163: Avoiding the ER—Dr. Madsen's Essential Prevention Tips

Scot: Mitch, I have a question for you. So what is something you think you could do to prevent needing to go to the emergency room?

Mitch: Not riding those little rental scooters around.

Troy: There you go.

Mitch: That's top of mind.

Scot: That's good.

Mitch: Wear shoes when you bike. I don't know. What are we thinking?

Troy: Nice. I like both those things. Although the shoes when you bike, I haven't seen many people with that, but I've definitely seen a lot of scooter injuries.

Scot: I was going to say get your health screenings.

Mitch: Oh, yeah. Okay. That'll keep you out of there, sure.

Scot: Well, that could help, right? Know your blood sugar. I think blood sugar and diabetes is a big thing. But I could be wrong. I don't know.

All right. So Troy is going to be, today on the episode, the Ghost of Health Future. He's often told us, Mitch, that he's seen the ultimate conclusion of health practices in the ER that could have been minimized or prevented. So we asked him today to give us five things that Troy has seen in his career, as an emergency room doc, that could have been prevented. They wouldn't have had to see the Ghost of Troy Madsen's Health Future . . .

Troy: That's right.

Scot: . . . had they perhaps paid attention or done these things. Well, I don't know exactly how we're going to frame this, but we're going to find out.

So this is "Who Cares About Men's Health," information, inspiration, and a different interpretation of men's health. My name is Scot. I bring the BS. The MD to my BS is Dr. Troy Madsen.

Troy: I'm here, Scot, and excited to talk about this.

Scot: And he's a "Who Cares About Men's Health" convert. It's Mitch.

Mitch: Hey. If he's going to be the Ghost of Future Health, we should get him a cloak, so he can menacingly point and be foreboding. I think that would be good.

Troy: That's right.

Scot: I like it.

Troy: You're going to be the Ebenezer Scrooge. I have my arm around pointing to the future. "This is your future, Mitch." That's right.

Scot: "Unless you make changes now." And that's the whole point, right? The Ghost of Christmas Future, the whole point is this is your potential future, but you could prevent this future if you make some changes or do some things.

Now, there is one thing I do want to say. I don't know what your list looks like, Troy, but I was concerned when I asked you to have this conversation that I didn't want it to come across like these are all things that somebody has control over and there's total personal responsibility here.

There's a concept called social determinants of health, and that basically says that there are different factors that are out of your control that go into your health, like socioeconomic status, your education, where you live. Do you live in a safe neighborhood? Are you even able to exercise? Do you live in a neighborhood where pollution is super high? Those sorts of things.

Are there any other issues that we'd want to keep in mind here as we go through this list?

Troy: Well, just simple genetics. There's only so much we can control, but then there are just genetic factors and things that we just have no ability to control.

So I think really the focus here is more just things that maybe you can do now to prevent that visit in the future while understanding that we all face certain limitations, whatever those limitations are, and we just do the best we can.

Scot: Yeah, these are just some potential barriers you might face, but that doesn't mean that you should give up. You should still try to do what you can.

Troy: Yeah. Exactly. While accepting that you can't prevent everything.

Scot: All right. So, Troy, without any further ado, let's go over Troy Madsen, The Ghost of Health Future, the five things you've seen as an ER doc that could have been prevented. We'll start with number five. Was this a hard list to make, by the way?

Troy: It was a hard list because there were so many things to put on the list.

Mitch: Oh, wow.

Troy: Yeah, there are so many things I have seen people in the ER for that I've thought, "I don't want to end up in the ER with this thing. What can I do to prevent it?" And I'm not blaming them for being in the ER for that thing because things just happen. But yeah, it is tough because there are so many things.

Scot: All right. Number five.

Troy: So number five, we're going to start it off right at the top with heart attack and stroke. And I'm going to put both of those together because they work the same way where you have your blood vessels and they build up cholesterol in it and plaques, and then that cuts off the blood supply, and that then leads to either a heart attack or a stroke.

That's just the one thing you don't want to end up in the ER with. And if there's one thing that's going to kill you, it's a heart attack. That's one of the top killers of Americans, is heart attacks. Those numbers have gone down because we've gotten better at prevention.

And then there are strokes, where you have a stroke, and usually they don't lead immediately to death, but a lot of times just the disability it creates, down the road you just can't function well and that eventually can lead to death.

So when you talk about saving lives, we're talking about heart attacks and strokes. It's something I have seen so many times in the ER.

The prevention here, I'm just going to keep it very simple because we've talked about it so many times, Mediterranean diet. I love the Mediterranean diet because so many studies, they've looked at that specific outcome, really focusing maybe more on heart attack than on stroke, but it also relates to strokes. They've shown the Mediterranean diet reduces the risk of heart attack and stroke, without question, study after study.

That's why I told myself anything I can do to promote this diet . . . Rather than all these other diet fads that are out there, this is the one diet that really has great science, great evidence behind it.

It reduces that risk of heart attack. It reduces the risk of ending up in the ER with potentially something that's a life-changing event either because it leads to where your heart isn't functioning as well as it should, or in some cases leads to loss of life. So anything you can do to prevent that, and number one on my list to do that would be the Mediterranean diet.

Mitch: And what I like about the Mediterranean diet is that as someone who, in the past, hasn't been as financially stable, doesn't even know if I have insurance, etc., sometimes you hear about these different health fads and how to eat healthy, and it can be really expensive and really hard to afford that kind of diet stuff. But the Mediterranean diet . . .

I just got a book, actually, which was . . . I can't remember the title off the top of my head, but it was Mediterranean diet on a budget, and it really focuses on just increasing vegetables, minimizing portions of meat, etc. And so keeping those ideas in the back of your mind and maybe getting a few recipes, it's not undoable and it can actually be done pretty affordably.

Scot: I think this notion of how much it costs . . . The processed foods you're buying in the grocery store, the pre-prepared foods . . . I was in the grocery store the other day and there was a bag of chips for $6. I'm like, "What happened? I'm spending $6 for a bag of chips?" For $6, you can get some fruits and vegetables.

Troy: Yeah. Exactly.

Scot: So it's kind of a replacement thing a little bit.

I have a question, though, Troy. As you were saying that, I'm a listener, it was like, "Well, I've got to switch over to the Mediterranean diet." But I think anything you can do to move towards that would be of benefit, right? You don't have to be perfect. You don't have to do it exactly. But if you're moving maybe more towards that, you still get some benefits.

Troy: Exactly. And that's what lots of studies have shown also. If you can just increase your fruits and vegetables. And even one study that we talked about once talked about just going up to three servings a day. So if you just have very few servings, maybe you're just having a little bit of fruit here and there, try and get that to three servings a day. You'll see benefits just from that.

Scot: All right. Awesome. That was a good one. Makes sense, right? Heart attacks, Mitch. How come we didn't come up with that?

Troy: Yeah, heart attacks.

Mitch: Well, I did scooters, man.

Troy: I mean, think about the ER. There's always the scooters. But when you talk about saving lives in the ER, you're talking about heart attacks.

Mitch: Got you.

Scot: We have four more to go, so scooters could still make an appearance.

Troy: It might be on there somewhere.

Scot: Number four.

Troy: Number four on the list, and you already alluded to it, Scot, is diabetes. I see so many complications of diabetes, and these are complications of the disease itself, which can lead to heart disease and heart attacks. But then diabetes makes you more prone to infections, crazy severe infections.

You talk about the whole flesh-eating bacteria. You've heard about that. We call it necrotizing fasciitis. Diabetes makes you more prone to that in various locations on your legs, in the groin. Just awful infections.

Mitch: What? I didn't know that. I didn't know that was a thing.

Troy: Oh, yeah. I've seen that many times, and it is awful. So, again, we're talking about awful, awful things that I have seen that I'm just like, "Anything you can do to prevent it."

And then there are just the complications of high blood sugar, what we call diabetic ketoacidosis where people will maybe have some kind of infection and that just sets things off with their blood sugar to where they get severely dehydrated and very acidotic. Their blood level is very acidic, very acidotic, and that requires admission to the intensive care unit. It's a life-threatening condition.

So what I'm getting at here with diabetes would be anything you can do to lose weight. If you're overweight, that's the number one thing you can do to prevent diabetes, is focus on weight loss.

Scot: Really? Well, I guess your diet would have to play into that.

Troy: Oh, yeah, for sure. Your diet is going to play into it as part of the weight loss, but anything you can do to improve your weight. People who are pre-diabetes, even early diabetes on oral medications, that's something that can be reversed or at least improved if you can lose weight.

Getting back to our Core Four, in this case, sure, it's diet. I'm going to relate this one a little bit more to exercise. Exercising, just getting out there three times a week, 30 minutes each time. If you're not doing that right now, that's a great place to start. That's going to help reduce weight and prevent diabetes and everything bad that comes with it.

Scot: Plus the exercises we learned in another podcast. I think we did. Didn't we learn that . . .? Yeah, we did. When we talked about weight training for all of us, we learned that physical exercise, especially strength training, helps prevent insulin sensitivity. So that would also help. That's another mechanism why exercise is good.

Troy: Yeah. Exactly.

Scot: All right. Well, I got one, Mitch. How about that?

Troy: You did.

Mitch: Good for you.

Scot: I came in at number four. By the way, are these ranked in any particular order, Troy? Like, from least to worst, or worst to least, or . . .?

Troy: No, they're not. I see all of these things. I guess in terms of worst, when you're talking about the most cases of actual death in the ER, that would be number five on our list, the heart attacks. But yeah, it's not in any particular order.

Scot: All right. Let's go to number three.

Troy: Number three is asthma and emphysema. So this is not at all an uncommon thing to see in the ER. Emphysema or COPD is just an awful thing to have. It just gets worse and worse and worse over time, and there's not a lot you can do for it.

You can do some medications. People will go on steroids for a while. Steroids have their own side effects and own problems. People then go on oxygen. And then over time, they just turn the oxygen up more and more and more until it won't go any higher. Then they'll get some kind of respiratory illness, and that puts them over to the edge, and that's it.

I've seen it way too many times, people with just severe COPD, in particular, who come in and they're at that point where you say, "Well, we're going to intubate you. We're going to put a breathing tube in," but you know and they know that they're probably never going to come off that breathing tube. And that's a really awful situation.

So it's trying to avoid getting to that point. This really gets at smoking, and we've talked about smoking a bit before. If you smoke, try and cut down. That's going to reduce your risk of COPD. Obviously, if you can quit, try to quit.

But COPD is an awful disease and you just hate to see as people progress with this disease, as it gets worse and worse. And it's so frustrating because I'll see them in the ER, I'll give them antibiotics, try and patch them up and help them out, but over time, you just know it's going to keep getting worse until there's that inevitable outcome, which is just an awful thing to know is down the road.

So try to prevent it. Number one thing would be quit smoking.

Mitch: And it's not just tobacco either. There was a recent study. It's still early days in the long-term studies, but Johns Hopkins did an article last week about how people who are vaping have an increased chance of asthma and COPD. Even if you think you're skipping a lot of those negative things, which was something that was pitched before, sometimes these vapes are also being shown to cause it, too.

Troy: Yeah. That's good you brought that up, for sure.

Scot: How about Mitch bringing the research on Johns Hopkins?

Troy: Love it.

Scot: I love it.

Troy: Citing my alma mater. I'm so proud of you, Mitch.

Mitch: No problem.

Scot: I've got to step it up, man. All right. Number two.

Troy: Number two, and this is a shout-out to Mitch because we're going to talk about trauma now.

Mitch: Oh, yeah.

Troy: That's right. So not just scooters, but all trauma in general. We see so much trauma in the ER, but maybe not as much as you think we do. I think some people think of the ER as just crazy, crazy trauma, like one thing after another, after another. But we do see a lot of traumatic injuries, and these injuries range from cutting your finger with a glass that broke. That may have happened to Mitch once.

Mitch: Yeah, that's me.

Troy: To severe motor vehicle collisions. How do you prevent this kind of stuff? Well, occasionally, I do see cases of people . . . And I'm trying, again, to think in terms of prevention with trauma. One certain risk for trauma, as it comes to motor vehicles . . . Well, two certain risks. Number one would be being sleep deprived, not sleeping well, drowsy driving. And then number two would be substance use.

So, again, in terms of prevention, sometimes with trauma, things are going to happen. Obviously, we try not to put ourselves in situations where we're going to get injured. But in terms of prevention, try not to drive when you're drowsy. That can be a big thing.

I've seen some just awful accidents where people have been . . . like single-car rollovers where they've been driving drowsy and just trying to power through. Yeah, you see those things.

I've seen just awful cases, like truck drivers, transportation, who have been drowsy and have led to fatalities. It's just awful. And then you see people who were in that accident in the ER.

And then certainly substance use is a big, big thing for us with trauma, whether it's motor vehicles, using power tools, ATVs, riding on scooters, even bicycles, bicycle accidents while intoxicated, all things that I've seen many times in the ER. So it's certainly something to avoid to prevent a visit to the ER.

Scot: And if you're going to ride those scooters, like Mitch suggested, have a helmet. Wear a helmet, right?

Troy: I know.

Scot: I've seen more people . . .

Troy: That's the recommendation. Are you seeing it?

Scot: I am seeing a few people do that now.

Troy: Good.

Scot: The majority still no, but I'm seeing a few. You'll see them on rented scooters and they have a helmet, or they have a backpack and they've got a helmet attached to it.

Troy: Yeah. That's great because I have never seen anyone on a rented scooter with a helmet on. So I'm glad to hear some people are starting to do it because that's a big thing.

Scot: All right. We are here. He's cloaked in his scary Ghost of Health Future cloak.

Mitch: Bong.

Scot: He's been pointing at each one of these, five, four, three, two, and now he's pointing at number one. Imagine if it just all of a sudden appears in space, the letters of number one. What is number one?

Troy: Number one, psychiatric emergencies.

Mitch: Really?

Troy: We see so many psychiatric emergencies. And by psychiatric emergencies, I'm talking about people who are brought in after a suicide attempt, who have overdosed on any number of pills or combined with alcohol or different substances, to people who are brought in, fortunately, in advance of that who are contemplating suicide, who either decide to come in or are brought in by a family member, or people who feel just completely overwhelmed and just don't know what to do and the only option they really have is to go to the ER.

So, again, getting to the Core Four, the mental health piece of it. Anything you can do in advance to recognize maybe some challenges you're facing, or challenges a family member or friend is facing, I think that's time well spent to try and get in to talk to a therapist or get in to see a professional, to hopefully avoid that visit to the ER.

The takeaway here is to recognize the importance of your mental health, take the steps to take care of yourself, and try to help others also in your life who may be needing help to avoid that potential visit to the ER down the road.

Scot: And some of those warning signs we've talked about on past episodes. Men tend to show it in terms of anger a lot of times. I think fatigue is another one we've talked about. What are some of those other kind of warning signs?

And I think us guys too also don't . . . I don't know. With mental health stuff, it's not like physical stuff. I can see when I've broken my arm, and it's undeniable evidence sitting right there that I've broken my arm a lot of the times. If a bone is poking out, you broke your arm.

But I think a lot of times we might be experiencing early-onset symptoms of mental health issues, but we don't recognize them or we don't take them seriously. What are some other things to look out for?

Troy: A lot of times some people just become very withdrawn. And then sometimes people will start to talk fairly openly about suicide, and even say things like . . . Or they'll start to give away possessions, things like that. I've seen that.

Certainly, there are other factors. There are established risk factors, like single older men are more likely to attempt suicide and be successful with suicide. Having firearms in the home is something as well that is a predictor of successful suicide. That's something that we see in the ER, is people who have attempted suicide with firearms.

So those are things I think just to be aware of and just recognize those changes in people in your life.

And it's something that often happens after kind of a life-changing event, whether it's loss of a spouse, relationship changes, job changes, those major life events. So just be aware as people are going through those events. Just be in touch. Check in. "How are you doing?" Watch for some of those red flags. If things just don't seem quite right, it's always a tough conversation to have, but I think you can at least . . . don't necessarily have to bring up suicide per se, but just, "How are you doing? How's your mental health?"

We've talked about, too, just trying to meet up with people for lunch or something, or just go out and do something where you can just chat. That's often very helpful and may also be something where you may identify some of those challenges they're facing.

Scot: All right. Well, that's the list of things Troy has seen as an ER doc. He's kind of the end of the road. He sees these . . . I don't know. The outcome.

Troy: The end of the road.

Mitch: Oh my god.

Scot: Sorry.

Troy: It's so depressing. Gosh. It really went dark. But now we have to open the windows and say, "What day is it, young boy? It's Christmas day." None of this actually happened. We can prevent it. So that's the point. That's the takeaway. We can prevent all this stuff. It's pretty dark. That's what I often . . .

Scot: Thanks for saving me on that one.

Troy: Yeah. But I've often tried to remind myself of that. No one, or at least very few people, wakes up in the morning thinking they're going to go to the ER that day. And for many people, that is the absolute worst day of their life.

So there's a good chance someday you're going to end up in the ER for one reason or another. But these are just the things I see on my end of the health spectrum, where things just have reached a head and it's just . . .

Scot: It could have been prevented.

Troy: Yeah. But I guess I internalize it more just saying, "Man, I don't want to end up in the ER with a heart attack. I don't want to. I'll do everything I can to prevent it," because it's not where you want to be.

Scot: All right. So you said you had so many that coming up with just five was tough. Why don't you just kind of rattle off some of the other options? I can't imagine there's more, but . . .

Troy: There's more stuff. There's definitely more.

Scot: Wear eye protection? It is Christmas time. Wear eye protection. Don't play with a BB gun.

Troy: Yeah, don't play with a BB gun. If you have a bottle rocket in a bottle on the 4th of July and it doesn't launch, don't hold it up to your eye to look at it and see what's going on in there. Not recommended.

Abdominal pain. People are like, "What's the most common thing you see in the ER?" It's not heart attacks. It's not trauma. It's abdominal pain.

Scot: And how could that have been prevented?

Troy: The most common underlying cause of abdominal pain is constipation. Try to have a good bowel regimen.

Scot: Eat more fiber.

Troy: Eat more fiber. Take a stool softener. Things like that. I think that's great just to avoid that pain, and discomfort, and trips to the ER.

And then there's cancer, too. We see so many complications of cancer. And there are certain things you can do to prevent cancer, whether it's reducing alcohol intake. Again, smoking, we talked about that.

We even had that article . . . We talked about short bursts of activity. Just taking the stairs and those short bursts of activity were shown to reduce cancer risk. So cancer is a big one as well.

So those are just a few things that . . . Again, the list could go on, but . . .

Scot: Sure. And what are those little things that you can do? I like your phrasing of it, Troy. "I'm going to do everything I can to prevent that from happening." It doesn't guarantee that it's not going to happen. You could be 100% on all of it, and just for whatever reason it does happen. But there are things that one could do to try to prevent it. And the more you do, the better your chances.

Troy: Exactly.

Scot: So I like that phrasing. All right. Well, thank you very much, Troy, Ghost of Health Future. I'm going to go ahead and wave goodbye to you now. Thank you for showing us . . .

Troy: Thank you.

Scot: . . . the path we don't want to take as opposed to the path we do want to take.

If you have any thoughts on today's episode, any feedback, we'd love to hear from you at hello@thescoperedio.com. Thanks for listening. Thanks for caring about men's health.

Mitch: God bless us, everyone.

Scot: Aw.

Troy: Thanks, Mitch.