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

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah healthcare. Dr. Madsen, what changes have you made in your lifestyle because of what you've seen in the ER? I mean, you see the end result of decisions. Have those decisions, what you see there, changed any of your behaviors?

Dr. Madsen: That's a great question and you're right. We do tend to see the end result of decisions and the end result of disease processes, and I think being in the ER, you realize there is a certain amount you can do in those situations but you're also so limited in so many ways. So I think for me, I can think of a few things that probably it's affected me over the years where I really realize that, you know, they say the best medicine is prevention.

And I think that's kind of how it has affected me personally is trying to make changes in my lifestyle to prevent certain diseases and certain things so I just hopefully never end up in the ER. I'm sure I will at some point, I have in the past, but I try to avoid it at all costs unless I'm working there.

Interviewer: So what have you discovered?

Dr. Madsen: So one thing I, you know, from a personal standpoint, about eight years ago, I actually adopted, technically the term is a pescetarian diet. So not vegetarian but pretty much vegetarian and then I occasionally eat fish. This is something personally I did after kind of seeing some of my cholesterol numbers and that and having a family history of high cholesterol. That's kind of what prompted me to do this.

I think for a lot of people adopting a dietary change like this is kind of a personal decision and maybe other factors that go into that as well. But a big part of it was seeing advanced cardiovascular disease and seeing my cholesterol numbers that just maybe weren't as great as I hoped they were and thinking, "Wow, I'd like to make some changes to see if I can make a difference there." And I can say I've seen a difference and at the same time, I'll tell you that you can be a vegetarian, or a pescetarian or vegan or whatever you want to do but you can still eat very poorly. So you still have to be very careful with that. I don't think that's any sort of a golden ticket to having good health but I think personally for me, seeing some of the outcomes of heart disease and where things have gone, it's been a positive change for me and something where I have seen some improvement in cholesterol numbers and some improvement there.

Interviewer: So there was a personal reason that you mentioned but what is it that you're seeing in the ER that really solidified that for you then when it comes to cardiovascular disease?

Dr. Madsen: Yeah. I see a lot of people who come in with heart attacks, who come in with a lot of heart issues. I have done a lot of research personally on heart disease and seen some of the outcomes that people have. I look at people on lots of different medications to lower their cholesterol and I think for me, I just said, "You know what, I don't want to get to a point where I have to go on medications."

Maybe there would be that point someday, but I thought if I can prevent that and try and take some steps to prevent that, then that would be great and I was encouraged also just in terms of my research and seeing a couple of studies that were out there that looked at people's different dietary practices, one that looked particularly at the Mediterranean diet which does incorporate a lot of fish, olive oil, vegetables, things like that. These studies were fairly convincing in showing that these people in these diets really did have improvements in terms of their cholesterol by primarily really looking at outcomes of heart disease and in different changes there. So, yeah, if it works there, it's worth trying.

Interviewer: And what was it about those outcomes that scared you?

Dr. Madsen: I don't want to end up with a heart attack. I don't want to end up in the ER, getting rushed to the cath lab like I see so many people coming in and then trying to get a stent in to open up a blocked artery and then hopefully it's successful but maybe then there are adverse outcomes and complications down the road. So again, it was in my mind seeing a lot of cases like this and saying, "Hey, if I can prevent hopefully ending up in that situation someday, that would be great." Maybe this prevents and maybe it helps, maybe it doesn't but personally, I think it's been a positive thing for me, just looking at cholesterol numbers over time. Again, I'm just speaking purely anecdotally but I've definitely seen improvements there so I think that's been a good thing.

Interviewer: All right. And what else have you learned?

Dr. Madsen: I think another thing too, and this has been at my wife's prompting as well, is I'm trying to run a lot more and that's also a preventive thing. I think that gets to, again, heart disease, just general health, certainly avoiding obesity. We see many, many complications of obesity in the emergency department. Again, heart disease, diabetes, stroke, things like that. So just trying to have an active lifestyle. I ran a bit in college and then I just stopped running during medical school, just stopped altogether. I was still fairly active but then, every birthday, my wife seemed to give me something for running, like a pair of shoes or some other thing and . . .

Interviewer: And how many years did it take you before you picked up on that?

Dr. Madsen: It took several years. Finally, I took the hint. I was like, "I better start running." So I'm proud to say I actually completed my first marathon two weeks ago.

Interviewer: Oh nice.

Dr. Madsen: So I'm very excited about that but I don't think you need to go on and be a marathon runner or anything like that. I think just having an active lifestyle, trying to get some sort of cardiovascular exercise, at least three times a week for 30 minutes at each time, that's going to prevent a lot of these things that have been concerning to me, again, seeing complications of obesity and inactive lifestyles and a lot of the things that then just develop over time and then develop into an emergency and something I might see in the ER.

Interviewer: Yeah. It's interesting that it comes back to kind of two very basic things: diet and exercise, right?

Dr. Madsen: It really does.

Interviewer: And when you go visit your doctor, that's what they harp on and a lot of times, I think we tend to get numb to that and think, "Well, how much of a difference does that really make?" But based on what you've seen, I think a lot.

Dr. Madsen: I think it's huge. I think the answers are simple. We want complicated answers sometimes for a disease. I think the answers are really quite simple and it really is, the prevention is the absolute best thing you can do. Again, speaking as someone who sees things on the other end trying to deal with things when they have developed, you can prevent it and the keys to prevention, I really think, do come down to diet and exercise.

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