From the Frontlines: DecemberDec 19, 2013
It might be the shorter days. Maybe it’s the colder weather. It could just be the holidays. Emergency room physician Dr. Troy Madsen says starting in November and through December he starts seeing more patients for reasons that could be avoided if they took a few simple preventable measures, or if families knew what to watch out for. Find out what he tends to see more of this time of year and how you, or a loved one, can easily avoid a trip to the ER this holiday season if you take his advice.
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Scot: It's time for another edition of From the Front Lines with Dr. Troy Madsen of the emergency department of the University of Utah hospital. As an E.R. doctor, you have your finger on the front line of our health concerns, likely you're going to see it before anybody else, what's going on?
Dr. Troy Madsen: So what's going on right now, and this is what we really start to see this time of year, picking up into December and then really getting further into January, is psychiatric emergencies. I know, it's kind of interesting, I think a big part of it we're seeing right now is, it's darker, we have the change with daylight savings time.
Scot: Yeah, that depresses me.
Dr. Troy Madsen: It sure does, I know it's like you're walking outside a 5:30 and its dark. If affects people, there's no question about it. Sunlight affects mood, it's been shown multiple times to really affect things there and I think that's a lot of what we're seeing. I'm seeing a lot of depressed people in the E.R.
Scot: It legitimately affects people?
Dr. Troy Madsen: It does.
Scot: Like research supports that?
Dr. Troy Madsen: Yeah, it does. Research supports it and research also supports the effect of sunlight, or even sometimes simulated sunlight, some of these lamps that people can use that help, but we are seeing a lot of people depressed in the E.R. and then seeing some very serious psychiatric emergencies, people who are contemplating suicide, people who may have attempted suicide, and just anecdotally I can say it seems like I'm seeing a lot more of those patients now and it's kind of what I expect now. You get closer to the holidays, you combine that with the darkness, sometimes you know, you have family together, it can be a wonderful time but it can be a very stressful time.
Scot: So what does it look like when somebody with a psychiatric issue comes into the emergency department? Do the come in by themselves or does usually somebody bring them or?
Dr. Troy Madsen: It can be any of a number of things, you know, and hopefully the best case sort of thing is that the person comes in on their own, they recognize that this is an issue, they need help, they come in, they get the help. Maybe it's not that case. Maybe they send a text message to a family member or a friend saying, hey I'm thinking about killing myself, and we see these things all the time and then the family member says hey, we need to get you in there, they call 9-1-1 to get someone over there.
The worst case of course is if they actually attempt something, maybe they overdose on something or even try something violent, some kind of violent means, sometimes gun shot wounds or hangings, those are just horrible things to see. But, you know, those are the other situations as well where someone comes to the house, the person is not responding, there are bottles of pills on the floor, we do see many of those cases as well in the E.R.
Scot: And what do you do for them if they come in? Obviously, if somebody has already attempted, you're trying to save their life. If it's somebody that's come in before that what do you do?
Dr. Troy Madsen: You know if we get them early enough and they haven't attempted anything, number one, my big concern is making sure, have you taken any pills, have you tried anything and most people are straightforward. You know sometimes there are cases where people may be a little bit evasive but I'm always paying attention to their vital signs, things like that. We will often times send blood work on them to make sure we're not seeing anything concerning there that would suggest an overdose or any problems.
And then the next thing is, we have these just these wonderful people in the E.R., they're called our crisis workers, they're licensed social workers. They will come in after I do my assessment and do a very detailed assessment with the patient, get him in touch with resources, decide, hey is this something we need to admit your for to an inpatient unit or can we get you in to see someone outpatient, a psychiatrist, get help for you. Whatever it is we're going to try and get these people on the right track to get the help they need.
Scot: Generally I think by the time you see somebody, there has been a long history, a lot of things building up to this. What could somebody do if they start to feel the inklings of depression or any other sort of psychiatric things before they have to last minute come to the emergency department
Dr. Troy Madsen: Yeah, and you're exactly right, it's not like these people we're just walking along fine and then something snaps and they think, oh I'm going to kill myself.
Scot: Does that ever happen?
Dr. Troy Madsen: I think there may be some kind of situational things, we do have some people who come in after a breakup or a divorce or something like that, where that just pushes them over the edge. But I think 99% of the time, like you said, something's been going on and maybe they haven't recognized it, maybe family have seen something, but the biggest thing is to get in and talk to your doctor. Just even with your primary care physician. They can then get you on the right track, get you a referral to see a psychiatrist.
You know sometimes you may need to try some medication, and maybe it's just a short term thing, just something to kind of get you back on your feet and get you going and then they could wean you off that at a certain point. But at least try and recognize it, get in and see a doctor. If you've got a family member or a friend that's in this situation, work with them, talk with them about getting that help for them.
Scot: So the medication, you bring up an interesting point, because some of this might actually be caused by chemical imbalance.
Dr. Troy Madsen: For sure.
Scot: In the brain, or something.
Dr. Troy Madsen: Absolutely.
Scot: Which is completely beyond the person's control.
Dr. Troy Madsen: Yeah. Absolutely and that's where, you know, we have to be careful because sometimes we may say to ourselves, oh I'm depressed, oh that's a personality weakness, that's my fault, I just need to kind of buck up and get going and pull by boot straps up and I'll be just fine. But it doesn't work that way, you know, there's no question that there are abnormalities that are beyond peoples control and if anyone has ever questioned that all you have to do is come in the E.R. and see someone at the extreme of that abnormality, someone who is incredibly manic or psychotic, and there's no question these people, it's not just their personality, there's something else going on there. And so, you know, don't feel guilty about it, don't feel ashamed, get the help you need and certainly try and get it before it's too late and you end up in the E.R. after something serious.
Scot: Do you run into any patients that come in and have that attitude, like I'm weak or this, talk about that a little bit.
Dr. Troy Madsen: There's no question. We do see a lot of people who are embarrassed to be there, and I think most family members are supportive at that point, but the patient may make statements about how at some point they may have talked to family members or friends and they were like, well you know, you've just got to improve your mood or have a better outlook on life. So I think they feel like, well, this is something I really can't control, where a lot of it is really out of their control.
Scot: It's just not that simple.
Dr. Troy Madsen: It's not that simple and unfortunately thinking that it may be that simple may be why it takes so long sometimes for some people to get the help they need.
Scot: Final thought?
Dr. Troy Madsen: Be aware, as you're getting in the holidays, it can be stressful, take time for yourself, recognize if you are having issues but try and keep some perspective, know that it is an issue this time of year.
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