Today Jeff and Michelle share some of the lesser-known symptoms of a heart attack and also visit with Dr. Patrick Carroll about some trends that are emerging in health care. Listen up at the Huntsman World Senior Games Active Life podcast.

 

 

Jeff Harding:
Hello, and welcome to the Huntsman World Senior Games Active Life. My name is Jeff Harding, and I'm filling in for Kyle Case who's out of town today.

Jeff Harding:
Joining me in the studio is Michelle Graves, who recently moved from our office to another office, but still great to come back. How are you doing, Michelle?

Michelle Graves:
Great. Thanks for having me back.

Jeff Harding:
Haven't seen you for a while, but it's good to see here.

Michelle Graves:
I know. I'm thrilled to be with you today, Jeff.

Jeff Harding:
Well, Michelle, did you know that heart attacks have secret warning signs or less known warning signs that can hide in plain sight?

Michelle Graves:
I have heard that it could be called the secret killer.

Jeff Harding:
According to a 2016 study from the American Heart Association, 45% of all heart attacks in the United States are silent, meaning they don't come with the obvious or the expected symptoms. I found a list of five signs from different studies that are kind of less known.

Jeff Harding:
The first one is a hot flash. Even if you're a woman going through menopause, you should not automatically assume that those hot flashes are from the result of hormonal changes. In 2013 a Canadian study of 1015 heart attack patients, approximately 45% of the men and 55% of the women experienced the feeling of hot or flushed as a symptom of an acute coronary syndrome, which is the fancy way of saying heart attack.

Michelle Graves:
Okay.

Jeff Harding:
Just because you're going through menopause or manopause...

Michelle Graves:
There is manopause, yes. Do you feel that once in a while?

Jeff Harding:
Yes, I do as a matter of fact. Thank you for asking.

Michelle Graves:
I haven't quite gotten there yet, but a part of me is looking forward to feeling warm instead of cold. You know that about me.

Jeff Harding:
Yeah.

Michelle Graves:
Okay. Well, let's take turns. The next one is the dizziness. So feeling dizzy is something that a lot of people can feel. But in a JAMA study, it said that approximately 24% of male patients and 27% of female patients report dizziness as one of the heart blockage related symptoms they experienced.

Jeff Harding:
So that's something else. We feel dizziness for lots of reasons, but you can't rule out a heart attack as a possibility.

Michelle Graves:
Just be attuned to, yeah, that possibility. But not elevated in worrying because dizziness is very common.

Jeff Harding:
Yeah. You just have to be aware that that could be a possibility.

Jeff Harding:
The third one is shortness of breath. If you're short of breath when you bend over to tie your shoes or lift yourself off the couch, you want to pay attention. In that same 2013 JAMA study, shortness of breath was the fourth most common symptom of acute coronary syndrome patients.

Michelle Graves:
Interesting. Then there's-

Jeff Harding:
I can relate to bending over and trying to tie my shoe and be out of breath.

Michelle Graves:
You and Kyle talk about that a lot of the radio.

Jeff Harding:
For my case, it's more from a lack of flexibility than it is from anything else.

Michelle Graves:
I'm surprised there hasn't been some big intervention. We're going to have to solve that problem eventually.

Michelle Graves:
Okay. The next one is back pain. Heart attacks can cause back pain, so that's important to know. The scales are a little bit tipped. 27% of men reported having back pain during heart attacks, but nearly 43% of women experience this symptom.

Jeff Harding:
Usually, we think of chest pains, but in a lot of cases, it's the back pain-

Michelle Graves:
Can be manifest in your back.

Jeff Harding:
Right, so you have to be careful.

Jeff Harding:
The fifth one that we have is confusion. Though less common, disorientation is yet another possible indication of a heart attack. In a 2018 study of 2009 heart attack patients, published in the Journal of Circulation, approximately 12% of women and 11% of men told researchers that their heart attack manifested as confusion.

Jeff Harding:
So there you have it. Some things that are fairly common in our lives, they can also be indicators of a heart attack.

Michelle Graves:
The brain gets fuzzy, so worry a little bit about that when that happens. Well, those are good symptoms to know. Symptoms that can be non-related to heart attack, but to be a little aware of-

Jeff Harding:
And therefore easily written off. You can easily write them off because they do not normally heart attack symptoms, but they can also be symptoms of a heart attack.

Jeff Harding:
I think we have somebody in the studio with us that might be able to voice in on this concern a little bit.

Michelle Graves:
I think he's going to have a lot more knowledge than we have, especially regarding this.

Jeff Harding:
Joining us in the studio today is Dr. Patrick Carroll. Dr. Carroll graduated from the Medical College of Wisconsin and is currently the medical director for Dixie Regional Medical Center.

Jeff Harding:
What do you think of those hidden symptoms, Dr. Carroll?

Dr. Carroll:
Yeah. Well, thank you very much for having me on. It's great to be here. I think they're really important to understand, really important to think about.

Dr. Carroll:
We know our bodies, and sometimes when something just doesn't seem right, even if it's not one of the more common symptoms of a heart attack, something to not ignore, something to pay attention to, to reach out to your primary care provider and make sure that everything is okay.

Jeff Harding:
Well, I think that's great sound advice.

Michelle Graves:
Very sound advice indeed. I think that leads us to talk about the medical field. I think we're going to get into insurance and things today.

Jeff Harding:
Today we're going to talk about trends and thing in health care, trends in healthcare.

Michelle Graves:
Yes. Well, I'm just concerned along this thread, that you should always go to the doctors when you have a symptom of a problem, but people tend not to because of maybe the cost associated or the inconvenience of going.

Jeff Harding:
Or just plain stubbornness.

Michelle Graves:
Yes. That may speak to someone I know.

Jeff Harding:
Yes. Not me. I do go.

Michelle Graves:
So we're going to debunk some of these things today, right, and solve the problems of the world, it sounds like. No pressure.

Dr. Carroll:
No pressure at all.

Jeff Harding:
The first thing I want to talk about, is there a shortage of physicians in the world today, or at least in the United States today, Dr. Carroll?

Dr. Carroll:
Yeah. In the United States, there's certainly a shortage of physicians, and that's particularly true in some areas. We're not unique here in St. George, we're very lucky in some areas to have the physicians that we do. And frankly in a community the size of St. George, to have some of the subspecialties that exist here is unusual. We have geneticists here. We have a strong neurosurgical department at the hospital.

Jeff Harding:
We do.

Dr. Carroll:
We have very strong cardiovascular services, speaking of heart attacks. So some areas are very robust, very strong.

Jeff Harding:
Even the emergency care facilities locally are very strong and robust.

Dr. Carroll:
Absolutely. I was in a meeting earlier today in which we reviewed some of the data and some of the impact that is being looked at and some of the initiatives that are being taken in our emergency department at Dixie Regional Medical Center.

Dr. Carroll:
The continuous improvement that that team is taking with the leadership of Jared Stevens, our nursing manager, and Dr. Brett Christiansen in the emergency department, they're decreasing the stroke time. If a patient is having a stroke and it's identified in the emergency department, the time to get that patient treatment has steadily decreased at Dixie Regional Medical Center over the last several months.

Jeff Harding:
That's so critical with a stroke.

Michelle Graves:
That's lifesaving. Yes.

Jeff Harding:
It is.

Dr. Carroll:
Time is muscle, time is life is often what we talk about, and time is the brain in the case of stroke.

Jeff Harding:
What is the answer? There's a shortage of medical professionals. That means there's a shortage of people choosing to go into the medical profession.

Dr. Carroll:
Well, in particular, there's a shortage of primary care physicians.

Dr. Carroll:
Following medical school each, each physician has an opportunity to choose what specialty they'd like to go into, whether that's a subspecialty or whether that's primary care. Increasingly physicians when they graduate medical school is choosing to go into some of the surgical subspecialties, some of the non-surgical subspecialties, which leaves a shortage in some of the primary care areas.

Dr. Carroll:
When I say primary care, think your family practice doctor, your internal medicine doctor, your pediatrician. It's becoming increasingly difficult to identify, to find physicians that are primary care in the area.

Michelle Graves:
I want to know what you attribute that to, because I recently read a study that said that because of a high cost of medical school, a lot of doctors are picking this more specialized kind of choices in the healthcare industry because the rate of return to them will be greater, because they accumulate so much debt.

Dr. Carroll:
Yeah. That certainly is one aspect of-

Michelle Graves:
Is that a factor?

Dr. Carroll:
Absolutely. I won't go so far as to say it's the only factor. Every person is a bit different. But you're right. The reimbursement rate for physicians in primary care is generally lower than the reimbursement rate for some of the procedural based specialties. It's not uncommon for individuals to graduate medical school, for doctors to graduate medical school with $200000, $300000 of debt from medical school alone.

Michelle Graves:
Which is so much. It's so unfortunate. Then would you say another factor would be liability insurance?

Dr. Carroll:
Liability insurance doesn't necessarily predict which specialty a person will go into at the time of medical school, but it's something that has increased in a lot of ways.

Dr. Carroll:
Every state has different rules surrounding what goes into liability insurance. We're very fortunate to live in Utah where it's very patient-centered but supportive of doing the right thing.

Jeff Harding:
Oh, that's great. I don't know if there's anything we can do to change this trend, but hopefully, there'll be more people that'll be interested in...

Jeff Harding:
As far as reimbursing my primary care physician, it feels like I pay them a lot as it is when I go in there for my copays and we have a high deductible plan, so we're paying a lot. But I understand that's not as much as the specialists are getting.

Jeff Harding:
But hopefully we'll be able to come to a point in society where things are a little more equal, equal, and things can balance out, so we get more primary care physicians to cover the basics of healthcare for our population.

Dr. Carroll:
Yeah. And Jeff, you're not alone in feeling that way. Over the last 10, 15, 20 years there has certainly been a trend in health insurance, in health insurance copays, in premiums.

Dr. Carroll:
As an individual what we feel most directly is how much out of pocket are we paying when we go to the doctor? How much out of pocket are we paying when we go to the pharmacy and pick up that medication?

Dr. Carroll:
Although the costs have increased, the cost to us directly has increased in part because of the different insurance products and the different insurances that we have. High deductible healthcare plans are extremely common. That's been an important tool to help reign in some of the costs of healthcare in general. But that's also led to-

Jeff Harding:
In catastrophic health care.

Dr. Carroll:
In catastrophic health care, and also in non-catastrophic health care. The vision behind a high deductible healthcare plan is that it puts me as a patient in the driver's seat to look out, do some price shopping, find out which pharmacy can provide the medication for the least. Transparency becomes important in that as we participate as patients in that.

Jeff Harding:
But as a consumer, I just don't know what I want the cheapest doctor out there looking at me.

Dr. Carroll:
That's exactly right.

Jeff Harding:
I'm like, "How much do you charge for a visit? How much do you charge for a visit? Oh, you're $20? Well, I'll come to see you."

Michelle Graves:
But it's also the reason that our insurance rates have skyrocketed. I think there's probably not one great solution. But that is something that helps maybe balance cost and make competitors more competitive in their fees and their rates.

Dr. Carroll:
That's right. Increasingly what we are seeing and what we'll see more of over the ensuing years is that price transparency. Historically and even now, it's very difficult to know what the cost of a procedure is-

Jeff Harding:
Until you get the bill.

Dr. Carroll:
Until you get the bill. That's something that Nationwide Healthcare is looking at, is providing that transparency so that people are aware. You're certainly right. We don't necessarily want the lowest cost care.

Dr. Carroll:
At Intermountain Healthcare and Dixie Regional Medical Center, the goal is to provide high-quality care to every single patient. When they present to us in the emergency department through the doors of the hospital via referral from their doctor, the goal is to provide them with the highest quality of care and to help them live the healthiest life possible.

Jeff Harding:
We are indeed spoiled here because of the quality. I mean, award-winning care here in Utah because of the likes of Intermountain Healthcare and other providers here. But hopefully, everybody else out there in the country who might be listening to this has that same blessing in their community as well. We just can only hope.

Dr. Carroll:
Absolutely. That's something that we continuously strive for, where we're very, very lucky to have a very strong leadership team. Mitch Cloward, the administrator of the hospital, has a very clear vision of providing excellent care and being a leader throughout the state and the nation.

Dr. Carroll:
We recently learned through US News & World Report, we're the fourth-ranked hospital in the entire state of Utah. So among all the hospitals in the state of Utah, number four. The residents of St. George, the residents of Washington County, they can be extremely proud of the care they're able to receive.

Jeff Harding:
If you're just joining us, you're listening to the Huntsman World Senior Games Active Life. We're talking with Dr. Patrick Carroll, who is the director of medicine at Dixie Regional Medical Center. You're listening on AM 1450 St. George News Radio. We're talking about trends in health care.

Jeff Harding:
Something you kind of hit on earlier Dr. Carroll that I'd like to go back to a little bit is being the master of my ship. I mean, I'm responsible for my health and my wellbeing and my health care. Are you seeing any trends of that in medicine these days, where people are taking charge and trying to be the masters of their ship?

Dr. Carroll:
Yes, absolutely. I think that's a great question and certainly a nice lead into one of the things that Dixie Regional Medical Center was one of the leaders throughout the state of Utah, and that is the LiVe Well Center that exists at the hospital.

Dr. Carroll:
Often we think about healthcare and we have to separate that a little bit. Are we talking about health care, or are we talking about illness care? Health care I think is exactly what you're talking about. It's identifying problems early, doing things that will be preventive.

Dr. Carroll:
The Huntsman World Senior Games is a phenomenal example of that, of really embracing the active life and embracing healthy choices at all ages. That partnership I think is extremely valuable, and once again, very lucky in St. George and in the community to have that influence and see the great work that's happening.

Jeff Harding:
As a physician, are you seeing individuals choosing behaviors? Are you seeing trends of individuals choosing behaviors are going to be better for them in the long-run health-wise than the less productive behaviors? Just as an example, like smoking.

Dr. Carroll:
Yeah, absolutely. Smoking is a great example. In 2018, the Utah Department of Health released some data looking specifically at adolescent health trends. One of the things that they noted was that secondhand smoke rates from 2013 to 2017 had steadily decreased.

Dr. Carroll:
In 2013, 23% of adolescents were exposed to secondhand smoke. That's nearly one in four. That can have a significant impact on our long term health. In 2017, that rate had decreased to 17.4%. So still nearly one in five, but a nice trend and a nice decrease.

Dr. Carroll:
What we're seeing is we're seeing, for that to happen, that the parents in the household are smoking less, and subsequently their children, the adolescents are being exposed to secondhand smoke-

Jeff Harding:
And less likely to maybe pick up the habit themselves.

Dr. Carroll:
Absolutely. We're seeing some nice trends in smoking and secondhand smoke. There are some other concerns that we look at. Concurrently they reported the use of vaping in adolescent children, and I think you don't have to look too far to recognize that that's been a trend that's been on the increase. As recently as 2017, approximately one in 10 adolescents had experienced or were...

Jeff Harding:
Currently.

Dr. Carroll:
Currently vaping. That's a concern on several levels. Just in the last month or two, there have been additional results noted throughout the country on some permanent lung damage that appears to be a direct result of vaping behavior.

Jeff Harding:
It's been in the news recently that there were like five people in the state of Utah that were hospitalized because of lung deterioration due to vaping.

Dr. Carroll:
Yeah. It's heartbreaking. One of my classmates from residency recently noted that one of her patients now has permanent lung disease as a result of this. It's not something just in the news, it hits close to home.

Michelle Graves:
Is the data finding that vaping will be as detrimental or even more than smoking? Or do we not know that yet?

Dr. Carroll:
Well, I don't think we know it yet. It's relatively new, so we don't have the decades worth of experience and decades worth of data that we do with smoking. It'll be something that will be important from a public health standpoint to continue to follow.

Dr. Carroll:
But Jeff, your question initially was exactly the right question and exactly the right focus, and that is focusing on those healthy behaviors. There's so much that we do know about things we can do to impact our long-term health. Simple things like exercise, diet, attitude.

Jeff Harding:
Yes. Well, and... Go ahead, Michelle.

Michelle Graves:
Oh, sorry, Jeff. I do want to say that the LiVe Well Center if you're not familiar with it, is this really extensive health promotion, wellness type integral piece that is a big part of Intermountain Healthcare.

Michelle Graves:
I've been so impressed by that because I've lived in different places and I haven't seen that. My background is in that, and I worked for a national bank back in the day, and we rated people and then deducted their healthcare rates based on some of these factors. Did they smoke? Were they physically active? Did they get enough sleep at night? This was in the early nineties and it was very controversial.

Michelle Graves:
Now we know it's life-saving and it really can make a difference in what we promote a lot, living the active life and having a great quality of life as you go on. I love that a hospital is thinking more in terms of wellness.

Jeff Harding:
It's almost like they're trying to put themselves out of business, isn't it?

Michelle Graves:
Yeah, exactly. More in terms of wellness then fixing kind of, yes.

Dr. Carroll:
That's exactly the model. I'm a neonatologist by training. We frequently joke in the neonatal intensive care unit that we're doing all we can to put ourselves out of business. We'd like to eliminate prematurity. We'd like moms to be able to stay pregnant and not deliver premature babies and not require a NICU stay. As neonatologists, we'd be happy to find another job somewhere else if there was not a need for us medically.

Jeff Harding:
If I may just say on a personal note, I'm very grateful for the NICU because I have a great-granddaughter that's in the NICU here at Dixie Regional right now. So I'm very grateful for the work that they do when it's needed.

Dr. Carroll:
Well, thank you very much. We feel honored to be able to take care of every patient that comes through the NICU. It's an honor for us.

Jeff Harding:
Yeah. So getting back to this, we talked about, are there things besides just the regular exercise, the diet? I guess that's not the right question I want to ask. It doesn't take a lot of exercise, it just takes a few minutes a day to make a difference, does it not?

Dr. Carroll:
Absolutely. Similar to smoking, stopping smoking even for a couple of days, you can have some immediate improvements, in addition to long-term improvements. With exercise, those few minutes can make a very big difference. It doesn't need to take one, two, three hours a day. 5, 10 minutes, doing different exercise exercises at your desk, and...

Jeff Harding:
Or just getting up and walking occasionally.

Dr. Carroll:
Absolutely.

Jeff Harding:
We joke about in our office that I tend to be more sedentary than some of the other folks in our office. And Michelle's laughing.

Michelle Graves:
Jeff can hear me all day long because of the volume of my voice, and I sometimes, Jeff will pass late in the day, and I think to myself, "Has he been here all day? I didn't even know he was here." Because you don't leave that room, do you?

Jeff Harding:
Well, I do, but only when I need to because I'm old school. I'm an old person. I'll admit that.

Jeff Harding:
But back when I was learning the trade and the business world, you'd be at your desk unless you have a reason not to be at your desk. That was the rule of thumb. You're at your desk unless you have a business reason not to be at your desk.

Jeff Harding:
But now the [inaudible 00:21:13] and wisdom has changed, where it's like, you need to get up and move from your desk so you can be at your desk longer and live longer.

Michelle Graves:
Yeah.

Dr. Carroll:
Right. Some of that physical activity that you get by standing up, moving around, in addition to the physical activity, the social interactions, standing up, talking to a coworker for a few minutes, stepping away from social media. Making those real interpersonal connections can make a big difference.

Jeff Harding:
They really can.

Michelle Graves:
We could have a whole show about that I feel like.

Jeff Harding:
Well, we probably will. We'll have to do that one of these times.

Michelle Graves:
Let's lead to life expectancy rates. I think that's an-

Jeff Harding:
We've got about four minutes left, so we can quickly-

Michelle Graves:
Can we address that topic quick?

Dr. Carroll:
Absolutely. Life expectancy rates, we've seen those increase over the last several decades. I remember as I was growing up hearing 72, 73 years old is kind of an average life expectancy rate. We're seeing that that's no longer the case. The life expectancy has increased.

Dr. Carroll:
Nowadays for a person's born today in St. George has a life expectancy of over 81 years. That includes all people from birth.

Dr. Carroll:
When you start looking at the life expectancy rates when somebody is 40 years old or 50 years old or 60 years old, their life expectancy goes beyond that. So we are living a bit longer.

Dr. Carroll:
Over the last several years that seems to have plateaued, however. There's some discussion that it may start to decrease because of these lifestyle choices, and because of some of these behaviors that we choose.

Jeff Harding:
The self-destructive type behaviors.

Dr. Carroll:
That's right.

Jeff Harding:
Yeah.

Michelle Graves:
Or diet. I mean, there's probably a lot of-

Jeff Harding:
That's self-destructive behavior. Eating badly is self-destructive behavior. You may not think of it that way, but it is, It's a choice. It's a behavioral pattern, and it's self-destructive.

Jeff Harding:
We've got about a minute and a half left before we need to say goodbye to Dr. Carroll. Dr. Carroll, what would you say to somebody who's listening to this show and is maybe not as active as they should be, or sitting on the couch? What would you say to them to maybe get them motivated to get off the couch and get active and make some proactive choices?

Dr. Carroll:
Yeah. Great question. I would say take a step back and find out what you're why is. What is the reason that you want to do these things? Do you want to live to enjoy time with your grandkids? Do you want to travel the world when you're retired? Do you want to have an active lifestyle?

Dr. Carroll:
Take things one step at a time. You don't need to make dramatic changes all at once. Choosing to spend five minutes doing exercises you're not currently doing, that's a victory. One step at a time and you can do it.

Jeff Harding:
Then making the choice to repeat it is a victory.

Dr. Carroll:
Absolutely.

Jeff Harding:
It is a choice you have to make every single day. At our office, we have a health and wellness plan, and the reward is from the consistency of doing it. Not just doing it once, but doing it consistently. So that's the choice. You have to choose to do it consistently to get the benefits from it.

Dr. Carroll:
That's right. The consistency over time is more important than one or two single times for a long period.

Jeff Harding:
That's right. Well, Dr. Carroll, thank you so much. We'd like to have you back again if that's okay with you. There are so many topics that we just barely brushed the surface that we could probably spend a lot of time on. If you'd like to come back, we'd like to have you back.

Dr. Carroll:
Absolutely.

Jeff Harding:
Well, we'll get you back on the show then. Michelle, wow, learned a lot.

Michelle Graves:
Wow, we did take in a lot, and I agree, one thing's for sure, medical advancement has helped us live longer. But we also need to be responsible for ourselves. It's a great thing. It's great to see so many senior athletes. So tell us about the Huntsman World Senior Games.

Jeff Harding:
All right. Well, we want to, first of all, remind everybody to join us every Thursday at 5:30 for the Huntsman World Senior Games Active Life on St. George News Radio 1450 AM. You can also listen to this or any past show on www.seniorgames.net.

Jeff Harding:
You can also subscribe to our podcast. Just search for Huntsman World Senior Games Active Life in Google Play or the iTunes store and subscribe.

Jeff Harding:
Michelle, believe it or not, registration closes on September 1st, but right now we have over 10,150 people who've already signed up for the games.

Michelle Graves:
That's looking pretty good.

Jeff Harding:
It is. We're also way ahead of last year's schedule. We're on pace for maybe 11,200-300 so we're going to have a big year. If you want to register, just go to seniorgames.net and click on register.

Jeff Harding:
Our quote for the day is, there are two great days in a person's life, the day we are born and the day we discover why. Until next time, stay active everyone.

Michelle Graves:
Bye-bye.