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Justin Knox is a physician assistant who works in urgent care. He knows first hand the importance of younger men not taking their health seriously.

It’s common for men in their 30s to assume they will be healthy forever and put off the life changes they should be doing now. These men typically do not have a primary care provider. They wrongly assume they get enough physical activity in through occasional recreation in the summer and winter. They drink too often and a healthy diet is low on their priorities.

Most of these men will only start caring when health problems start happening when they reach their 40s.

Justin cares about his health, but he admits that healthy lifestyle choices can be difficult. Justin is a socialite, so he often goes out with friends, which means drinks and bar food. It can be easy for him to stray from a healthy diet.

Staying healthy is a battle. Your choices may wax and wane, but it’s important to stay focused and make the best choices when you can.

For most men, an urgent care is the first stop for acute problems like a cough or cold. But often, patients will go to an urgent care just to be told there’s nothing the doctor can do. So when should you go in, when should you wait, and when should you just stay home?

Justin says you should trust your instincts. You will will never be turned away from an urgent care. Even if your symptoms end up being nothing serious, an urgent care doctor can still provide reassurance.

Major part of Justin's job is education and reassurance. Educating patients on when to wait, when to seek help, and what they can do at home makes up a majority of his cases.

Fear is a great motivator for patient. When someone is hurt, bleeding, or scared they seek treatment. And turning to the internet for health diagnosis has a way of scaring people more than anything else.

If you have any major health concern, seek professional help. Even if the doctor is unable to provide treatment, they can provide education and reassure you that everything is fine.

You’re suffering from what you believe is a sinus infection. You had one years ago. The doctor prescribed you an antibiotic. The symptoms went away a few days later. Now, the doctor is telling you he’d rather wait than give you antibiotics. What gives?

This is the classic mindset of “transactional medicine.” A patient comes in seeking a medication that has worked to treat their symptoms in the past. They pay the copay and assume the doctor will give them the drug that has worked in the past.

More modern practices and newer providers often take a more conservative approach to treatment. They rely on the latest research and clinical data as a guide for best practice rather than relying on the strategies that anecdotally work in the past.

The over-prescribing of antibiotics and pain medications have had serious consequences. Doctors are now dealing with antibiotic strains of diseases and the impact of the opioid crisis. As such, modern treatments are more conservative. Most colds and sinus infections will go away on their own without antibiotics, so modern best practice is to only prescribe antibiotics if the problem becomes more severe.

Trust your doctor and don’t approach your visit to an urgent care as a transaction for medication.

When trying to determine whether or not you should go to an urgent care, it’s easy to think of your symptoms in terms of time. You may assume that if a cough lasts longer than five days, you should seek help. Unfortunately, diseases don’t work that way.

According to Justin, there is no definite time frame for any symptoms to get better. A common cold can last seven to ten days in one patient. It can last up to two weeks in another. A persistent cough may last anywhere from five to ten days before there’s any improvement.

Instead of thinking of your symptoms in terms of a timeframe, look for these signs to determine if you need to seek treatment:

• Has there been a significant change in your symptoms?
• Are there any new symptoms forming?
• Are the symptoms getting worse over time?

If you notice any of these, seek help. At the very least, a checkup with your doctor can screen for any underlying problems and provide reassurance if they detect nothing serious.

When is something serious enough for an emergency room and when can an urgent care help?

First and foremost, “remember your ABC’s.” That stands for airway, breathing, and circulation. If you are experiencing any trouble with those three systems, go to the ER immediately.

For other situations, Troy and Justin explain what is and isn’t an emergency:

Asthma attack - Where you should go depends on the severity of the symptoms. If you’re seriously struggling to breathe, go to the ER. An urgent care can handle minor breathing difficulties, but they are limited on medications, specialists, and equipment to treat more serious asthma attacks.

Sprained ankle - Most sprains are easily managed in an urgent care setting. An urgent care is able to take an xray and determine how serious the injury is. They are able to give you a brace and instructions for recovery. If they detect anything more serious with your injury, they can send you to get more help.

Broken bones - Like sprains, an urgent care can handle the diagnosis and treatment for most fractures. If they determine the fracture requires a specialist or emergent care, they will get you to where you need to go. However, if you can see the bone, go to the ER.

Lacerations/cuts - If you are suffering from severe blood loss, you’ve severed a finger, or there’s a chance of losing a limb, go to the ER. For all other cuts, it’s best to start at and urgent care. They can handle a majority of cuts in house. If they determine your injury is more serious, they can send you to the ER.

Stomach pain - Stomach problems can be very subjective, so it’s important to pay attention to you body. If the pain is so severe that you can’t stand up or you feel an intense pain localized to your lower right abdomen, go to the ER. These are potential signs of appendicitis.

For less severe stomach pain, start at an urgent care. They can diagnose your symptoms and decide how best to proceed.

Concussion - If you lose consciousness, vomit, or are severely confused after a head injury, go to the ER immediately. These are symptoms of something very serious that needs emergent care.

For a minor bonk on the head, an urgent care can diagnose and treat your head injury.

Numbness in right arm - It’s best to go to the ER. General arm numbness can be complicated to diagnose. It can be caused by all sorts of things, some more serious than others. It’s up to a clinician to rule out whether or not it’s a stroke. However, most urgent care’s do not have the equipment necessary to diagnose a stroke.

On this episode's Just Going to Leave This Here, Scot can’t help but imagine the worst case scenario when people wear flip flops while riding a scooter. Troy is fostering twelve adorable cats in his home, which remind him of an old YouTube video, Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Dr. Jones: Why can't a woman be more like a man? In the musical "My Fair Lady," Professor Higgins for singing his frustrations in his research project to turn Eliza into a proper lady. But in healthcare the, difference is important. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and this is The Scope.

Announcer: Covering all aspects of women's health. This is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope

Dr. Jones: Men and women aren't the same. However, in the history of research into health outcomes in medicine, men's biology was the default mode. Except in Obstetrics and gynecology, of course. Researchers were wary of including women in the studies because they knew that there could be variations in how the body worked and how drugs were metabolized during the menstrual cycle. And men, of course, were the same every day, which was not quite true.

Also, women might become pregnant and for untested drugs undergoing research into dosing and side effects, that would be a problem until drug safety was established. So we counted on men to go into the risky drug development battlegrounds, but not anymore. Gender health medicine has become a significant focus at the National Institutes of Health. Research funding requires that a woman be included where appropriate. For instance, not necessary on prostate research but very important in diabetes research. Okay. Well, what are some of the differences?

Body size. Of course, we know that men are often bigger than women, but not always. If body size alone were a bigger factor, we should be dosing drugs by body mass index, or body surface area or just weight. But body size does predict lung size, heart size, artery size and kidney size and the size of the organs may predict how it metabolizes drugs or how it's affected by disease. For instance, a woman's heart vessels are smaller and they might clog up a little more easily and more quietly. Women are less likely to have a massive heart attack and more likely to quietly have heart damage leading to heart failure.

What about body composition? Women carry more fat than men, usually. This may affect how some drugs are stored. Some drugs are distributed in water and some are bound by fat. This can be somewhat important in anesthetic agents, which are fat soluble and might be taken up by fat in women leading to a lower effect per weight in women.

Anatomic shape. Well, we know girls are curvy, but some girls are more curvy than others. Most women have a different hip configuration than men. They have wider hips and that is hip bones, not just fat on the hips. This means that the angle from the hip to the knee is bigger and men's legs are straighter from the knee to the hip. Now, this is important in the rate of knee injuries in female athletes, which is greater than men. And a knee replacement in women doesn't have to be smaller, it has to have a different angle. This is important for your orthopedic surgeon to know.

Absorption. We absorb pills through our stomach in our intestines. Women have slightly less stomach acid and slightly lower gut transit time, which can make some drugs stay around longer to be absorbed more. Of course, there are some men who have lower stomach acid and lower transit times as well.

Metabolism. Women make more of certain kinds of metabolic enzymes in the liver, particularly women on oral hormonal contraception or women who are pregnant. This is particularly important in certain anti-seizure drugs, which may be less effective in women and doses may need to be changed. On the other hand, women have smaller kidneys and less kidney function as they age. So drugs metabolized by the kidneys can hang around much longer in older women.

Another important difference is in narcotics, for which women have a greater effect at lower doses. The same thing with alcohol, women have a greater effect at lower doses. The same is true for some prescription sleeping pills, for which the FTAs implemented labeling to make sure that doctors and patients know that women should be prescribed lower doses.

Now there is the "we don't know why" core category, one of my favorite categories. In this category, we don't really know why there is a difference. We don't know why women have less serotonin than men in their brains. So anti-depressants and anti-anxiety drugs like selective serotonin reuptake inhibitors, SSRIs, have a greater effect, are more effective in depressed women than in depressed men.

All these differences can lead to different side effects in women compared to men. Women have more side effects in drug studies than men. They have more nausea as a side effect. So what should we do about this as clinicians and as patients? First, we should be wary of assuming that all men are alike and all women are alike. We've already been in trouble to say all people are the same, they're all like men. But not all women are the same and not all men are the same. The differences between men and women are evident when we look at large groups of each sex, but individuals may be larger, smaller more or less fat, have different metabolisms than average for their sex.

If our medicine isn't working in the way we hoped, we should take a look at the individual and ask if different dosing or a different drug should be better. If you're having a side effect from a drug, you should let your clinician know. If you're being prescribed a drug or a course of the action like physiotherapy or joint replacement, you should ask your clinician if there are differences between men and women and how should their recommendations be modified.

I read a research study from Japan where there words like "obese" or "fat" or "overweight" were flashed in front of the eyes of men and women in functional FMRI. In men, the brain activity went right to the language center of the brain. "What was that word?" In women, the brain activity went all over to the language center, to the emotion center, to the judgment center. I hope they didn't spend too much money on that study because every woman and man I know could have told them that women are different than men.

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