71. Dr. Michael Collins - The Truth about Concussions and Recovery with the Clinical & Exec. Director of UPMC's Sports Medicine Concussion Program
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The Truth about Concussions
Dr. Michael Collins, the Director of UPMC’s Sports Medicine Concussion Program. Dr. Collins breaks down what is a concussion, and explains the 6 different types of a concussion. Then, dissects the ideology of a Process vs protocol, an individual-based therapeutic approach vs. the one size fits all approach. Finally, Dr. Collins expresses that this is a treatable injury and should be evaluated like any other body part. With that, we are excited to introduce Dr. Michael Collins to the show.
Concussion info:
List of Dr. Collins’ Concussion Research: https://bit.ly/3KYaWJJ
Concussion Website: https://bit.ly/37xZRAy
Dr. Michael Collins: https://upmc.me/3xI0m65
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Ken Gunter 00:01
What's up everybody, and welcome back to another episode of the professional athlete podcast. We are joined this week by Dr. Michael Collins. So Dr. Collins is a clinical neuro psychologist, and he is the clinical and executive director of the UPMC sports medicine concussion program. He and his team have been instrumental in the development of numerous concussion management programs for youth, collegiate and professional sports leagues and teams. And he's actually currently a consultant for the Pittsburgh Steelers, and Pittsburgh Penguins as well. So, you know, if I'm being honest, the very topic of concussions in sport can be a bit of a hot button issue. You know, and to that, and honestly, I'd be lying if I hadn't personally thought about, you know, what is the impact? Some of the concussions that I've sustained, you know, in football over the years had on my own well being past current or future? You know, it's concerning. And so I think that's the point is that there is and maybe even to a greater extent was so much we just didn't and don't understand about the impact concussions have on the brain. So what I really enjoyed about this conversation is to get to hear from one of the foremost experts in the field, a straightforward account of where we are today. And, you know, so by no means required, but he also happens to be on the front lines working directly with everyone and anyone from professional athletes to the general public to help recover from these head traumas and injuries. So he does a great job today, he explains what a concussion actually is dispel some of the common myths. And he talks about how and this is what I thought was maybe among the most interesting things, is that really, a concussion can be rehabbed, similar to any other physical injury. So this one was jam packed with aha moments in new realizations, and I trust, you're gonna get a lot out of this one. So to that end, if you're enjoying the show, please do leave us a rating and a review. And make sure to follow us on whichever platform you're listening to. It goes a long way, and we certainly appreciate it. And it would not be right if I didn't wrap up this intro with a big thank you to Frank Spino, who made this introduction possible. So thank you again, Frank, one of my favorite conversations we've had. And without further ado, let's welcome Dr. Collins to the show. All right, here we go. Alright, well, Dr. Collins, welcome to the show.
Dr Michael Collins 02:46
Thank you. Glad to be Yeah, yeah.
Ken Gunter 02:48
Excited. We were just catching up. You're actually somewhat in my backyard out in Pittsburgh. So
Dr Michael Collins 02:55
I was away four hours away, something like that.
Ken Gunter 02:57
You know what people don't appreciate how big of a state Pennsylvania actually is. Yeah, yeah, it is. It is no joke getting from east to west when
Dr Michael Collins 03:03
you drive on the highway or interstate? It's like it says Williams port for like 80 miles. Is that have you noticed that?
Ken Gunter 03:10
I have noticed that I have noticed that? Well, I'm really excited about having this conversation, we were introduced by a mutual friend, Frank Spino. Thank you, Frank. And, yeah, I'm so fascinated by the work that your team is doing. And as a former college football player, I'd be lying if I said this wasn't something that was top of mind. You know, what sort of impact and lasting impact that concussions have on people who've sustained them. But maybe a great place to start, you know, I get the sense in some of this is just based on, you know, my own experience. But in talking to other people. It seems like there's a lot of existing either misconceptions or misunderstandings as to what a concussion actually is. Can we just open it up by you kind of defining like what a concussion actually is?
Dr Michael Collins 03:58
Yeah, the word concussion or concussive, this literally translates from Latin to English to mean to shake violently. And think about your brain is like an egg yolk inside an eggshell in the brain is encased in the cerebral spinal fluid. And if there's enough biomechanical force, either linear or rotational force, the brain is going to shift inside the skull, no matter how good your helmet is, the brain moves inside the skull. And if the brain moves violently enough, everyone on this podcast hopefully know what a neuron is. So we have billions and billions of neurons in our brain. There's more neurons in our brain than there are stars in the sky, literally. And what causes concussion is when the brain moves in the skull, the membrane to the neuron will stretch. And this little chemical called potassium, which is supposed to be inside the cell or neuron will get leaked out of the extracellular space. And when potassium goes outside of the cell, there's an increased demand for glucose or energy. It's called hyper glycolysis. So the cells demanding more energy At the same time, this little chemical called calcium, which is supposed to be outside, the cell, will link across that stretch membrane and go into the cell. And when calcium goes in, we get constriction or our blood vessels vasoconstriction. And the very time we need more energy, we actually get reduced cerebral blood flow and less supply of it, because blood supplies energy to the brain. And at the end of the day, all concussion is is energy crisis that causes the cells to not work as efficiently as they should. And what we've now learned is that there's different systems in the brain that can D compensate from that energy problem. And we've actually learned now that there's different types of concussions, it's actually six different types.
Ken Gunter 05:39
Oh, interesting. Yeah. Can we carry? Well, and, you know, I've heard read and heard a little bit that like plaque buildup, can be one of the contributing factors to long term effects. Is that accurate? I noticed that we don't know
Dr Michael Collins 05:54
yet. There's a lot of myths. What you're going to hear from me today is I feel concussion is a highly treatable injury, I really believe that if you come to come to our clinic, or if you go to a specialty clinic, there are treatments that can be applied that treat these problems, and you don't have to live with the symptoms and difficulties. And really, the best way to prevent problems with concussion is to manage it effectively when you have one. Yeah. And to make sure that the injury is resolved before one goes back to playing it again. And and that's easier said than done, because awareness. And but the reality is, is this, this is a treatable injury, and a lot of people aren't aware of that. That's one of those misconceptions that you brought up earlier. Yeah, everyone. I mean, I think there's a lot of sort of confusion out there about this injury. And hopefully, I can set the record straight on some of these things today.
Ken Gunter 06:45
No, that'd be great. And maybe I cut you off a little bit there. But this might be a great dovetail into those, you know, better defining the six types of concussions. Yeah, so
Dr Michael Collins 06:54
literally are six different types of problems that we see after concussion and six different types of concussion, if you think about these, all these six things is six interlocking circles. So you can have one of these problems, you can have all six of them. But the six different types. The first type is cognitive or think, you know, cognitive means thinking, we can see thinking changes memory, attention, concentration, you know, and the actual type that we call that concussion is cognitive fatigue. So not only do we see cognition issues, but a lot of fatigue by the end of the day. The second type of concussion is a problem to a system called the vestibular system. That's the part of the brain that allows us It begins in the inner ear. And then there's all these pathways in the deep part of the brain. And that system allows us to stabilize our vision, we move our head, it allows us to interpret motion. It allows us to be in a grocery store, car ride, shopping center, party, dynamic exercise, anything that involves a lot of sensory integration, lights, noises, movement, people, or movement around you or you are moving around something that system because concussions and energy problem that system can D compensate. And when it does, the athlete will feel like this weird, slow, wavy, Dizzy, foggy kind of one step behind, detach, remove disassociated, busy environments will bother them. It's never lights, noises, movements, that kind of stuff. That's an important one. And I'll get back to that it's one of the more common ones that we see. The third type of concussion is ocular. So which means eyes, so your eyes have to work together as a team. It's a very complex neurological system. In fact, 60% 60 to 70% of the cells in our brain are devoted to eye movement. Interesting. And so that system is the most complex neurological system that we have. So it would make sense that an energy problem in the brain would affect that system. Yeah, and that would involve people having a hard time having their eyes move together, follow at Target, converge, diverge, accommodate, there's a lot of different ocular motor functions that can be compromised as results of this energy crisis that we see. Yeah, the fourth type of concussion is migraine, which by definition is headache with nausea and or light or noise sensitivity. Typically, migraine headaches occur more commonly in the morning. And headaches associated with the similar problems occur more commonly in the afternoon. There's a lot of little crumbs that if you understand this injury like I do, you can follow these crumbs to figure out what's going on and get the right treatment for the right problem but migraine is you know, that's the one probably people are most common with. The fifth problem that we see is neck issues cervicogenic you know, neck problems that we can see from head trauma, okay, and the sixth subtype is mood issues, anxiety, a lot of anxiety, difficulty turning thoughts off rumination hyper analytical, panic, sadness helplessness, yeah, depression stuff. And think of these all as six interlocking circles. So there's a lot of sort of biology between these circles, for example, the same pathways in the brain that subserve the vestibular system, so serve as our sympathetic nervous system. So people that have a similar problem, will get anxious, their thoughts go faster, their heart rate increases, they feel this sort of arousal, that's unpleasant to feel. People that have anxiety are more likely to have migraine. People that have ocular motor issues are going to have cognitive issues. People have anxiety have cognitive issues, people have anxiety have neck issues. So you can see how this might start with one of these circles. And if it's mistreated, it can spread to the other six circles pretty quickly.
Ken Gunter 10:49
Well, and what's interesting is, you know, I came up we talked about this when we started I played college football. And you know, I can identify clearly at least two to three significant concussions, one of which I sustained in college. And as you're kind of walking through this list of those six interlocking rings I'm I kind of had a little bit of that a little walk
Dr Michael Collins 11:09
me through Canada, like let's go through and what did you experience when you got hit? Do you remember what you felt?
Ken Gunter 11:16
I do. So you know, the it's funny because you've mentioned a couple things now that are making a lot of bells go off but we were doing like the Oklahoma drill. So I was going up against our middle linebacker I was running back at it like a head on head collision and just felt really kind of woozy and off right enough to where it was like I got pulled out of the drill. I can find
Dr Michael Collins 11:38
out a little better you tell me if I'm yeah. So when you say that it makes me you feel one step behind detached disassociated, sort of disoriented for sure. That foggy that's modern comes to mind we call foggy. And that is the vestibular system D compensating for the energy problem. So when that system isn't working efficiently, it will literally feel like you're one step behind detach and sort of just so it's like taking a lot of NyQuil and waking up the next morning, you just feel that haze that foggy feeling. And that is literally at that moment is when your vestibular system D compensated and didn't work as efficiently.
Ken Gunter 12:19
Yeah, well, and, you know, take that a bit further, and I can't remember how long I got pulled out for. And I definitely want, you know, I mean, we a lot has changed since I played. But what what really kind of did me and as I think less than a week later, I was back on the field. And I kind of got horse collared from behind, and I got my head driven into the turf. And that experience was different. Like, I don't remember anything for the next minute, couple minutes. And
Dr Michael Collins 12:47
that's the cognitive stuff that's going on there.
Ken Gunter 12:51
Yeah, and the symptoms that kind of came out of that was one, you know, I watched myself back on tape. And luckily someone pulled me out because I clearly had no idea what's going on. But then, you know, that man days, maybe a week, you know, I couldn't read a book and get through a sentence without having to go back to where I
Dr Michael Collins 13:09
was, that's very likely oculomotor. So that was very likely your eyes were not normal. Because it was engaged when you were trying to read. Typically, that's associated with like a frontal headache, you get really tired, you can't go because math is harder. Science is harder. Yeah, classes that have a lot of visual spatial kind of functions are more difficult.
Ken Gunter 13:32
Yeah. So, you know, it's making me kind of like think through all the various symptoms. And maybe it's because you mentioned this, too, it's like, hey, how quickly can we identify and start treatment makes a big difference, the fact that maybe I definitely returned too quickly. And you know, that initial impact. And
Dr Michael Collins 13:49
the good news is, is that you didn't have the same symptoms. The second one is you did the first one. And so that would not indicate to me necessarily, I'd have to evaluate you. Sure. But, you know, normally, you can get in trouble with this pretty quickly. If you're not recovered and get hit again, and then you go down that pathway further. Now, the good news is there's treatments for this, like, I can treat everything you just said that we actually have treatments for it. And that's another misconception that people aren't aware that there's actual therapies for these problems, which there are, yeah, can
Ken Gunter 14:29
we dive into that a little bit? Because I think, again, you know, I mean, to give you more context, so I was playing from like, 2006 to 2010. You know, so when this happened, it was over 10 years ago. And at that time, I think the treatment was, you know, rest, you know, no contact, which I mean, that clearly makes sense. But I would love to kind of hear you know, just like based on those initial explanations of what I was experiencing, like, what are the sorts of treatments now that people who experienced concussion could potentially
Dr Michael Collins 14:58
use so we actually So you have tests that we would run on you. So that first injury you had. Now I actually have a physical exam that I would conduct on you to see if there's a suit, I listened to your symptoms, get an idea of what's going on. And I actually have a physical exam I could conduct on you to to elicit if there were problems coming from the vestibular system, okay, we identify, once we identify what those problems are, you know, the first thing is, is when in doubt, sit them out, you know, you don't put those patients back to play, make sure they're seen by a specialist that has the right tools to look at this, we actually can quantify this and measure it, we can look at it and see it. Now. So with that being said, the treatment for a vestibular problem is actually rest is the worst thing you can do. Interesting, because the way we treat that problem is by training it. Okay. But because the vestibular system is linked in with the nervous system, it will make you feel anxious when I do rehab with you. And a lot of patients will start to avoid activities that produce symptoms, like a grocery store, for example, is a great example of an environment that's very difficult for someone with a vestibular problem, a party, a restaurant exercise movement, they will get dizzy, they will feel foggy, they will get headache when they do those things,
Ken Gunter 16:12
just a bit of like sensory overload sights, sounds, a lot of racks.
Dr Michael Collins 16:16
But the way you get better from that problem is by training it. So actually going into a grocery store is the right thing. But your nervous system is telling you not to do that. And patients that don't get the right treatment and get told the rest, they start limiting those activities. And then they lose outlets to get rid of stress and the stress will build up and up and up and up and up. And then that is migraine. So interesting. We treat migraine with activity and exercise and, and so you can get in trouble with this injury lickety split if you don't get in the right pathway for treatment. Yeah, we just published a study in JAMA, where we looked at all the factors that predict outcomes from concussion. And believe it or not, the biggest risk factors for having a longer outcome from concussion is history of car sickness, history or lazy eye history of anxiety, history of migraine being female, these are all risk factors that have a longer outcome. But the risk factor, we found that best predicted poor outcome was if it took longer to get into our clinic, if you can get into our clinic into our clinic within a week, your outcomes are like a quarter of the time it would take to recover if you don't come into treatment.
Ken Gunter 17:26
I read that and why is that? Is that just because patients
Dr Michael Collins 17:29
in the right treatment? Yeah. And you got to make sure that you assess this injury properly, so you know what's going on, and to get them to the right treatment. So every one of those circles has different treatments for it. And this is not about protocol. It's about process. And when I hear the concussion protocol, it sent shivers up my spine, because it's not about protocol, every case we see is different, and every case has to be managed differently. And because of what you hear on TV about the protocol, everyone wants to stick to this one size fits all approach. Right? It's not effective, and it needs to be individualized. Hmm.
Ken Gunter 18:08
Yeah, I think you know, even for me, I guess I never thought about it in terms of an injury the same way you might treat, you know, more traditional, like physiological injury, right? Like pull your hamstring like, hey, there's, there's treatments and things that you can do to improve it. I felt like my experience was much more like, hey, we just kind of kind of wait this thing out. No, and we'll continue to test you consistently to see when you get back to a, you know, a baseline cognitive load
Dr Michael Collins 18:34
actually really liked the analogy of this being now, this is gonna rub some people the wrong way. And yeah, but it's true. It's like I look at this as it is an orthopedic injury, like, we've gotten to a point now with our treatments, like, with a knee injury, this is a type of knee injury you have, this is the rehab, we have to do to correct that problem. This is how long you're gonna take to be able to play. And when you recover, you're gonna be safe to go back to play. Right. That's exactly what we do with concussion. Now. Wow, this is concussion, this is the type of concussion. This is the act of and targeted approach, we're going to take it treating it this is your rehab program. And this is how long you're likely to be able to play. We can we can treat the injury in that fashion. And if you treat it effectively, we can mitigate the long term problems from it. Yeah. And it's critical that patients and parents and athletes are aware that these, you know, these advances have occurred, which they have.
Ken Gunter 19:32
Yeah. Well, and maybe just to take this one step further, you know, is it the sort of thing where you have a window of time where that treatment can be effective? Because I imagine there's a lot of people, you know, like me, played 1015 20 years ago or were in the military or gotten a car wreck or you know, any other reason that someone might sustained a concussion? Is there still an opportunity to do some of this rehabilitation or has that window kind of closed?
Dr Michael Collins 19:59
Is No, it's not closed. We see patients I just, I just had a busy clinic this morning and I saw an NFL guy that was injured about 18 months ago kept playing through it. And we're able to identify his problem today, and we'll be able to treat it and he'll be normal when we're done with him. And he'll, he'll be okay. It's not uncommon to see patients that have problems months out even years out, where we can identify where that's coming from, and actually get them better. This really is treatable. There's, there's always reasons for people feeling the things you're feeling. And it's our job as clinicians to identify where the aberrant signals coming from, and then apply the right treatment to correct that problem. The great, great majority of the time, we can do that. Now. Can I tell you, we can treat everyone fully 100%? I'm not going to say that. Sure. But I feel that way. Every time I see a patient, there's never a patient, I don't feel I can treat fully. I'm sure this case is where it's happened. Yeah, but we'll do everything possible to get them better. Yeah,
Ken Gunter 21:05
no, I think that's encouraging. And you mentioned to write a lot of the conceptions, you know, that that people are aware of with regards to concussions oftentimes make their way to the general public by the NFL. Right. So concussion protocol? You know, I think the other topic of interest over the last 10 years plus has been this idea of of CTE, you know, is that something that you would say, falls within that same realm of, hey, this is an injury that can be treated? Or is that kind of a completely different animal? And it's worth? I think, a lot of that, too.
Dr Michael Collins 21:40
I think a lot of people are confused by this construct. And yeah, I'll be honest with you, as someone who does this every day in my life, and as I'm devoting this entire career to studying this problem, it's confusing to me too, because the science isn't clear on it. We don't know if concussion in and of itself is what's causing that tauopathy And the protein buildup and things that are being seen. We don't know if it's concussion plus X, Y, or Z, or we don't know if it's XY and Z and not concussion. Yeah. And so the science hasn't evolved to the point where we really can fully determine cause and effect relationship to this. And I'll be honest with you, it doesn't match my experience is because the great majority of people that leave our clinic are people that get better. And we get them back to play safely. And they look and feel great, and they're not reporting problems after we get them back to play. So it's a little bit of an enigma, because I think that we need better diagnostic clarification for this construct. We need more science. Fortunately, that science is being done currently. Yeah. And the story is the scientific story is not written on this construct yet. You know, we have the one of the largest studies ever done. Looking at a bunch of former NFL players and controls and seeing what the potential long term effects are on behavior on neurological health there are from playing football. That study is ongoing. I don't have data to report on that yet. We're collecting it now. But it's the most rigorously, most rigorous methodological methodologically controlled study that's been done in the space. And we're going to have answers very soon in terms of what the potential underscore the word potential effects of playing football are on neurological health. Now, that study hasn't been done. And so we're left as clinicians to not have answers for our patients. Again, that same guy talk to you about this morning that I saw, I was like, Well, if I play one way, or football, what's my relative risk of injury, increasing my odds of having neurological problems? And I'm like, I can't answer that for you. And that makes people uncomfortable. But this reality right now, there's no one in the world that can answer that question. Yeah. What I feel is that the thing that the measure that the tools that we've developed to measure this injury are highly effective, we can see if there's problems with patients. And fortunately, we found that we can treat those problems a great majority of time. And so what I'm hearing in the media doesn't correlate with my experiences with this injury, because we see people get better from it. Yeah, and you don't want to be cavalier and put some of that to play if there's risks there. We just needed better science to better understand these issues, and that science is not currently available.
Ken Gunter 24:30
Got it? Yeah, I mean, you know, as someone who played football this is this is clearly something I think about and then I have three young kids too, which are boys once for once too. So I feel like I have hopefully some time for the science to catch up and there to be more clarity, you know, but I would be lying if I said like, wow, um, um, you know, now knowing what I know now I'm a little, you know, concerned as to whether or not it's in their best interest to let them play football and again for me, right, a sport that I love dearly and probably created a lot of opportunities for me that I wouldn't have had otherwise. Right. So, you know, what would you say to parents out there not that you need to be the one that convinced them whether or not to play football? But like, what are the sorts of things they should take into consideration when when making that decision? Like, are there resources you can point them to?
Dr Michael Collins 25:19
Yeah. You know, I actually have parents that will come come here for me to evaluate their children to see if there's, we know the certain risk factors for having longer outcomes from concussion. We know, you know, long story short to answer your question. I'm a dad of four daughters. If I had a son, I'd let my son play football. Yeah, without question. I think it's a great. There's so many benefits of sport for children. In terms of physical activity, and teamwork, and all the things that you learn in football, and applied to life, that opportunity exists for, for kids that play the sport. And like I said, we see football players every day here in our clinic, and there's very few that walk out of here sick are not normal and not doing well. I do feel it's a treatable injury. And until proven otherwise, I don't think those patients are going to go on to have problems from from playing, because we know it can be treated. Yeah. And so my advice would be Yeah, I think football is a great opportunity. But make sure if there's symptoms of concussion being be knowledgeable about that, be aware of it, you don't want to play through this stuff. And make sure these kids get to a specialty clinic, like UPMC here, where we can evaluate and treat the injury properly. Because the best way to prevent problems with with concussion is is to manage it effectively when you have one. And it can be fairly tacit, and you know, and a lot of kids don't even know that they are can cost. It's very subtle. Some of these symptoms, it can happen. Right? Um, but yeah, my advice is, let's, I think sports are wonderful. I do have four daughters that play sports, and three out of four of them have had concussions and and we treated them and they're doing great.
Ken Gunter 27:05
Well, that's what I was gonna ask you next, you know, I know football, rightly or wrongly is often the poster child for concussions. But within like the realm of your practice, and at UPMC, you know, I mean, is it truly it's like a the majority of concussions that walk in the door from football are concussions being sustained across a wide diverse array of just sports and just general you know, everyday life
Dr Michael Collins 27:28
60% of my patients are female, females are more at risk to sustain a concussion have a worse outcome from it. Interesting, there's migraine is a big risk factor for concussion, and females are six times more likely to migraine than boys, that's likely the very reason why that happens. There's hormonal issues that we've shown to occur, that pose some risk for females, neck strength, their necks are not as strong as males. So car sickness is more likely to occur in females and males. These are all risk factors. So that's why patient girls are more likely to have concussions. But I mean, yes, we see a large number of football players here, you can expect and according to our research, about one out of every 10 football players will have some symptoms of concussion during the course of a season. 10% And you know, female hockey is maybe the highest risk sport there is. Walker, if you compare females to males and soccer and hockey, it's the same, you know, same sport, essentially. And you can compare, you know, it's apples to apples comparison, females are much more likely to have concussion than males. So, yeah, football, I mean, any sport was is forcing, you know, force equals mass times acceleration. So, you know, this can happen in a number of ways. For my girls, their basketball players, it was back in the head off the court, you know, for a loose ball. Every time. In soccer, one of my girls got in soccer, you know, he got blasted from 10 yards or whatever, but this stuff happens. And it happens across it's not only sports, either. It's slip and falls are very common. Right? Older folks. Car accidents, obviously, this can get domed in a number of ways and we see it unfortunately, a lot of people with a lot of different types of injuries guy have some very interesting stories about that whole thing, but it's a fascinating job. Oh, I
Ken Gunter 29:25
can imagine. Yeah, well, you know, and that's the thing too, like, I can think anecdotally about all the ways that I've knocked on my head over the years, some certainly football but some other you know, just like I said everyday life. Well, one of the things that we've kind of focused on so far is, you know, once you've sustained a concussion, best course of action, and if I'm not putting words in your mouth, it sounds like it's identification of a concussion as quick as possible is key to recovery and then finding the appropriate treatment with a specialist with someone like yourself,
Dr Michael Collins 29:59
you and being aware of the subtle symptoms of injury and just one quick thing, you know, yeah, please. Our research shows that on field dizziness is six times more predictive than any other symptom and predicting worse outcome from concussion. And being dizzy as six times more predictive of poor outcome than losing consciousness. You believe that? Wow.
Ken Gunter 30:19
That, I'm glad you brought that up. So if someone gets knocked out, does that inherently mean that there was a concussion? Yes, or okay. Yeah,
Dr Michael Collins 30:29
unequivocally if you get? Yes, yeah. But also, if you have dizziness on the field, nausea, lights, noise, sensitive headache, fatigue, you know, vision changes, feeling foggy or detached one step behind, those are all clear signs that a concussion has occurred. And other things can occur, it can cause that too. But like I said, when in doubt, send them out. And if there's been trauma, and those symptoms are occurring, don't put them back to play. This study will be very interesting to you. We looked at that kids, we looked at a very large cohort of kids, I think around 500 250 of whom had symptoms of concussion, and came out of play immediately, once their symptoms occurred. Kind of half the sample had symptoms of concussion, and played only 15 minutes longer with those symptoms of concussion. The kids that came out immediately recovered in 19 days in terms of their concussion, the kids that continue to play for 15 minutes recovered in 44 days. Wow. So playing 15 minutes longer with having symptoms of concussion, added almost a month of recovery. Do we know what that's attributed to because the systems that D compensate the vestibular system, if that system compensates, then you overtax it, it can lead to migraine, it can lead to a lot of different things that add more time on your recovery, it can further de compensate the system. And so it's very important that to recognize this injury and to kick kids kids out of play immediately. Now those same kids that took longer to recover, if they receive treatments, they can get better, much faster, through the physical therapies that we've developed in the rehab, you know, we've developed rehab for all these problems now. And so you can actually you don't have to take 44 months if you play 15 minutes or longer. But you need to be seen by a specialist who can treat this stuff and apply the right treatments for it.
Ken Gunter 32:28
Yeah, I think that'll probably be eye opening for a lot of people. The thought that it can be it can be rehabbed, right. And there's an actual treatment. And it's not just time,
Dr Michael Collins 32:37
yeah. Now, with this injury, with the vestibular subtype, the ocular subtype and the migraine subtype, then even the anxiety subtype, we can actually treat this with with certain types of rehab and treatments. Like, for vestibular therapy, we have physical therapy. I mean, for vestibular problems, we have physical therapy exercises, that retrain that system, we actually have workouts that we give patients that retrain that system, you come see me, I'm gonna work you out. Even if you're having bad headaches, we actually work people out to get them better exercise for treats this stuff, and you just have to do it in a very targeted and prescriptive way. You got to exercise them correctly.
Ken Gunter 33:19
Yeah. Yeah, I don't even know if this is worth mentioning. But it's interesting. I felt like, again, that 2006 to 2010 timeframe, there was kind of a shift in perception that had happened with regards to rehabilitation, away from cheer, just, you know, rice and F and rest, it was actually beneficial to go in and attack the injury quote, unquote, right? Right. So if you had some sort of like, major contusion in your leg, right, rather than avoiding it and just giving it rest, like you're actually going to recover much quicker by going in it might be more painful, but doing some dedicated work on that area in around it. And because of that, right, you would you would recover faster. This is kind of triggering that same moment I had back then kind
Dr Michael Collins 34:03
of, you know, again, it's a great parallel that orthopedic model of care. And it's not irony that I work in orthopedic surgery. I'm a neuro guy, I work in orthopedic surgery. And I've worked alongside sports men, I'm in sports medicine. So I've worked alongside our sports medicine physicians and seeing what they do, and treating orthopedic injuries. And quite honestly, I've been doing this for 20 years now at UPMC. Now, and we're applying those same principles to concussion, we're and we're proving it through randomized controlled trials, and we can treat this stuff. Yeah. And it's it's a very similar model, like you described, and, yes, we do provoke symptoms to treat it. Hmm.
Ken Gunter 34:40
Yeah, I think it's both eye opening and hopefully encouraging. One thing I wanted to ask you, you know, a lot of what I've been asking you about today is, hey, from the moment that a concussion occurs, like, what can be done, and I think you even said as much like the best prevention is either proper identification or proper management of the symptoms. Am I saying that correctly? Yeah. You know, given your focus on the brain, neural pathways and all that, is there anything that you recommend in terms of a best practice to kind of just optimizing brain function on the front end. So I would love to hear like, hey, you know, stay hydrated that maybe that'll reduce your risk of concussion or if I
Dr Michael Collins 35:21
can describe to you a model that I think is very effective. So okay, so let's talk about that. Let me just go off beat here a little bit. So migraine is a threshold problem. Okay. So anyone that falls below this line will have a migraine, anyone that's above it won't have a migraine. And that's the way neurological problems exist is thresholds. Alzheimer's disease is a threshold problem. Yeah. So people hopefully are up here and off the line with migraine. Okay, right. There's five things that cause migraine in patients. And if you do these five things poorly, you will get a migraine guaranteed. What they are, is if you take naps and don't have a consistent sleep schedule, so if you nap, or you sleep in two hours long, and you shoot or go to bed two hours earlier, if you pick a bedtime and a wake up time, and you don't nap during the day, you're gonna stay up here off that line, if you nap, interesting, you're gonna go down here, okay? The second thing that predicts migraines if you're not exercising. Third thing is if you don't eat three meals a day at the same time. Fourth thing is if you don't hydrate well, and the fifth thing is if you're stressed and have internal stress, people that don't express stress well, that they have this internalization thing where they hide stress really well. Those are people that pop a migraine. So those five things also serve as a threshold for injury for concussion. So if you are stressed out to make the team, you're you're not sleeping consistently, you're not exercising before training camp, you're sitting here, you get hit in the head, yatse. Wow, if you're doing all those things really, really well. And you get hit in the head, you don't feel anything. And so we there's different thresholds for concussion that exist depending upon those lifestyle factors. And so think about training camp when you went to training camp, for instance, okay. Maybe you know, your third min, third man on the depth chart. And you're stressed out about getting above to number one, you got internal stress, you don't want to show stress, you just wearing it inside, you know, you're not vocalizing in Arctic articulating it, you're just swallowing it, because you don't want to show weakness. Let's say you took two naps, or two days before training camp started. Or you you know, you had to wake up at 5am When you've been waking up at 8am. Also all summer. Okay, yeah, let's say that it's 101 degrees out and you can't hydrate well enough. And no matter how well you hydrate, you're gonna be dehydrated. Let's say that you skip breakfast. Those factors all put someone right above that line and you get hit in the head, you're gonna go over that line much easier than if you can do these other things. So there are ways of happening. And those things I just mentioned are things we've learned very clearly predict who gets a concussion and who doesn't?
Ken Gunter 38:13
Oh, wow. You know, it's funny, the themes that keep popping up, the more I do this podcast, sleep and stress come up more than any other and in ways to like, I did not anticipate that our conversation would kind of go here today. And that those two factors, maybe, you know, you would identify as having a potential impact on increasing your likelihood for a concussion. But those those two things continue to pop up time and time again, which I just
Dr Michael Collins 38:43
say that stress plays a huge role on your bodily functions, if you want to physiology behind stress in physiologic difficulties, yeah. And there's a lot of relationship between stress and stress and physiologic difficulties. Yeah, you know, if you don't treat stress properly, you're gonna have belly stuff, you're gonna have headaches, you're gonna feel tired, you're gonna get dizzy. When you stand up quickly, you're gonna get lightheaded, you're gonna have cognitive issues, you may have vision changes, there's a lot of things that can occur with stress.
Ken Gunter 39:16
You know, it's not your we're literally, this always seems to happen. We're talking on a day where I've been up since like, three, and I've probably had one of the more stressful work days that I've had in a while, right. So it's just it's just the irony is too much to notice. Or do you have all those things going on right now is what you're saying. So I'm just avoiding contact like the plague. Let's put it that way. Yeah, yeah. Yeah. Is there anything that you're interested in I get I get now that we're kind of venturing a little bit away from the concussion discussion. Boy, no pun intended. Is there anything like like nootropics right, it when you start thinking about human optimization, that's something that has really gained a lot of steam and a lot of interest. Are there Those things that your practice is paying attention to at all,
Dr Michael Collins 40:02
or you haven't learned of any supplements, nutritional advances that that prevent this from happening. And quite honestly, I don't see any relationships. You know, we don't delve into that as much, you know, just like orthopedics maybe that's the next frontier looking at some of these things. But no, to answer your question, we haven't found any relationship between that and thresholds or problems.
Ken Gunter 40:29
Yeah, yeah. One of the things that I was interested in is, I believe it's a recent study that you conducted and it kind of got my my wheels spinning around some of the testing that you're able to do nowadays, um, it was a test, I believe it was like biomarkers and saliva. Were does that sound accurate? To be able to we're doing a lot of work in that space. Yes,
Dr Michael Collins 40:50
we're, you know, everyone wants a biomarker for concussion. I'll be honest with you, we've been looking for a biomarker for Alzheimer's disease for four decades and haven't found it yet. So don't think there's anything around the corner. Now. But we are looking at there's a whole panel of biomarkers that we're examining, to see if they're effective at predicting concussion and outcomes. And, and we've yet to find when in fact, all these you know, the physic pathophysiology I talked about earlier, we don't see it on CT scan or MRI. There's no imaging modality that we can use to show concussion at this point in time, right. So there's nothing we have to measure this through other ways. And we've developed tests like the impact test, which is computerized neurocognitive tests that can measure cognition following concussion, you know, baseline testing, that kind of stuff. It's very effective and very helpful. We've created an exam called the vestibular ocular motor screening exam, that we can use a physical exam to measure this stuff. Right now, there's nothing, you know, from a biomarker standpoint that's ready for primetime.
Ken Gunter 41:56
Yeah. Again, you know, one of the things that now I I'm just like, almost embarrassed to say this, I remember the mentality was such when I was playing, that when we were gonna go in and do like our baseline testing, right? The kind of like, the word on the street was like, hey, sandbag it a little bit. Sure, you know, lower, lower your baseline so that once you take this test, you know, God forbid me, you need to you can get back on the field. The next day,
Dr Michael Collins 42:24
even though you went to Princeton, you weren't very smart. Because not first of all, that would be something that would be kind of stupid, do. But beyond that,
Ken Gunter 42:32
you can say idiotic, yeah.
Dr Michael Collins 42:36
I get I would have done the same thing. But we actually have measurements inside the tool that shows someone that's doing that. And we have studies that prove that we can, you it's very hard to do that and not be picked up on the test. There's statistically we know exactly where someone should be. And there's little, there's areas that people try to fake that on, that we it actually shows in the report that they're faking bad, raises a red flag, and then what ends up happening is it literally will get flagged, and then the test is baselines and valid. And we always have a higher standard if we don't have a baseline to put someone back to play. Yeah, so you just got a screwed yourself, because you can actually probably have to do better than you would have had to do in the first place. Right? Well, it's not real smart. And we've shown that the studies have shown that we're up to 80 to 90% effective at picking up on sandbagging. So interesting. Yeah. It's it's hard to cheat the tests and us not know about it.
Ken Gunter 43:37
Yeah. Well, that's good to hear. And again, I think, you know, part of it is just being stupid, 18 year old kid, part of it was just I don't think there was as much awareness, round repercussions and you know, the magnitude of, you know, what a concussion could do if untreated, and then played through.
Dr Michael Collins 43:57
Yeah, the thing is, is I hopefully athletes get in this mindset. Okay, like if they, they, if they have knee pain, and they're wondering what the hell's going on, right? I've got knee pain, I need to get this evaluated. Like, people aren't scared to do that. Because they want to know, what's the effect say, What am I going to do to myself if I keep playing is it gonna hurt worse right now, like, liken that to concussion care, like come in and get evaluated. If you're concerned, this is things we can do. And on the most aggressive guy you'll ever meet about getting back to play. I'm not fearful of this. I feel it's treatable. I feel we can get kids back to play safely. I'm very aggressive and getting patients back to play if I know they're safe to do so I'm the biggest fan of sports there is and it's all about getting kids back to play. That's the goal in you know, and we're not going to put you in dark rooms and stuff in a closet to get you better. We're going to actually actively treat it we're going to rehab it. So um, as this takes hold, with all the research that's being done and the awareness And, and that people are aware that this is new information for people. I hope it gives them confidence that, you know, look, we're actually treating this pretty effectively now and report your injury and you're going to actually prevent poor outcomes from happening. Yeah, just like you would any injury.
Ken Gunter 45:17
Yeah. No, I, I'm one glad to hear that, again, with, you know, three young kids, and they're starting to play sports, and whether or not they play football, right? I mean, if you're, if you're being an active person, and you're engaging in a sport, where, like you said, you know, bodies are moving quickly. There's the potential for concussions to happen. But I also don't think that the flip side of that is, you know, putting them in a bottle and bubble and protecting them from everything is is any better? In fact, I would believe that's worse. So it's kind of like, well, if weighing the risk reward,
Dr Michael Collins 45:49
if you listen to my talk earlier about thresholds, people that can put in a bubble, and aren't allowed to do things, they're highly anxious people, and they're gonna be sitting right above that line. So yeah, the risk of injury is going to be much higher than someone that's playing football and not having that bubble.
Ken Gunter 46:05
Interesting. Interesting. Well, thank you this is this has been an incredibly hopefully eye opening, and hopefully inspiring conversation for a lot of folks, especially if they've either dealt with a concussion, you know, or just are concerned about, you know, what are the long term effects? And what is the treatability of it, if they are loved, whenever it sustains when in the future? I guess, you know, for those who do want to find more information, you know, where where can I point them?
Dr Michael Collins 46:31
We have a very good lay person website that outlines some of the things we talked about, and there's good information on there. It's, it's www dot rethink concussions.com. And we call it rethink concussions, because it's, there's a lot of, you know, we try to dispel the myths that are out there. Yeah, on that site. And there's a lot of really cool information about, you know, our clinic and patient care and, and, you know, vignettes, clinical vignettes and cases that we've seen and treated and research and all the things that go along with a good academic program. So that would be the site I'd recommend to go to. There's a lot of really good information there.
Ken Gunter 47:08
Oh, excellent. Well, perfect. Dr. Collins, this has been a really good conversation. And thank you for making the time.
Dr Michael Collins 47:15
I enjoyed it a lot, Ken, thank you for having me. Appreciate it.
Ken Gunter 47:23
All righty. Take two.
Sonia Gunter 47:27
Here we are. Here we go again. We're starting over
Ken Gunter 47:31
because our first first take was pretty low energy because yeah, we just kind of
Sonia Gunter 47:35
had a very boring conversation for five minutes.
Ken Gunter 47:38
Yeah, we were all sick. We've been battling it for a week. And we were basically just commiserating. And then I think halfway through we realized we weren't talking about the podcast, we were just complaining about being sick. By we, I mean, me, I was doing a little bit of moaning but stay positive,
Sonia Gunter 47:55
staying positive, staying positive.
Ken Gunter 47:59
I actually really enjoyed listening to this one back. And now that's not to say that I don't enjoy listening to some of them. But this one I like found myself listening to it. I was like, Oh, wow, that's really interesting. That's really interesting. Oh, I forgot about that. There's a
Sonia Gunter 48:10
lot of information. Yeah. Well, and it's just and it's a topic that's, that is especially important to
Ken Gunter 48:18
it is especially important to me, because I do think about it. Well, and so maybe I should expand on that. Like I my late 20s You know, started getting like brain fog, tired, had trouble remembering things, and I couldn't help there's all this you know, commotion going on about CTE and brain injuries from football. And like anyone I was like, oh, man, like maybe I got some of that going on. Now. I'm like, Well, you just weren't sleeping. You're super stressed.
Sonia Gunter 48:45
You're eating mushrooms, which you're allergic to is eating
Ken Gunter 48:47
also. I was eating almonds by the handful, which I found that I was allergic to. So clearing up most of those things. Things have gotten much better. Less worried now. But yeah, no, I mean, I think anyone who's sustained concussions, you'd be like, Oh, boy. Yes, it's gonna affect me long term.
Sonia Gunter 49:05
I know. Interesting to hear that. It's more you're more susceptible as a woman to get concussion due to your weaker Knick Knack
Ken Gunter 49:14
due to your weak neck I don't know how the feminists are gonna think about that one. But yeah, that was that was surprising to me. I think he said something like 60% of all patients can walk through his door female. Yeah, I
Sonia Gunter 49:28
thought when he was talking about how soccer or how like different sports have more concussions. I thought it would be soccer because of the head butting to the ball. Yeah, head butting to the ball. Yeah, no, I
Ken Gunter 49:41
think that's the that's the actual term. The heading header.
Sonia Gunter 49:46
Sure. Headers. Yeah,
Ken Gunter 49:48
I like head butting to the ball more actually. I think that is though I think especially I think for youth soccer players like a miss Hit would be right like they haven't. They haven't been like taught how to do it the right way either. Also not like soft new. I also think some of it too is like, you know, I think he said this, like the kids just get kicked by a soccer ball in the head at a short distance like that thing. It's packing some punch. I know. But I was surprised to hear that 60% You know, that come through the door female. But yeah, I mean, people get cut. That's the other thing too. It's
Sonia Gunter 50:21
no wonder it has something to do with the fact that women might be more likely to like fess up to having an injury like that. Like maybe a man would try to like, Oh, that's really interesting. Or like, No, I'm hurt. I'm gonna get this fixed.
Ken Gunter 50:35
Yeah, probably right. No, I mean, look, I mean, like, there's very like, you know, football. I didn't tell the story on this podcast. I feel like I told it on one about the baseline. How I used to try and have like a low baseline test.
Sonia Gunter 50:51
On this. I tell on this one. Yeah. He was like, You're a dumb. He's like you went to Princeton. But you're dumb. Yeah. Okay, so basically what he said, Yeah, almost verbatim.
Ken Gunter 51:02
All right. Well, you've made your point. You said it twice. But yeah, no, absolutely. Look like I was trying to
Sonia Gunter 51:08
hide it. Yeah, it's so dumb. It's dumb. But ya know, you're
Ken Gunter 51:12
probably right. A lot of males probably don't want to report it. Because they don't want to miss time. You know, like, Oh, I got my my 12 football games this season. I don't want to be out for two of them or whatever. It's going to be wherever they think it's going to be. Yeah, not good. Not good. Not good kids.
Sonia Gunter 51:28
It's wild now that their tests can detect that though. If What do you mean? Now, if like that baseline are the tests that you have to take in the beginning season? Or I don't know when you take it, whatever. Yeah. But now he said that the test conduct detect whether you're trying to fudge it. Right. Right. Right. Right. Right. Which I'm sure was the case back when you were taking them? Probably not
Ken Gunter 51:47
probably didn't care. Yeah, well, it's just honestly though, it sounds crazy, because it was not that long ago.
Sonia Gunter 51:59
A long time ago. It was like 15 years ago. Alright, sorry. You're talking now, man? Yeah. It's a long time ago,
Ken Gunter 52:07
I guess. I guess. Yeah, that was a long time ago. But we really did not know much. Yeah, if the medical community did maybe that's a whole other conversation. But as players we didn't it was more just like the stupid inconvenience. But wasn't there like going to have a headache for a few days on
Sonia Gunter 52:24
your team that they like made stop playing? Because he had gotten like 17 concussions?
Ken Gunter 52:28
Oh, a bunch of? Yeah. And I'm sure you talked to any person on any college football team, a national team, they all they all have. They'll have someone
Sonia Gunter 52:36
to bring them with weak necks.
Ken Gunter 52:38
You know? I mean, like, Look, you knew like boxers Yeah. How the weak neck men. That's but you know, what was it didn't fall in that camp. So I wasn't worried about it. But like, everyone was like the punch drunk boxer. Like you knew eventually there were issues with getting hit in the head. But I think you know, the thought was, it's like, you get your bell rung. That's just part of the game. You know? Yeah. Like, people were saying shit like that from a very young age.
Sonia Gunter 53:02
Yeah, I don't like that.
Ken Gunter 53:05
Oh, I don't like it at all. It's terrible. But that's just how it was. It was just different people didn't know.
Sonia Gunter 53:12
Yeah. I mean, people. No, no. My family knew they didn't let my brothers play football because they didn't want them getting their brains rattled, though they don't want to get hurt. Yeah.
Ken Gunter 53:23
Okay. Exactly. Yeah. But like your dad had like the inside track on like concussions and like brain trauma. You just didn't want to play football.
Sonia Gunter 53:32
Yeah. Okay. Disagree. Agree to disagree.
Ken Gunter 53:35
Okay. Agree to disagree. But yeah, so anyways, just threw me off. But I thought there was a lot of relation things that came from this. I think the most interesting thing that I took from this is that nowadays, they treat rehabbing this, like you said, like you would treat you know, I think you said an orthopedic injury. You know, a strain a muscle pole, like now, I'm way oversimplifying it, but I guess like the broader point being, it's like this can be if identified correctly. This can be treated. You know, it can be rehabilitated. Yeah. Which I again, I guess not so long ago, or long ago, 15 years ago, whatever it was. I don't think we were doing that. I think it was just rest.
Sonia Gunter 54:21
Yeah. Yeah, that's crazy. I know. I thought it was wild that you can use exercise to treat
Ken Gunter 54:30
concussions. I think it's certain types.
Sonia Gunter 54:32
Yeah. But was there any type of that? That was crazy. That that would be like a prescribed recovery plan.
Ken Gunter 54:40
Yeah, I think I think what it comes down to is like it really depends. You know?
Sonia Gunter 54:47
Like it's also cool. He was able to identify that you probably got two different types of concussions and that week, yeah, period where you thought you got to Yeah, just from like, a simple explanation of you're
Ken Gunter 54:58
right and I don't I definitely didn't think like, oh, what form of concussion is this?
Sonia Gunter 55:03
I know that concussion concussion. Shit is gonna sit in a dark room.
Ken Gunter 55:11
History is going to be so hard tomorrow morning. Yeah. No, I know. It's it's crazy. The other thing though, that I thought was really interesting too. Is that
Sonia Gunter 55:22
what history is gonna be so hard tomorrow morning? Yeah, if
Ken Gunter 55:26
I went to a whole nother podcast, this kind of relationship between the five things that kind of put you at a higher risk of getting migraines also put you at a higher risk of getting concussions. Yeah. Again, it's just like, this stuff is not hard.
Sonia Gunter 55:45
Again, it was being a girl having carsickness. Yeah, can
Ken Gunter 55:49
I also say that was my favorite thing. It was like it was like, getting dizzy. carsickness having a weak neck being a woman. But he didn't mean to say it like that. But it's just the way it came out. Amazing. But no, I think like for the migraine stuff, it's like, if you are someone who has an irregular sleep schedule, and you nap, if you're someone who like does not like handle stress well or get your stress out? Yeah. There's a there's five I hadn't written down. But again, like it just kind of comes down to generally, to give yourself the best chance like the stuff is really straightforward. Yeah. It's like, you need to sleep. You need to handle stress. And you need to generally be healthy.
Sonia Gunter 56:35
Yeah. You know, like this. You need to definitely not be a lady. Yeah, try
Ken Gunter 56:39
if you can help it not be a lady. He's gonna listen to this back. Like I could share this with my patients. But no, again, but I thought like, you know, to go back to the female piece. I think the media at least portrays it as like football, football, football, hockey, hockey, hockey. Yeah. Which again, like, not completely incorrect. But it's like, people get concussions for any sorts of reason.
Sonia Gunter 57:09
Yeah, car accidents. car brands pulling out of a training you
Ken Gunter 57:13
Yeah, classic branch falls out of a tree.
Sonia Gunter 57:17
No, we were on vacation a couple months ago. And my mom and I were checking out the beach. And this tree had huge seeds are nuts in it. And one felt like five feet for me. It would have killed me if it hit me.
Ken Gunter 57:29
How big was the seed?
Sonia Gunter 57:30
It was like the size of a softball. Didn't you remember them?
Ken Gunter 57:35
I mean, they weren't
Sonia Gunter 57:36
visual. Yeah. See?
Ken Gunter 57:38
What kind of tree was it? Actually?
Sonia Gunter 57:40
I don't know. I have no I forget. I know. I asked at the time coconut type. No, it was a coconut. It was like softball size. Maybe like in between it baseball and softball. But I was like, that's unsafe. Yeah. Yeah. Concussion? Yeah, concussion,
Ken Gunter 57:54
you would have been wrong to just sit in a dark room? Yeah. But no, I think, you know, like, look, this, this conversation is probably gonna be really interesting for the person who's like, either concerned about this, or they're gonna find this at a time when they need it. someone in their family just got a concussion? Which hit like, what do we do? Yeah, I think it's amazing now that there are and what would be interesting, too, is to know, like, how many other practices are there? Because, you know, we technically live within driving distance of UPMC. It'd be a long trip. But you know, like, just around the country, like, are there like a bunch of these places who now have like experts who could properly diagnose you and get you the appropriate treatment? You would hope? So I'm sure it'll, it'll continue to get better. But it's just interesting to see how much things have changed. Tony, oh, something I want to talk about. And I know we're going a little long here. But I thought it was very intriguing that he said, Look, we don't have answers to a lot of these questions right now. He's like, but the work is being done. And we're probably going to have answers to a lot of these questions very soon. Yeah. So crazy, very encouraging. Right? Because I'm, look, I'm not like so crazy about football, that I'm like, Oh, my boys are gonna play no matter what. Yeah, like, I would just want what's best for my kids. Like, they're not in a situation where like, their only way out of a bad situation is a football scholarship. Right? You know what I mean? Like? So it'd be nice, like, hopefully over the next 510 years, like you get that information back. And it's like, okay, like, now we have something to really make a decision based off of, you know, yeah. Or maybe they just are, you know, great pitchers. And we only have to worry about this. And I can just retire when they signed that big major league contract questions and baseball. Should Yeah, we should just hide them from the world, basically.
Sonia Gunter 59:46
I think that's what he said to do. Right? Yeah. Just hide your children.
Ken Gunter 59:48
That's what I took from it. Yeah. That's the thing though. It's like, you can't you can't protect yourself from everything. It's like if you want to be like a participant in the world. Yeah, it's like you there's inherent risk everywhere. are falling off a horse. Yeah, you know, I mean, like you name it. Like there's just working outside on a ladder like there's like, anything you want to do comes with some level of risk. So it's just like what are you comfortable with? Right?
Sonia Gunter 1:00:12
Yeah, you're not wrong.
Ken Gunter 1:00:14
I don't know. Unless you feel differently. No, I agree. Yeah. Ah, should we wrap this up? Let's wrap it get some sleep. Much needed. Yes. Awesome. Another good episode in the books, actually next episode. Fantastic one on sleep. So I don't want to give too much away. But this is a really good one. The real snooze fast. Yeah, the sleep doctor. Nice. You've got some good stuff today. Good, good material out of you. All right, everybody. Well, thank you for listening. We will be back next week. Hopefully completely healthy. More energy. Bring to bring back to you a better one about my wife episode. All right. Thanks, everybody.
1:00:59
Bye bye.