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Keith: Dee-do, dee-do, dee-do.

Scot: Is that how an ambulance sounds?

Keith: Dee-do, dee-do, dee-do.

Troy: In England, it does.

Scot: And how do they sound here?

Keith: Wooo-wooo.

Troy: There you go. I'm not even going to try and do it. Now do the three raff ones. Woo-woo-woo.

Keith: Hi, I'm Keith Roper, and I'm a physical therapist, and I care about men's health.

Scot: Well, how about that, Dr. Madsen? We've got somebody else here that cares about men's health.

Troy: This is great. We're recruiting people to the team. I love it.

One Physical Therapist's Turning Point

Scot: Keith is a physical therapist, and we brought him on the show to talk about when you might want to make a physical therapist part of your healthcare team. We talk about some of our core six things that you can do at this point in your life to make sure that you have a healthy later life, activity, nutrition, stress, sleep, nagging health issues. That might be where Keith will be able to help us with, some of those aches and pains that are preventing you from enjoying life, sleeping, those sorts of things. And also, we talk about managing smoking and drinking too.

So, before we get to that, Keith, one of the things we'd love to do is find out stories about was there a time you realized that you needed to make a change in your health? Talking about one of those core six. Dr. Madsen and I, we've both had these things. For us, it was some test results that showed us that we needed to change our nutrition or activity. How about you?

Troy: Yes. Exactly. Kind of woke us up to some changes. But yeah, Keith?

 

Keith: Yeah, absolutely. I think one of the big moments for me was I was out of school, I'd gotten married, had a ÑÇÖÞ×ÔοÊÓƵ, and life was changing for me. I looked in the mirror one day and really just didn't recognize myself because I was putting on so much weight.

And I'd gone through the thing where you get a bigger pair of pants and a bigger pair of pants. And when I really started to look at it, I realized I'd gained nearly 50 pounds from my high school college weight. So, yeah, I wasn't really having any serious health problems at the time, although I had some nagging back issues and just simply didn't have the energy level that I used to. But it was really, for me, a wake-up call to say, "I don't recognize that person in the picture, and I need to make a change now before it becomes a more of a problem."

Troy: So it wasn't your wife pointing out to you, "Hey, Keith, we keep going up on sizes on these pants I'm buying for you." You saw, "Oh, I've got a little extra weight on here."

Keith: Yeah. It was just shocking to me really. It was a photo that I looked at and said, "Wow, I can't believe that's me."

Scot: That's a lot of weight. Is it genetically? I mean, are your parents bigger people?

Keith: No, they're not really. It's not an issue that runs in my family. And I think really one of the big things for me was I was a huge soda drinker. And it was a stressful time in my life and I was drinking a ton of soda. I don't think that was the whole issue, but I think that was a really big one.

I wasn't exercising regularly, which is one of our key factors that we're talking about in this show, and my nutrition wasn't as good as it could have been. So those were the two big things that I changed, was I started to exercise more and I virtually quit drinking soda, although it sneaks back into my life every once in a while.

Troy: That's amazing though. I am thoroughly convinced if anyone just cut soda out of their diet . . . I mean, it's amazing the amount of calories in it. And that's obviously something you saw, it sounds like.

Keith: Yeah, absolutely.

Troy: That was a big piece of it, just cutting that, and then focusing on diet from there.

Keith: Yeah. I had a lot of people asking me what I did, and that was my quick answer, was I stopped drinking soda.

Troy: Yeah. It's amazing. Yeah. I think if you cut soda, you'll drop the pounds, and that's what you saw.

Scot: I think that's awesome. I also find that very frustrating because I don't drink soda. And I'm trying to lose my excess body fat.

Troy: "Where will I go?"

Scot: So I don't have that.

Troy: "What's my excuse?"

Scot: Like I hear about these people, "Just cut soda. My wife lost 30 pounds in a month." What? It takes me forever to lose that kind of weight.

Troy: You already cut the soda, so what's left?

Scot: So what's left? Good story. Good story.

Troy: That's great.

Scot: Yeah. And you're looking great now.

Keith: Well, thank you.

 

Scot: All right. So one of the goals of this show is to help our listeners navigate the healthcare system in the most efficient, cost-effective way possible. And we thought maybe physical therapy might be a great way to do that, especially take care of some nagging issues.

I had one with my left wrist, where it would kind of click and pop anytime I rotated my wrist. So I went to an orthopedic surgeon who specialized in risk care, made the appointment. They did the imaging and he took a look at it. Everything was fine. Gave me an exam, and then said, "Well, I'm going to send you off to physical therapy." I learned that maybe I should have started with physical therapy.

What it ended up being was just, over time, I had somehow hurt my arm. I know exactly how I did it. I was making tomato cages out of heavy gauge wire with these pliers, and I was twisting them, right? And that went on for five or six years and that evolved into this wrist thing. And when they did the test, what they found out was I was making accommodations because it had hurt, I guess. So I had lost some muscle strength, which allowed normal functioning, which then affected the way it was going. Is that pretty common?

Keith: Absolutely. That's a great story. It's a really classic example of how there's not necessarily one thing that brings it on, but repetition over time, and then the accommodation that you make.

Scot: And I'm still exercising to strengthen those muscles and it gets better all the time. The clicking's gone away, and I'm getting stronger and stronger.

Keith: The strength is an issue definitely, but there are probably some other neurological factors as well. Our systems are incredibly complex, and pain is more than just a tissue issue. And so it's interesting to look at the whole neurophysiology of it and realize that there's more perhaps than just the repetition.

The Top 4 Things a PT Can Treat

Scot: So my story, I think, highlights what most people think of when they think of a physical therapist, I suppose. You've got some sort of an injury, and you would go to the physical therapist, and they would give you some exercises. Is that what you do, or are there other things that you could bring to the table for somebody?

Keith: Yeah, that's a pretty common perception. Physical therapists, you know them for whatever it is your experience has been. And for a lot of us, it's postsurgical or a referral of a physician. A lot of times, people think they need to have that diagnosis first so that then the doctor will tell us what to do, not understanding that physical therapists have extensive training and probably know better . . . certainly know better, do know better on the rehab side of it than the physician does. I'm not going to tell them how to do surgery, but I certainly know how to do the rehab side.

Scot: And diagnose.

Keith: And diagnose as well. And there's a gray area there in the physical therapy profession, where from a legal standpoint, we play with the definition of diagnose and whether or not that's practicing medicine. But from a functional standpoint, yeah, we do what we call a physical therapy assessment or physical therapy diagnosis. And we're going to deal with those functional issues.

Troy: I see a lot of patients in the emergency department where I'm thinking, "Wow, it would be great if I could get them to see a physical therapist." And if you had to put together just a list of maybe top five things, just for someone to say, "Come see a physical therapist. Don't feel like you need to go to the ER, like you need to even maybe go to an orthopedic surgeon, but these are great things that your first stop could be physical therapy."

Back and Neck Pain

Keith: Yeah. That's a great question. And so I think that, obviously, the big ones are back and neck pain. That's such a common thing that we see all the time in emergency, isn't it?

And so people have this idea that the worse the pain is, the worse the problem must be and so, "I better go to emergency." And we see it all the time that they come in with severe pain, but they haven't had an injury. There's not been a specific incident that they can really attribute it to. So back and neck pain would certainly be a huge one.

Overuse Injuries

The overuse injuries and generally that people describe tendinitis problems, "I'm having pain in my knee. I've been running," or hip pain, or elbow, shoulder issues, some of the stuff that Scott just referred to, those are typical things.

Vestibular Problems

Vestibular problems with dizziness/balance is one that people typically don't think of physical therapists as being specialists in, but . . .

Troy: And this is one that really surprised me, because we worked closely together in the emergency department. And that's such a frustrating thing. And it affects older people and it affects . . . I've seen it just be debilitating for younger people, where things get off with the vestibular, the balance system, and you just feel like the room is spinning. And, as you mentioned to me, you can do therapy specific to that.

Keith: Yes. And so that's one that really surprises people, and whether it's the classic "I woke up this morning, and the room's spinning, and I can't walk because I'm so sick," those are typically fairly simple to settle down. But then there are many other variations on vestibular balance issues that physical therapists are specialists in. So that's another big one.

General Physical Conditioning

Just conditioning issues in general, people that are having difficulty with activities of daily living, just functioning in their life because of pain, or because of weakness, or because of coordination issues. I'm trying to think if I've missed any big ones there, but I think those are several good ones.

Chiropractor vs PT - Which Is Right for You?

Troy: Makes sense. I always try to refer patients to physical therapy when they come in with back pain, neck pain, a lot of these things we've talked about. One very common question I get from people is well, "Why don't I just go see a chiropractor? What does a physical therapist offer to me that a chiropractor wouldn't?"

 

Keith: Yeah. And that's a great question, and it can be difficult to answer because there's so much variation in practice both within the chiropractic and the PT profession. One of the things that's been a frustration of mine for years is that we have a tendency to think of physical therapy as a commodity. It's like a thing. "I've tried physical therapy and it didn't work." And the thing that I always like to come back to the patient and say is, "Well, if you went to the doctor and you didn't get better, would you say, 'Well, I've tried doctoring and it didn't work'?"

Troy: Some people say that.

Keith: Some people say that. But we have a tendency to think that way with physical therapy, like it's a thing that's done and that we all do the same thing.

Troy: Yeah. And most people would go for a second opinion if they saw a doctor. They would say, "Well, I'm going to talk to a different doctor."

Keith: Absolutely. So I think the same thing can be said for chiropractic and physical therapy both, is that have you perhaps tried a different provider?

One of the things that I perceive as a big difference is it's really that traditional chiropractic is based around the notion of the subluxation, and there's something out of place, and you need to come to me, and I will fix you. And if it goes wrong again, come back to me and I'll do it again. And hopefully, physical therapy comes from a place of, "Let me give you some agency back. Let me give you some control back. Let me teach you how to take care of this yourself. Perhaps there are some interventions that we're going to do hands-on or face-to-face, but can I teach you things that you can do to prevent this? Can I teach you things to do to help take care of this?"

And to be fair, I want to be careful that I'm not saying that chiropractors don't do that, because there are a lot of chiropractors that are fantastic providers. And physical therapists, I hate to say, I'm not crazy about how they practice. And so it really depends on the person and the philosophy that they bring to the table.

Troy: And that's huge. I mean, I think across the healthcare profession so often we create dependence on the system. And I've seen that just with the opioid crisis, and people who their pain flares and their response is, "I need to go to the ER. I need to get IV pain medications. I need to get opioids." And like you said, if you can take an approach where it empowers the patient, I mean, that I think is huge in really getting people on the right track.

Keith: Yeah. It's interesting to me some of the data that I read on patients who come to emergency for back pain. About half of them, their symptoms are bad enough that they come to emergency, but they don't do any follow-up visits after that. And to me, that was a light bulb moment because coming from my education being painted as a structural thing, and that something's wrong, and needs to be fixed, I realized that surely if all those people had structural issues only, they didn't get better just with one pill, one shot, one visit to emergency, but a whole bunch of them that never sought any more care.

So there's obviously more going on to that pain experience than just a tissue problem once again. And they got something that helped them through that stressor that they were in at the time. So I think that that's been a really interesting piece of my realization or my perception.

Troy: No, it makes sense. Yeah. Well, honestly, yeah, we're often putting a Band-aid on the problem, not really addressing what's underneath, like you said, without that follow-up and addressing the underlying issue there.

Should You Do PT Before an Injury?

Scot: So we talked a lot about physical therapists helping when there is a problem. Are there merits to going to a physical therapist when there's not a problem?

 

Keith: That's a great question. And I think that you're seeing more and more therapists that are seeing that. Looking at the prevention side of things can be massive. One of the thresholds that I see that oftentimes brings people into therapy, it's an older person who gets to the point where one day they go to get out of a chair and they can't stand up. Obviously, that's a massive life changer for a person if you can't get out of a chair. And if a person realizes that that's coming and says, "I'm having a harder time doing things. Maybe I should start . . ." Sort of with my weight loss thing, I was like, "I recognize that this is going to become a problem down the road if I don't do something about it."

And when we see a person that . . . there are tests that we can do that we can say, "You're at high risk for fall. You're at high risk for not being able to walk safely." And by doing a screening . . . and a lot of physical therapists will do an annual screening for just general health conditions, "What's your strength, your flexibility, your balance like? Are there any issues of nagging musculoskeletal things?" that you mentioned a while ago. "Is there anything that you're feeling that you haven't really addressed?" And very often, by taking those things before they're a big problem, you can nip them in the bud and help keep them from turning into a bigger problem.

So, yes, and that's actually something that Medicare covers once a year. They will pay for, just from a financial standpoint, that you can do a wellness screening once a year. So that's a good thing to know.

Learn to Walk Before You Run a Marathon

Troy: And what about for the average 30-year-old male out there? We talk a lot about running. Maybe they want to get into running more and they don't have a whole lot of aches and pains. You usually get your aches and pains with running. Do you ever see people like this who you're able to offer something in terms of injury prevention?

 

Keith: Yeah. So there are probably a couple of questions in there. The typical 30-year-old might have a tendency to just go do it. I know you just told me a story about finishing a marathon a few days ago and . . .

Troy: To say I finished . . . yeah, I did finish.

Keith: You finished, yeah.

Troy: Yeah, I got through it.

Keith: But struggling through it. Say I wasn't a runner at all and I decided it was a goal of mine to run a marathon. I'm not going to go out and do it this weekend. I'm going to start a little bit at a time. And we have a tendency oftentimes, particularly as a young male, perhaps to do too much too fast, and kind of overestimate our ability.

And very often what we'll see is a person that comes into therapy with a nagging injury. "Oh, I've been trying to run and I keep having this problem with my hip, or my knee, or something like that." And so it can be as simple as giving some education on how to pace, on how to progress their way through a program, rather than just going for it.

The other side is that person that has a tendency to . . . they're getting just a little bit older. They're noticing that they have some of those nagging issues that they just think if they ignore it and keep going, it'll get better. But quite often they don't. And being able to address those things, again, like we were saying just a minute ago, before they turn into something bigger.

So, definitely, if a person's having nagging issues . . . upper back pain is a really classic one. A person that has a tech job, and you spend time at a computer, or you spend time in an office, really classic you see that upper back, middle of the shoulder blade pain. And that's what we see in emergency. It gets really bad and people come in for . . . A person that has had some sort of a throwing issue, and they go to play with their kids, and they can't throw because their shoulder hurts, or an ankle that continues to sprain.

There are lots of issues like that that you might not have thought you need healthcare for, but it's nagging you, and a physical therapist would be the perfect place to start for any of those issues.

Does Perfect Posture Exist? Probably Not.

Scot: I would think that they can give me some exercises and whatnot. I talk about battling this shoulder-forward lifestyle that I lead because I'm at a desk all the time. My shoulders are forward. My head's out. A lot of the exercises I just intuitively started doing on my own revolve around the back, trying to get that back strengthened again. And I'd imagine a physical therapist could maybe help with some of those suggestions.

Keith: Definitely.

Scot: And I was also a runner as well and started having nagging issues in my knee. Ended up it was in my hips. It was my gluteus minimus, and they gave me those exercises. Had I gone beforehand, they probably could've sensed there was a weakness there . . .

Keith: Very possibly.

Scot: . . . and maybe helped me from getting as bad as it was.

 

Keith: Yeah. Yeah, I think that that common sense approach to saying, "If I'm at a desk, if I'm over a microphone, if I'm at a computer quite a bit . . ." I'm not sure how much of your day is over a mic, but just simply being over a desk definitely, it just makes sense to say, "Can I interrupt that position if there's anything that I'm doing for a prolonged period of time?"

Some interesting research around whether or not perfect posture really exists and whether posture fixes back pain. And bottom line is the research suggests that it doesn't, which surprises an awful lot of people. It certainly surprises people to hear it coming from a physical therapist.

But what we find is that our bodies are meant to move on and our bodies are healthiest when we move. And I think really the issue is when we become sedentary and when we do any particular position for a long time that it really starts to be an issue. So your idea of just saying, "Well, if I stoop forward all day long, it makes sense to stretch backwards."

So is that really a matter of "Am I improving my posture, or am I just going to a different position than the one I'm usually in to get some variability into our movement pattern?"

Scot: We probably should wrap this up here. The notion of cost. Generally covered by insurance? I mean, we would encourage everybody to make that call.

Keith: Definitely. Physical therapy is virtually always covered by insurance. It's one of the things that's frustrating. We're still, by most insurance companies, considered to be a specialty referral, and so typically copays are higher than they are for certain other types of office visits. And depending on the type of issue you're having, physical therapy can sometimes involve several visits. And so you definitely want to talk to your insurance company, find out what your benefits are, but physical therapy is virtually always covered by insurance.

Scot: And then ask that provider to help give you some . . . I mean, generally, I think it's part and parcel with what physical therapists do, but give me some things I can do on my own time to help me speed through those.

Keith: Absolutely. Yeah. How can I most effectively do this on my own? Give me some prevention information.

Scot: Keith, thank you very much. Very informative.

Keith: My pleasure. Thanks for having me.

63% of E-Scooter Injuries Happen in Your First 9 Rides

Scot: Have you ridden a knee scooter yet, Troy?

Troy: Is this on air?

Scot: Yeah.

Troy: No, I haven't.

Scot: But if it wouldn't have been on air, would I have heard a different story? I mean, what's the difference?

Troy: I don't know if I can admit it, because I kind of run the E-Scooter Center for Research Excellence. I've never ridden one. That's our joke, is that we're the Center for E-Scooter Excellence here based on our research, but I haven't actually been on one.

Scot: I've been tempted, but I always hesitate because . . . I don't know why. I don't know if it's I'm afraid that I'll look dumb doing it, or if I'm just afraid of them, because I see other people riding them and they'd look like that can be scary.

Troy: See, my excuse is my iPhone is so old that if I download a new app, it will crash it. So I would have to download an app to be able to ride an e-scooter and I'm like, "It'll crash my phone." I refuse to buy a new phone. Like, when you look at the data on my phone, the "other" section is like 90%. I have no idea what that stuff is or how many viruses are on this phone.

Scot: But that's one way to avoid riding the scooters.

Troy: Yeah, that's my excuse. But I would like to ride one.

Scot: So the scooters are back out and around, and there's been a lot of research on how dangerous they are, because I think inherently we're all like, "Oh, that seems kind of dangerous." Right? This one was from the and they did a study, and I thought this was interesting. One out of three injured riders were hurt on their first trip. That's a pretty high number. And then about 63% had ridden nine times or fewer before their injury. So we're seeing these injuries happening pretty quickly, pretty soon in their scooter riding career, which I think makes a little bit of sense.

The other thing that this pointed out that was interesting were some of the causes. Some people are saying that road conditions, such as potholes and cracks, contributed to their injuries. That was 50%. More than a third said excessive scooter speed contributed to their crashes, and 19% said that they think their scooter malfunctioned, which there have been reports of that. So, anyway, people are getting hurt quickly on them and those are some of the reasons, which indicates a couple of things. What's your take on that as an ER doc?

Troy: Yeah. Looking at this, it doesn't surprise me. And we've done research looking at our scooter injuries, just published them, "The American Journal of Emergency Medicine." So we looked and we're, essentially over a six-month period, seeing about one injury a week in our emergency department. And it makes sense to me. The people I've talked to, they seem like they're not really prepared for how fast the scooters can go, up to 15 miles an hour.

Scot: Which is fast.

Troy: That's really fast.

Scot: You don't think of it as fast, but it's fast.

Troy: And what happens is the majority of injuries we're seeing are pretty serious. These are severe head injuries. They're severe orthopedic injuries, fractures, things that need to go to the operating room. And I think what happens is if you're not prepared for that speed . . . you think, "Okay, I'm on a scooter. It's got small wheels. I'm close to the ground. If something happens, I can jump off and I'll be fine." But you figure if you're moving 15 miles an hour, that's a four-minute mile. And, Scott, I know you're fast, but I don't think you can run a four-minute mile.

Scot: No.

Troy: And to jump off and continue to move at that speed, you have to be running a four-minute mile. You can't run that fast. You're going to fall over. You're going to try and catch yourself and break something.

And so, yeah, I mean, what stands out to me here is I think something others have talked about, we've talked about, that you really need to take that time when you get on the scooter to familiarize yourself, know how to go up and down curbs, and just don't go quite so fast on it.

Scot: Yeah. Be aware of potential road obstacles coming up because those can come up on you quickly.

Troy: Oh, yeah.

Scot: In this article that I was reading, which is from CNN Business, but I'm sure you could probably find it in a lot of different places, I guess there's another scooter company that they're making scooters now that have seats. It looks like a bicycle really, and bigger tires to help negotiate some of those road issues that you might face. But those little tiny wheels, 15 miles an hour, you hit a crack, that can be pretty substantial.

Troy: Yeah, you hit a crack, I mean, that's . . . we've seen cases where people have gone off curbs or are trying to get back on the curbs on a sidewalk. Like you said, hitting cracks, hitting potholes. People have run into trees, I think, probably trying to avoid things. So it's going to happen obviously. And like you said, based on this study, it's probably going to happen fairly early in your experience in riding a scooter.

Scot: I think if I do try one, I'm going to do it at about a quarter throttle at first until I get used to stuff.

Troy: Yeah. Take it slow.

Scot: Yeah. And especially if I'm in an area that I've never ridden before, go maybe a little extra slow. So I think . . .

Troy: Right. And wear a helmet too. That's the other thing too. That's, I think, the biggest thing with these scooters. You jump on it, you don't carry a helmet with you, and they don't have helmets.

Scot: And people that would normally wear a helmet when they ride a bike probably don't have one with them on the scooter.

Troy: Right. I mean, that's what stands out to me. It's not often you see people riding bikes without helmets. I think that culture is out there, but I do not know if I've ever seen someone wearing a helmet while they're on a scooter. I can't say I ever have. So something to consider.

Scot: Well, that's the data. Do what you will with it, but hopefully, you make a smart decision.

Troy: Exactly. Hopefully so.

Scot: Troy is a great guy, but you don't want to visit him in the ER

Troy: You don't. You really don't.

ER or Not: Hit in the Head with a Softball

Scot: ER or Not? Hit in the head with a softball. Of course, this is the segment of the show where you decide whether or not you would go to the ER or not for this. And you can check your work with Dr. Troy Madsen sitting right here who is an ER physician. So let's say I'm out playing the company softball game and I take a hit to the head by a softball. ER or Not?

Troy: So this is one where you've really got to look at your symptoms to decide do you need to go to the ER? And we've done study after study trying to determine, "Okay, when do you really need to be seen for a head injury?" Whether it's a softball, or a baseball, or you fall and hit your head, or whatever it is, the first big thing is did you get knocked out? So if you got knocked out, you've definitely had a concussion. That means your brain has been shaken up.

Scot: One hundred percent concussion.

Troy: You've had a concussion.

Scot: All right.

Troy: Yeah. If you're having any symptoms after getting hit in the head, like confusion, headaches, difficulty focusing, or anything like that, you've had a concussion. But the big thing for me in the ER is, are you bleeding in your brain? I mean, that's the number one reason to go to the ER and get a head CT if there are concerns for that.

So if you've gotten knocked out and then you're having symptoms like confusion, nausea, vomiting, really difficulty focusing, if you're trying to walk and you just cannot walk in a straight line, these are all symptoms of a more serious head injury and times you need to go to an ER and get a CT scan of your head.

Scot: Okay. Get hit in the head and don't get knocked out. What do I do then?

Troy: Good question. That's where it becomes really tough for me as a physician because we see these cases all the time. But again, if someone comes to the emergency department and they say, "Hey, I didn't get knocked out, but I just cannot focus. I am so confused," family members are with them, they're saying, "They're just not themselves. It's been six hours since the head injury," that's also a time to go to the ER.

Scot: Okay. So that confusion, even if you don't get knocked out, is a good time to go to the ER.

Troy: Exactly.

Scot: This sounds like a tough thing though because we don't want to necessarily tell anybody what to do with this segment, but say I get hit, I don't get knocked out, I'm not really experiencing any symptoms other than, "Wow, that hurt." Is that a reason to go to the ER generally? Does research show my chances of having something more serious at that point?

Troy: I think, if you're not having any serious symptoms, then the likelihood of something more serious developing is fairly low. But I would say . . .

Scot: It still could happen.

Troy: Still could happen. As a precaution, make sure you're with someone else, friend, family, at least for six hours after, someone who can keep an eye on you if your symptoms get worse. I mean, that's the big thing we worry about. These symptoms that just come on because you've got a rapid bleed that's developing that maybe at first you feel fine and then things changed dramatically, those are the really bad things. So make sure you're with someone who can get you to the ER if you need to.

Scot: Okay. And this sounds like a complicated thing to figure out, really.

Troy: It is. And it's tough for me as a physician. There are certain decision rules that had been established based on research that said, "Okay, if the person meets this, this, and this criteria, you get a head CT." But even then, like you said, these cases where people don't get knocked out . . . all these studies are on people who got knocked out, so, "Okay, someone didn't get knocked out, but they're having symptoms," these are decisions I have to make too and it really becomes tough. So if you're at all wondering, head injuries can be serious. Just go to the ER, and they can figure things out.

Scot: Not able to get that kind of care at urgent care?

Troy: You can't. If you go to an urgent care, they'll send you straight to the ER.

Just Going to Leave This Here

Scot: Just Going to Leave This Here. Wrapping up the show with just random thoughts, that's what Just Going to Leave This Here is about. It might have something to do with health. It might not.

Today, my Just Going to Leave This Here is do you ever watch kids play? I mean really watch kids play. I went out to the playground with my wife the other day, and we were just watching kids play. And there's this one little boy that just was running all over the place, and he was watching his feet as he did it. He was just running to watch his feet move, and he would be more likely to jump on and off something than he would be to step on and off of it. And he was just moving for the pure joy of moving and just experiencing what it felt like to do that with your body.

And as I sat there watching that, I thought, "Why don't we as adults continue to do that? At what point do we stop doing that?" Because what a great way to stay in shape, to maintain that muscular strength. So I don't know. I was wishing I could move around like he was, I guess.

Troy: That's cool. I like it.

Scot: One of the ways that I do though, actually I must admit, is anytime there's a curb on my walk and it's safe to do so, I will walk on the curb and pretend like there's a lake of fire on either side of me. And then I have to balance on the curb. I mean, that's kind of doing like a little kid. I've got believe there are some balance benefits there, right? Because at first, I couldn't do it.

Troy: Do you get some looks or . . .

Scot: I can't care. I'm sure I do.

Troy: That's good. That's the thing, kids don't care.

Scot: No, they don't.

Troy: Yeah. So I'm Just Going to Leave This Here, but since you're talking about joy and things that bring us joy, the joy I experienced, and this is going to sound bad, but the joy of peeing in the woods, of urinating in the wilderness.

Scot: Yeah. Tell me about it.

Troy: Well, I'm really at risk of embarrassing myself here.

Scot: No, you already have, so you're fine.

Troy: I already have.

Scot: You're already just charging . . .

Troy: This is all about being open and talking about just the little things in life that bring us joy. I heard a story about a trail runner, who is really an incredible runner. And a guy was running with him, and as he was running, he found it remarkable that this trail runner was able to pee without breaking stride.

Scot: Serious?

Troy: And I'm not joking. So he's talking to the guy and then he realizes the guy's actually urinating as he's running. And he's like, "This is so cool." I have not mastered this technique.

Scot: I thought you were just talking about finding a tree and going behind it, but you're talking about while you're moving.

Troy: I have not mastered this technique, I will say this, but I have developed technique to be able to urinate while running, but pausing for, say, 10 seconds. I know this sounds really weird, but again I think there's a certain amount of joy in being out in the woods and being out in the wilderness.

And I love running. I love just getting out in the backcountry and running and just being out there where there's nobody else. And I guess that's one of those things where it's like,"Hey, this is awesome. I'm just out here in nature, and I can just stop here and pee, and who cares?"

So, anyway, that's a very random thought. But that's my parting shot. I'm Just Going to Leave It Here.