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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.

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.

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.

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.

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

Dr. Madsen: Today's health hack is having an antibiotic in your bag when you travel. The antibiotic I really have in mind here is Ciprofloxacin. And the reason for it is urinary tract infections. So if you're female and you're traveling, you may have experienced this before. I mean anyone could experience it, but urinary tract infections are more likely in females. And if you're traveling and you experience a urinary tract infection, you know how miserable this can be.

If you're in a foreign country or just even another city, just trying to get in to find health care, interrupt your plans, getting the help you need to get a prescription for exactly what you know you need can be an incredible headache. So I think it's not at all unreasonable if you're going on a big trip or, you know, if you meet with your doctor just to ask them, "Can I get a prescription for an antibiotic to have on hand for this kind of situation?"

I think it's a reasonable thing to have. Typically you know when you have a urinary tract infection, and studies that have been done have shown that if a person feels like they're having a urinary tract infection, they're probably right.

So the health hack here is have an antibiotic on hand. Ciprofloxacin is one that I recommend that works very well for urinary tract infections. Take it with you when you travel. If you have symptoms of urinary tract infection, you can take this, avoid a trip to an ER or to some health care facility in a foreign country.

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

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

Dr. Madsen: Well, today's health hack is a trick to try and get a raisin or any other sort of foreign body out of your child's nose. Now, this health hack is a little bit gross, but it works, and it could save you a trip to the ER.

So if your child sticks something up their nose, a raisin or anything else they find around the house, you can't see it to pull it out and you're thinking to yourself, "There's no way I'm going to get this out." One trick is to have your child lie down on a couch or on a bed. You place your mouth on your child's mouth. You blow into their mouth forcefully, quickly, only maybe a second or two of forceful air into their mouth. That air then gets forced up through the nose and that is going to ideally force this raisin or whatever else is in there out of their nose.

Now, it's a little bit gross because you've got to put your mouth on your child's mouth, you have to blow in there, and most likely that raisin or whatever else is in there is going to get blown out onto your face with some mucus. But the good news is you avoid the trip to the ER. If you were to come to the ER with the same problem, I would probably ask you in the ER, "Are you willing to try this here? Because it can avoid a whole a lot of trauma to your child, a whole lot of probing around in their nose." So, if this happens at home, give it a try. There's good evidence that this works well. It can save you a trip to the ER.

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

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

Dr. Madsen: Today's health hack is a simple thing you can do to drop calories from your diet and lose weight. So let's say you're cruising along, you want to lose weight, but you just cannot seem to drop the pounds. Simple trick is look at your diet. If you're having a soda every day for lunch, particularly a large soda, or maybe breakfast, maybe dinner, whenever you might have a soda or several sodas, if you can cut a large soda, one of these gas station soda-sized things from your diet every day, you will lose a pound per week.

This is based on the fact that these large sodas probably have 500 calories. If you're just maintaining that drop right there, 500 calories for a man or a woman, is enough that you should be dropping about a pound of weight per week as long as you're keeping things steady with the rest of your diet. It's a simple thing you can do, just a matter of trying to replace it. Just drink more water, avoid the calories from that soda, and over several weeks, you're going to see the weight start to come off.

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

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

Dr. Madsen: Today's health hack is treating an ingrown toenail to prevent it from getting worse. So if you've ever had an ingrown toenail, you know they're pretty miserable. They get inflamed. Sometimes you need to have a piece of the toenail cut off, you need to have the infection opened up and drained, and you need to go on antibiotics. So if you can catch this early, you can save yourself a whole lot of pain and headache.

An ingrown toenail essentially happens when one side of the toe or one side of the toenail digs into the toe and it grows out. It causes that area to just get inflamed. So if you can get that corner of the toenail and somehow lift it up so it's not pushing into the skin, you can prevent it from getting worse.

The hack here is to use a cotton swab. You take that cotton swab, you pull the cotton off the end of it, throw the stick away, and then take that cotton and roll it up so it's kind of a little bit longer and thin, and then you lift the edge of the toenail up, slide that cotton up under it, and then leave it there. Do that every morning after you take a shower when the skin's a little bit softer. What that does is it lifts the toenail up away from that edge of the skin. It prevents the toenail from growing into the skin and getting worse. If you do that for about a week, you're going to be good. The toenail will grow far enough you're not going to have an ingrown toenail. You'll save yourself from having to have any sort of procedure done or having that drained.

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

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

Dr. Madsen: Today's health hack is using a combination of ibuprofen and acetaminophen instead of an opioid for injuries and pain from those injuries. This is all based on a study. Came out in the Journal of the American Medical Association a few months ago. It was eye-opening for me, for a lot of people I work with because we've always assumed that opioids worked better.

So this study, patients got a combination of ibuprofen 400 milligrams and acetaminophen, also known as Tylenol, 1,000 milligrams. These are standard over-the-counter medications, and they compared it to patients who got opioids. Those who got this combination of ibuprofen and acetaminophen did just as well with their pain. So I think the take home from this would be if you're in the ER and you're offered opioids, ask for some Tylenol, ask for ibuprofen. Avoid the opioids and avoid that addiction potential.

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

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

Dr. Madsen: Today's health hack is getting just three to four servings of fruits and vegetables a day. So personally, when I hear about how many servings of fruits and vegetables I'm supposed to eat a day, I get overwhelmed. And we're talking about recommended amounts of five to nine servings.

So this is based on a study that was done that appeared in the journal called, "The Lancet," where they looked at patients and they said, "Well, where's really this maximal benefit?" And they found that these individuals who were eating three to four servings a day, when they looked at their risk of heart disease, they seem to do just about as well as those who are getting even more than that. So the health hack here is have some fruit with your breakfast, have a banana, have an apple, have some snacks around the house, meaning having some fruit, having some fruit sitting out at eye level where when you reach for something, that's what you're grabbing.

And then if you can get three to four servings a day, feel good about yourself. Don't feel like you need to eat five to nine servings a day. You're probably getting just as many benefits to your heart by eating that amount.

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