ways to scale that biopsy finding and say whether it's likely to be problematic or not.
But as you say, for a lot of people, you'll fall into a gray zone, and then it very much is a judgment call.
Roger: So, in this example, you can go down getting procedures that one will cost money, two will cost time, three will cost discomfort, and four could also cost complications. Right? The infection or other things from the procedures.
Then probably lastly, well, there's probably a lot more, is mentally this could be trying as well. The whole time you're worried and you're thinking you're sick and you're going to die and you start overthinking a potential problem that might actually be there.
Dr. Bobby Dubois: Well, that's right. I think that you can't really avoid the uncertainty and fear while you're going down the path of figuring out, is it a true positive or a false positive?
Some of these cases, you'll get to the end and you'll say, Oh, great news. I'm absolutely fine with respect to this abnormality. All the pain and time and worry aside.
But let's say you did that routine executive physical and you had your positive treadmill and then you did another study or another study and for so many people, you have a little bit of plaque in your cardiac arteries. I mean, almost nobody. I mean, they did studies in the Vietnam era where people died at 18 because they were killed in action and they did autopsies and lo and behold, they had plaque.
Now, was it hurting them at that point? No, but if you do further cardiac testing, almost everybody's going to have some blockage of some sort.
Now you may go to the cardiologist and they'll say, oh, it's nothing to worry about in terms of, we don't need to give you a stent or put you on fancy medicines, but you're going to walk out of the cardiologist's office wounded. You're always going to be thinking, yeah, my cardiologist said it's not a significant blockage. There is stuff there, and next time I exercise, I'm going to be a little worried not to push it too hard or activity in the bedroom eh, you know, maybe I better be a little cautious. And for the rest of your life, you may carry this worry consciously or subconsciously, that all began because you did some screening tests that were not indicated and that's really the point of all this is really to say there's a positive to all these testing, but there's a downside and less to understand that before folks rush in.
Roger: That behavioral change of going from exercising regularly and pushing yourself, right, has over time typically had a spiral effect upwards of a health benefit.
But mentally, if you say, well, maybe I shouldn't, well, that changes the trajectory of the compounding of habits that could lead to other things later on.
Dr. Bobby Dubois: That's exactly right.
Roger: That's one that doesn't quite come out when you think about it, that's a wonderful example. Do we want to talk about my test briefly and a few things that sort of demonstrate both of these?
Dr. Bobby Dubois: I think that'd be great. Maybe begin by telling people, why did you decide to do it? And then let's explore what we found, you and I, and then kind of your reflections on what we found.
Roger: Yeah, so my intent was to know where I'm at and get a normal protocol of testing outside of the doctor that I can actually track because a lot of times they just send you something and maybe circle one or two things, but I can't see trends easily.
So one was, I wanted to be more proactive in seeing trends so I can try to figure out how do I make proactive changes to influence those compounding of things. Maybe I change my diet. Maybe I lower my alcohol consumption. I just wanted to have some agency over my health.
That was one and two was that. It's very available and affordable and I didn't realize that.
Then lastly, I wanted to start doing things now that my future self, I'm 56, my 66-year-old or 76-year-old self would be happy that I did in this earlier start.
So that was my intent, and because it was so affordable and they had these platforms where I could see trends over time, it wasn't the individual test. I thought it was the consistency of doing that was. going to be valuable. I just want to be healthy when I'm older and active. So that was my intent.
Dr. Bobby Dubois: Again, that makes eminent sense, and then there's the downside.
Roger: There are downsides and you actually pointed a few out. So, I used a platform that I found. It's called Function Health. I have no association with it. Bobby has no association with it. We don't recommend or we don't have any opinions. Just what I use.
So, I'm going to share that. Again, as you're thinking about these things, I think it's important to have a guide or a partnership with your doctor as you're making these types of changes because they are who you should be turning to. We're just trying to flesh out some of the positives and negatives around this testing, so I just want to make sure I reiterate that.
Let me share my screen here, Bobby. I got to figure out how to do this because I haven't done this a lot lately. Are you seeing it, Bobby?
Dr. Bobby Dubois: I am not.
Roger: Okay. Here I am. Here's my dashboard. The first thing I noticed was, hey, I'm 56 and it says my biological age is 47, which makes me feel better about myself.
And it tested, it looks like 139 biomarkers and all of these are quote unquote in range. Of course, what does my eye go to? What do you think, Bobby?
Dr. Bobby Dubois: The red numbers of 10 out of the 139, and that just goes to my nerdy example, which is if you define things as 5 percent as abnormal on the top and then 5 percent on the bottom, lo and behold, you're going to have a bunch and you have 10 that we now have to like go down the rabbit hole and say, Do I worry about this? Do I not worry about this? Uh oh.
Roger: But I don't think of it in nerdy terms like, wait a second, why are there 10 that are out of range? What's going on there? That's where my mind goes. I don't know where we want to go in this, but obviously on the heart one, which cardiovascular disease is the number one killer by far of everybody, right?
Obviously, that’s a worry. Do you want to go there first?
Dr. Bobby Dubois: We can, or we can go directly to the immunology one, which is where we have the most interesting set of findings.
Roger: Let's do that. I think that was this one, right? Yeah, this one surprised me and I think you said it surprised you too. Why don't you navigate this because you know these words better than I do.
Dr. Bobby Dubois: Sure, and for those that are not watching on YouTube, I'll just explain it.
So, of the 139 that measure all aspects of life, there were four that related to immunology, autoimmune disease. These are things like lupus or rheumatoid arthritis or psoriatic arthritis or psoriasis. There's a whole host of these types of conditions.
It turned out for Roger that two of them were positive. Rheumatoid arthritis, the rheumatoid factor, and then the anti-nuclear antibody screen was positive and it had a speckled pattern which can be associated with lupus.
So now, Roger has markers that imply there could be a problem immunologically with either rheumatoid arthritis or lupus.
Roger: As a layman, Bobby, just so you know, when spackling and anti-nuclear antibodies, ANA screen, those words are intimidating to somebody who's not a doctor like me. I'm like, I don't know what that means, but it sounds important.
Dr. Bobby Dubois: Absolutely. If you were now to submit your application for life insurance where they ask you every problem known to man, has the doctor ever told you, you're now going to have to answer yes to some of these.
Roger: Exactly. Even yes. A good point is, you know this information now, so you have to disclose it when you go down long-term care insurance application, all of those kinds of things.
Dr. Bobby Dubois: You may get denied because of this, and all because it seemed like a good idea at the time to do these testing.
Okay, so.
Roger: So, from a retirement planning standpoint, I just want to put an exclamation point on that. That's a big one. If you do these tests and you know this information, that's another downstream, practical implication of knowing this stuff.
Dr. Bobby Dubois: Absolutely. Okay, so, now what do you do with this information? You might talk to Dr. Bobby, and he might say, well, look, you're going to have positive results, here's some positive results. Go talk to your doctor, but I personally wouldn't worry about it.
But let's just say serendipitously, you were having aches and pains. Or you were having fatigue and pick your number, but a huge percentage of all people in the United States of our age group have some aches and pains and maybe are a little more tired than they were when they were 25.
Surprise.
Roger: I think everybody, that would be everybody.
Dr. Bobby Dubois: I was not going to say that, but that's a reality.
So, you now go to your doctor and let's just say you have been complaining of these problems and then the doctor finds these. And all of a sudden, now, 2 plus 2 equals 4, okay, let's maybe treat you for one of these conditions.
Now, of course, the doctor might talk to you, a little bit more information and say, nah, these are false positives, don't worry about them. But you might also have a doctor who then connects the dots and says, oh, let's start you on some of these therapies, which have their own toxicities and problems and fear of, oh, I have rheumatoid arthritis and my grandmother had it and she was crippled from it.
So, you go down this worrying path. So again, this is ultimately a false finding, probably for you, now you have got to deal with the consequences of it.
Roger: Let's bring back that spiraling example of, because I'm a very active person, you and I are going on a rucking adventure, I row, I do lots of things, and I have lots of aches and pains, pretty much all the time.
Psychologically, I'm in a place where I'm comfortable seeing these kinds of results and have some perspective on them that I feel like are healthy, right? It's not changing my habits and not changing the internal story in my head about myself, but it's very easy to see these and say, oh, that's why I have these aches and pains.
Like your example, maybe I should stop doing these things, rowing or rucking or whatever it is you enjoy doing because I have rheumatoid arthritis, or I might. So you change those behaviors, which have downstream health impacts that likely aren't that healthy if you slow down your activity, maybe I just sit on the couch for another hour because I don't want to aggravate my arthritis that's not really diagnosed.
There's a lot of downstream impacts to these things I can see that can happen depending on who you are.
Dr. Bobby Dubois: Absolutely. I went on this discussion topic with another one of the RRC members and there were abnormalities and he was in the frame of mind that it wasn't going to bother him one way or the other.
He's very analytic, understands false positives. It wasn't going to eat him alive. But there's a reason why we describe the worried well, and the first word of that is worried. Some people tend to worry about health issues and false positives. That's fertile territory for worry and anxiety.
Roger: I like that phrase. I think of that even in financial retirement. They're well financially, but they're still worried all the time. I see that exactly all the time.
So, I think we gave a lot of perspective. to some of the dangers of over testing or testing, but there's still a lot of positives. At the end of the day, how might we go about this productively?
Dr. Bobby Dubois: Well, I don't want to be a complete nihilist. One of the topics we were going to explore, I might as well just pop into now, which is, are there any tests that I do like?
Absolutely. If following the general guidelines of the screening tests that U. S. Preventive Services Task Force, you need to get your colonoscopy. You need to get. lung cancer screening if you've been a smoker. You need to get your pap smear and mammogram. You should get your eyes checked and your glaucoma pressures in your eyes. I mean, there's some things that absolutely make sense.
I also love wearables, not just because I'm a walking laboratory, but I think because the wearables, like your heart rate monitor, or your sleep monitor, or your continuous glucose monitor, or a blood pressure monitor, by and large, for things like sleep and heart rate, there is no absolute. My heart rate's this, is that good or bad.
They're just ways of understanding. Oh, I had a lot of caffeine and my sleep monitor says that didn't look good. It's not this issue of positive or negative, it's something that's very, very actionable.
When I think about testing, I ask myself the following questions. I'm more cautious about doing screening tests. If somebody comes in with back pain, I apply the same kind of rationale. First, is there a reasonable likelihood that the test is going to show something? If it did show something, would I do something differently? If I'm going to recommend exercise and a good diet regardless, then the test really isn't going to change much of anything. If the test showed something and I did something unique, would it change the patient's outcome?
I try to keep that in mind with all of that and the beauty of some of the wearables, which are not screening tests per se, but they're highly actionable to what I do in my daily life.
Roger: I've been down this road and it's really connecting the dots.
Oh, I ate those chips at 10 p. m. and this is what my sleep looks like or I had alcohol. It's much more actionable. It's the basics, the blocking and tackling of how we live our life without going down the screening rabbit hole.
What's the big message you want everybody to take home?
Dr. Bobby Dubois: Well, the first is I may be a doctor. I may play one on TV, but I'm not your doctor.
Whatever decisions you make regarding screening and such, speak to your doctor and get some guidance. That's why the direct-to-consumer stuff, which cuts out the doctor, you know, has its challenges.
Outside of a small number of the highly recommended routine screening, there's both an upside to doing all of these tests, and hopefully now people understand that there's a downside as well.
I am not against testing. If you have symptoms by God, if you have something really going on, that's what we as doctors do, we do tests and we recommend treatments. So, I'm not against testing. It's the routine testing in somebody who doesn't have symptoms. that has an upside and now hopefully people have a greater appreciation of the potential downsides. Not that you should not do this.
Buyer beware and know that you may or you will likely have positive results that you'll have to figure out what to do with.
Roger: The whole intent here is for us to build our energy so we can rock retirement.
Dr. Bobby Dubois: And live long and well.
TODAY’S SMART SPRINT SEGMENT
Roger: On your marks, get set,
and we're off to set a little baby step you can take in the next seven days to not just rock retirement, but rock life.
Alright, for the next seven days, I want to suggest that you organize the medical tests that you've received from your doctor. Usually, we get them in an email or they're mailed to us. I have a portal I have to go into.
One thing that I've started doing is downloading each one and putting them in a file. I use a digital file just on my computer, but I think it's healthy to have all of the past medical tests so you can start to at least identify trends. and get more perspective when you get the next one. So, it's not just one.
I think having all that stuff organized can be very helpful for you on your medical journey, but also keep you organized. So, if you have to deal with something, you can provide a lot more information on the medical perspective in terms of past testing.
So that's your action item. If you choose to do it, get all those medical tests that you received from your doctor at least in one organized folder.
CONCLUSION
This month, we're going to be a little lighter on listener questions because we have so much going on with Mark and Mary, but we are committed to answering your questions to help you take baby steps. So, if you have a question for the show that you want to get answered, you can go to askroger.me and we'll log that.
When we get back to answering your questions, if not this month, next month, we'll start to go through those and really hammer out so we can help you take a baby step on rocking retirement.
Have a great day.
The opinions voiced in this podcast are for general information only and not intended to provide specific advice or recommendations for any individual. All performance references are historical and do not guarantee future results. All indices are unmanaged and cannot be invested in directly. Make sure you consult your legal, tax, or financial advisor before making any decisions.