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After 50,000 ER Patients, I Noticed This Pattern... — Transcript

by Doctor Alex · 3,557 words · 531 segments · language en · Watch on YouTube

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0:00So, I worked out recently that I've seen
0:02over 50,000 patients in my career so
0:04far. And after a while, you start to see
0:07things that the textbooks don't really
0:09prepare you for. Patterns that you start
0:12to notice again and again. And the
0:14pattern I keep seeing isn't really about
0:17the emergencies themselves. It's about
0:19what came before those emergencies. The
0:22patients we see in A&E with serious
0:24medical problems like heart attacks and
0:26strokes and heart failure, kidney
0:28failure, diabetic problems. The vast
0:31majority of these patients are over the
0:33age of 50. And that is not surprising on
0:36its own because as we get older, things
0:39go wrong. Our bodies age. But what
0:41really bothers me the longer I work in
0:43emergency medicine, and really is the
0:45reason why I started this channel, is
0:48how often we'll run the tests, we'll
0:51look at the results, and realize that
0:53whatever brought this patient in has
0:55clearly been developing for years and
0:57years, sometimes a decade or more, and
1:00nobody has caught it. Or if they had,
1:02nobody has acted on it.
1:05Modern medicine is amazing. We can do
1:07amazing things, but we are terrible at
1:10preventing things from happening in the
1:12first place. If you're new here, then
1:14hello. My name is Alex. I'm an emergency
1:17medicine doctor, and my mission these
1:19days is to help people from ever ending
1:22up in the A&E in the first place, and to
1:24teach you everything I know about how to
1:27stay healthy and prevent disease. And if
1:31you'd like to support what I'm doing
1:32here, then the best thing that you can
1:33do is like the video and subscribe to
1:36the channel. It really does make a
1:38massive difference. And only about a
1:40quarter of people who watch these videos
1:42are subscribed. So, please help me out,
1:45show your support, and I'll keep making
1:47these videos for you to help as many
1:49people as possible. Anyway,
1:51what I want to do in this video today is
1:54talk about six things. Six numbers, six
1:58markers that I think everyone should be
2:01checking every single year. Not because
2:05I want to sort of medicalize your life
2:07or turn you into somebody who's really
2:09anxious about their health. The opposite
2:11actually. The whole point of longevity,
2:13the thing that the people who live
2:15longest tend to have in common is that
2:18they've had the least input with their
2:20doctor over their lifetime. Not because
2:24they've been lucky, but because they've
2:26looked after themselves well enough that
2:28serious intervention was rarely needed.
2:32It's a bit like a car. If you do the MOT
2:34every single year, if you check the oil
2:36and you pay attention to the warning
2:38lights and you deal with the small
2:40things before they become big things,
2:42then that car will last far longer than
2:45one that only ever sees a mechanic when
2:47something has already gone wrong. I hope
2:49that makes sense. Your body is very
2:52similar and the six things that I'm
2:54going to talk about today are like your
2:56dashboard. The thing is, most of these
2:59patients that I talk about hadn't just
3:01been completely fine and then suddenly
3:03collapsed. They'd had symptoms. They'd
3:06felt a bit off. They felt tired in a way
3:09that felt a bit different for a long
3:10time. They felt breathless doing things
3:13that didn't used to make them breathless
3:15or they felt a bit foggy or, you know,
3:17odd sensations in their hands or feet
3:19that they couldn't quite explain.
3:21And almost universally, they'd put it
3:25down to getting older. Which is
3:27completely understandable because when
3:29symptoms come on very gradually over
3:31months or years, your brain adjusts to
3:34them. They become your new normal. And
3:37the thing is, you've only ever lived in
3:39your own body. You don't have another
3:41version of yourself to compare all of
3:43these symptoms to. You don't know
3:46whether the tiredness you feel is just
3:48what a 55-year-old tiredness feels like
3:51or whether it's a sign that something
3:52else has been quietly going wrong for
3:55the past 3 or 5 years. So, what is
3:58actually going on with these patients?
4:00And what are we seeing when we do these
4:02tests? Well, a lot of the time it comes
4:04down to one of a handful of things, or
4:07more often a combination of them.
4:09And none of them are expensive or
4:12complicated. They are things that can be
4:14measured with a simple test, often at
4:16home. And the first one I want to talk
4:19about is blood pressure. Because it's
4:21the one that surprises most people when
4:24I talk about what it actually does to
4:25your body over time. So, high blood
4:28pressure is sometimes called the silent
4:31killer, which sounds a bit like a
4:32cliché, until you've watched what it
4:34does to people in their 60s and 70s and
4:38beyond. The reason it's silent is that
4:41it genuinely doesn't feel like anything
4:43for a very long time. Your blood vessels
4:46are under higher pressure than they
4:48should be, essentially, day after day,
4:50year after year. And they are quietly
4:52being damaged by it. The walls of the
4:55arteries and veins thicken and stiffen.
4:59The heart has to work harder to push
5:01blood through them. And what that means
5:04is that the small vessels in your brain
5:07and your kidneys and your eyes get
5:09gradually damaged. And then one day,
5:11without warning, something gives way.
5:14Something happens. Like a vessel in the
5:16brain ruptures or blocks, or in the
5:19heart, exhausted from years of overwork,
5:21starts to fail, and that's what we see
5:23in heart failure. Or a kidney that has
5:25been struggling for a decade tips into
5:28serious dysfunction. And we see these
5:31sorts of things in A&E all the time. And
5:34we look at their history, and their
5:36blood pressure has been elevated for
5:38years. This is what we see most of the
5:40time. Sometimes they knew about their
5:43blood pressure, and they weren't really
5:45treated properly. Sometimes they had no
5:47idea at all because they'd never had it
5:49checked.
5:50The thing is, a home blood pressure
5:52monitor costs less than 20 quid, 30
5:55quid, and it gives you one of the most
5:58important numbers that you can know.
6:01Your blood pressure is something that
6:03everybody needs to monitor.
6:05You're looking for something
6:06consistently around 120 over 80 or
6:09below, unless you are particularly
6:12elderly and frail, in which case we like
6:15a bit of a higher blood pressure just to
6:17sort of prevent any falls from, you
6:20know, a postural drop or anything like
6:21that.
6:22Anything regularly over 130 over 85, if
6:26you're not frail, is worth taking really
6:29seriously and discussing with your
6:30doctor. Because even just mildly
6:33elevated pressure can do real damage if
6:36it's sustained over decades. Number two
6:38on the list, right alongside blood
6:40pressure, is something else that we
6:42always pick up, which is a high resting
6:44heart rate. So, people don't really
6:46think about this one, but a resting
6:48heart rate that's consistently elevated,
6:51sitting sort of above around 80 beats
6:54per minute, certainly above 90, and we
6:56do see this,
6:58is a really important signal. It often
7:00reflects a heart and cardiovascular
7:03system that is under strain, a nervous
7:06system that's stuck in a low-level state
7:09of stress, or underlying metabolic
7:11dysfunction as well.
7:13A healthy resting heart rate sits
7:15somewhere between 50 and 70 for most
7:18people. Mine is around 45, and I have
7:22seen a resting heart rate in the high
7:2430s as well. This guy was in his 50s,
7:28and he was an Ironman triathlete, so
7:31all of the alarm bells went off, and
7:33everybody came running, and he was the
7:35fittest guy you've ever seen. He just
7:37had an ankle injury. And you can measure
7:39this yourself right now if you don't
7:42have a smart watch. So, just put two
7:44fingers on the inside of your wrist over
7:47your radial artery and count the number
7:50of beats for 30 seconds and then double
7:52it.
7:53If that number is higher than you'd like
7:56it to be, so if it's higher than 80,
7:58then it's worth paying attention to.
8:00Most smart watches and fitness trackers
8:03will measure this continuously and then
8:05give you a really good resting average,
8:07which is even more useful than a single
8:10reading. The third one in this video
8:12today is your kidney function and we
8:14check this, well, to be honest, in most
8:17patients in the A&E and it's one that
8:19most people never really think about
8:21until something goes wrong. And by that
8:23point, it's been declining for years and
8:25years. Your kidneys are doing a massive
8:29amount of work every single day,
8:31filtering your blood, regulating your
8:33blood pressure, managing fluid balance,
8:35getting rid of waste products and they
8:37are delicate. They are vulnerable to
8:39high blood pressure, to high blood
8:41sugar, to inflammation, to certain
8:43medications.
8:44The problem is that the kidneys are
8:46remarkably good at compensating. You can
8:50lose a significant proportion of your
8:52kidney function and feel basically
8:54nothing. No symptoms, no warning,
8:57nothing that would make you pick up the
8:59phone and call your doctor. And we see
9:02patients all the time who come in with
9:04something that looks unrelated like
9:06breathlessness or nausea or confusion.
9:10And we run a basic blood test for this
9:12patient and then we find that their
9:13kidney function is severely impaired.
9:17They have kidney failure. And when we
9:19dig deeper into the history, the signs
9:22had been there on previous blood tests
9:25from the GP, quietly getting worse for
9:28years without anybody putting the pieces
9:30together. So much of this is just put
9:32down to aging.
9:34And this is wrong. This is one that you
9:36actually do need a blood test for. It's
9:38called your EGFR, estimated glomerular
9:41filtration rate, but it is a standard
9:44part of any basic blood panel that your
9:47doctor can arrange really easily, and
9:50you can also get it done privately as
9:52well if you're struggling with that. It
9:54might cost, I don't know, 50 or 100
9:56quid,
9:58but if you do that once a year, it's
9:59really worth doing. Now, your
10:00triglycerides and LDL cholesterol are
10:03another piece of this puzzle, and I want
10:06to be careful here because the
10:07conversation around cholesterol has been
10:11sort of quite noisy recently, and to be
10:14honest, very confusing. I did a video
10:16recently on statins
10:18that has become quite popular, and I'd
10:19recommend checking that out if you're
10:22confused about whether to take a statin
10:23or not. What the evidence consistently
10:26shows is that elevated LDL cholesterol
10:29and chronically high triglycerides, and
10:31I'm talking about the stuff on just a
10:33standard blood panel at the moment.
10:35These are really meaningful contributors
10:37to cardiovascular disease over a long
10:40time. They are part of the process that
10:43leads to plaques building up inside your
10:45artery walls, the process that
10:47eventually causes heart attacks and
10:49strokes.
10:50And again, you feel none of this
10:51happening. There are no symptoms of high
10:54triglycerides. There are no warning
10:56signs of an elevated LDL sitting in your
11:00blood. It is invisible until the
11:02consequences aren't. And again, this is
11:05just a really cheap, easy blood test
11:07that we do all the time that your GP
11:09should be able to do for you. And if you
11:11can't get it through your GP, then go
11:13privately. The next one on this list is
11:15all about your blood sugar, and this is
11:17the one that most people
11:18underappreciate, but it's the one that
11:20you can fix most easily. So, we run a
11:23random glucose test on most patients in
11:26the A&E, and very often we find it is
11:28elevated. Not sort of diabetic level
11:31necessarily, but a higher than it should
11:33be.
11:34And then what we do, either on the ward
11:36or sometimes in the A&E as well, we run
11:38an HbA1c or A1c if you're an American,
11:42which is a test that shows your average
11:45blood sugar over the past 2 to 3 months,
11:47not just what it is at this exact moment
11:50right now.
11:51And that often is elevated as well.
11:53And what this tells you is that
11:55somebody's blood sugar has been running
11:57high consistently for months or even
12:00years, to be honest. Not just spiking
12:03occasionally in response to a sugary
12:05meal or refined carbs, but chronically
12:07elevated day after day. And that is the
12:10environment in which blood vessels
12:12become damaged, where your nerves get
12:14damaged, where your kidneys and your
12:16heart get damaged as well. A healthy
12:18HbA1c sits below 42 if you're in the UK
12:22or below 5.7% if you're in America, but
12:26really the lower the better. And this is
12:28something you can address really easily
12:30with walking after meals and trying to
12:33include as much fiber and protein and
12:36roughage in everything you eat. And
12:38finally, the last test on the list today
12:41is your LFT, liver function test. And
12:43again, this is a really cheap test that
12:45we do all the time for most patients
12:47that come through the doors. And what we
12:50find again and again is that, you know,
12:52these tests are quietly abnormal in
12:55people who had no idea at all. And the
12:58most common reason for this is fatty
13:01liver disease, which is becoming
13:03increasingly common these days. We see
13:05it all the time.
13:07And this is almost entirely driven by
13:09diet and your metabolic health and your
13:12activity levels. So, too much sugar, too
13:14many refined carbohydrates, too little
13:16movement, and the liver starts
13:18accumulating fat.
13:20This does not hurt. It doesn't cause any
13:22noticeable symptoms. It just quietly
13:24becomes less efficient over time and
13:28more inflamed and more damaged over
13:30time. And a damaged liver affects
13:33everything. It affects your cholesterol,
13:36your blood sugar regulation, your
13:37hormones, your ability to process
13:39medication properly. It is really
13:41important. A liver function test is just
13:44a standard cheap test that your GP can
13:46arrange for you. Or if you're having
13:48problems,
13:50it is again a test that you can get
13:51privately. And it's worth saying I don't
13:54get any money or benefit from suggesting
13:56that. In an ideal world, our doctors
13:58would just do this for us every year to
14:01try and prevent things in the future.
14:02But that is another story.
14:05Now, if your results come back with a
14:07raised ALT or AST, which are enzymes
14:11that leak into the blood when liver
14:12cells are under stress, then clearly
14:15that is something that needs addressing
14:17properly with a doctor's appointment
14:19where they examine you, they take a
14:21thorough history, and probably some
14:23imaging as well, probably an ultrasound.
14:25And this brings me to the final point in
14:27this video. And it's worth saying that
14:29this isn't meant to scare you. It is
14:31meant to say that we have the tools
14:33available to see things coming. The
14:36technology exists right now to measure
14:39the things that matter. Blood pressure,
14:43resting heart rate, HbA1c, kidney
14:46function, triglycerides, LDL, and liver
14:49function tests. And to catch problems
14:52while they're still problems rather than
14:54after they've become catastrophes.
14:57Think about how most people treat their
15:00car. They have a regular MOT. They have
15:02regular oil checks. You know, warning
15:04lights are taken seriously. You wouldn't
15:07drive a car for 10 years without ever
15:10looking under the bonnet and then act
15:12surprised when the engine fails. That
15:14just doesn't happen. But that's
15:16essentially what most of us are doing
15:18with our bodies. Most of us wait until
15:21something goes wrong badly enough to end
15:23up in the emergency department, and then
15:25we're shocked to find out it's been
15:27building since our mid-40s or early 30s
15:31or whatever. Most people assume that we
15:34go through life healthy, healthy,
15:36healthy, then we age and something bad
15:39happens.
15:40But that's not the case.
15:42Some of these tests your GP can do for
15:45you, and I would really hope that if
15:48you're trying to prevent illness and
15:49really take charge of your health, that
15:51your doctor would do these for you. Go
15:53out and buy a blood pressure machine and
15:55actually check your blood pressure
15:57regularly, get an average, and track it
16:00over time. And buy a smart watch as
16:02well. You can get a smart watch for less
16:04than 20 or 30 pounds these days. And not
16:07only does it check your resting heart
16:09rate, but many of them measure your
16:11steps per day, your sleep score, and
16:14your VO2 max as well. It gives you so
16:16much information. Now, all of these
16:18tests are actually extraordinarily
16:20valuable. Not because you'll necessarily
16:22find something wrong, but because
16:24knowing your numbers means you have a
16:27baseline for where you are right now.
16:29You know where you stand. And if
16:31something starts to shift over time,
16:33then you can catch it early when the
16:35window to act is wide open rather than
16:39nearly closed, which is what we see in
16:42recess. Just remember that the symptoms
16:44of chronic disease are very subtle. They
16:47are sneaky. They feel like normal life,
16:50like getting older. Like nothing in
16:52particular. Like the tiredness that you
16:55assume is just stress, or breathlessness
16:57that you put down to being a bit out of
16:59shape maybe, or your memory that feels
17:02slightly less sharp than it was a couple
17:04of years ago. Like tingling in your feet
17:06that comes and goes that could be
17:07diabetes.
17:09These things feel really unremarkable
17:12because they arrive over years.
17:15Your brain just adapts to them. And
17:17because you've only ever been you, you
17:19don't have another body to compare it to
17:22to see if this is normal, if that makes
17:23sense. Basically, what I'm trying to say
17:25is that the only way to know what's
17:27going on is to measure it properly and
17:30regularly, like it matters, because it
17:32does matter. Very often, your life will
17:34depend on these numbers at some point.
17:37The vast majority of what I see at work
17:39in the hospital is entirely preventable.
17:42It is not inevitable. It is not just a
17:45part of getting older. It is the end
17:47result of a process that has been
17:49running for years and years, but very
17:51often visible in the numbers if anyone
17:54had actually looked at them.
17:56Now, I'm not trying to blame anybody
17:59here. It's not about people doing
18:00something wrong. It is about a system
18:02that is brilliant at treating crises and
18:05genuinely very poor at preventing them
18:08in the first place, which means if
18:09prevention is going to happen, a lot of
18:12it has to come from you.
18:14You cannot rely on the health care
18:17system to keep you healthy, and that is
18:19a really sad thing to say.
18:21You've got to know your numbers. You've
18:23got to treat your health like the most
18:25important thing you maintain, because it
18:28is. The people who live the longest, the
18:30healthiest, and the most independently,
18:33they are not the ones who spent the most
18:35time in their doctor's surgery or in the
18:38hospital. They are the ones who rarely
18:41needed to see their doctor. They are the
18:43ones who prevented these things from
18:44happening in the first place. Now, I'm
18:47trying to keep this video as short as
18:48possible, because really what this video
18:50is is just giving you a starting point,
18:53a set of signals worth paying attention
18:55to.
18:56And there are so many other videos on
18:58this channel that go much deeper into
19:01specific parts of this, whether that's
19:03blood sugar or cardiovascular health or
19:05kidney function or blood pressure or
19:08what to actually do about any one of
19:09those numbers. So, if something here has
19:11resonated, then there is a lot more to
19:13explore on the rest of the channel.
19:16What I would say is this. Each of these
19:18markers I've mentioned today is pointing
19:21at something. A high resting heart rate
19:23might be telling you something about
19:24your fitness or your breathing or how
19:26much chronic stress your body is
19:28carrying. A raised HbA1c is almost
19:31always pointing at your diet and how
19:34sedentary your life has become. Elevated
19:37triglycerides often reflect the same
19:39thing as well. A poor kidney function
19:41might be pointing at your blood pressure
19:43or your blood sugar. And again, your
19:45liver function is almost always about
19:48your metabolic health, which is again
19:50about what you're eating and how much
19:51you're moving. Now, none of these
19:53numbers exist in isolation and none of
19:56them are a diagnosis on their own. They
19:58are just signals. And the whole point is
20:02that the signals, if caught early
20:03enough, give you time to do something
20:06about them before they become the kind
20:08of emergency that ends up walking
20:10through my doors at work. And if any of
20:13these tests come back abnormal or if
20:15your blood pressure or resting heart
20:17rate is a little high, then clearly what
20:20you need is a sit-down appointment with
20:23your doctor who examines you thoroughly
20:25and takes a thorough history.
20:28This is the bare minimum. This is what
20:29you deserve.
20:31I really hope you found this video
20:32useful today. If you did, then please,
20:35please, please like the video, subscribe
20:36to the channel, and let me know in the
20:38comments what you'd like me to focus on
20:41next time.

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