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Interviewer: You have a wound on your foot, or your leg, or someplace else on your body and you've tried everything. You've even seen your primary care physician, and it's not going away. What can you do?

Dr. Troy Madsen from University of Utah Health, first of all, what's going on when you have kind of this chronic wound that's not going away?

Dr. Madsen: Yeah, Scot, this is something I see all the time. So I do emergency medicine, and then I do wound care as well. So it's kind of two ends of the spectrum. I'm taking care of emergencies, and then I'm taking care of these people who I see who have had a wound on their foot or on their leg, and it's just this hole there that will not heal.

They may have been to a primary care provider. That primary care provider may have tried different dressings on it, saying, "Well, let's try this. Let's try this ointment on there. Let's put this bandage on there," and it just has not improved at all.

I've seen people who have gone through this process for over a year, and it is frustrating for them because the wound limits what they can do. They can't go swimming because they're told, "You've got to keep it dry," or they're told, "You've got to keep it elevated." So they've been going around on a knee scooter trying to keep it up, things like that, and they're incredibly frustrated.

So what can often happen with these wounds, once they get to a certain point . . . So let's say you get a wound on your foot or your leg, and you may have an underlying issue, say, diabetes, or peripheral vascular disease, or something that affects your ability to heal that wound, and the wound just stalls. It just sits there. And it sort of just gets in this comfort zone where it says, "Well, we're doing all right. We're not going to close up. We're just going to stay this way."

And unless something else happens, it's just not going to heal. You get bacteria that sit in that wound. Sometimes infections can affect it. And so you really need to get to a point where you can see someone and get some additional help to try and get that wound healed.

Interviewer: And what do these wounds kind of look like? Describe what somebody is seeing.

Dr. Madsen: So the classic wound in someone with diabetes is a wound on the soles of their foot. It's often overlying the joint, right where the toe meets the foot or maybe it's on the toe itself, and it just looks like a hole there. And maybe it's got kind of a dusky appearance to it, kind of a gray appearance in the base of it, maybe some drainage, kind of some clear or yellowish drainage out of it.

People who have vascular disease often have wounds on their lower leg, so down below the knee, often from the mid calf down through the ankle. These wounds are very painful. They're very sensitive. Again, they kind of have that appearance. The base of the wound, if you take your bandage off, you look at it, that wound just kind of looks gray in the base. It's not a healthy pink tissue.

And again, most often, they just have not seen any change. People have taken pictures of their wound to look for progress over months, and you'll look at the picture from a month ago or two months ago and now, and it's not any better or it's even worse.

So they're just not healthy looking tissue. They're gray. They're kind of this dusky appearance, some drainage maybe with it. Maybe they have a bad smell to it as well. And it's just . . .

Interviewer: Are they kind of scabbed over? Or is that a completely different thing?

Dr. Madsen: Sometimes, they are. Sometimes, on the lower leg, they may just have a scab that's sitting there and the scab just never seems to fall off and the wound never seems to heal beneath it. So that's definitely the case as well.

Interviewer: All right. Then what are some things that you can do to help kind of get things going again if that wound is not healing?

Dr. Madsen: Well, certainly, if you're in that situation and you haven't seen a doctor yet, go to your primary care provider. And sometimes just trying some different bandages, getting some ointment on there, something to maybe moisten that wound a little bit better is going to help it to heal, or at least kickstart that healing process.

But again, a lot of these patients I see, the large majority, have been seeing a primary care doctor and have been trying these things and aren't seeing any progress.

So there are clinics throughout the Salt Lake Valley or wherever you live that are dedicated to wound care. And this is what these clinics specialize in, people with chronic wounds.

And the process of going to that clinic . . . once you go there, a lot of the process is saying, "Okay, is there something underlying here that's just affecting this wound so it's not healing?" So if you have diabetes, how well controlled is your diabetes? If you have peripheral vascular disease, is there anything we can do to help these veins so you don't have fluid just backing up in your legs and leading to these wounds that just won't heal?

So that's a big part of it, is saying, "Okay, let's not just focus on the wound. Let's focus on your health and some of the other issues we can do to improve those things to try and help this wound to heal better." If your diabetes is not controlled, if your blood sugars are high, the wounds are not going to heal. If you've got fluid . . .

Interviewer: No matter what you do.

Dr. Madsen: Yeah. It's really not. You can try all kinds of things. If you have peripheral vascular disease and you've got lots of fluid building up in your legs, that just makes your skin so much more fragile and it causes it to break down. It causes new wounds. It affects the wounds that are already there. So you've got to address those things first. So that's a big part of going to the wound clinic.

And then the next piece of it is actually taking care of that wound and treating it. Like I said, a lot of these wounds are kind of . . . it's like the wound is in this comfort zone. It's just like, "I'm happy being a wound. I'm not going to do anything about it." So you've got to do something about it.

And part of what we do in the wound care clinic is debriding the wound. And what that means is actually putting some cream on the wound to numb it up, some lidocaine cream, and then once it's numb, scraping at the wound to get rid of that dead tissue.

As you get that dead tissue out of there, then you've got this bacteria that builds up in the wound, you get that bacteria up. That process then stimulates the healing process. It gets all the bad stuff out of the way. So then you're getting down to the good tissue. Then as you're treating that good tissue, this process kicks into play again, this process of healing and producing the growth factors, everything that's necessary to try and get that good tissue built up again.

So we go through that process every week of re-evaluating the wound, doing the debridement, getting rid of the dead tissue. Sometimes, it takes weeks or months to get a lot of that nasty dead tissue out on some of these really big wounds.

But as you do that, it's just remarkable to see how these wounds heal, to see that base fill in, to see this healthy red tissue in the base. And then as that fills in and fills in the base of the wound, to see that skin, that epithelium just kind of work its way across the wound until it's finally healed.

Interviewer: So what you described is scraping away some of that old dead material. Why is it a good idea to go and see a professional and have that done versus . . . That sounds like something that maybe anybody could do at home. Why is that a bad idea?

Dr. Madsen: Well, Scot, a lot of it is about maintaining some sterility using sterile instruments and then also really cleaning that wound well, which typically we're doing before we're doing that debridement. So I think that's a big reason to not necessarily try this at home, but go to a wound care clinic where they have the instruments and also the skill to do this.

A big piece of it too is that in debriding a wound, it's kind of like a balance. And I've heard it compared to sculpting. You can always take things away, but you can't put them back. So, as you're debriding the wound, you're trying to get rid of that dead tissue, but you've got to be careful because you don't want to take away the good tissue.

So, unfortunately, if you are trying to cut into your own tissue at home, there's a potential that you could really slice things up there, cause a lot of bleeding, and really make things a whole lot worse.

So it's a tough balance. It's a skill you develop over time in terms of doing these debridements. It's something I love doing, really cleaning these wounds up well. And you're really best to have a professional doing that.

Interviewer: It must be really satisfying when somebody comes in and has gone through all this frustration of just a wound that won't heal and the inconvenience it causes in their life, and spending . . . It sounds like it can take some time, but it sounds like it's really worthwhile.

Dr. Madsen: It really is. And quite honestly, it's just such a rewarding thing because I see these patients week after week. And to see that healing process, and to hear them talk about their frustration and the limitations and even embarrassment that wound has had and the impact on their lives prior to this, and then to have it heal, and then to see the healing process.

We do so much as doctors where we are healers, but to actually just watch that healing process is incredibly rewarding. So it's something I thoroughly enjoy doing. I love the people I'm able to work with. And it's always great when they are healed. Then they have a bell in the clinic. They actually let them ring the bell once they're healed and they leave, and that's always fun. So it's a great thing to see.

Interviewer: And for somebody looking for a wound care clinic like this, do they tend to be only in bigger cities or do most towns have them? I mean, where do you even start to find one?

Dr. Madsen: You're probably going to find them primarily in larger cities. So usually small areas, rural areas, it's typically not something you're going to see in smaller towns. So you're probably going to need to be looking more in an area . . . the same city in your region that has the referral center for other conditions. So it may mean traveling a bit.

We've had people travel from a couple hours away to be seen in our wound care clinic simply because they just haven't had the resources or haven't been able to get the help they need in their hometown, but they've wanted to do that and have certainly appreciated being able to do that to get their wound healed.

Interviewer: And being able to find that, is that something you would talk to a primary care provider? You go to the internet? What would be the first step to actually finding that clinic? I suppose Googling it.

Dr. Madsen: Yeah, you could Google it. Google "wound care clinic." Certainly, you can talk to your primary care provider. It's been funny, though. Sometimes I think a lot of primary care providers aren't aware of the resource or haven't utilized that resource before. So sometimes it may be a matter of even just contacting your insurance company, seeing what's in network.

They may require a referral through your primary care provider. But I think if you've had a primary care provider dealing with your wound for months, they're probably just as frustrated as you are and would be more than happy to refer you to a wound care clinic to try and get some additional help.

Interviewer: If you're not really physically active and you don't quite know how to get that 30 minutes a day in that they say that you should of physical activity, you shouldn't completely give up because there is benefit to shorter amounts of exercise.

Dr. Troy Madsen is from the emergency department at University of Utah Health. And Troy, tell me about this recent study that came out that said even just little bits of activity could make a huge difference in your health.

Dr. Madsen: That's right, Scot. So there was a study in the journal "Nature Medicine" that looked at people who basically were pretty much sedentary. And then within this group, they compared people who were having just what they were describing as vigorous, intermittent lifestyle physical activity, which basically just means short bursts of energy like a minute long. So I'm talking like walking up the stairs, moving furniture, shoveling snow.

And they found that people who were just doing just a very minimal amount like that, maybe three times a day, had significant improvements over the next six or seven years in their cancer risk, in death from cancer, heart disease risk. Really surprising results just based on very small amounts of activity, just short bursts of activity that yielded big results for  them.

Interviewer: That's pretty incredible. Does that surprise you?

Dr. Madsen: Oh, it really surprised me, yeah. We always think, "Okay, you've got to get 30 minutes three times a week." And that's kind of the number we put out there. If you really want the health benefits of exercise, it has to be more than just a minute. But again, they were comparing people within groups where they were pretty much sedentary otherwise. They really weren't exercising, and they weren't doing 30 minutes three times a week.

But I think the point is if you happen to be in that group where you're just not getting a lot of activity, if you can just take the stairs, just do stuff that kind of gets your heart rate up, vigorous activity, a minute, two minutes two or three times a day, you will definitely see benefits compared to not doing those things.

Interviewer: So then if somebody starts incorporating that into their life, is that good enough, or can you actually then get more benefit if you do that more exercise like we tend to believe?

Dr. Madsen: Yeah, you definitely do get more benefit. So that's one thing they found as well. Once you went beyond that, certainly if you are going beyond that, you are getting additional benefit. But all that being said, the point they tried to drive home with this was there was a significant benefit from doing a lot less than what a person thinks they might need to do to get some benefit from exercise.

Interviewer: And what would your takeaway for a patient be with this information?

Dr. Madsen: My takeaway would be if you're just sedentary, you just don't exercise consistently, try just taking the stairs. Try doing something. Again, they talked about people who are saying they move furniture or they shovel their snow, just things like that. Short bursts of activity, just do that a few times a day. I think you're going to be better off in the long run for sure.

Interviewer: So are you advocating then that instead of that 30 minutes a day, if I'm getting that, I could just do one or two minutes a day?

Dr. Madsen: That's a great question, Scot. You're definitely better off doing the 30 minutes three times a week. No question about it. Researchers showed that as well in this study. But compared to those who were doing nothing, if you can at least get this one or two minutes a few times a day, you're better off than that group.

Interviewer: And maybe that'll get the ball rolling and help somebody get up to the 30 minutes that thought that they might not be able to do that.

Dr. Madsen: That's exactly right. I think you're going to get immediate benefits from it. There are long-term benefits. I think you're going to feel better doing it, and then hopefully get up to more of that 30 minutes three times a week.

Interviewer: And we're talking about internal health benefits. You might not necessarily see weight loss or anything like that.

Dr. Madsen: You might see a little weight loss too. But the study is talking specifically about, like you said, those internal benefits, reduced risk of death, heart disease, cancer years down the road, but I think you might even see maybe a little weight loss. You're going to feel better. You're going to feel more active, more mobile. So I think all of those things are going to have immediate benefits. 

Interviewer: So during the summer months, temperatures are rising, people are getting out more, and you might be getting a little concerned about heat exposure and how it might be impacting your health.

We're here with emergency room physician, Dr. Troy Madsen. And Dr. Madsen, when it comes to heat exposure, what do people need to be concerned about?

Dr. Madsen: Well, the biggest thing with heat exposure is just your body overheating. That's where you really start to see issues not just with feeling uncomfortable, but potentially having even a life-threatening situation. Some people . . . you know, you may be familiar with just being out in the heat, you've been hiking or on your bike, or you know, whatever you might be doing, and you're probably familiar with that feeling of just feeling thirsty and tired and maybe a little bit nauseous and maybe a little bit of a headache. Well, at that point, you may be experiencing what we call heat exhaustion. But the big risk becomes when you move beyond that, and your body temperature continues to rise. And then you can experience what's called heatstroke. And that becomes a much more serious thing.

In those situations, your body temperature is often very high. You can have damage to the organs in your body, meaning damage to the kidneys, even potentially the heart, the brain. And in some of those situations, when you hear about these stories of people in places where there is just extreme heat and people are dying of the heat, it is often because of heat stroke that that's happening.

Interviewer: Yeah, we hear about these deadly heat waves and things on the news. And it's, you know, what does that even mean? We're talking like organ damage. Like the heat is getting so high that . . . are you talking brain? Are you talking heart? Who is at risk, and what is it actually doing to the body?

Dr. Madsen: It's exactly that. The body is getting so hot that it is leading to damage and breakdown of the tissues in the brain, the heart, the kidneys. Sometimes part of that is dehydration that's contributing to that as well where that's affecting your kidney function. But in terms of risk, there are a few groups who are really at risk of this. Number one is people who are experiencing homelessness, who may be out in the heat, aren't in a cool place. Other people who are out doing outdoor activities. And maybe you find yourself in a situation where you're out, you're exposed, you know, there's no way to really cool down, maybe you didn't bring enough water along on your hike or your bike ride.

But then there are also certain groups that are really at risk. And these are the very young and the very old. So young babies, infants, and then older people have a tougher time regulating their body temperature. So you might be out, and let's say you take your baby, you know, in a stroller, you're out on a walk, or you go to the zoo or something and you're feeling okay, or maybe you're feeling just a little bit of a headache or a little bit hot. Your baby could be experiencing very severe symptoms in that situation. So if you live with the very young or the very old, just be aware that if you're not feeling great, they're probably experiencing a whole lot more of the heat and much worse effects than you are.

Interviewer: So it sounds like heat exposure affects basically anyone and everyone if you don't, you know, take the right steps. What are some of the ways that a person can, say, prevent heat exhaustion and then later heat stroke?

Dr. Madsen: Well, the biggest thing, you know, is to try and be in a situation where you can cool down. If you're out on a hike or you're out somewhere in the outdoors, try to go in shaded areas, ideally areas that have a water source, something where you can cool down if you need to. Carry plenty of water, you want to make sure you have lots of water with you. The general rule of thumb is 16 ounces of water per hour. I tell people start with at least eight ounces if you're just doing moderate activities. Sixteen ounces can be a lot to carry if you're out on several hours, but try and do that if you can, or at least know where you can get some water.

The big thing I would suggest too is if you have elderly parents, relatives, friends, neighbors, check in on them. One of the sad things that sometimes happens is older people, especially right now, may not have checked their air conditioner, may not know if it's working, or it may work and then it stops working. And sometimes a very sad thing we see is people in this situation then are either embarrassed to reach out for help or don't know who to call for help. And the house temperature gets very hot, and they experience severe symptoms with heatstroke or even death. So check on those people. If you have babies as well, just be aware that they can experience these heat symptoms much more than you may be experiencing at that same time.

Interviewer: So heatstroke, something to keep in mind, something that could be very, very dangerous. ER-worthy if it gets bad enough?

Dr. Madsen: Absolutely, yep. If it's bad enough, if you have a family member or yourself who's just confused, not feeling well, absolutely, get to the ER. Try to get cooled down quickly. Call 911 if you need immediate help.

Interviewer: Are you working out from home with exercise bands? Well, you might want to watch out for this injury.

Dr. Troy Madsen is an Emergency Room physician at University of Utah Health. And a lot of us are trying to get in some exercise at home, and we might reach for those exercise bands. But, Dr. Madsen, I understand that there could be some risk working out with those exercise bands. Tell me more about that.

Dr. Madsen: You know, Scot, I have used exercise bands, and this is a risk I've never really considered, but apparently there is an increase in risk and injury to the eye that has been something that's been noted since the pandemic started. So what we're seeing, I think, more and more people are not going to the gym, they're working out from home, and a great tool is a resistance band. If you've ever used this, it's like a giant elastic band. You know, these things are huge. You put it around your foot, and then maybe you're leaning back or doing something with your leg, all kinds of different things, stretching, strengthening.

Well, at the University of Miami, they actually published their experience with seeing multiple patients come to the Emergency Department with injuries to their eyes from these resistance bands. So the title of this article is "Ocular Trauma Secondary to Exercise Resistance Bands During the COVID-19 Pandemic," published in the "American Journal of Emergency Medicine."

And you can imagine how this can happen. I don't know if this has ever happened to you, but let's say you wrap it around your foot, and you're stretching your leg out, and that thing is really tight. And then, maybe you've got socks on or something, and it slips off your foot and flips back and hits you in the eye.

Interviewer: Oh. Ow. Oh.

Dr. Madsen: Yeah, sounds miserable. Sounds absolutely miserable.

So they reported their experience in the "American Journal of Emergency Medicine," and they talked about 11 patients they had seen, and these were not minor injuries to the eye. So they said 11 patients, 14 eyes, so that means several of these patients had both eyes injured. Eighty-two percent of these patients had a hyphema.

So a hyphema is a pretty big deal. That's where you get blood behind the cornea. And, you know, if you ever look in the mirror, you see the cornea, you see your iris, the colored part of your eye. The cornea is the clear part over the top of that. And if you ever see blood there, it just looks like just this red line that's filling up behind there, that's a pretty big deal. That's a serious injury.

And then, vitreous hemorrhage in 36% of these patients. That's blood back behind the iris, back in kind of the main part of the eye. That can really affect your vision. Potentially, if it causes enough damage, potentially have long-term effects. Same thing with a hyphema if it's not treated.

So these are not minor injuries, but they saw a number of these, and just given the number they've seen, they reported on it in the "American Journal of Emergency Medicine" to make people aware that things are happening with resistance bands.

Interviewer: All right. So not happening to, necessarily, a large number of people that we know of, but is in the realm of possibility of happening apparently.

Dr. Madsen: Exactly. And I think the reason they published this and their conclusion was, if you're using a resistance band, wear glasses or consider wearing goggles. I mean, it may seem like overkill. It is something that emergency departments are seeing. This is one emergency department's experience. I'm sure it's happening elsewhere. I have to be honest. I have not seen this in the ER yet, but if we talk to some of our ophthalmologists, my guess is that they probably have. So it's out there, it's happening. You know, takeaway, be aware of it and consider wearing some glasses or goggles if you're using a resistance band.

Interviewer: Yeah, or consider just making sure that you're looking at how you're using it, and "If it was to slip right now, would it slip back and snap me in the eye?" And is there an adjustment you can do in your form that would, you know, prevent that from happening?

Dr. Madsen: Yeah, exactly.

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Scot: Okay. Let's talk about COVID now. Woo!

Troy: Yeah. Love COVID.

Scot: Do you really? If you love it so much, why don't you marry it?

Troy: I pretty much have. I feel like COVID has just moved in here and it's joined the family.

Scot: Just sleeping on your couch, will never go away.

Troy: Sleeping on my couch, yep. Just on the couch, just a guest that just does not take a hint.

Scot: The podcast is called "Who Cares About Men's Health," and around here, we like to think of health as the currency that enables you to do all the things you want to do. My name is Scot. I am the manager of thescoperadio.com, and I care about men's health.

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

Scot: And today's show, Troy, Dr. Madsen, is an emergency room physician. And of course, all across the United States, we are seeing new stories that this big, huge wave of COVID is coming. I wanted to talk to Dr. Madsen, because you and I don't necessarily talk about this that much, about what you're experiencing in the emergency room when it comes to this pandemic.

So, first of all, are you seeing a lot of COVID in the emergency room, or do you not really see it there?

Troy: We are seeing a lot of COVID in the emergency room. So anyone who has symptoms where they're concerned about COVID, they're coming to us. They're not really going to a primary care doctor because the primary care doctor is going to say, "Hey, if you think you have COVID, go get tested. And then if you're feeling really sick, don't come to clinic." If the clinic is even open. They're saying go to the ER. So we truly are on the frontlines of this.

We have a dedicated respiratory unit, so an area of our emergency department that is set aside for patients who have COVID or potentially have COVID. And I will say that the shifts I've worked there lately, that unit is full, and we have patients waiting to try and get back in there. So there's no doubt we're seeing COVID, and we're seeing a lot of it.

Scot: And what's a typical patient that comes into the ER with COVID? How bad of a sick is it?

Troy: Yeah. Great question. So, first, to break that down, I would say in our respiratory unit I see three different types of patients. Number one is the patient who comes in who has a cough and fever, who you think has COVID, but is well enough to go home. We'll send the COVID test, tell them it's going to take 24 hours to come back, go home, self-isolate.

Then we get the people who come in who know they have COVID, they're one to two weeks into it, and they feel absolutely miserable. Sometimes they're well enough to go home. Sometimes they need to be admitted, because their oxygen level is low.

And then the third type of patient we have come in I see a lot of are the people who are probably a little bit on the older side, have some medical issues, who come in and are really sick. High fever, maybe their blood pressure is low, their heart rate is going fast.

Some cases, I have had people come in with oxygen levels that I have never seen in a living person or someone who is actually able to walk and talk. I've had people come in with oxygen levels on room air, which is breathing room air oxygen, in the 50s and 60s. Just for reference, normal is greater than 95%. This is down at 50% to 60%. It absolutely blows my mind to see this, but I've seen it on several occasions, people who come in with these unbelievably low oxygen levels. We put them on oxygen. We have high-flow oxygen, all these things we're doing for them to get their oxygen level up. They get admitted to the intensive care unit.

Scot: So then, every shift, are you dealing specifically with COVID, or as an emergency room physician, sometimes you work in the regular ER, sometimes you have to go to the respiratory unit where the COVID patients are coming in? How does that work?

Troy: So probably a third of my shifts, third to a half, depending on the month, are in the respiratory unit. The rest are in the main emergency department seeing all the other stuff we see -- abdominal pain, chest pain, heart attacks, strokes. Obviously, none of that stuff has gone away, so we're still seeing all that as well.

Scot: So how are you holding up mentally as a healthcare professional with COVID? Is this truly unlike anything you've seen before? Is it taking a toll on you in a way that the day-to-day that is very stressful in the emergency department not during a pandemic is?

Troy: Yeah, it's interesting, Scot. I try to be fairly objective about things and try not to overstate things or overdramatize things, but this has been a unique situation. It is unlike anything I've experienced before, and I think it's unlike anything anyone working in healthcare right now has experienced before.

The closest analogy I can have for this is H1N1. And when we dealt with that, that I think put everyone's anxiety up a bit and we're all like, "Are we going to catch H1N1? Are we going to get it ourselves?" But this has certainly been a whole other level of that.

Prior to COVID, I had never sent anyone home on oxygen. We'll have people come into the ER and if they're sick and they need oxygen just to be able to breathe, they get admitted to the hospital for it. But now with COVID, our hospital, we're at capacity. The way we've been able to work with that is people who are under 50 and maybe don't have other medical issues, we're sending home on oxygen and telling them, "Use the oxygen. Try and check your oxygen levels. Turn it up if you're having trouble breathing, and if you can't turn it up more, if you max it out at six liters, come back in and we'll have to admit you."

I've never done that before, but that's a contingency we had to put in place initially to be able to deal with the surge of patients and be able to have hospital beds for the people who absolutely need it. It's a strange situation to be in to be doing that. And as I look ahead, I don't know what the next month or two will hold.

There have been some times when I'm in the respiratory unit and it feels a little bit like being in a war zone, where you've got all these people, they're sick, we're taking care of them, let's get them upstairs. We've got three ambulances coming in. We've got no beds for them. It's been interesting.

And all that being said, I think our administration has done everything possible, has done an incredible job of dealing with this and having contingency plans and surge capacity and everything we can do, but at a certain point, those resources max out. And again, I've always worked in busy ERs, and we've always dealt with overcrowding and all that.

But you asked about from a personal standpoint, I think I went through a phase initially over the first three months where I was very, very anxious. I was very anxious. I would go into work, and I'd be like, "Man, I am going to catch this virus, and this is not going to be good." I think I've settled into things now, settled in the routine, and also, in terms of taking care of this new disease, become much more comfortable with that after seeing so many patients with it and so many sick patients.

I've probably tried to compensate for it just by running more. I think we may have talked about this. As of June 1, I increased my weekly mileage by about, I don't know, 30%, 40%. So I have probably tried to just compensate for it just by running more. And partly, that's just to say, "Hey, the best defense against this virus is being in the best shape you can be in."

Scot: Yeah. Having a strong immune system. And also, you've talked about how that's how you deal with things from a mental standpoint, is exercise.

Troy: Oh, yeah.

Scot: I read something that was really . . . actually, somebody told me that I need to get this book. It was fascinating. It talked about if you find yourself in fight or flight mode . . . which I'd imagine COVID does. That's what stress is for any of us. It's a fight or flight mode. That's what stress is. You have these chemical reactions happening in your body. It's dumping cortisol into your system. The way to get around that is you have to do something physical.

And I'd love to get this book and find out if they talked about why, but on the surface, and this is not the scientific explanation, it makes sense, right? Because if you are in this fight or flight mode, then from a physical standpoint, your body is ready to do that. So if you can do that, then you feel better about things.

It's just the difference is it's not a physical threat like it was if it was a saber-toothed tiger. A lot of times now it's mental threats, but still, the way to get over that is to . . . I also heard getting hugs, so get hugs, but to physically just get rid of it, which I find fascinating.

Troy: Something I've done as well is . . . because I just felt like, "Okay. This is a new disease. I've got these sick, sick patients," and that created some anxiety, but I just thought, "I'm going to hit this head-on. I'm going to hit this head-on, and I'm going to be ready for them."

And every day, every day for the past several months, I have practiced physically . . . talking about taking that physical action. I have physically practiced and I have this lo-fi simulator I've created. I physically practice walking through the steps that I will take when someone comes in and they can't breathe.

And it's not just sticking a tube down their throat because we want to avoid that. We want to keep them off the ventilator. You may have heard some of the numbers on that. It's every step along there. "The oxygen. Okay. That's not working. Add on the non-rebreather mask. Okay. High-flow oxygen. Then we go to CPAP. Okay. Let's get ready to intubate." I walk through that every day physically.

And you would laugh if you saw the simulator I created. Laura saw it. She's like, "What is this?" I would probably be embarrassed to send a picture, but it's essentially my simulator and just some old equipment I've gathered over the years of just stuff I can physically handle, just like putting the oxygen on this on my simulator and putting the non-rebreather mask just so I feel like I'm physically doing this every day. And then, when I've had these patients come in, it's just like that muscle memory is there.

So I think partly, yeah, there's the physical running. There's that part I've done to deal with it, and that I think helps process a lot of things. But just being able to physically walk through this every day and just be like, "Hey, I want to be ready for this, and I feel ready for it," I think that's helped a lot with that anxiety piece as well.

Scot: You are one of the people that I just admire so much because I know that this virus is taking its toll on healthcare systems and healthcare workers all over the place working tremendously long hours, the stress that comes along with it, but you always seem to manage to maintain a pretty good attitude. How do you do that?

Troy: I don't know, Scot. Sometimes I feel like my attitude is not very good. Thank you. Great question. Maybe that is my coping mechanism, to put more of a positive spin on things.

But emergency medicine is inherently stressful, and that's one thing I've accepted over the years, and it inherently has a lot that you take home with you. And I always say emergency medicine keeps you up at night. It keeps you up at night because you work night shifts and it keeps you up at night because you take a lot of it home with you and you think about it.

COVID, I think, has compounded the stress of emergency medicine several times, many times. Just that sense of sometimes feeling overwhelmed. And seeing those cases multiplied many times of . . . the cases that you used to see here and there and that you'd think about a lot, but to see that many times over.

To have someone come in the ER who's about your same age and you're doing CPR on that person and you don't get them back has been a lot of what has been challenging for me over 15 years of practice compressed into about nine months of . . .

Scot: Wow.

Troy: Yeah, just in terms of really tough cases. Tough cases meaning cases where you have cared for people who didn't make it. It's been a lot more of seeing that over this period of time than I've seen in my career prior to this. So that's tough.

I think you're right. I'm probably downplaying things a bit and focusing on the positive, because there is a lot of positive too. I don't want to say there's not, but I think just the teamwork aspect, the way our team has come together to deal with this in spite of their personal challenges and professional challenges, the way our administration has responded has been very positive.

And then to see these people who come in really sick and to be able to care for them at this time is a positive thing, in spite of the challenges. At least you're able to offer something. I can't offer a cure. The treatments we can offer are not great. At best maybe some evidence behind it, but not great, but at least to be able to offer that during such an uncertain and difficult time for them. I think that it's difficult, but it's also empowering.

And while I think so many of us feel like we're stuck at home and there's nothing we can do, at least I do have that where I can feel like, "Hey, I'm doing something. I'm trying to help."

I'm doing some research with COVID too, which hopefully has a bigger impact on understanding COVID and the disease process. So I think at least that gives you a little bit more sense of empowerment, and I am grateful for that, that I do have that.

I think certainly distractions of health. I like listening to these Great Courses. I don't know if you ever listen to The Great Courses on audiobook, but I love listening to that kind of stuff. A lot of science stuff. Some stuff that has nothing to do with my job. I just love listening to that.

And it's funny. I'm actually listening to a book on stoicism right now on philosophy, on the stoics, and certainly relevant to our time. I think that helps as well.

It helps being able to come home to a supportive spouse with Laura, who's very supportive, and I think certainly has faced her challenges with work and with adjusting to working from home as well, but in spite of that, obviously, has a great attitude and is a very positive person.

And coming home to 17 kittens. If that doesn't brighten your day, I don't know what will. We don't have 17 kittens right now. At one point this summer we did have 17 kittens, but we have four little kittens right now that are the cutest little things you will ever see. And when you come home grumpy and you see those little faces, honestly, it's hard not to feel good about things when you see that.

Scot: So COVID is real? It's a real thing?

Troy: Yeah, it's real. It's legit. Yeah, it is real. It is such a weird disease process unlike anything I've seen. When you look at chest X-rays of people who come in with COVID, the best analogy I can come up with would be . . . If you have an X-ray of someone's lungs, on an X-ray, healthy lungs are black. They're dark with some little thin white streaks on it. The chest X-rays of people with COVID look like you took a black piece of paper, put it against a wall, and shot it with a white paintball gun, little white paintballs. There are little splotches all over it. Just really unlike anything I've seen before.

It's just such a bizarre process and just to see the full range of how sick people are . . . yeah, it's legit. It's real. It's a crazy disease. It's challenging to deal with. We're seeing really sick people. The hospital is full. The best thing you can do is the simple stuff: wear a mask, wash your hands, avoid social gatherings, social distance, all the stuff health officials are telling you.

Again, it's something we hear again and again and again, and I don't want to get on my soapbox about it, but as a healthcare system, we certainly appreciate the help and support people are offering.

And a thank you goes a long way. I'll say that as well. It's been funny. We got a lot of thank-yous in the ER. Back in April and May, when we were really not that busy. It was like, "Well, you're welcome."

Scot: Compared to now, right? It's a lot worse.

Troy: I know. Tell your healthcare worker thank you. We're nine months into this. We could use a hug, a socially distanced hug. Pat on the back, a thank you, whatever it is, I think we're all feeling that and we appreciate it when people offer that.

Scot: Time for "Just Going To Leave This Here." It might have something to do with health, or it could be something completely random that we just feel compelled to talk about. Troy, do you want to start with "Just Going To Leave This Here"?

Troy: Scot, I'm just going to leave this here. We just talked about COVID and talked everything about COVID. And obviously, COVID and 2020 have become synonymous. Although it's COVID-19, but it's 2020 that's . . .

Scot: We're on a first-name basis with this thing now.

Troy: Yeah. We don't call it COVID-19. It's just COVID. So I know you have seen me many times pull out my little black planner, and you have harassed me for pulling this thing out.

Scot: You don't use electronic means to keep track of your schedule like the rest of the world. You still have a little black planner that you keep in your shirt pocket.

Troy: Yeah. I am still stuck in the '90s. I have a little black planner I pull out. I just bought my 2021 planner. It has November and December of 2020 in it, and it was such a relief to take that 2020 planner and throw it away and start using this one that says 2021 on it. It filled me with a sense of hope that maybe we're moving into something better.

Scot: Did you burn it? Did you throw it out in the yard and stomp on it?

Troy: Yeah, I should have held some sort of ceremony.

Scot: Just going to leave this here. This might also bring some light to your life. I don't know if you like eating raw cookie dough. So I like eating raw cookie dough. My wife hates it. I don't know where you're at on it.

Troy: I don't know. The raw egg piece of it is kind of . . .

Scot: See, that's the thing.

Troy: There's that.

Scot: There's the safety element. Eating raw cookie dough can be dangerous because you've got the raw eggs, so they tell you not to do it, although that never stopped me. I bought some cookie dough the other day that on the outside it says, "Safe to eat raw." So, apparently, technology has finally given us cookie dough. Somehow, and I don't know how they've done it and I ain't asking questions, they are marketing and put on the package "safe to eat raw."

So, in this time of a pandemic, now at least if you're eating cookie dough, you're not worrying about salmonella. So there you go.

Time to say the things that you say at the end of podcasts, because we are at the end of ours. Troy Madsen, go.

Troy: Check us out on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. You can reach us at hello@thescoperadio.com or you can call us at . . . Scot, what's that number?

Scot: Oh, that's a good question. 801-55SCOPE?

Troy: 601-55SCOPE. Don't confuse it for the 801, Scot. This is 601-55SCOPE in Quitman, Mississippi.

Scot: Also, we would love it if you would subscribe to the podcast on the podcatcher of your choice. And thank you for listening and thank you for caring about men's health.

Interviewer: What is the fine line between a few drinks to relax or blow off steam and a potential alcohol abuse problem?

Dr. Troy Madsen is an emergency room doctor at University of Utah Health. Dr. Madsen, I hear that doctors have a series of questions that they ask patients, and it's pretty accurate at indicating if somebody has a potential alcohol use problem.

Troy: We do have a screening tool we use. We all learn this in medical school, and it is something that we will then use in our practice, is a quick screen to say, "Does this individual potentially have an alcohol use disorder that we should look into further and ask some more questions and see, 'Well, how much are you drinking? Do you need some help?'"

This is a tool that's called the CAGE questionnaire. So the first C, the C stands for cut down. Have you ever felt you need to cut down on your drinking? The A is annoyed. Have people annoyed you by criticizing your drinking? So, for each of these, you get a point if you answer yes. G is for guilty, G of CAGE. Have you ever felt guilty about drinking? And E is for an eye-opener. Have you ever felt you need a drink first thing in the morning or an eye-opener to steady your nerves or get rid of a hangover?

Now, if you answer yes to two of those questions, so if you have a score of 2 or higher, it has a 93% sensitivity for identifying excessive drinking and a 91% sensitivity for identifying alcoholism. That means it's a pretty good tool for potentially identifying individuals who may be needing some help, again, just answering yes to two of the four CAGE questions.

Interviewer: When you say over 90% accuracy that that person may have a drinking problem, this is research supported?

Troy: It is. Multiple studies. This CAGE questionnaire has been around for many, many years, decades. They've got studies going back into the '80s on this. So it's something that's been studied over many, many years, many, many people.

If you're answering yes to two or more of these . . . let's say you've had people tell you, "You really should cut down," and let's say people are critical of you, you get annoyed by it, if you've got two of those four, that's potentially a sign that maybe you need some help. Maybe you do have an alcohol use disorder.

Interviewer: What if you just have one? Is that supported by the research? Does that necessarily mean anything?

Troy: So that's considered a negative screen. So, if you just had one . . . let's say you felt guilty about your drinking, so you got the one point there, but you didn't answer yes to any of those others. It's like, "Well, no one has ever told me I should cut down. I've never really felt annoyed. I don't really need an eye-opener in the morning to take care of a hangover," so if you just get the one, technically, that doesn't get you a point.

Obviously, there are a whole lot of other variables that play into this, like who you are hanging out with. If you're hanging out with people who are drinking a lot, they're probably not criticizing your drinking and you're probably not getting annoyed by it. So it's one of those tools where it's not a perfect tool.

The advantage of this tool is just something quick that we can do as healthcare providers. It's a quick screen. Just talking through those questions took us maybe 30 seconds. And if you're getting a score of 2 or higher, it doesn't mean you have an alcohol use disorder. It just means, "Let's do some additional screening to see if that's potentially an issue."

Interviewer: It's pretty amazing how accurate the CAGE questionnaire is, but is that where doctors stop, or are there some additional questions that a doctor might ask, or is there an additional resource that a patient could go to on their own to find out a little bit more information?

Troy: There's something called the AUDIT questionnaire, and if you search for that, you can find it online, but that goes through in more detail about getting into exactly how many drinks you have per week, how many you have at once, and getting into the whole binge drinking thing.

And some of those CAGE questions, it kind of goes through some of those again as part of it, but it's a 10-question questionnaire and that really then breaks things down by a score to say "Are you a medium risk? Are you a high risk? Are you at a point where addiction is likely?"

So it's an additional questionnaire. We don't need to go through all the questions on it, but I think that can be helpful as the next step to potentially see, "Is there an issue that I should get some help for, or where are things right now?"

Interviewer: And if somebody has taken the test and they're thinking, "Wow, maybe I should look at getting some help or I would like to get some help," what would the next step be? Because that seems like it could be intimidating.

Troy: If you're looking for inpatient treatment where you need inpatient detoxification and you need medically-assisted treatment to be able to just reduce your drinking or cut off from drinking, it's something you can talk to your doctor about. I think, regardless, I'd talk to your doctor, but they can help set those things up for you. There are many community resources available for that as well.

In some people, it's just the sort of thing where they just reach a point and they just say, "I need help, and I need it now, and I need to make this happen, and I don't have time to wait on that." We see those individuals in the ER on a regular basis. You can come in. We can talk to you about options. In some cases, we admit people to the hospital for this if they are in withdrawal and they have severe symptoms. I'd say I admit people for this . . . it's a weekly thing for me where I'm admitting patients for this.

So, with any substance use disorder, I think the important thing is just reaching out for the help. And I think that's the hardest part, taking that initial step, but if you can reach out to family and say, "Hey, I've got an issue. I need help," I think that's . . . it's a huge thing just to be able to do that. Then you take it from there and you'll get the help you need as long as you just keep pushing forward.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

The COVID-19 pandemic has put most people in an unprecedented situation of stress. This is especially true for healthcare professionals working on the frontlines against the virus. For emergency room physician Dr. Troy Madsen, working in the ER during this time has been an emotional roller coaster.

Troy has been dealing with the stress of putting himself at risk for infection every time he goes to work. He shares his own experience of being a doctor during the pandemic and how he's been coping with the new normal.

If you have a friend or family member that is working on the front lines, Troy urges compassion and understanding during this time. Let them vent about their situation. Be kind to them and their needs. Be willing to forgive them during this time as they are dealing with a situation that is stressful and unlike anything they've ever dealt with before. Coping with Pandemic Life

For those of us that are not health care workers, Troy and Scot discuss some of the strategies they're using to stay positive during this taxing time:

• Be kind to yourself. Remember you don't need to be perfect right now.
• Find a healthy coping mechanism that can help keep you manage your stress.
• Schedule times in your day to unplug from the stresses of work and the 24-hour news cycle.
• Take time to recognize and celebrate the good things that may be happening in your life.
• Take stock of the things you can control in your daily life, and make decisions you can be proud of (how you act with your family, what you eat, etc.).

These past few weeks have been a struggle for everyone and not just physically but mentally as well. Be sure to take care of yourself. Talk to Us

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

Interviewer: It's time for "ER or Not." That's where I come up with the scenario, give it to Dr. Troy Madsen. You get to play along at home, decide whether or not it's something you'd go to the ER or not for, and Dr. Madsen will give us the definitive answer.

So today, it's more of a general "ER or Not." Like the ABCs of emergencies, how can I decide if something that's happened to me is a reason to go to the ER or not? Do you have some guidelines for us?

Dr. Madsen: Yes, Scot. You know, this is a great time to think about it because, like you said, we really need to think about these resources in the ER and leaving these for the people who really need them right now. So a good rule of thumb is to think ABC. And we'll say ABCD. We're going to add a D as well here. So A is airway, B is breathing, C is circulation, D is disability. So if you're having issues with any of these things, you need to go to the ER.

So A would be airway, your airway is blocked. You're just not getting air in. B is breathing. I'm feeling short of breath. I just can't get a deep breath. You know, I feel like my oxygen levels are low. C is circulation. So that would be your blood pressure. My blood pressure is low, or maybe it's just really, really high and I'm having other symptoms with that. Or I feel like I'm having a heart attack, something that's affecting my body's circulation. Or certainly, if you're bleeding, you know, that's going to be losing blood and affect your circulation. Or D is disability. That would be like a stroke, like I'm disabled. You know, suddenly I can't use my left hand or my face is drooping. So those are absolutely reasons to go to the ER.

But if you don't have those things, there are lots of other resources you can use right now. And I think telemedicine is a great resource right now to call in and talk to someone on the phone, talk to a physician or a health care provider, say, "These are my symptoms." You know, "I'm having this abdominal pain. This is where it hurts. What do you think I should do?" They may say, "Ah, give it 12 hours, see where you are." Or they may say, "Go to the ER." So great time to use other resources. At times, go to the urgent care. I do know urgent cares have been really busy with lots of people with coughs and respiratory symptoms as well. But try to do something besides going to the ER and only go to the ER if you are having those things. Otherwise, start somewhere else first. They'll direct you to the ER if that's where you need to be.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

It's easy when talking about health to lean towards flashy topics like the latest fad diet or some ‘new' exercise routine. Yet the majority of the threats to your health have very little to do with getting on the magazine of a cover. Dr. Troy Madsen has identified the top five bits of advice he suggests everyone take to heart to avoid the potentially life-threatening consequences that can impact your health.

1. "Wear your seatbelt." "Wear a helmet." "Get a spotter when using a ladder."
   We hear these phrases so often it's easy to ignore them, but injury from trauma is one of the biggest threats to your health, especially for men. Even if the injury is non-fatal, it could cause long term consequences to your physical ability and health that may be permanent. Heed common sense practices to prevent severe trauma.

2. "Talk to Someone" about Your Mental Health.
   Low-level anxiety, work-related stress, and even minor depression are all emotions we feel relatively regularly. It's easy to just "deal with it" or "tough out" these feelings. However, these feelings could all be symptoms of something more serious or a growing condition. It's important to seek help for your mental health before it develops into a crisis.

3. "Drink in Moderation."
   Alcohol is involved in so many of the health emergencies Dr. Madsen sees in the ER. Whether it be people making bad decisions after a few drinks, flat-out alcohol poisoning, or driving while drunk, too much alcohol can lead to immediate threats to your health.

   Additionally, long term over-use of alcohol can lead to severe chronic - and often permanent - damage to your health. These conditions include liver disease, heart disease, and kidney disease. Some of these conditions can be so severe that they require organ transplants.

   There are many immediate and long-term health problems related to overusing alcohol, so drink in moderation to prevent bad decisions now and potential problems 20 years down the road.

4. "Eat Your Vegetables."
   A healthy diet and good nutrition are more than just for weight-loss. A proper diet keeps your body strong and capable as you age. Dr. Madsen sees a lot of patients in their 50s and 60s dealing with problems related to poor diet. Premature aging, heart disease, obesity, and other health problems can form over time with a bad diet.

5. "Go to the Doctor."
   A lot of health conditions can be prevented and treated with proper screening and professional intervention. Unfortunately, a lot of people are not using the healthcare resources they have available through their insurance. On top of basic preventative care, most insurance plans include services like health screenings, mental health assistance, and even fitness benefits. Dr. Madsen highly recommends checking out what services are available to you and really taking the time and effott to utilize them. It's worth the investment.

If you can address the more mundane, cliche, boring stuff now, then you can keep your health boring for the long term. It's best to avoid anything "too exciting" like a heart attack or stroke, so do the boring things and keep your health static. Talk to Us

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

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

In this week's special episode, the Who Cares Guys are doing their part in flattening the curve by recording remotely and practicing physical distancing.

It's important during this time of the COVID-19 pandemic to change your usual behaviors to limit the spread of the disease. Even young healthy individuals can be carriers for the disease without showing any signs.

"Don't be a vector," says Scot. He urges listeners to think of others when they think of their hygiene. It's important to be diligent during this time not just so you don't get sick, but to ensure the health of your family, friends, and the community around you.

That being said, the relatively sudden shift to working from home and physically distancing has been rough for a lot of us. Troy, Scot, and Mitch have all been adjusting in their own way and have been trying different strategies to adjust to the new normal under COVID-19.

Maintaining your health during this time is crucial, regardless of your age or gender. Maintaining and improving your healthy habits can bolster your resiliency and keep your immunity up. It's important now, more than ever, to focus on the Core 4.

The Who Cares Guys share the strategies they're using to keep up their activity levels while distancing and eating well when stuck at home. They also discuss what they're doing to keep their stress levels down and keep up a decent sleep schedule during this time. Talk to Us

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

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

If you've ever looked up your medical symptoms online, it can seem like every website assumes the worst possible scenario. These results can be alarming to say the least. So where can you find reliable health information online?

Dr. Troy Madsen has dealt with the stress of trusting bad online information personally and professionally with his patients. He's put together a list of websites he uses and has found to be the most reliable to find information on any medical topic.

• Centers for Disease Control and Prevention (CDC)
• The Mayo Clinic
• The Cleveland Clinic
• University of Utah Health
• MedScape.com
• UptoDate.com

Each of these websites are from reputable health organizations run by professionals. Dr. Madsen highly recommends using these sources over a basic web search to make sure you're getting the best information possible. How Can You Tell if a Health Article is Valid?

When it comes to research you see in your news feed, it's easy to get bad information. There are a lot of potential problems with online health journalism. Media groups often write articles about science and medicine in a way that can get them clicks. Due to limitations, the story is not always able to go as deep into a topic as is necessary to fully understand the complex nature of scientific studies. And finally, most journalists lack the medical or scientific background to accurately present the findings.

Dr. Troy Madsen has a list of tips that he suggests everyone follows when reading any study to help you decide if it's true.

• First and foremost, make sure the article links to a published scientific study. If there's no study, there's a good chance the information in the article is misleading.

• Make sure the linked study actually claims what the article says. Most scientific journals will give access to the abstract or short summary of the research for free. Read through to make sure the journal isn't twisting the findings.

• Make sure the study is published in a reputable scientific journal. There are "predatory journals" that allow any group to pay to publish research in official sounding publications. To be safe, only trust journals like The New England Journal of Medicine, The Journal of American Medical Associations, The Lancet, or The British Medical Journal.

• Avoid studies that make bold and definitive claims. Science is nuanced and seldom makes hard and fast claims about anything.

• Make sure the claims are backed up by multiple studies. For example, if chocolate really did cure cancer, multiple studies would be looking into it.

• Be sure to check the sponsor of the research. It's not uncommon for companies to back skewed research that shows the positives of their products.

Be a skeptic! Next time a scientific story comes across your feed, keep an eye out for these elements to make sure you really are getting reliable information. What Makes a Good Scientific Study?

Troy also suggests a few things to look out for when judging the validity of a study. A good scientific study should have the following:

1. Low "P-values." A p-value is a statistic that describes the likelihood of the collected data having errors. As such, a lower p-value means a more reliable study. Look for data with a p-value less than .05. That means there is less than a 5% chance of the data being wrong.

2. Large numbers of subjects. A scientific study about health should include over a thousand subjects minimum. Ten thousand is even better.

3. The best type of studies use "randomized control trials."

4. The gold standard for medical research are "prospective studies," where the scientist actively follows the patient and their behavior rather than rely on anecdotal information.

Maybe you didn't chew as well as you should have. Now you have a piece of food stuck in your throat. It's not obstructing your airway, but it's definitely uncomfortable or painful. The food won't come up, it won't go down. ER or Not?

First, make sure the food isn't obstructing your airway. Any blockage of the airway needs to be seen at an ER immediately.

If you can't get the piece of food up, you may need to go to the ER to get it removed by a professional. But first, there's a trick you can try at home that may save you a trip and the cost of an ER visit.

Take a drink of a soda, preferably a cola. Try to get a swallow of the cola down your throat and let it sit there for five minutes or so. Carbonated cola has some properties that will help the esophagus relax. It may be able to relax your throat enough to swallow the food the rest of the way. Repeat a few times if necessary.

If the cola trick works, it is important to go talk to your doctor afterwards. There are some conditions that can be related to getting food stuck in your throat that would be important to catch to diagnose and treat.

If the cola didn't help push the food through to your stomach, you will need to go to an ER. You will need to be treated by a gastroenterologist immediately. An urgent care will not have that kind of specialist on hand. Try to go to a larger ER that would have an oncall specialist. Housekeeping - Hello Ladies.

This podcast is called "Who Cares About Men's Health." The goal of the show was very focused and very singular. Create a podcast by men, for men. Yet our our most recent statistics surprisingly show that about 40% of our listeners are women.

Guess this just goes to show that women also care about men's health.

Listener Danielle recently gave us a shoutout on Facebook.

"I love listening to bits and pieces of this podcast Who Cares About Men's Health. You don't have to be a man to find it interesting."

Women, if you are listening, be sure to share it with the men in your life. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Troy would rather have a broken finger than a long-lasting cold, because he can't get sympathy. Scot has a moment of honesty about his personal health struggles and he reminds us that health is a practice with ups and downs, not a linear journey. Talk to Us

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

Announcer: "Health Hacks" with Dr. Troy Madsen on The Scope.

Dr. Madsen: Today's health hack is standing at work. It's something simple. You've probably heard about it before. There are all sorts of problems associated with sitting at work causing potentially even more health problems than things like obesity and smoking. But just sitting at work for prolonged periods can have a very significant effect on your health.

So the health hack is standing at work. If you've noticed problems at work, such as anxiety, just lack of engagement with work, even issues with sickness, missing work, standing has been shown to make a big difference.

The health hack is to do something very simple to remind yourself to stand. My recommendation is set the timer on your phone for 30 minutes. Set it, hit start when you sit down. When it goes off, reset it, hit start again. When it goes off, stand up, walk around. Go get a drink of water. Go use the restroom. Just stand and work. Anything like that so you're not sitting for prolonged periods.

I think anything where you're just not seated for prolonged periods. And I would say if you can just get up and walk, that's probably better than just standing. But anything to do to get out of your seat and have that consistent reminder to do it. You're going to get in the habit of it probably after a week or two. You won't even need the reminder. You'll know 30 minutes, I stand. I walk around. I'm used to it. It makes me feel good.

Announcer: For more health hacks, check out thescoperadio.com. Produced by University of Utah Health.

Interviewer: Three things that kill young, healthy people. That's coming up next on The Scope.

Announcer: This is "From the Front Lines" with emergency room physician, Dr. Troy Madsen on The Scope.

Interviewer: Today we're going to talk about from his perspective in the ER, three things that can kill young healthy people. Because generally young healthy people aren't prone necessarily to dying, but there's some kind of usual suspects that you see come up time and time again. So let's start with number one. What is that?

Dr. Madsen: So number one, the one thing I see that it's just devastating to see this, but this kills young healthy people is a pulmonary embolism. This is a blood clot in the lungs. Some people are prone to these because they may have a genetic disorder that makes their blood more likely to clot. But what will happen with the clot, it often forms in the legs, somewhere else in the body, breaks through, goes to the lung. And if it's large enough, can just cause just a massive collapse of your cardiovascular system where your heart is just not squeezing the blood out like it should, and that can kill people. It's a devastating thing. We do see it occasionally, and these are very often people who are otherwise healthy.

Interviewer: Now we're talking 30, 40 otherwise athletic. A lot of times it can affect them.

Dr. Madsen: Exactly. For a lot of these people, it's their first time in the ER. They may not even see a doctor. They may have zero health conditions, no meds and this can happen out of the blue.

Interviewer: Are there any warning signs for a pulmonary embolism that they could have been aware of that might have prevented it?

Dr. Madsen: So sometimes these people may have had a small pulmonary embolism before the big one hit, and they may have had some chest pain, shortness of breath. Classically the chest pain is worse when you take a deep breath. A lot of times they describe that they just can't do their usual activities. They feel shorter breath while they're trying to walk upstairs or run or things they would typically do. These are all things to watch for and try and get some medical attention if you're having these symptoms.

Interviewer: And not be confused for maybe some other things like maybe thinking you've got asthma all of a sudden.

Dr. Madsen: Exactly. You know, usually people who have asthma have probably had asthma before. It would be unusual for that just to come on out of the blue. So if you have new chest pain, new shortness of breath, especially if that pain is worse if you take a deep breath, if you're passing out, if your heart is going really fast, all reasons to get checked out.

Interviewer: All right, go to the ER for that.

Dr. Madsen: I would go to the ER absolutely.

Interviewer: Three things that kill young healthy people. What's number two?

Dr. Madsen: So number two is an aneurysm in the brain or what we call a subarachnoid hemorrhage. This is when an aneurysm bursts. There's bleeding in the brain. This is a devastating thing, and I can think of cases I've seen of people who have come in, young, otherwise healthy people and classically they describe a severe sudden onset headache. They describe it as a thunderclap headache. It just comes on like that sound of thunder. Just out of the blue, out of nowhere, severe sudden onset, maximal intensity, very quickly and they have bleeding in their brain and that bleeding can expand very rapidly.

Interviewer: Is that caused by trauma or something like that? Or does it just come on you even if you're just sitting and not doing anything?

Dr. Madsen: So trauma can absolutely cause this sort of thing. We definitely see lots of cases of trauma, but the cases I'm thinking of are people who have not had any trauma and who just say, "Wow, I got a headache out of the blue. I don't normally get headaches. This is a 10 out of 10 headache. This hurts like crazy. My head just feels awful." Maybe they're confused. Maybe they're having nausea and vomiting. This can be a very devastating thing and, like I said, can go south very quickly if this bleeding expands.

Interviewer: So if you're a young, healthy person and you're having those symptoms, again, go to the ER immediately.

Dr. Madsen: Absolutely. I mean anyone of any age. But this is one of these things in young, healthy people that is just, again, people who may have no other medical issues, no indication of anything wrong get a sudden severe headache, get medical attention, get checked out.

Interviewer: All right. Three things that kill young healthy people from an ER doc's perspective, number three.

Dr. Madsen: So number three is trauma. And this is often one of the most devastating things we see. You know, young, healthy people sometimes are more likely to take risk, whether it be on, you know, motor vehicles, motorcycles, outdoor activities, that kind of thing. You hate to see people who are severely injured by trauma, but it's a devastating thing to see. We see lots of trauma, and a lot of those traumas are again in people who are young, healthy, otherwise have never had issues, never been to a doctor, and suffer severe trauma. Sometimes no fault of their own or sometimes maybe because they are taking some risk.

Interviewer: So I think the takeaway for me anyway, and you can help verify this, it sounds like if you're having any sort of symptoms of a pulmonary embolism or a brain aneurism, that either shortness of breath that we talked about where normally you wouldn't have that or that thunderclap headache, you should immediately go to the ER even if you're healthy because these are some pretty serious signs, and as far as trauma's concerned, just be aware that that's a danger for us young, healthy people.

Dr. Madsen: That's exactly right, yes. Pulmonary embolism, subarachnoid hemorrhage, like you said, watch out for chest pain, shortness of breath, sudden severe headaches, trauma.

Interviewer: Take it seriously.

Dr. Madsen: Take it seriously. Take the necessary precautions. Stuff's always going to happen. There's always risk in any activity, but take the necessary precautions. Wear a helmet, wear your seat belt, make sure you're safe in any kind of activity.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.