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Scot: Justin, what did you have for breakfast this morning?

Justin: I had fresh eggs and biscuits.

Troy: Wow.

Scot: When you say fresh eggs, you have chickens in your backyard?

Justin: We do.

Troy: Wow.

Justin: We have eight chickens.

Troy: So very fresh eggs. Nice.

Justin: Yeah, one of them was warm when I picked it up out of the coop this morning.

Scot: Wow.

Troy: Never getting grossed out.

Scot: It's "Who Cares About Men's Health?" where we have a theory that contrary to what people, say men do care about their health. And it's cool to take ownership of your health. That is what we're trying to talk about here on this show. Also building a community of men that care so we can get more men to care about their health.

My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.

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

Justin: I'm Justin Knox. I'm a physician assistant that works in urgent care, and I care about men's health.

Scot: Fabulous to have another member joining the fight. How come I'm the only one clapping though?

Troy: I don't know. I didn't know what you were doing. Yeah, I should have started clapping too, but . . .

Scot: We're going to talk to Justin about urgent care and, you know, the types of things that come into urgent care. And hopefully, we're going to learn a little something about men and health and how to navigate the system, because for a lot of men, especially younger men, urgent care is their primary care physician. Like, they don't have one. So when they have an issue, they go to the urgent care to get it taken care of. You know, it can be a more cost effective way to actually get your care.

But before we get to that, Justin, we always like to talk about kind of our core four plus one more, which is that in order to invest in your health in the future, you need to get some activity, nutrition, sleep, you need to manage your stress, your smoking and drinking, those nagging health issues, and it's a good idea to know your genetics as well. So out of those, is there one in there that you kind of struggle with? Do you have a story you can share with us?

Justin: I think it's pretty common with a lot of younger men just to assume you're going to be healthy forever. So we tend to kind of put off what we should be doing now for later. And we see this a lot in our clinic. You know, guys in their 20s and 30s say, "Hey, you know, I don't have a primary care provider because I'm pretty healthy and, you know, not too worried about it," but then you hit 40 and things start happening.

So, yeah, I think it's pretty easy just to assume, "Oh, I do activities in the winter. In the summer, I don't need to, like, pay attention to it all that much," and so things kind of go under the radar.

Scot: Is there anything in particular you struggle with?

Justin: I think food and diet is kind of a hard one. You know, I'm a socialite, and so when I think about my food intake and my health, you know, it's like, "Yeah, I'll pay attention," but then you go out with friends, you have drinks, you eat foods just kind of socially, and then you kind of get off track with that stuff. That's probably my biggest problem.

Scot: How do you try to manage that then, or aren't you?

Justin: Have less friends.

Scot: Because you're invulnerable, is that . . . are you actively trying to manage that or . . .

Justin: Yeah. I mean, I do, you know? And I think, like a lot of people, it waxes and wanes. It's like you kind of get on board with things, you say to yourself, "Oh, I've got to be careful about this stuff," and so you have a stint where you do better, and then you go on vacation and you eat poor foods, you know, whatever the case may be. And so, then you've got to kind of remind yourself and get back on track. That's the case for me.

Troy: It's tough. I mean, like you said, I think travel is the hardest thing with eating well and when you go out with people, just so many times there just aren't great options there. But, yeah, it's a battle.

But like you said, I think the whole exercise thing too, I remember times in my life looking like, "What have I actually done for exercise this week?" and just to think, "I haven't done anything." And I'm convinced that I exercise because I go skiing here and there, but then you're just like, "Ah." It's crazy how that sneaks up on you.

Scot: I think the lesson that keeps coming back to us about this is it's just something . . . you just can't put it on autopilot. It's something you're constantly managing, you know? Any of these things, whether it's nutrition, sleep, activity, just you're constantly managing that.

Troy: It is. It's a battle sometimes, I think. Exercise, it's sometimes incredibly rewarding and sometimes it's just a battle to power through.

Scot: Yeah. All right. Let's talk about urgent care. So, Justin, here's my struggle with urgent care or even going to the doctor a lot of times. I feel as though that I go in and they're like, "Well, there's nothing really wrong, or there's nothing we can do," like if I go in for a cold or something.

And usually, I'm there because somebody in my life has told me, "You need to go there." In my mind, I'm like, "Well, this is just a cough. It's going to go away eventually." But somebody else in my life, and sometimes me, was like, "Well, what if it's not? What if it's, you know, something more substantial?"

So how do you manage that? How do you kind of manage knowing when I should go in versus when I should just wait or things I can do at home?

Justin: Yeah. I mean, I think is the biggest challenge, at least in my setting, where people come in. . . . and from my perspective, I think, "Well, you should have waited longer, possibly," but they don't know. And so, a big part of my job is educating people about when to come in, and when you can wait, and things you can do at home. And that tends to be a big portion of the visits I have with patients, is kind of like when it's appropriate to come in and when it's not.

I never turn people away. I'm happy to see anybody that comes in. And, you know, oftentimes, I find that opportunity to educate and say, "Yeah, you know, I'm glad you came in. We needed to see you today." But sometimes it's like, "You know, the good news is it's nothing serious. We can kind of wait on it."

Scot: I think it's worth saying though right now that if you do feel the need to go to the ER or the urgent care, you should always trust your instincts.

Troy: Sure.

Scot: Yeah. So we're not discouraging anybody. We're just trying to give you maybe perhaps more information. And even after you get this information, if you're like me, I feel that I'm pretty well educated, but then when I'm in the moment, I'm like, "Oh, I don't know. Should I or shouldn't I?"

Troy: Well, it's funny. I mean, fear is such a great motivator. And I've often heard the reason people come to the ER or would go to urgent care is either because they hurt, they're bleeding, or they're scared. And obviously, if you hurt somewhere, maybe it's because of injury or maybe something's going on your abdomen, or you're bleeding, it's pretty obvious that you need help. But then fear, it plays so much into seeking medical care.

And like you said, Justin, sometimes it's hard to know when should I be scared and when should I be okay. And often, I think we turn to the internet for those answers and that just makes things so much worse.

Scot: That's so funny you say that because it does.

Troy: It does.

Scot: Either it's nothing to worry about or you're dying of cancer when you go to the internet.

Troy: Yeah. Every symptom leads to cancer. If you Google it, you will have cancer. At least you'll think you do.

Justin: You can go down the rabbit hole pretty quick. But I think a lot of times people come to my clinic just to be reassured, you know? And if they say, "Hey, I've got a sore throat. I'm worried about an infection," you know, we do a quick test. We say, "No. There's no infection," and they say, "Great. I'm glad that's not the case. I feel better already."

So reassurance is a big part of what we do in urgent care, especially with children. Parents worry a lot about their kids. They want to take care of them. They say, "You know, my kids had whatever going on for a few days. We're just worried about it." We do a great exam, and we say, "Look, your kid looks great. Everything looks great." You can just see the relief and parents say, "Okay. We just wanted to make sure."

Scot: So that's interesting, coming in for reassurance. And I would imagine there's probably a mind-body connection there. What are some of the common things that you see come in that you do think, "Oh, you could probably waited a little bit," or, "This isn't going to really manifest itself in anything too complicated"?

Justin: I'd say that a couple of the most common things would be, you know, the classic cold symptoms like, "I've had a cough, or a runny nose. It's been going on for a few days. I don't know if this is going to get worse."

And the question is the same for me. It's like, "I don't know if it's going to get worse. Probably not, but, you know, here are the things that you have to look for if it does get worse and what we really should be seeing in clinic." And so, the flu season, the cold season, I mean, this is all day, every day we see this kind of stuff.

Troy: Yeah. And that's always a tough one too. I got a call from my brother-in-law not too long ago. He said, "I've got a sinus infection. This happens to me every year. I get antibiotics, and I get better. I need antibiotics." And it's tough because sometimes people have been conditioned, "Well, I get antibiotics, and I get better." It's like, "Well, you would have gotten better without antibiotics."

And I think sometimes teasing that out and helping people recognize maybe what providers have done before wasn't the best thing and readjusting expectations, like you said, with things like cold, flu, things that you really just have to ride out.

Justin: Yeah, I think this is a really common request with people coming into the clinic, is like, "Hey, you know, I've gotten this thing before," whether that's an antibiotic or medicine, "and this has helped." And a lot of times, my response, especially if I'm not concerned about a bacterial problem or something that needs an antibiotic, is I say, "Hey, you know, that may have been the case back then. And now, medicine is kind of shifting to where we're trying to do less. Oftentimes, less is better. And so, we're trying to break some old habits."

This is really apparent with opioid crisis-type stuff, where, you know, for years, those medicines were given out not maliciously, but just lots of them, and now we have major issues with that stuff. And so, you know, newer providers and newer ways of thinking are saying, "Let's try more conservative approaches or, you know, simple stuff."

Troy: That's such a great point you make there too, because I think when I trained, you know, when I was in residency, sometimes I felt like it was almost like this transaction sort of agreement. People paid to come to the ER or urgent care, and it's like, "Well, I'm paying for this, so I want something." I want an X-ray, or I want opioids, or I want some sort of transaction here, and I should be able to walk out with something.

Hopefully, more and more, like you said, we're moving toward saying, "Hey, we don't need to do all this stuff. Maybe what you need is just reassurance. And I'm going to sit down and take the time and talk to you and go over all these things." And I think I am seeing that more, which is great to see, and it sounds like you're seeing that as well.

Scot: The trouble with that old mentality, if I understand correctly, is that the things that you do for that patient, whether it's antibiotics, or obviously opioids is the obvious one, could actually cause more harm than just waiting it out.

Justin: Absolutely. I mean, we are seeing increased problems with antibiotic use and resistance and, you know, new issues that we just didn't deal with in the past. And so, again, I think the up-and-coming approach is "Let's treat this based on research, and data and good clinical indication," instead of just kind of like, "Oh, I've done this for the last 10 years. I'll just keep doing that same thing over and over again." We want to use, you know, good clinical information and make educated decisions about how we treat our patients.

Scot: What are some of the common things that men are coming in for that they're waiting too late?

Justin: At least in my clinic, I see a lot of sexually transmitted disease type stuff where, you know, maybe men are embarrassed about it. It's almost like, "Well, if I just ignore it, it will go away," kind of thing.

Scot: Which is funny. We'll come in for a cold, but we won't come in for that. Really?

Justin: Exactly.

Scot: Come on.

Justin: Yeah. I mean, I see this a lot. In fact, I had a gentleman the other day that, you know, came in with what I thought was a pretty significant problem, and he waited too long. And the only reason he came in was because his partner was like, "Yeah, this has got to be addressed." And of course, it was beyond what I could do for him. And so, I recommended that he go to the ER for further evaluation. And, you know, he was kind of like, "Well, I don't want to go there. You've already looked down there. I don't want more people looking down there." It's kind of like, "Yeah. I mean, you've waited too long now."

Scot: On a bigger scale . . . I mean, I'm trying to think for me, as a patient, what's a little checklist I could have in my mind, like the difference between something I wait out or a signal that I'm getting that something that I have is something I should get looked at? I think a lot of us guys, or at least I, will sometimes go a little too far, just like, "It'll take care of itself." Is there criteria?

Troy: That's really tough. I think through this myself.

Scot: That's why we have you guys.

Troy: I know. And I'm thinking myself. Obviously, there's the whole ABCs, any airway, breathing, circulation. You know, chest pain, strokes, those kinds of things, that's immediate attention. But then you think we're talking about coughs, colds, fevers, all those sorts of things.

Scot: That could possibly develop into something.

Troy: It could be something, and you wonder, "Am I waiting too long, and putting things off?" I don't know.

Justin: I think people have a hard time with the timeframe, you know? So we get a lot of people that are like, "Gosh, this has been three days, and it's just not getting better," or, "It's been 10 days, and it's not getting better." And so, I think a lot of people have kind of this idea of a finite timeframe where things have to get better in three days, or five days, or seven days.

And what I often tell people is it's not necessarily the timeframe. It's any change in the symptoms that you are experiencing. So if you have a cough, and it lasts five days, but doesn't necessarily change, probably not a bad thing. But if the cough is getting worse, or if you're having additional symptoms, that to me is a pattern that something is progressing as opposed to just kind of being there.

Troy: That's a good point. I mean, most disease processes that aren't really serious should stabilize or start to get better within 48 hours. You figure vomiting, abdominal pain, coughs, colds, fevers, all those sorts of things. So it makes sense that if it's just getting worse beyond that point, it's probably worth getting looked at.

But then there are some things that within 12 hours can be really serious, like meningitis, if you're having fevers, and neck pain, and the light is bothering your eyes.

Scot: Because that could be mistaken for a flu, couldn't it?

Troy: It could. So that's the challenge here, is trying to tease this out. I don't know if there's a hard and fast rule. I think if you're just really feeling weak and just really debilitated, and . . . yeah, there's the whole "man cold" thing, but if it's something more than that, then it's probably worth getting attention sooner rather than waiting that 48 hours to see what happens.

Scot: I like the progression of symptoms. I think that's a good thing to go by. What is the realistic . . . I know you said don't think of it so much in time, but I think that's how we think. What's the realistic timeframe for something like that to kind of progress? After seven days, if you're not seeing any improvement, is that it?

Justin: Yeah. I mean, I guess it depends with any given disease process. But, you know, if we're kind of talking about really typical things like coughs and colds, if you read the literature, a lot of literature suggests that a common cold should last anywhere from 7 to 10 days. But we often see people that have just protracted symptoms for two weeks or three weeks and nothing changes. It's just like, "Yeah. I've had this nagging cough."

I certainly think at that point, you know, it's reasonable to come in just to make sure everything's okay. Because sometimes symptoms can kind of be stable, but we do an exam and we hear something concerning in the lungs, or we get a set of vitals and we see something concerning. That then pushes us to do a little bit more. And, you know, sometimes we uncover things that maybe on the surface don't seem significant.

Troy: And it's tough. I mean, when I see patients and I think to myself, "Oh, why did they come to the ER for this?" I often think of myself and being a healthcare provider with years of experience and training, and there are times where I have certain symptoms and my mind automatically goes to the worst thing. I mean, at various points in my life, I've been convinced I have brain cancer, I have a brain tumor, or various other forms of cancer, or all sorts of other things.

So it's one of those things where, you know, I have a lot of empathy for people just based on my own experience and knowing when symptoms are really serious, and when I should get help.

So I think if you feel like you need help, it's totally reasonable to go in, and if it's nothing serious, get that reassurance, maybe get some testing done if it's necessary. But, yeah, it's tough on a timeframe. I think that makes it challenging.

Scot: The next segment that we want to do actually is going to try to help people make what can be a difficult decision, "Should I go to the urgent care for this, or do I need to go to the ER for this?" And I figured since we have a physician assistant who works at an urgent care and an ER doc, we could get a definitive answer here. So I'm going to come up with some scenarios. We're going to call this "ER or Urgent Care?" Help us decide where we should go. Are you ready?

Justin: Ready.

Scot: All right.

Troy: Ready.

Scot: You don't look intimidated at all. Okay, you got this doc.

Troy: Ready.

Scot: Justin's fine. Yeah. All right. ER or urgent care? Severe asthma attack. ER or urgent care? Who wants to weigh in?

Justin: I think it depends on the severity. I mean, if people are really struggling to breathe, you know, we can start things in an urgent care, but oftentimes, it's hard for us to monitor them for a long period of time. And we're pretty limited with medications that we can use. So, you know, if there's what we would consider respiratory distress, like if someone's really struggling, I think an ER is appropriate.

Troy: I agree. I think this comes down to the whole ABCs thing. And when you talk about severe allergic reactions, usually you're talking about risk of airway involvement. Same thing with asthma. It's crazy the number of people that asthma kills every year.

So for me, in my mind, if someone tells me, "Hey, I'm having a severe allergic reaction or asthma attack," I would tell them get to the ER, just because like you said, Justin, we've got respiratory therapists there. We've got people who can help. And if things are really bad, we can intubate the patient, put a breathing tube in. Hopefully it doesn't get to that point, but you've got all those options available.

Scot: Gotcha. Quickly, before we move on to the next section, ABCs, what are they?

Troy: Airway, breathing, and circulation. So if it's an airway issue, if you're having a hard time breathing, if it's a circulatory issue, meaning your heart, concerns about the heart not squeezing or low blood pressure, those are the big things in my mind that you want to get to the ER for.

Scot: So that's kind of the criteria for emergent issues.

Troy: Those would be the number one things in my mind to get to the ER because those can go south pretty quickly.

Scot: All right. So if you're listening, you can apply those to these future questions and see if maybe you can guess where you should go. All right. Next one, sprained ankle.

Justin: I think that's pretty easily managed in a lower acute setting like an urgent care. I mean, this kind of stuff happens all the time, especially in summer months where people are out recreating. So we do get lots of sprained ankles. You know, if we feel like an X-ray is needed to rule out a fracture, we can do that in the urgent care setting. And then, you know, it's typical supportive care. Oftentimes, we send people home with a brace and, you know, instructions on what to do at home to kind of get back on their feet, so to speak.

Troy: Yeah, agree 100%. And, you know, obviously, you can see these patients. If something more serious is going on, you can get them to the ER if they need to go there, but . . .

Scot: Because it's not a life-threatening thing.

Troy: It's not.

Scot: So you can go through the progression.

Troy: The exception there, of course, would be the very severely sprained ankle where you've got a bone sticking out, sprain plus fracture. You know, that you're going to see and you'll know you need to get to the ER.

Scot: Justin, can you handle broken bones in an urgent care?

Justin: A lot of times we can, and at the very least, we can get people stable and get them to where they need to be. You know, sometimes broken bones are going to require more emergent care, like a surgical type of a treatment, which we're pretty good at identifying that and saying, "Okay. Look, we're going to call orthopedics. We're going to try to get you kind of fast tracked to see them today." But a lot of times, we can follow up in a few days to a week on a lot of common fractures.

Scot: So it sounds like an urgent care, if you've got a broken bone, might be a good place to start.

Troy: Agree.

Scot: Number three, ER or urgent care? Play along at home. Lacerations, which is what we common folk call cuts, a cut.

Troy: "I got cut."

Scot: ER or urgent care, Justin?

Justin: I think you can start at the urgent care. We can manage a lot of lacerations. But sometimes, you know, if we're worried about involvement with tendons in the hand or something where it gets a little more complicated, yeah, that's more of an ER consult with ortho hand surgery or kind of the next step up. But a lot of simple lacerations pretty easily managed in the urgent care setting.

Troy: For sure. I agree. And, again, adding to that whole list, the ABCs thing, we also added D for disability. So if you're going to lose a limb, if there's a threat there, it's a severe laceration with lots of bleeding, that's for sure an ER. If you have a finger that gets chopped off in a snow blower or something like that, that's a good reason to get to the ER and take your finger with you.

Scot: I'm not laughing at the conditions. I'm laughing that you keep adding to your little ABCs.

Troy: I know.

Scot: How long until we get further down the alphabet?

Troy: I just went to D. We're going to D.

Scot: All right.

Justin: There are a lot of lists in medicine.

Scot: A lot of lists in medicine? All right. ER or urgent care, if this happened to you, where would you go? Stomach pain, like really bad stomach pain.

Justin: I think, you know, bad stomach pain can be very subjective. But, again, everybody's got to kind of pay attention to their body. I mean, if it's severe where you are having a hard time standing up, I think that's an ER visit. But if this is kind of like run in the mill, "I've got a bellyache," yeah, you can always start in the urgent care and we can do a really good assessment and exam. And if we feel like you need to be somewhere else, we'll get you sent to the appropriate place.

Troy: And are you doing IV fluids in the urgent care as well?

Justin: Yeah, we can. I mean, it's certainly something that we can start and, you know, if that's helpful and gets people moving in the right direction as far as feeling better, great. If not, again, we have a pretty low threshold for things that are going to be complicated or, you know, potentially life threatening to send them on.

Troy: That's exactly right. It's not unusual for us to get someone sent from the urgent care because they say, "I'm concerned about appendicitis." They've examined the patient, done some labs, and they'll send them to the emergency department to get a CT scan done. That's probably the most common reason people will come from an urgent care, is to get a CT scan of the abdomen, just because there's a certain point where you say, "This is possibly more than just a viral gastroenteritis."

So I agree. I think the urgent care is a great place to start. If as you're driving to the urgent care and you feel pain in your right lower abdomen, and every bump you hit, it just makes it hurt in that spot, they'll probably see you there and very likely, eventually, you'll end up in the ER. So that might be one case where you're just, "I'll probably just go straight to the ER. I need a CT scan."

Scot: What's that lower right quadrant?

Troy: So that's the appendix.

Scot: That is the appendix.

Troy: That is the appendix, the right lower side. So that's the spot in your abdomen when you're hurting a lot there. Like I said, every bump you hit on the road, it just hurts. You'll probably end up in the ER eventually. But you can always go to the urgent care, get examined, see what they think, get some labs done, and then take things from there.

Scot: All right. ER or urgent care? Concussion. So whether you took a header over your mountain bike, or you were playing some sports, or you just fell and hit your head.

Justin: Yeah, I think in some cases you probably need to be in the ER. But I think a lot of it depends on the severity of the injury and the mechanism of injury. So, you know, if it's really traumatic, you're on your mountain bike, you're flying down the trail at 35 miles an hour, and you crash into a tree, you know, that's an ER visit.

But, you know, if you're a 15-year-old football player, you bonk your head, you see stars, but don't necessarily have loss of consciousness or vomiting right after the incident, these are probably things that can be seen in an urgent care and kind of evaluated on a case-by-case basis. And then we kind of decide where people need to go after that.

Troy: Justin, that's a good point you mentioned there as well. If you didn't lose consciousness, you're not vomiting, you're not severely confused, you probably don't need to go to the ER.

And, again, the distinction here is really "Do you need a CT scan of the head or not?" And there, we're thinking, "Okay, if you need a CT scan, I'm thinking this is potentially more than a concussion. Maybe there's some bleeding in the brain." And that loss of consciousness, persistent vomiting, confusion, those are all the things in my mind that potentially could trigger getting a CT scan.

Justin: I agree.

Scot: All right. Are there any bonus questions you want to cover, or did we do an all right job?

Troy: Your right arm is numb.

Scot: That's a stroke, isn't it?

Troy: I don't know.

Scot: Or is that a heart attack? What is that?

Justin: That's the question.

Troy: That's the question.

Scot: I was sitting in my chair wrong? I don't know.

Troy: Let's say I'm a young healthy guy, and I'm feeling some pain in my right arm, and my right arm feels a little bit numb and kind of weird. I don't know.

Scot: Hey, Producer Mitch, what do you think?

Troy: What do you think, Mitch?

Scot: Would you go to an urgent care or ER for that?

Mitch: Well, I don't ever want to go to the ER. I mean, I just assume it's going to be really expensive. I would rather have . . . my approach . . . I mean, even my boyfriend broke both of his arms and we went to a . . . in a knee scooter injury, and he's like, "I think I need to go to the emergency room," and I'm like . . .

Scot: I love that he had a knee scooter injury on top of this. We need to bring him on the show.

Mitch: Oh, he broke both of them at the same time, and he was like, "We should probably go to the ER." I'm like, "Or the urgent care."

Troy: He had bones sticking out.

Mitch: And so, I always go there first. I would rather have a doctor tell me, "Hey, go to the . . ." I mean, it wasn't like he had cut his arms off or something like that. It was just broken.

Scot: Okay, so what about just a numb right arm?

Troy: Urgent care. Mitch is like, "Your face is drooping, you can't walk, go to the urgent care, man."

Scot: By the way, if that's happening, that's a stroke. Call 911 if that's happening.

Troy: That's a stroke.

Scot: So right arm, what's going on?

Justin: Yeah. I mean, I think from a clinical standpoint, we're always worried about things like stroke or heart attack. And I think, you know, when it comes to real concerns for stroke, time matters. I mean, we have a pretty narrow window of time to get these things treated.

But I've had this show up in my urgent care clinic, you know, two days after symptoms. Then you're kind of like, "Okay. I mean, if this truly was a stroke, we might expect to see progression or worsening of symptoms." But strokes are kind of on a spectrum where you can have mild strokes, and you can have very severe strokes.

And so, these things can be really hard to tease out in a setting where I don't have a CT scanner. I don't have a neurologist to consult with. So, you know, it gets to be pretty challenging in my clinic.

Troy: So probably more numbness, weakness may be better served in the ER, like you said. You don't have a lot of those resources to really tease that out.

Scot: So what's the right arm thing? You've brought this up and not answered it, Troy.

Troy: I'm so sorry. Yeah. Well, I don't know. It depends a lot . . .

Scot: You don't know?

Troy: Well, it could be a herniated disc in your back, and that's probably the most common thing in a young healthy person where they get some numbness and tingling down their arm. Maybe they were sitting weird, or doing a lot of lifting the day before. They maybe get some pain down the arm as well, versus let's say you're a 65-year-old who has high blood pressure, high cholesterol, and a previous heart attack. There, I'm absolutely concerned about a stroke.

Scot: So right arm pain, most people perceive that to be a heart attack or a stroke symptom. Is that what we're saying here?

Troy: That would be my number one concern.

Scot: Okay. Gotcha.

Troy: So, if you're saying, "I have some numbness down my arm. I have some pain," I'm always thinking worst-case scenario, and then that's often where my mind goes. But it could be something that's really not that serious.

Justin: I actually saw this in my clinic a few days ago. An older woman came in, right arm/hand tingling and kind of the reported inability to grip things. You know, my mind immediately goes to this, "You potentially could be having a stroke." However, after speaking with her for, you know, 20 minutes, finding out she has these really severe headaches, she has a history of migraines, this also can be a manifestation of a migraine complication.

And so, you know, it's not always the worst-case scenario. But our job as clinicians is to rule out those worst-case scenarios and then talk about other stuff. If we're not, you know, worried about a stroke, not worried about a heart attack, we can have a conversation about other things.

Troy: So in that case, what did you end up doing?

Justin: I think this woman, if I remember correctly, has a neurologist that she sees for her migraines. You know, this had been several days, and so I thought, "Okay, at this point, probably not overly concerning." I did my kind of thorough mini neuro exam. I felt comfortable, you know, having her follow up with her neurologist as opposed to going up and sitting in the ER for however long and then getting sent home. And ultimately, that boils down to just kind of my clinical judgment, which is scary sometimes.

Troy: It's hard. That's why I throw it out there. That's one of the hardest things I think we have to deal with, is teasing that out. People who come in with that numbness or tingling in their hand, and it's like, "Do you have stroke risk factors or not? And I need to take this seriously, but how concerned am I really?" So that's always a tough one.

But obviously, you're dealing with it there. And I think it's even harder there. Like you said, do you have to pull the trigger and say, "Go to the ER, have a long wait time," versus, "It's okay"?

Scot: ER or urgent care? Good round, guys. I'm the only one clapping again.

Troy: That was great. Clapping. Group applause.

Scot: I think the big takeaway that I learned from this was just this notion of you guys have a hard job. I mean, you have to use this knowledge and experience and tease . . . and there's sometimes no cut or dry answer, right? So, in the instance of this last patient you talked about, she came in to have a professional work through this to help her figure it out, and that's a totally valid reason to go to an instacare.

Justin: Totally valid reason. And like you said, it is hard sometimes. You know, I've only been practicing for five years. But in that time, you start to pick up on patterns. I don't know if I have a very good explanation of this, but sometimes you look at someone and you say, "Man, this is not right. What's going on here is not right." And sometimes you look at someone, despite all the things that they are concerned about, and you say, "I think you're just fine."

And there's not really a way to describe how that develops. It's just you start to recognize patterns over time, and I think the more you practice, the better you get at picking up on these patterns and things that could potentially be worrisome.

Troy: I agree. You know, where I work, I have so many resources available, testing specialists, pretty much anything you need. And for you, obviously, to deal with a lot of these things, that is challenging. I think an urgent care setting, it can be challenging because you're making a lot of these decisions, and you're really having to rely a lot on your clinical gestalt and not saying, "Oh, I'm just going to get a CT scan on everyone who walks in the door." So I think it's a tough job.

Just Going to Leave This Here...

Scot: All right. Time to move on to our next to last segment of the show, Just Going to Leave This Here. It's our opportunity to talk about whatever happens to be on our mind in a brief sort of fashion. I have to say that because I sometimes get a little verbose.

So just going to leave this here. I'm going to go ahead and start out by saying that if you ride a bicycle, or a skateboard, or a scooter, or a motorcycle, and I see you wearing flip-flops, let me tell you, it sends shivers down my spine. I will physically react in a . . . I will have little spasms. Please don't do that.

Troy: I'm going to do it just so I can see this reaction, the spasms, just you convulsing on the sidewalk.

Scot: I saw a guy on a scooter the other day wearing flip-flops. And all I can do is imagine putting that foot down, that flip-flop folds under and the toes just . . . yeah, that's what happens in any of these scenarios, is I see toes . . .

Troy: You see worst-case scenarios. See, this is what we've done to you. Your mind automatically goes to worst-case scenario.

Scot: Oh, come on. I mean, with this, this is just asking for trouble if you're doing that.

Troy: It is.

Scot: Yeah. I mean, I'm not overreacting, but I fear for their toes.

Troy: Understandably.

Scot: So don't do that.

Justin: And my guess is he wasn't wearing a helmet either.

Scot: I don't even remember. I was so hyper-focused on the feet.

Troy: Why would he have a helmet on? I mean, he didn't have shoes on. Why would he wear a helmet?

Justin: Who needs a helmet?

Troy: Exactly. Well, I'm just going to leave this here. I know we've talked about animals before, but we have 12 cats in my house right now. And I know I sound like a crazy cat person. We're fostering all these cats.

Scot: You do.

Troy: I'm going to blame my wife for this. She brings all these cats home, and we're fostering them, and they'll eventually get adopted out. But they're absolutely adorable. If anyone wants to foster kittens or is looking for a kitten, please get in touch with me.

Speaking of kittens, I saw the funniest YouTube video. You've got to search for this. It's called Kittens Inspired by Kittens. And it's a 6-year-old . . . it's a little bit dated, but it's just so weird. It's hilarious. It's this little 6-year-old going through this book with various pictures of kittens and narrating the kittens, and you have to watch it to get the full effect. It's weird. But it was hilarious in the context of lots of kittens in my house.

Scot: Justin, it's been wonderful having you on the show. And it's great to have another team member on team "Who Cares About Men's Health?"

Justin: Glad to be here.

Scot: All right, Troy. What'd you think of that one? Justin was pretty cool. I liked him.

Troy: Yeah, it's great talking to him. And I think he makes some great points about when in doubt, you're probably okay going to urgent care. They can tease out a lot of these things. They can be essentially your triage doctor or triage PA, where they can say, "Yeah, this is serious. Let's get you to the ER," or, "It's not serious, and you're fine, and you don't need to rush to get to the ER." It's a whole lot cheaper to go to the urgent care. So that was one of my big takeaways.

Scot: One of my big takeaways was trying to figure out when I should be concerned about something or when other people in my life tell me I should be concerned about a physical ailment and when to actually be concerned.

So his insight about "Are the symptoms stable? Are they the same as they were a couple of days ago? Are they getting worse? Are they getting better? Are they the same?" If everything's kind of stable, it can take 10 to 12 days for a cold to resolve, which I never knew. I always figured it would be a lot less time than that.

And then also, if you're feeling weak or if the symptoms are manifesting themselves in a different way, or you feel like, "This doesn't feel like the typical cold," that's when perhaps you should go to an urgent care or something like that. But it's not always cut and dry. That's the other thing I learned.

Troy: It's not, and that's maybe a takeaway too that I often remind myself and that came out in that conversation. For those of us who practice in . . . he's in an urgent care. I'm in an ER. It's not always cut and dry. And he talked about his clinical gestalt and just the feeling he gets or the sense he gets sometimes to say, "This is serious. We need to get you some more help." So never hesitate to get help. That's the bottom line.

Scot: And based on his experience, that's something that none of us have.

Troy: Exactly.

Scot: But you two gentlemen do. All right. Well, it's time to say the things people say at the end of podcasts. So go ahead and if you enjoyed this, rate and review us and give us an honest rating and review because it'll show the bosses how much you love us, which is always a good thing. Plus, it'll also help other people.

Troy: Mom, we're talking to you. Please, Mom, give us five stars.

Scot: It'll also help other people find us, you know, that might enjoy us as well. And if you have questions or comments, where do you send them, Troy?

Troy: Help@thescope.com.

Scot: No, no, no.

Troy: Oh, I'm sorry. That's customer service.

Scot: It's hello.

Troy: Hello@thescope.com.

Scot: Hello@thescoperadio.com.

Troy: Hello@thescoperadio.com.

Scot: I'm going to keep working with you. You're not a lost cause.

Troy: Thank you. Hello@thescoperadio.com. I'm just going to start sending random emails to that.

Scot: Hello@thescoperadio.com. And thank you very much for listening and being an advocate for men's health.