Feb 23, 2021

TRANSCRIPT

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Scot: Great. Yeah, Mitch is our producer, and he doesn't even listen to the podcast. What hope . . .

Mitch: I'm listening to the podcast right now.

Troy: What hope do we have?

Scot: What hope do we have beyond the walls of these microphones?

Mitch: I'm sorry I didn't remember what you were . . . okay.

Scot: I love how frustrated you get, Mitch. That cracks me up every single time. "Okay, fine. Yeah. Right. We're doing this now. Okay."

Helping provide the inspiration and the information to care about your health, this is "Who Cares About Men's Health." My name is Scot Singpiel, I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Scot: All right. Today, we're going to talk to Troy about five things that you figure are common-sense medical things, but they really aren't true. So, Troy, how long have you been an emergency room physician?

Troy: Scot, I graduated from medical school in 2003, so I started residency in emergency medicine 17 years ago. Man, I say that and it makes me feel really old, but it's been 17 years of emergency medicine. Fourteen years since I finished my emergency medicine residency training, so it's been a little while.

Scot: What's the average career expectancy of somebody in emergency medicine? Because I'd imagine it's not like just being a family physician. I'd imagine that burnout is higher, or maybe not.

Troy: It is a bit higher. Yeah. Studies have been done and it used to be they'd look at burnout in emergency medicine and say, "Well, it's because it's a lot of people who didn't train in emergency medicine," but I think since then we've seen that yes, there is, unfortunately, a higher rate of burnout in the ER.

So you don't see a lot of really old ER doctors. That's why I think I'm starting to feel old. You don't see a lot of white-haired guys going around talking about the old days 40 years ago. It's not something you see in the ER.

Scot: Yeah. And all the ER docs talking about the old days 14 years ago, so . . .

Troy: That's right. I feel like the old guy now. There are guys older than me, trust me, but I'm starting to feel the years.

Scot: So point being you've been doing medicine for a long time and emergency doctors sometimes see a lot and hear a lot and experience a lot, some that might make most of us shake our heads, probably make you shake your head as well.

And today, Troy came up with a topic that I just absolutely love, and I would love it if you'd share this with us. So "Common Sense That Doesn't Make Sense." So in your experience as an ER doc, these are five things that you have seen and heard from people and patients that think are common sense medical things, but aren't really true.

Troy: That's right. These are things that I grew up believing. And maybe even in medical school, I still thought, "Yeah, this makes sense to me. It's common sense." These are things maybe your mom told you as a kid, like you need to do this if this happens, or it's just stuff your friends have told you. Maybe even a doctor told you at some point.

But from my perspective as an emergency physician who deals with certain things and sees these things, it's just, from my practice, it doesn't make sense. These are things I've heard, and then I've heard them again after years of experience. I'm like, "Wait a sec. I believed that at one point, but it doesn't make any sense." It's not something you really need to know or you really need to pay a lot of attention to.

Scot: All right. So we're going to run down through this list right here. And some of them, I'm like, "Really, that's not true?" Number one here, for example. Number one, putting rubbing alcohol to clean wounds is on Troy's Madsen's . . .

Troy: Yeah. It's something you always hear.

Scot: Yeah, common sense that don't make sense. So that's not true? That's what I did all the time. That's what my mom did all the time.

Troy: Oh, I know. Me too. Do you put rubbing alcohol on your wounds now still? I mean, is that something you do?

Scot: I don't live a life that I end up with a lot of wounds.

Troy: You don't have a lot of wounds on your regular wounds?

Scot: But if I was to get one, I would come home, I'd get a cotton swab or a cotton pad, I'd probably put rubbing alcohol on it, and I'd try to clean it up.

Troy: Yeah. I mean, it makes sense. You've got to get that wound clean and that's what you're thinking. Like, what better thing to do than pour some rubbing alcohol on it and just scrub that thing out? You think back as a kid, just the pain and agony from that. Your mom grabbing some rubbing alcohol and rubbing it on your wound or that sort of thing. It's like, "Well, you've got to get it clean." Or even soap, just getting a bar of soap and rubbing it on a cut or just scrubbing it in there. It's not something we do.

And it's not only not something we do in the ER. It's something I tell people not to do. Let's say you get a wound on your hand. And there have been a lot of great studies done on this. All you have to do is run that wound under some kind of lukewarm tap water for five minutes. That does a great job. It washes it out. It gets it clean.

If you do have a lot of debris and dirt and rock stuck in the skin, maybe you do have to get a little scrubbing brush or something really that's not going to tear the tissue apart, but something to kind of rub that stuff out. But you don't want to use rubbing alcohol.

And the reason I say that is because rubbing alcohol or a lot of these things kills a lot of that healthy tissue in there. So that can actually affect the wound healing and even make things worse than if you just did nothing.

Just putting that rubbing alcohol in there can do some damage, so I tell people don't put rubbing alcohol on. Just run it under some nice lukewarm water for five minutes. Just get things irrigated really well with that. It doesn't have to be sterile water. You don't have to boil the water on the stove for five minutes. Just tap water is perfectly fine. It's going to clean the wound out great and keep that healthy tissue there.

Scot: All right. And cleaning out the debris, you just want to be gentle, it sounds to me. You don't want to get in there and really make sure . . . better to have a little debris. I mean, is that damaging the tissue as well if you get in there and, even without rubbing alcohol, just really scrub?

Troy: Yeah. It's a tough balance because you've got debris in there and you've got maybe some chewed-up tissue that's just going to die off anyway. But you don't want to just get in there and really scrub it super hard. I mean, that sometimes is just going to tear things apart and damage the healthy tissue you've got there.

Scot: All right. "Common Sense That Doesn't Make Sense." This is five things you figure are common sense from a medical standpoint, but they aren't true. Troy has encountered people that still believe that they are true. He even believes some of this stuff. I even believe of this stuff.

Number two, know your blood type. I have a memory that back in the day didn't they have blood type bracelets?

Troy: Yeah. You can have cards you carry in your wallet. Because you know your blood type, right?

Scot: Yeah. I'm A-positive.

Troy: I know you know that because you say you have special baby blood or something like that.

Scot: Yeah. Well, first of all, I know my blood type because I donate blood, but I also have baby-saving blood because apparently. I don't have some virus or something that most adults have. I don't know what it is. I'm pure.

Troy: You're pure.

Scot: Yeah, I'm pure apparently.

Troy: You don't have the coronavirus. You are pure.

Scot: Yeah. But the average person doesn't need to know their blood type. That's not something I'm going to be asked if I'm in an accident. "Hey, what's your blood type?"

Troy: The reality is if you come to the ER and you need a blood transfusion, there is absolutely no way I would ever trust you to tell me your blood type, and then I would give you the blood. Scot comes in and he's like, "A-plus." "Okay, let's order up some A-positive blood for Scot." Because if I gave you the wrong blood and you told me, "I'm A-positive," and you're not A-positive, you're B-positive or AB-positive or AB-negative, and I gave you the wrong blood, I could kill you. That would be a really, really bad thing.

So the reality is you don't need to know your blood type. You're never going to get a blood transfusion based on what you say your blood type is. We're either going to give you blood that's what we call universal donor blood that's essentially the blood type that is okay for anyone to receive, or if it's not an emergent thing and we've got time, we'll do cross-matched blood. What that means is we just test your blood, tell what type it is, and then we get you that type right then.

So, again, like I said, it just always kept . . . I can't say it kept me up at night, but it worried me as a young boy to know I didn't know my blood type. "What's going to happen?"

Scot: Well, that's interesting. All right. And it makes total sense too. "Common Sense That Doesn't Make Sense." Number three, speaking of the ER, this was a favorite one of moms everywhere, including my mom. "You better wear clean underwear in case you end up in the ER." I always thought this was just a vanity thing. Did other people have the impression it's a health thing, or was it always just a vanity thing?

Troy: It's a vanity thing, but it's one of . . . yeah, you always hear it too. "You better wear clean underwear because if you end up in the ER and you've got dirty underwear on, it's like . . ."

Scot: "Sorry. Can't help you."

Troy: Sorry. But it's this idea that you're just going to be absolutely humiliated going in the ER and like, "Oh, I haven't changed my underwear in three days," and you're going to have nurses pointing their finger at you, like, "Look at this dirty little kid," or something. But no one cares. I mean, honestly, no one cares.

Number one, no one is going to look at your underwear. But the only time we ever see anyone's underwear is if they come in as a critical patient or a trauma patient, and there, I'm not looking at their underwear. If they're a trauma patient, we've got these scissors, trauma shears, and we're just cutting their clothes off all in one fell swoop, and everything just gets bundled up and tossed in a bag. I don't care. Like I said, it all gets bundled up.

Scot: Not on your list of concerns.

Troy: It's not. No one is going to look at your underwear or judge you for your underwear, whether it's clean or not.

Scot: All right. That was a fun one. Number four, getting a little bit back more to the seriousness. "You should go to the ER if you have high blood pressure so you don't have a stroke." Now, I can't say that I believe this. So I'm hard-pressed to believe what situation this arises in. So maybe you could shed some light on that.

Troy: Well, have you ever checked your blood pressure? Like, just gone to the grocery store or at a pharmacy and sat down on one of those machines and it squeezes on your arm and tells you your blood pressure? Is that something you ever do?

Scot: Yeah. Usually screwing around, but . . .

Troy: Yeah, like, "Hey, what's my blood pressure today?" It is not at all uncommon for us to have people come into the ER who have done that exact thing, and they checked their blood pressure and they got a high reading.

The reality is, number one, we don't base a whole lot off a single blood pressure reading. People's blood pressures fluctuate when you're exercising. If you've been kind of worked up, like you walked in from outside and it was hot outside, maybe that raised your blood pressure.

But the other reality is that you're not going to have a stroke from just high blood pressure like that. It's not going to just somehow cause you to rupture an aneurysm necessarily or do something like that. It's one of those things where the body tends to respond pretty well to fluctuations in blood pressure.

And unless you're having other symptoms with high blood pressure, like chest pain or stroke-like symptoms, like numbness, weakness, difficulty speaking, anything like that, just a single blood pressure reading at a grocery store or a pharmacy or home blood pressure cuff, it's not a reason you have to rush to the ER.

You could call your doctor. You could see them in a week or two. They may check your blood pressure there. And even then, they're probably going to say, "Well, let's see what your blood pressure does over the next three months. We're not going to start you on medication. Let's just keep an eye on it, and then we'll see what it does over the next few months and then kind of make some decisions from there."

Scot: So without the symptoms, if your blood pressure comes back a little high, don't worry about it too much. Maybe check it again a little bit later if it's a home cuff.

Troy: Exactly.

Scot: Okay. That's good advice.

Troy: And you know what happens 90% of the time? When people come in with high blood pressure and maybe they're in the waiting room, as they're getting triaged, they do have a high blood pressure. We get them back to the room, turn the lights down, let them relax, check their blood pressure 30 minutes to an hour later, and it's come down. And it's kind of like, "Well, we don't need to start medication. Don't need to rush to do anything. Sometimes just different things make our blood pressure fluctuate."

So, like I said, it's one of those things where we see it often enough that it's . . . certainly, I think people worry about that, but no reason to rush right in to get things checked out.

Scot: Is there a number that I should be concerned about?

Troy: No. I'm not going to say any number.

Scot: All right. Fair enough. The no other symptoms part, that's the key there.

Troy: That's the important piece, yes. As long as no other symptoms.

Scot: Five things you figure are common medical sense, but they aren't really true. This is "Common Sense That Doesn't Make Sense." And we are up to number five on Troy's list. "Get an annual physical to get a clean bill of health."

Yeah, I've heard this before, but that's not true. That's going to make a lot of guys feel good because we don't necessarily want to go in every year, do we? I mean, does that mean we don't have to go in every year?

Troy: Well, I think the "common sense that doesn't make sense" piece of this is this whole idea of a clean bill of health. Occasionally, I'll see people in the ER who are coming in with chest pain and they say, "Well, I just saw my doctor last month and he gave me a clean bill of health."

Scot: "So this couldn't be a heart attack."

Troy: So it's kind of this idea of I saw my doctor, he listened to my lungs and my heart, maybe did a little bit of blood work. You've got a clean bill of health. It's a funny term because you think about that and you're like, "Wow, that sounds really reassuring. It means everything is good. It means I must be healthy. There are no impending heart attacks or strokes." But there's no way of predicting those things.

You could go to your doctor and get your annual physical and get whatever you might consider a clean bill of health. They say everything checked out, and your blood work looked okay. You could still walk out the door and have a heart attack. Nothing about their testing is going to be enough to predict whether or not you could have a heart attack within the next hour or two hours or week or month or whatever it is.

So I guess kind of the point of that isn't to say don't get an annual physical. It's more to say this whole idea of a clean bill of health really doesn't hold a lot of weight.

Scot: Got you.

Troy: Basically, what it's telling you is during the visit things looked okay, your vital signs look good, everything checked out. Stuff can still go wrong. You could still have strokes, heart attacks, etc. So still a reason to take those symptoms seriously if you do have those, even if you just saw your doctor a week ago.

Scot: Got you. So the danger for the average person is "I was with my doctor a month ago. He said I had a clean bill of health." Now, somebody has these symptoms and they're like, "Well, it can't be anything. I have a clean bill of health. It's written right here. It says on this piece of paper."

Troy: "It says I have a clean bill of health, so I must be fine."

Scot: So then people will ignore those symptoms to their detriment.

Troy: Yeah. They ignore those. It may create a false sense of reassurance.

Scot: And get that annual physical. Sure, it might not predict that you could become sick a week or two from now, but a lot of times those numbers that they get can actually start to recognize a trend that you can turn around, as in Troy's case with cholesterol, and my case with my higher blood sugar.

Troy: Yeah. And I want to be careful there in saying, "The common sense that doesn't make sense." The annual physical makes sense. I think you want to do that to predict stuff and prevent stuff down the road and potentially uncover issues. But if it doesn't uncover an issue, stuff can still go wrong.

Scot: All right. There you go. Five things that you figure are common medical sense, but really aren't true. "Common Sense That Doesn't Make Sense" according to emergency room physician Dr. Troy Madsen.

Any final thoughts as we wrap up this segment of the show on "Who Cares About Men's Health"?

Troy: Like I said, these are all things that are just funny thoughts I've had over the years of stuff that I've just thought, "This used to be a really big deal for me. I used to think a lot about this and now I realize it's not worth worrying about it. It doesn't make any sense."

So maybe you've had some other ideas, other questions that you've wondered about, like, "Is this really something I should worry about? Is this sort of a medical myth?" Feel free always to contact us at hello@thescoperadio.com or reach out to us on Facebook. I'd love to get your questions and explore some more of these things as well.

I would sing it, but I . . .

Scot: Na-na-na-na-na. Thunder. Thunder. Troy, do the honors of singing, "You've been Thunder debunked."

Troy: I can't do that, Scot. Come on.

Scot: Thunder debunked.

Troy: I have to maintain some sense of dignity.

Scot: Thunder debunked.

Troy: I'm sorry. I can't . . . I think you already did it.

Scot: All right, Troy. Excited again to have Thunder. Thunder is back. We love it when Thunder comes on the show. He's our resident nutritionist here at "Who Cares About Men's Health." Thunder Jalili on the show.

Troy: Yeah, Thunder.

Thunder: Thank you.

Troy: Thanks for being here.

Scot: Where else do you go in life that people applaud you like that when you show up?

Thunder: I'm pretty sure you two are the only ones.

Scot: Yeah. Well, me. I mean, Troy, he never claps for anybody.

Thunder: He didn't even applaud? Okay, it's only you, Scot.

Troy: It was just Scot, but I was clapping in my heart for you, Thunder.

Scot: All right. We have a listener question. That's why he brought Thunder on the episode today. So how can you gradually improve your eating habits? That is one of the questions that we got. There are a lot of ways to contact us, which we'll give you at the end of the podcast, but this individual is interested in improving their eating habits, just doesn't quite know where to start. Where do you start? Do you just the next day decide, "Oh, I'm eating healthy. Let's go"? Is that what you do?

Thunder: No. I think it's really hard to do anything cold turkey like that. We are kind of creatures of habit, so really, what we have to look at is how do we build new habits? And that requires maybe making some smaller changes and going from there.

So what would I tell someone who wants to try to improve their eating habits? First, I would say take a look at how much natural versus processed foods you consume, and how many beverages that may contain sugar you consume, and pick a couple of the low-hanging fruit, easy things to modify, and go with that. And then build on that over time a little bit.

Because it is really hard, especially if you're not sure how to eat well, to just wake up one day and say, "It's all over. I'm going to the store and all I'm buying is quinoa and green beans." You have to build up into it. So that would be my advice.

I find that when people start doing that, and they get kind of used to maybe a different way of shopping, a different way of preparing food, then they can . . . it's like a snowball rolling effect. They can kind of build on it and it increases over time. But it is daunting if you just try to go all-in in one day, because you don't even know what to buy, how to cook, when to eat, everything.

Troy: Yeah, cold turkey never seems to work well, that 0-to-60 thing. Same thing of someone going out like, "I'm going to run a marathon," so they go and run 10 miles and they're injured and then they're just done. It seems like the same thing happens with diet. You're just like, "I'm just going to go cold turkey and eat great." It seems like people are miserable. It just doesn't go well.

Scot: Interesting take. At first, it's just getting rid of some of the stuff that's not optimal. Just one or two of the things. You don't have to all of a sudden get rid of all of it, but maybe you just decide, "All right. A couple of meals this week, I'm going to try to get rid of some of this suboptimal stuff and replace it with something that's a little bit better."

I'm going to also say, Thunder, at least from my experience, you've got to be kind to yourself. Because at first, you're not going to get it right. You're going to have setbacks. You're going to have moments of weaknesses. So don't beat yourself up. Just go, "All right. Well, try again next time."

Thunder: Yeah. If I could give a quick concrete example too, because this is something I've talked to people about. There's a bigger push, I guess, in society that maybe we should eat less meat, some of the health effects associated with meat intake.

I've had people say, "Well, I'm not really sure. If I don't eat meat, what do I eat? I don't know what kind of foods to eat." And I tell them, "Well, why don't you try to pick one meal in one day and make that a vegetarian meal? And if that works out, then try to pick one day and make that your vegetarian day. And this just gives you time to think about it and practice a little bit and buy some different foods and build into it, and you can just keep adding days."

So I think that is a good way to go, because if you tell somebody, using the meat example, "You're going to go vegetarian starting in an hour," you're like, "Okay, the only thing I can figure out is I'm going to have cereal for every meal of the day."

Troy: Right. When I went vegetarian, I just tried to replace everything that was meat with non-meat. So I used to eat turkey sandwiches every day, grilled turkey sandwiches. So I bought about all this Tofurky, this soy turkey, and that was disgusting. It often doesn't go well. You're right.

Scot: Time for "Just Going To Leave This Here." It might have something to do with health or it could be something completely random.

Just going to leave this here. I've been kind of into sayings lately, Troy, so I'm going to throw another saying down for "Just Going To Leave This Here." It might be a new paradigm to look at something if you've recently found yourself kind of at square one again on a project. For a lot of people, COVID has kind of put them back.

I like this. It says, "Don't be afraid to start over again. This time, you're not starting from scratch. You're starting from experience." So I like that. Just try to think about you're in a different place when you start something over again, and that different place is actually going to help you make the next part better. So I like that and wanted to share it. Hopefully, it helps somebody out that's listening.

Troy: Scot, I'm just going to leave this here. I mentioned recently on our podcast that we have a pull-up bar outside the ER. It sits outside the ER right there in the ambulance bay. I have been very intimidated to go out there and try and do pull-ups on it, but I've taken a couple of steps in my life recently, Scot.

Step 1 was during shifts, if I just kind of hit that lull halfway through the shift, I go out there and I do a few pull-ups. Fortunately, none of the EMTs have been out there who are generally pretty big guys.

Scot: They make it look easy, right?

Troy: Yeah, exactly. So, fortunately, none of them have been out there to laugh at me and no ambulances have pulled up while I'm doing it. But the other thing I've done, Scot, is I actually got a pull-up bar. So I'm now doing pull-ups at home too.

Scot: I want to know more about that. Is that one of those indoor pull-up bars, or where is it?

Troy: It's indoors. It goes over the doorframe. It's got a wide pull-up . . . kind of your arms wide and then a handle for closer arms. And you definitely find doing this, when you do the wide arms, those are tough. When your hands are in closer together, it's a little bit easier doing the pull-up. But I've been doing it now for a couple of weeks. I like it.

Scot: Does the pull-up bar feel safe and secure, the one that you put in between the doorway?

Troy: It does. Yeah, it does feel safe and secure. I was a little concerned about that, but the way it's set up, it loops up over the doorframe and it's got these pads. So as long as you have it set up correctly and it shows you the diagram to make sure it's safe and it's not going to flip off the doorframe or something, it's been fine for me. And I've been using it for a couple of weeks. I haven't had any issues.

Scot: I've been thinking about getting one of those pull-up bars, because you talk to just about anybody that knows stuff about exercise and doing resistance training, that is kind of one of the big exercises, the king of back exercises, because you're using so many of those back muscles.

Troy: Yeah, it's great. I'm enjoying it. I would be embarrassed to tell you the number of pull-ups I can do, but I'm enjoying it. You definitely feel like you've had a workout in a very short time. So I kind of like that.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE. And leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

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