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Troy: What's the name of our podcast again?

Scot: "Who Cares About Men's Health."

Troy: Who cares? That's easy to remember. It's called "Who Cares?"

Keith: It's one of those things . . . Scot and I've talked about a podcast that I want to do and I still don't have a name I'm happy with. I can't start if I don't have a name for it.

Troy: How can you brand it? Yeah.

Keith: Yeah. "My name is Keith, and welcome to the podcast without a name." Hi, I'm Keith Roper. I'm a physical therapist and I care about men's health.

Troy: That's great, Keith. I care about men's health, too. I'm Dr. Troy Madsen, and we're talking today about pain.

Scot: Can I introduce myself?

Troy: Who's this third guy in the room? Oh, it's Scot.

Scot: Yes. I'm Scot Singpiel. And I'm the Senior Producer for thescoperadio.com. Now you can talk about pain.

Troy: Thanks, Scot. So one of the things we deal a lot in the emergency department is seeing people in pain, and it's something that we've tried to correct the pain, but it's also been a source of frustration for me over the years because I see so often people coming back again and again and again. And then we have the opioid crisis, where essentially we're creating addicts with our approach to pain.

We have something really unique here at the University of Utah. And this is something that you started, Keith, where you came to me and several other people in the emergency department a few years ago and said, "Hey, what about a physical therapist in the emergency department? Not just there providing referrals, but actually doing hands-on physical therapy and talking to patients." This is something very unique. You've done it now for a couple years. What do you think about it? Why do we have someone there?

Scot: And this was all to deal with pain?

Troy: Yeah. This was to deal with all this stuff that frustrates me like crazy, where we're just throwing opioids at them and Keith says, "We can do something better."

Scot: I think that's fascinating that it's a physical therapist that you brought in to help deal with pain.

Keith: And how often do you see it happen where you've given a person one, two, three medications and they're still saying, "I still have pain. What are you going to do, doc?"

Scot: It's all the time.

Keith: And you're sending them out the door saying, "We're done," and they're still upset because they're still in pain.

Troy: Yeah. They're not happy. We're not happy.

Keith: They're not happy. Exactly.

Troy: Everyone's frustrated.

Scot: And you can help them.

Keith: Well, quite often.

Scot: Okay.

Keith: So it's been a really interesting and incredible learning experience for me to shift my practice into emergency and to learn how to be better at dealing with these people right up front.

You referred to the opioid crisis. And definitely we know the staggering numbers about how many people die every day, every year, from opioid overdoses. And anything we can do to get people out the door without starting them on a dangerous medication is huge.

And so physical therapy in the emergency department isn't a new idea. There are actually people that have been doing it for quite a few years. And so I don't want to take credit for coming up with the idea myself. But it's still a very unique practice. And to our knowledge, there are perhaps 60 emergency departments in the United States that have physical therapists present, embedded in the emergency department. And so I'm certainly not unique, but it's still a pretty new and growing practice.

Scot: And it really speaks to, I think, the faith and confidence in physical therapy being able to help people with pain.

Keith: Yeah. It's an area that physical therapists are uniquely trained in. Physical therapists coming out of school now have doctorate degrees in physical therapy, which is confusing sometimes because people misunderstand the "doctor of physical therapy." We're not physicians, but it's important to understand that there's a significant level of education there both on the anatomy structure, or the biomechanics as well, but around the neurophysiology of pain, because we know that pain is a very complex experience that's more than just around tissue.

And so physical therapists typically have quite an extensive education in the neurophysiological system. And there's so much overlap between emotion, physiology, immune system, and pain, and so it becomes a very complex interplay of the whole person's experience.

Troy: When I trained, our approach to pain was we called pain the fifth vital sign. So you've got your classic vital signs, your temperature, heart rate, and then there's pain. And the whole approach to pain was we asked, "What's your pain score?" The whole goal was to get that number down to zero. And that was our focus. Now, we've moved away from that, seeing in the effort to do that, we're probably causing more harm than good.

What do you tell people about pain? Do you focus on pain? Do you focus more on function? How do you tell people to approach their pain and where that pain should be?

Keith: That's a great question, and it's one that I suppose varies some from person to person. One of the things that I think is really important for a person to hear when I'm talking to them about pain is that as long as we've screened for the red flags, as long as we've ruled out the bad things, most of the time, pain is not an indication of serious tissue damage. And what we know is that it's safe to move.

And so a couple of the things that I really emphasize with people is that, "I know you're in pain, but you're okay." And that's a powerful statement for people because they're worried that, if they continue to move with pain, it may do further damage, that they may do harm to themselves.

And so that reassurance that, "This will pass. You will get better" . . . it's difficult for us to predict how long it takes sometimes, but we know that it's safe for you to move and we know that the best way to get through a pain experience is to stay moving.

So, classically, what people do . . . it's a common sense response. It makes sense that it hurts, don't do it, right? It's one of the oldest jokes in the book.

Troy: That's what we always say. If it hurts, don't do it. But you're saying if it hurts, keep doing it. Keep moving.

Keith: Exactly. And so, as long as we've made sure there's not something broken, something out of place, something that truly is damaged, and it's important to make sure we don't . . . we don't just say, "Keep moving," until we've made sure that that's the case. But reassuring a person that pain is not directly proportionate to tissue injury, and that you can have a lot of pain and it can still be safe to move, is such an incredibly important message for people to hear, I think.

Troy: This is a real shift. I mean, you're telling people pain is okay. We don't have to get the pain score to zero.

Keith: Absolutely. And it's really important to understand that . . . if you asked a person, "Wouldn't it be great if you never felt pain?" what would you say?

Troy: "Yeah."

Scot: "Sure. Why not?"

Keith: Your knee-jerk would be, "That'd be great. I'd never have any pain." But it's interesting. There is a rare small group of people that have a genetic issue where they actually are chronically insensitive to pain. And I don't know if you're familiar with this condition, Troy, but typically, they die by the time they're in their mid-20s. Because pain is protective.

Troy: It is.

Keith: If you step on a nail, you need to know about it, right? If you burn yourself, you need to know about it.

Troy: Yeah. I do work in a wound care clinic too.

Keith: Absolutely.

Troy: So many wounds we treat are because they can't feel pain.

Keith: They can't feel . . .

Troy: They're diabetics who lose that sensation in their feet and they get amputations.

Keith: Exactly. And so pain is protective, and it's really important to understand that it serves a purpose. But sometimes, pain can become out of proportion to the actual physical condition that's going on and you can end up with a nervous system that's overly sensitive.

I like to use the analogy or the metaphor of an alarm system. And we've all had it happen. It just happened to me last week walking into work. As I'm walking through the parking lot, all of a sudden, a car alarm started ringing just down the row from me. And I looked around and there was nobody in the car or anywhere near the car, but something triggered that alarm, and perhaps the alarm is a little too sensitive.

And we see that in our nervous system, where the alarm goes off at just the breeze blowing. The touch of a feather can be exquisitely painful to a person that has a chronic pain condition.

And so it's important to understand in those situations that there's not this linear relationship and that we need to make sure that we know how to start to move with the pain.

And that's one of the things that's, I think, a real specialty of physical therapy, is that we can figure out how to grade that activity and start to give a person education where they believe and feel that it's safe to move. But then also to have some guidance as to how to start moving again.

Physical therapy sometimes has a bad reputation of being, "They're the physical terrorists. They're the people that like to hurt people."

Scot: Really? I'm sorry. I've never heard that.

Keith: You've never heard that, right? People say,"I don't want to go to physical therapy because it hurts. I went and it made me worse." And so what happens is those were examples where the activity wasn't graded, perhaps, appropriately where they were . . . we know that if you push too hard, you can sensitize the nervous system even more. And so, there really has to be some skill in understanding when to push and when to back off, and that's where the guidance or the coaching of a good physical therapist can come into play.

And that's one of the things that I try to start in emergency. Of course, I'm not going to follow through. I don't want them to keep coming back to emergency, but I'll typically refer them out to another physical therapist.

Troy: So I'm going to be selfish here and get some free advice, because I have upper back pain.

Scot: Perfect. You absolutely should.

Troy: I want free advice.

Scot: Why else would we do this . . .

Troy: This is what we get out of this.

Scot: . . . if it couldn't benefit Dr. Madsen?

Troy: I know. It's all about free advice and . . .

Scot: It's all about me.

Troy: Yeah, exactly.

Scot: You don't have other doctor friends you can talk to.

Troy: I know, exactly. So I show up in the emergency department. Let's say I see you there because I've had this upper back pain. So mid-thoracic pain between my scapula. I work a lot . . .

Scot: For me, where's that now? Can you turn around and point?

Troy: That is between the wing bones. Take your wing bones, draw a line straight in between them, that's where my back hurts.

Keith: Classic spot for pain.

Troy: Classic spot. When I'm at work, I noticed I hunch over. Half of what I do is just sitting at a computer typing notes, and looking up lab results, and all this kind of stuff. I have dealt with this for 15 years. I mean ever since way back in my training.

Keith: Since you've been over computer.

Troy: Since I've been over a computer.

Scot: Let's fix it.

Troy: How are going to fix me? And how do you approach someone like this?

Keith: That's a great question, because there are three things that nerves like to be happy . . . three things that nerves need to be happy. They need blood, space, and movement. And so, when you're sitting over your computer, are you moving very much? Are you moving that mid-upper back area very much? You're really not.

Troy: No.

Keith: There's not a whole lot of space there. There's not a whole lot of blood flow. Those muscles aren't working very hard. And what happens is you can get pain from ischemia, which means a lack of blood flow. You can get pain just because they're sitting in one place and they start to get irritated.

Think about if you just sit on a chair for a long time, and you don't ever move. After a while, you start to get uncomfortable. Your butt starts to hurt and it says, "Move." You start to shift around in your chair, and that's a signal from our nervous system that we're losing blood supply, we need some movement, we need a little bit of space here, there's compression going on.

And so the same thing can happen in your upper back as you sit over a computer, is that there's not a whole lot of movement. There's not a whole lot of blood flow, and so you get this condition where the nerves start to protest and they start to be unhappy.

And so one of the things that can lead . . . so that's a short-term answer, is just change position. It's really typical that if you just get up and change position and move around a little bit, the achiness will go away.

Now, if you continue to have this practice of sitting over a computer for 10, 20 years, the nervous system becomes more and more sensitive, right? And so it takes less input to get the same response, less stimulus to get the same response.

And so what happens is that alarm system becomes more and more sensitive. And as soon as you sit down at the computer, your nervous system says, "Okay, here we go. He's at the computer again. I'm not going to wait for it to get bad. I'm going to start warning him now because I want him to change position."

Troy: It's funny. I've been sitting here, we've been talking for total here 20, 30 minutes, and I feel it.

Keith: You feel it, yeah.

Troy: It's the exact same thing. Like you said, it gets triggered.

Keith: Yeah. So blood, space, and movement. Our bodies like to move, and so much of our lifestyle is sedentary, and just the importance of changing position.

But one of the things that we worry about, and this is something that I classically see with persistent pain problems, is that we're worried that we don't know the cause of the pain. And so we're afraid to move.

And I have people all the time that tell me, "Yes, I have this pain and I'm afraid to move because I might do more damage. I need to know what it is before I know if it's safe to move." And what we find is that the pain doesn't go away until you start moving.

People have a tendency to say, "Well, I'm going to wait for the pain to go away, and then I'll move." But almost always it goes the other way around. You have to move more, and that makes the nervous system happier and our pain levels decrease.

Troy: So if I'm coming to you and you're seeing me in the emergency department for this, typically, obviously, we're talking through it, talking through the issues there, talking about movement. And then are there specific sorts of interventions, exercises, you're going to be teaching me as well, things that I can do at home, or things at work?

Keith: Definitely. Yeah. So that's a great question. One of the big things is, as I said a bit ago, I really want to reassure a person. I want to do a good exam, take a good history, and do a good exam to make sure there's not something going on.

Because there's this saying in emergency about watching out for the zebra, right? You want to make sure you don't miss that that one-off rare thing. But for most of us, it's a matter of changing what we do a little bit.

And so some general advice about moving more, but then some specific things around, "What are some exercises I can do? What are some little hacks, some little techniques that I can do when I have some pain that I can change things?"

If I saw you in emergency, I might do some hands-on stuff. I might not. It depends on what I thought the cause of your pain was and how bad of pain you were in that day.

I do less hands-on than I used to because I'm really passionate about the idea of teaching a person how to take care of themselves. And I've discovered that as soon as I do something, the credit goes to what I did rather than what a person did themselves. And so, I think that we need to be careful.

At the same time, touch is powerful. As a physician, you know that, how just the compassionate touch of a healthcare provider can be so soothing and can be so healing. And so, I think there's a balance there between those two.

But the big things for me are education and exercise, giving a person tools that they can use themselves, definitely.

Scot: So what exercises does Dr. Madsen need to do here?

Keith: Well, the . . .

Scot: Does he need to actually . . . so, nerves aren't happy because of blood or . . .

Keith: Blood, space, and movement.

Scot: Space and movement.

Troy: Like you said, I guarantee I'm not the only one out there listening that has this issue. I mean, it sounds like this is classic.

Keith: It's like classic presentation.

Troy: Anyone who's working at a computer has experienced this probably.

Keith: Absolutely.

Scot: So you would figure out what muscles are involved.

Keith: Yeah.

Scot: And then would you have him do some strength training or do some movement exercises just to get more blood flow back there?

Keith: Yeah. That's a great question. Because I think it's really a combination of a couple of things. We see that simply starting movement in general is valuable. And so a person can do exercises like pull-downs, or pushups, or flies, we call them, where you're waving your arms side to side, forwards, and backwards. In a gym, you can do exercises like rows, and curls, and shoulder presses, and things like that. Anything that works your shoulder muscle group is valuable, obviously, for improving strength and blood flow.

But then there's also flexibility or stretching exercises. And so, oftentimes, people think, "Well, I just need to stretch more." And stretching is certainly a piece of it. I think it's important to interrupt positions if we have prolonged positions, like Dr. Madsen talking about being over a computer. And Scot's standing up right now in the studio.

Troy: Taking you to heart.

Keith: Yeah, I've got to change position here.

Scot: I don't why you're not, but . . .

Troy: I know. As we've been doing this, I'm flexing back and getting some motion here.

Keith: I teach people to flex and roll their shoulders forwards and backwards to squeeze those shoulder blades. So it's sort of a . . .

Scot: You look like Fonzie. "Hey."

Troy: Yeah. I like that.

Keith: You stick your thumbs out and you . . . and so that gets some movement and some blood flow through your upper back, which is two of the three things that our system likes, that nerves like.

And then doing some strength training as well. And one of the classic questions that people get is, "What's the best one? What's the best stretch or what's the best exercise?" And there really isn't a best. The research that I read suggests that it's movement in general. And so, when a person asks me about what the best exercise is, I like to ask them, "What do you have available? And what do you like to do?"

Scot: And what are you going to do?

Keith: What do you like to do? Yeah. Do you like to swim? Do you like to bike? Do you like to go to the gym? Do you like to do yoga in your home or at a studio? And so there's not really strong evidence that any one of those exercises is better than another. But the magic is in movement, and we like to say in physical therapy that movement is medicine.

Troy: That's great. Because it goes against everything probably everyone's heard from their doctor. "If it hurts, don't do it. Just rest." And you're saying something very different.

Keith: Yeah. And that rest really sets up a negative cycle. We think, "If I rest and it gets better, then I'll start moving again." But then you go to try to do the motion and it hurts. And you say, "Well, I need to rest some more."

And so there are a couple of things that happen. We start to get weaker. We start to get some muscle inhibition because that alarm system says, "Every time I move, it hurts. So I'm going to try to figure out a way to move different." And so we develop these patterns of compensation. And then that leads to something else being unhappy.

And the more we try to move, the more it hurts, and so the less we do. And we really end up in this persistent pain cycle where it hurts, and you move less, and so it hurts more, so you move less. And it really doesn't get better until we start to move.

And medication doesn't typically help that. It might take the edge off to make it easier for you to move, but until you actually start moving, the pain issue is probably not going to settle down.

Troy: So this has been a great discussion. And just to put this in the big picture of what we've seen with your work at the University of Utah, we've actually looked at this and have done a study to say, "Okay, let's look at patients that you've seen. Let's look at the typical patient who comes in who doesn't see you just because it's after hours, you're not there at that time." We looked at things like, "Okay, how many X-rays am I ordering on patients? How many MRIs? CT scans? How often am I giving these patients opioids?" And then a big question I had is, "Okay, are the patients you see, is it just extending the visit?" That's a big deal in the emergency department just because we're so crowded.

We've found that patients you see have less imaging, less X-rays, fewer X-rays, fewer MRIs. We give them fewer opioids in the emergency department, and on top of that, their length of stay is less.

So I think personally, I've definitely seen the impact of physical therapy in patients I'm caring for who you see. And across the board, we're finding impacts in all those areas.

Keith: Yeah. And that's a really exciting piece of data to look at. All three of those are huge. We know that the more advanced imaging you have, the more likely you are to have a surgery with no improvement in outcome. So we really have to be careful that we treat the person not the picture.

Obviously, we know about the negative aspects of opioids. And so we really want to keep people off opioids. If physical therapy can reduce a person's pain, and reduce a person's fear and encourage them to get moving, again, that's just a massive win.

Troy: Yeah. Well, Keith, thanks for talking to us today. This has been great for me. Like I said, I'm taking advantage of the free advice here. I've got to get moving more, start working on that Fonzie move you were showing me.

Scot: I think you've given us some great things to think about. Really describing why exercise can help pain, I think, is powerful. I think you've given some people some tools to maybe go do some research on their own and find some exercise and movement to help what they're doing.

But in a way, you've given us the ingredients and not the recipe. And it sounds like there are a lot of things mixing up, so I would imagine you would encourage people to come that are suffering from pain and you could help give them that right mix.

Keith: Yeah, definitely. I like to think of myself as more of a coach rather than an expert. I guess a coach should be an expert, but it's not me telling you what you should do, but it's me helping you explore what works for you. And I think that maybe that's what you're getting at with that question.

Scot: And overcoming barriers that you might run into.

Keith: Absolutely. So looking at barriers is a huge one. It's so difficult for people to say, "I don't have time to exercise. I'm tied to my computer. How am I supposed to change that?" And so, having somebody sit down with you, look at your lifestyle, explore your job, explore your habits, and say, "What can we do to help you solve this problem that's unique to your situation?"

And I don't think there's a cookie-cutter approach that works for everybody. So that's where seeing a physical therapist can really give you a personalized approach to dealing with whatever your problem is.

ER or Not: I Almost Drowned

Scot: Today's "ER or Not?" That's where we're going to throw Dr. Troy Madsen a scenario. And you get to play along at home, figure out if it's a reason to go to the ER or not. Today's "ER or Not?" is you're out swimming, having some fun with some friends. Maybe it's somebody else actually. And you go underwater and you almost drown, but you didn't. ER or not?

Troy: See, Scot, I can tell you've given these a lot of thought because you're trying to make it really tough for me. Because this is a tough one.

Scot: Yeah.

Troy: There are those situations where maybe you go underwater and you gag a little bit and you're like, "Ah, I spit out some water," and you're okay, versus the whole movie scenario, where they pull someone out and they pound on their chest, and they blow in their mouth, and then they spit water out, and suddenly they're sitting up.

If someone's actually pounding on someone's chest, and blowing in their mouth, and then they recovered, they absolutely go to the ER. The tough ones are those situations where maybe you do go underwater a bit, and you maybe struggle a little bit, but you're coughing up some water, and you feel okay. Then it's really a judgment call.

The biggest concern after a near drowning is aspiration, where you breathe water into your lungs. You can get a lot of fluid in there. Usually, you're going to be fine. You're just going to cough that up. Sometimes you can get a pneumonia that will settle in there, but that's usually a process over a couple of days.

Certainly, if someone's pounding on someone's chest, there are other issues like broken ribs and potentially puncturing along all those things. So that's why I say go to the ER in that situation. But otherwise, it's a judgment call.

And it's worth pointing out that no one will ever fault you for going to the ER, especially in this scenario or in any scenario. That's what always amazed me when I first started working in the ER, is to see people coming in for stubbed toes, and for blisters they've had for five weeks, and for abdominal pain they've had for a year.

So, if you haven't had something serious happen, no one's going to question you and say, "Wow, why did you come to the ER for this?" You'll go in, they'll get a chest X-ray, make sure your lungs look good, and then you'll probably go home, maybe cough up some more water over the next day or so, but probably feel fine.

Scot: Better safe than sorry, though.

Troy: Yes, exactly.

Scot: Especially in a traumatic event such as this.

Troy: Exactly. I always say anything that involves the ABCs, airway, breathing, or circulation, no one will ever fault you for going to the ER to get checked out.

Just Going to Leave This Here

Scot: "Just Going to Leave This Here," a chance for us to just talk about whatever is on our mind. It might be health-related. It might not be health-related. Troy, "Just Going to Leave This Here," what do you got?

Troy: I'm just going to leave this here. In my job. sometimes, at various points in my career, I've struggled to have faith in humanity. And I know that sounds bad, but I see so many awful things. And I see a lot of people who come in after awful things happen to them. You know, shootings, violence, things like that. But I saw a study recently that I thought was really cool. Kind of restored my faith in humanity.

Scot: So it's not a person that restored your faith in humanity. It's a research study.

Troy: Okay, it was a study, but there are people who do that as well.

Scot: I'm not as optimistic as you are about this at this point, but let's hear it.

Troy: Well, this was a really interesting study. Essentially, they left a wallet in various countries, 40 countries across the world, and they said, "What do people do with a wallet they find?"

Scot: If it's my wallet, they just look in it and they throw it away because there's nothing in there.

Troy: That's true. Your wallet, they would just throw it away. But they found that most people return the wallet.

Scot: Really?

Troy: They had a place where they had to return it. There was some sort of information in the wallet, like, "If found, return to this destination," or this person, whatever it was.

And the really interesting thing about this was the more money that was in the wallet, the more likely they were to return it. This was the shocking thing that really shocked me.

And their conclusion was that it was really more of an altruism thing, and also the sense that people did not want to be perceived as being a thief or doing something bad.

So, when they were up around $100 in the wallet, people were even more likely to return it versus $15. But even at $15, most people return the wallet. It was an interesting study.

Like I said, sometimes in my job, I see some really bad things. And sometimes you see the worst side of people. But it was a cool study to see that most people, especially with a lot of money in the wallet, were more likely to return it.

Scot: I think, generally, I have faith in most humanity.

Troy: That's good.

Scot: Yeah. I think you're in an interesting situation, maybe even like law enforcement and whatnot, is you tend to see the worst of the worst. I tend not to see that. But the worst of the worst is a very small, tiny, little percentage.

Troy: It is. And that's what I have to remind myself. I'm not saying I don't have faith in humanity. I'm just saying that there may have been various points in my career, maybe in residency, where I was just overwhelmed with some of the lesser sides, lesser actions of humanity, that maybe my faith in humanity wasn't so strong. But it was cool to see this study.

Scot: Cool. I'm going to restore your faith in humanity too.

Troy: Oh, good. Okay.

Scot: Yeah. Here's a voicemail I got about how I made a difference. Are you ready?

Troy: How did you make a difference?

Voicemail: Hi, Scot. This is Brenda with ARUP Blood Services. I am calling to inform you that your blood donation was used over the weekend to help one of our sickle cell patients over at Primary Children's. And we just wanted to call and say thank you for helping out again. Hope you have a great day. Thank you.

Scot: So people are returning wallets and I'm saving lives. What are you doing?

Troy: I know. This is your baby-saving blood.

Scot: It is.

Troy: This is your supper power we've talked about before. And that is really cool. But it's really cool that someone called from ARUP to tell you that.

Scot: And to tell me exactly it was for a sickle cell patient.

Troy: I mean, I've given blood. I have no idea where it was used or if it was used. But to get that kind of feedback is a really nice thing. I'm glad they're doing that.

Scot: It's pretty neat. Are you still donating blood?

Troy: It's been a few years. Like I said before, I say, "I donate my blood, sweat, and tears to this profession." But that's not a good justification.

Scot: Because I'm feeling pretty good about this, I want to share this feeling with you.

Troy: I know.

Scot: I think you should go donate some blood.

Troy: I don't feel good now. I just feel guilty. So I should probably go donate some blood.

Scot: That's going to be my cause . . .

Troy: I like it.

Scot: . . . is getting people to donate blood.

Troy: That's cool.

Scot: All right. Well, that's going to do it for this episode. But it is time for us now to say the things at the end of the podcast that people say at the end of podcasts. So go ahead, Troy.

Troy: See, now you're giving me your job. I don't know how to do this stuff. Usually, when I'm done with an interaction with another human being, I give them their discharge instructions, prescriptions, and say, "Call your doctor. Go see your primary care physician."

Scot: I'll do it this time.

Troy: Okay. And I will learn. I will actually pay attention.

Scot: I know you will. So kinds of things that people say the end of podcast is if you enjoyed what you heard, please give us an honest rating and a review if you like. It helps other people that will enjoy this content as much as you did enjoy it as well.

If you have something that you want to talk to us about, you can email us at hello@thescoperadio.com.

Mitch, our producer, is that it? Is there anything else people say at the end of podcasts?

Mitch: Tell them to subscribe if you like it.

Scot: Subscribe if you like it.

Troy: Subscribe if you like it.

Scot: Yeah, you're practicing.

Troy: I can practice. Hello@thescoperadio.com.

Scot: Thank you for listening to "Who Cares About Men's Health," and thank you for caring about men's health.