Nancy May: 00:00:00

And this is a rather I don't want to say fortuitous show,

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but it's a show I've been looking forward to for some time with Dr.

Nancy May: 00:00:09

Shea Gregg.

Nancy May: 00:00:10

Shea and I have known each other for a number of years, and beyond being a trauma

Nancy May: 00:00:16

surgeon, he is the president and founder of something called Fall Call, and focuses

Nancy May: 00:00:23

Well, his passion really is about helping patients, predominantly a lot of his

Nancy May: 00:00:28

geriatric patients who are dealing with falls, manage, hopefully, to not fall.

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Or, if they do fall, get the help that they need beforehand, or not

Nancy May: 00:00:37

even beforehand, but after the fact.

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But, Dr.

Nancy May: 00:00:40

Gregg is a husband, a father, and a caregiver for his parents,

Nancy May: 00:00:45

where he's going down the path of caring for the beginning stages

Nancy May: 00:00:49

of aging of his own parents.

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So he's kind of one of us, not just a brilliant doctor.

Nancy May: 00:00:54

So that's good.

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He received his undergraduate degree in neuroscience at Brandeis University and

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his MD at Dartmouth Brown Medical School.

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He is currently chair of the surgery department at St.

Nancy May: 00:01:06

Vincent's Medical Center, which is He's predominantly based in New

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York, although they have locations all around the New England area.

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But he's also a trauma surgeon with Hartford HealthCare, a member of the

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board of the Medical Alert Monitoring Association, and is chairman, of the

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State of Connecticut Trauma Committee.

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And he's been that position for eight years or so now.

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But, if that's not enough, as I said, he's also the president and

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founder of an organization, which is best in class called Fall Call.

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And I'm going to get into a little bit about Fall Call a little later on in our

Nancy May: 00:01:42

conversation, because, Shea, I really want to talk first about explaining what

Nancy May: 00:01:49

A trauma is, and what a trauma surgeon does, I'm not a medical professional.

Nancy May: 00:01:54

So trauma might be different to you versus myself or somebody else that we know.

Nancy May: 00:02:00

So can you explain exactly what that is?

Nancy May: 00:02:04

Dr. Shea Gregg: Sure, so Nancy, again, as you mentioned, this is a long time coming.

Nancy May: 00:02:08

I'm so excited to be on your podcast and to be a part of your show.

Nancy May: 00:02:12

So, I get you forgot something very important.

Nancy May: 00:02:14

I also like to go fishing too.

Nancy May: 00:02:16

So,

Nancy May: 00:02:16

Oh, okay.

Nancy May: 00:02:20

Dr. Shea Gregg: uh,

Nancy May: 00:02:21

You killed a fish, so you're a doctor, so I'll double check that one.

Nancy May: 00:02:24

Dr. Shea Gregg: most, most of them make it, make it out

Nancy May: 00:02:26

Catch and release?

Nancy May: 00:02:27

Okay, I got it.

Nancy May: 00:02:28

Dr. Shea Gregg: it right, so we're pretty good about that, but, you ask a

Nancy May: 00:02:30

sort of a core question, what is trauma?

Nancy May: 00:02:33

And, when you think of trauma, depending on where your point of

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view is from, people can think of, people, I will say it's basically

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injury, unintentional injury.

Nancy May: 00:02:43

All right, when we think of many of the times, it's unintentional injury.

Nancy May: 00:02:47

Sometimes it's sadly can be intentional injury, but we can break it down

Nancy May: 00:02:50

and do with the taxonomy of physical injury versus mental based injury.

Nancy May: 00:02:55

All right, so when a trauma surgeon is dealing with a patient who is hurt.

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through some sort of mechanism, whether it's a penetrating trauma as in guns

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or knives or a fall, which is the most common cause of trauma, that we see

Nancy May: 00:03:11

in the United States and in our trauma centers, or motor vehicle crashes.

Nancy May: 00:03:15

There's another obviously mechanism, motorcyclists, we think of physical

Nancy May: 00:03:18

injury and, we, as trauma surgeons, are trained to manage the injuries

Nancy May: 00:03:24

associated with physical trauma.

Nancy May: 00:03:28

That's when you think of trauma surgery and you watch the, you know,

Nancy May: 00:03:30

the medical dramas on TV, that's the, that's where you sort of think of

Nancy May: 00:03:34

where a trauma surgeon fits in, is fixing those injuries or managing those

Nancy May: 00:03:39

injuries with their incredible team.

Nancy May: 00:03:41

But that being said, which I'm very excited about, is that, that finally

Nancy May: 00:03:46

we embrace the fact that mental injury actually accompanies physical injury.

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And we are learning with time how to better manage, patients who suffer

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physical injuries, but also the scars associated, with mental injury, um, which

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could be anything from PTSD to prolonged depression to, anxiety, not being

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able to sleep, nightmares, et cetera.

Nancy May: 00:04:08

So it all goes together and we have to, um, yes, we'll, you know, fix the physical

Nancy May: 00:04:14

things and, um, uh, based on mechanism.

Nancy May: 00:04:18

But we also have to really address what the trauma is associated

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with, because the mind is a very powerful thing, and that needs to

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be in the recovery process as well.

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And there's more being done, both from societies and from hospitals on

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managing both aspects of the trauma.

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Well, I, I can actually understand that because, years back,

Nancy May: 00:04:40

that's probably about 30 years ago, I had a very bad head on car accident myself,

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right in front of our house on Super Bowl Sunday, and, both my legs were broken.

Nancy May: 00:04:50

But I have to tell you, the, I will call it so that the flinch reaction that I

Nancy May: 00:04:57

had anytime my husband was driving and I was not in control, which I couldn't

Nancy May: 00:05:03

be, because I've got a cast on one leg, a boot on the other, and sitting in the

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back seat, my reaction was like, stop!

Nancy May: 00:05:09

Don't do that, turn left, put your blinker on.

Nancy May: 00:05:11

I'm like the backseat driver, the worst there ever has been.

Nancy May: 00:05:15

And hyper, hyper sensitive when I got behind the wheel as far as what

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was happening, what was around me.

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So I'm not sure I would call that trauma necessarily from my

Nancy May: 00:05:25

perspective, but it was a heightened awareness of what could happen when.

Nancy May: 00:05:32

so I guess there was some, mental stress,

Nancy May: 00:05:35

Dr. Shea Gregg: Oh, absolutely.

Nancy May: 00:05:37

And there's a classic book that's out there, um, called,

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uh, Trauma, The Body Keeps Score.

Nancy May: 00:05:43

And what they found in, a variety of studies is that, people who

Nancy May: 00:05:48

suffer physical trauma do, Many of them suffer, emotional and or

Nancy May: 00:05:53

mental trauma associated with it.

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So, the startle reflects the, it's sort of like a baseline.

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You know, they might be sort of hypervigilant, um,

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uh, that could be one form.

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But the waking up, I mean, I screen my patients now on a regular basis, where

Nancy May: 00:06:09

I will say, are you having nightmares after your motor vehicle crash?

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And like, and a lot of them are saying, yeah.

Nancy May: 00:06:14

We didn't ask those questions years ago.

Nancy May: 00:06:16

Um, or people who are the victims of gun violence or, or knife related

Nancy May: 00:06:20

violence and penetrating trauma, they can remember hearing those.

Nancy May: 00:06:23

And if they hear a loud sound, it's, it's, it's something that haunts them.

Nancy May: 00:06:28

So, we really have to be tuned in to all aspects of that, when it comes to

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dealing with the physical trauma, always remembering that there's emotional

Nancy May: 00:06:36

and mental trauma and the body has that intense reaction at the time.

Nancy May: 00:06:42

And that intense reaction is something that may be in our subconscious that

Nancy May: 00:06:46

we have to learn how to get ahead of and how to treat that in addition

Nancy May: 00:06:51

to, as part of the recovery process.

Nancy May: 00:06:53

I would imagine that if, let's say, you've got an older patient who's

Nancy May: 00:06:57

fallen and had a broken bone or some sort of issue happened, that even wanting to

Nancy May: 00:07:04

get up and stand on their own two feet for fear of falling can also be an issue.

Nancy May: 00:07:09

So now the body's not recovering as it could or should properly

Nancy May: 00:07:14

because the muscles aren't working.

Nancy May: 00:07:15

Is that correct?

Nancy May: 00:07:17

Dr. Shea Gregg: Um, yes, and that's multifactorial.

Nancy May: 00:07:19

So there's an indicator that we look at called the fear of falling, and

Nancy May: 00:07:22

if you do surveys on folks after they fell, that fear of falling is very

Nancy May: 00:07:27

real, and it actually gets magnified from before and after, as expected.

Nancy May: 00:07:31

And the reticence to get out of bed, especially when you're dealing with

Nancy May: 00:07:35

frailty or other sort of, metabolic issues, poor nutrition, and a variety

Nancy May: 00:07:38

of other things, that could potentially be affecting the older adult.

Nancy May: 00:07:42

Um, but it's something that we have to tune into and how we have to be

Nancy May: 00:07:46

empathetic and sensitive to as we think about the recovery process

Nancy May: 00:07:50

in older adults after a fall.

Nancy May: 00:07:52

I want to take a side detour because you mentioned something

Nancy May: 00:07:55

about, what outcomes and predictive models are understanding what's going

Nancy May: 00:08:00

to happen after certain situations, and I read in a, it was probably a two

Nancy May: 00:08:06

year old Twitter note that you put up there about AI means machine learning

Nancy May: 00:08:11

and better understanding predictive models as a result of AI or machine

Nancy May: 00:08:16

learning, whatever you want to call it.

Nancy May: 00:08:18

that were better in predicting outcomes than traditional methods.

Nancy May: 00:08:23

Are you seeing changes in that now so that, let's say a patient comes in or

Nancy May: 00:08:27

a family comes in and the doctor may say, oh, this is the routine, but if

Nancy May: 00:08:31

you put their information through some sort of program that you might have.

Nancy May: 00:08:36

Again, I'm not in the hospital, so I don't necessarily know what, software

Nancy May: 00:08:39

programs you have there, that you can actually predict what the outcome

Nancy May: 00:08:43

or recovery is going to be for that particular person versus just saying,

Nancy May: 00:08:46

yeah, we see this all the time.

Nancy May: 00:08:47

This is either going to work or not work.

Nancy May: 00:08:50

Dr. Shea Gregg: The answer is absolutely.

Nancy May: 00:08:52

And there's actually, it's interesting as we transition into this new world of AI.

Nancy May: 00:08:57

hmm.

Nancy May: 00:09:01

Dr. Shea Gregg: Which is really a prospective learning tool, on a classic

Nancy May: 00:09:03

model or based on the models of previous information that's been fed into it.

Nancy May: 00:09:08

I mean, that's really what AI is.

Nancy May: 00:09:10

So you have good, so long as you have good data in, then

Nancy May: 00:09:13

you can expect good data out.

Nancy May: 00:09:14

That's one key thing.

Nancy May: 00:09:15

So you've got to make sure that you capture the good data and then ultimately

Nancy May: 00:09:19

to predict, what people's outcomes were, are going to be, then you have to look

Nancy May: 00:09:24

at your different types of variables and.

Nancy May: 00:09:26

Traditionally, we did this through either prospective or retrospective and

Nancy May: 00:09:31

randomized control studies, et cetera.

Nancy May: 00:09:34

Um, many of this are observational studies where we know, if a person over the age

Nancy May: 00:09:39

of 45, and they have, rib fractures, 45 to 65, we say, then, they, their chance

Nancy May: 00:09:45

of dying with one to two rib fractures might be in the single percentages.

Nancy May: 00:09:50

You go from three to four, it gets slightly higher.

Nancy May: 00:09:52

But you get up to, greater than six, like your mortality might

Nancy May: 00:09:55

be, 10 to 15 percent at most.

Nancy May: 00:09:58

Whereas if you have someone over the age of 65, we would look at those studies and

Nancy May: 00:10:02

we know that the mortality is significant.

Nancy May: 00:10:04

Um, it could be, 10 to 15 to 20 to 25 percent based on

Nancy May: 00:10:09

the number of rib fractures.

Nancy May: 00:10:10

That's how we classically studied it.

Nancy May: 00:10:12

You know, we did it through retrospective observational studies

Nancy May: 00:10:15

or maybe some prospective validation.

Nancy May: 00:10:17

Now we have AI models where we can take much larger datasets, plug it in.

Nancy May: 00:10:22

And there are these databases that exist out there and ultimately

Nancy May: 00:10:25

predict, what is the risk of dying associated with this injury pattern?

Nancy May: 00:10:29

we get very, we can be very accurate.

Nancy May: 00:10:33

Does that change management is the ultimate question.

Nancy May: 00:10:36

And, um, really there's so many other sort of factors that we are now feeding into

Nancy May: 00:10:42

these models as in frailty, nutrition, labs that are associated with it.

Nancy May: 00:10:46

There's so much more that we need to learn from just the fact that I broke my ribs.

Nancy May: 00:10:51

Well, that's quite, that can be a very variable Patient population, but AI, I

Nancy May: 00:10:55

think will, at least in the predictive analytics within the hospital after it's

Nancy May: 00:11:00

happened, have some tremendous value.

Nancy May: 00:11:03

But I think what I'm excited about is the preventative aspects of AI.

Nancy May: 00:11:08

we talked about the mind earlier and and we even talked about

Nancy May: 00:11:13

this before we got on the recording, is that the mind itself, whether you're

Nancy May: 00:11:17

in a trauma situation or not, is a very powerful tool for any individual.

Nancy May: 00:11:22

And I'm guessing that if you are told that your outcomes of survival are

Nancy May: 00:11:29

minimal at best, that also has an impact on your ability to recover well too,

Nancy May: 00:11:37

Dr. Shea Gregg: The self fulfilling prophecy is what they say.

Nancy May: 00:11:40

Yeah, it definitely can be.

Nancy May: 00:11:41

And in.

Nancy May: 00:11:42

It really, what I, I, you

Nancy May: 00:11:45

I'm going to ask 1 more question before you go there.

Nancy May: 00:11:47

Dr. Shea Gregg: sure.

Nancy May: 00:11:48

And this is, probably more of a, I don't, I'm not sure I'd

Nancy May: 00:11:51

call it a medical moral question, but does a doctor have a right to

Nancy May: 00:11:56

tell a patient that information that they're going to potentially die?

Nancy May: 00:12:00

Or do they tell a family member in a situation like that?

Nancy May: 00:12:04

Not knowing whether that individual has a strong will to say, I'm

Nancy May: 00:12:08

going to fight like hell and screw that, I'm going to prove them

Nancy May: 00:12:10

wrong, no matter what their age.

Nancy May: 00:12:12

What's your take on that one?

Nancy May: 00:12:14

Dr. Shea Gregg: yeah, so I will basically say, um, first of all, when someone

Nancy May: 00:12:19

comes through the front door and who's at a status quo, any trauma, a physical

Nancy May: 00:12:24

trauma whatsoever, we are going to one, do whatever we can to save their life.

Nancy May: 00:12:29

Unless there's documentation that states code status, DNR, DNI, as in

Nancy May: 00:12:35

do not resuscitate, do not intubate, and a person's on hospice and they're

Nancy May: 00:12:39

sent in really to be made comfortable,

Nancy May: 00:12:41

But the majority of the time, if a person's coming to the hospital

Nancy May: 00:12:45

after a trauma related incident, which has resulted usually in

Nancy May: 00:12:49

injury, we will do everything possible to try to save their life.

Nancy May: 00:12:52

so that being said.

Nancy May: 00:12:55

When you actually are going through those initial moves, there are families,

Nancy May: 00:12:59

and there's actually support systems in these incredible, models out there,

Nancy May: 00:13:03

where there's geriatric medicine actually participating in the trauma.

Nancy May: 00:13:07

So they will actually talk to people as they go through.

Nancy May: 00:13:10

Maybe we'll do that initial resuscitation and they'll have a breathing tube

Nancy May: 00:13:13

in and they'll, go through that initial sort of life saving measures,

Nancy May: 00:13:16

get a bunch of blood, but then we discover that there's a horrible

Nancy May: 00:13:19

this injury or horrible that injury.

Nancy May: 00:13:21

Then it's a matter of saying, we know that based on this injury pattern, that

Nancy May: 00:13:27

there is a higher risk of mortality.

Nancy May: 00:13:29

What would your loved one want to do if they were standing at the base of

Nancy May: 00:13:32

their bed looking down at themselves?

Nancy May: 00:13:35

That's, some of them will say, they would want everything done because they,

Nancy May: 00:13:40

want to get to a wedding in two months.

Nancy May: 00:13:42

Other people will say, You know, this is not be what you're doing

Nancy May: 00:13:47

right now is not what she would want, and we want to respect that.

Nancy May: 00:13:51

So it's really the wedding of what are, what is the person's

Nancy May: 00:13:55

wishes through the door?

Nancy May: 00:13:56

Most of the time we basically go through and it's sort of working with the family.

Nancy May: 00:14:00

The best thing and the most powerful thing, I think, from a physician

Nancy May: 00:14:03

but not necessarily the patient if they're having problems

Nancy May: 00:14:06

making their decisions or not.

Nancy May: 00:14:09

Dr. Shea Gregg: If a patient is unable to make decisions, then your best,

Nancy May: 00:14:11

your best bet is going to be the prior paperwork as in power of attorneys,

Nancy May: 00:14:14

et cetera, to understand their wishes.

Nancy May: 00:14:16

And also, you're going to be relying on the people usually next of kin or close

Nancy May: 00:14:21

member of their friend or family circle.

Nancy May: 00:14:24

but if the patient can hear and understand what's going on and understand

Nancy May: 00:14:27

the dire situation, I guess you explain the situation on what's happening, but

Nancy May: 00:14:34

you don't say, you're potentially a goner.

Nancy May: 00:14:37

Dr. Shea Gregg: Oh, no, no.

Nancy May: 00:14:38

It's, see, again, we have to get back to what I believe,

Nancy May: 00:14:42

what medicine is all about.

Nancy May: 00:14:44

Medicine is really, it's advocating for the patient's wishes in many regards.

Nancy May: 00:14:48

We always, if we lose track of that, then I think we've lost our way in medicine.

Nancy May: 00:14:52

and honestly providing the medical opinion and, support a patient's autonomy to make

Nancy May: 00:14:57

decisions and also support the families.

Nancy May: 00:15:00

So.

Nancy May: 00:15:01

Uh, that's the whole basis of the doctor patient relationship in many ways.

Nancy May: 00:15:05

So, um, if we have the ability to engage someone, whether, even when they're

Nancy May: 00:15:10

intubated with flight sedation, we will.

Nancy May: 00:15:13

And they, they, they can make more informed decisions.

Nancy May: 00:15:16

Now, I will not say, you're a goner.

Nancy May: 00:15:19

That's not in my lexicon.

Nancy May: 00:15:21

that was my,

Nancy May: 00:15:22

Dr. Shea Gregg: Yeah.

Nancy May: 00:15:22

And,

Nancy May: 00:15:23

I wouldn't say that you would necessarily.

Nancy May: 00:15:25

Dr. Shea Gregg: Yeah.

Nancy May: 00:15:25

But the key, the key is, is just like you have a, you know, you have

Nancy May: 00:15:29

a significant injury pattern that's gonna require you potentially two to

Nancy May: 00:15:32

three months of, of hospitalization.

Nancy May: 00:15:34

In our best understanding in the likelihood of needing a nursing

Nancy May: 00:15:38

facility for the a good portion of the rest of your life, are we a

Nancy May: 00:15:41

hundred percent accurate in that?

Nancy May: 00:15:42

No.

Nancy May: 00:15:43

But there are certain injuries that can't be fixed, and there are certain things

Nancy May: 00:15:46

that can't be, brain injuries especially, on various other types of injuries.

Nancy May: 00:15:50

And, we can give us, give the best information that we can be aware

Nancy May: 00:15:55

of, but usually that comes later in the course of a hospitalization.

Nancy May: 00:15:59

right, after you fix them up, I in, again, like non doctor terms

Nancy May: 00:16:03

to make sure that they are able to then understand or comprehend exactly

Nancy May: 00:16:08

the situation as it is and how to make decisions for themselves or get somebody

Nancy May: 00:16:12

else to help them make those decisions.

Nancy May: 00:16:14

Dr. Shea Gregg: Time is your friend.

Nancy May: 00:16:16

we in the medical profession try to leverage that to the best of our

Nancy May: 00:16:18

abilities, and give people the most time if there is, highly fatal injuries.

Nancy May: 00:16:23

and if it's, less fatal, but have a high likelihood of long term morbidity or

Nancy May: 00:16:28

being in, um, a facility that someone doesn't want and they want, they're

Nancy May: 00:16:32

going to lose that independence.

Nancy May: 00:16:33

That might be the equivalent of a death sentence for someone in their mind.

Nancy May: 00:16:36

So we try to respect a person's autonomy and their wishes and, and,

Nancy May: 00:16:41

and a family's, support of that.

Nancy May: 00:16:43

and, and, uh, move forward in the, uh, medical journey.

Nancy May: 00:16:47

How frequently do you see doctors actually, I'm going to use

Nancy May: 00:16:51

the term, interfere in those decisions to try and direct a family or an

Nancy May: 00:16:59

individual to make a decision to, to end a life, to pull a plug or whatever?

Nancy May: 00:17:07

how frequently do you see that?

Nancy May: 00:17:10

Dr. Shea Gregg: the days of paternalistic medicine.

Nancy May: 00:17:13

I think are coming to a close.

Nancy May: 00:17:15

We really do view things, from a medical profession and many, at least

Nancy May: 00:17:20

in the hospitals I've worked at, and I've worked in many major health

Nancy May: 00:17:23

systems, is that it's the partnership.

Nancy May: 00:17:26

and even when families and people do not have family members, again, we

Nancy May: 00:17:30

always have to consider someone's best interest, what would be, based on a, a

Nancy May: 00:17:35

pattern, um, are there situations that are extremely, or have a very high fatality?

Nancy May: 00:17:42

Will we say that, um, this person has a high, you know, a very high fatality?

Nancy May: 00:17:48

You need to know this in preparation so you can actually speak for that loved

Nancy May: 00:17:52

one and provide their wishes to us since you know them better than we do.

Nancy May: 00:17:56

Um, but that partnership is integral to good care.

Nancy May: 00:18:00

uh, and, and then eventually, you know, it might lead to

Nancy May: 00:18:02

end of life care and hospice.

Nancy May: 00:18:04

It might lead to let's keep going.

Nancy May: 00:18:06

Let's watch for 72 hours and let's see how things go.

Nancy May: 00:18:10

or let's say that if this gets worse, Then we have to start to pull things back.

Nancy May: 00:18:16

And, based on, the, the family meetings, we have these things, these

Nancy May: 00:18:19

family meetings, and there is not going to be a physician that I, at

Nancy May: 00:18:23

least I haven't seen one in any time.

Nancy May: 00:18:25

In fact, I can't even remember if I've ever seen one where

Nancy May: 00:18:28

they, we walked in and said.

Nancy May: 00:18:29

We should stop.

Nancy May: 00:18:31

Everything should stop.

Nancy May: 00:18:32

This is, this is futile.

Nancy May: 00:18:34

I've seen the extremes, that, uh, where we all, like all the attendings might have

Nancy May: 00:18:39

thought someone was actually going to die.

Nancy May: 00:18:41

And, the bottom line, she didn't.

Nancy May: 00:18:44

Right,

Nancy May: 00:18:45

Dr. Shea Gregg: And, the body is going to do what it's going to do.

Nancy May: 00:18:46

The spirit's going to do what it's going to do.

Nancy May: 00:18:48

And I think the best thing that we can do is actually partner with the

Nancy May: 00:18:51

family to provide true care, along this journey, either to the end of

Nancy May: 00:18:56

life or wherever they're going to go.

Nancy May: 00:18:58

that's really, encouraging to hear.

Nancy May: 00:19:01

I had personally had a slightly different experience at one point with, with my

Nancy May: 00:19:05

dad where the hospital said we're not going to do it anymore and we said, yes

Nancy May: 00:19:10

you are, because these were his wishes.

Nancy May: 00:19:13

So it was, it was a touch and go with the, the hospital personnel to, to say,

Nancy May: 00:19:19

listen, if you're not going to do it, you're not You know, Forget insurance.

Nancy May: 00:19:23

Well, whatever it takes to get it done, to follow my father's wishes.

Nancy May: 00:19:27

So that was a rather interesting experience.

Nancy May: 00:19:29

Not that it happens everywhere, I understand.

Nancy May: 00:19:32

And yes, he was, you know, he was 99 years old at the time, so I get it.

Nancy May: 00:19:36

You know, when is enough is enough, and uh, and how do you make that decision,

Nancy May: 00:19:41

or help a family know when, A decision could result in pain and suffering.

Nancy May: 00:19:47

I guess is that might be might might be the alternate best way to say that.

Nancy May: 00:19:52

Dr. Shea Gregg: yeah, think of it this way.

Nancy May: 00:19:53

When we're doing things for people, We're doing the right thing where

Nancy May: 00:19:57

we're doing things to people.

Nancy May: 00:19:59

That's when we really have to consider it, you know, reconsider.

Nancy May: 00:20:03

And, there are times where we might be asked to do something that is

Nancy May: 00:20:09

futile, that's it's medical futility.

Nancy May: 00:20:11

And as a physician in many States, actually, I think probably in all States,

Nancy May: 00:20:15

we are not obligated to do futile things And that's where it sort of gets, it

Nancy May: 00:20:21

gets interesting, but I can say, Again, the partnership usually, heals that,

Nancy May: 00:20:26

that issue and it's rare that you get to a point where it's like, you know,

Nancy May: 00:20:30

it's a crossroads and a butting heads.

Nancy May: 00:20:32

we know we had a great cardiologist, who, who really was

Nancy May: 00:20:35

supportive and helped us with the decisions and, and help when we,

Nancy May: 00:20:40

when we know we couldn't do anymore.

Nancy May: 00:20:42

I mean, it's, uh, it's tough to come to the end of a rope when a parent

Nancy May: 00:20:47

doesn't want to give up and you know that, well, you know, it's either this

Nancy May: 00:20:51

or, you know, you know, you die and on, on an, on an operating table alone.

Nancy May: 00:20:58

And that's, It was a very difficult decision, but, in any case, thankfully,

Nancy May: 00:21:02

our situation was not everybody's situation, and I think we did the best we

Nancy May: 00:21:06

could when, when we needed to at the time.

Nancy May: 00:21:09

So, but that's just one family's experience, it's not 100 percent of them.

Nancy May: 00:21:13

Now I want to get into Fall Call because your background has been

Nancy May: 00:21:17

in trauma, in geriatric trauma predominantly, is that correct?

Nancy May: 00:21:22

Correct.

Nancy May: 00:21:22

Dr. Shea Gregg: Yes, as far as my research and my interests, I've

Nancy May: 00:21:25

really focused in on that demographic.

Nancy May: 00:21:27

and what are some of the, typical things, if there is

Nancy May: 00:21:31

such a thing, that happens within, a geriatric patient or an elderly

Nancy May: 00:21:35

patient as it relates to trauma?

Nancy May: 00:21:38

it's falls, heart attacks, I guess is in that category too, or is that not

Nancy May: 00:21:43

considered in the category of trauma?

Nancy May: 00:21:46

Dr. Shea Gregg: So again, with, with trauma, um, uh, even though,

Nancy May: 00:21:50

heart attack can actually lead to traumas and falls, the number

Nancy May: 00:21:53

one, mechanism, for, uh, Traumatic injury in the older adult are false.

Nancy May: 00:21:59

That's the number one.

Nancy May: 00:22:00

we also can treat people with, motor vehicle crashes, people are driving, you

Nancy May: 00:22:04

know, God bless them and that's great.

Nancy May: 00:22:05

They should, drive for as long as you can, if that's what you and some people are out

Nancy May: 00:22:08

on motorcycles, so we take care of those.

Nancy May: 00:22:12

But, but falls and hip fractures.

Nancy May: 00:22:14

There's basically three types of injuries that we see in the older

Nancy May: 00:22:17

adult, and that's going to be hip fractures, rib fractures, and head

Nancy May: 00:22:21

trauma, usually with intracranial bleeds.

Nancy May: 00:22:23

Yeah, those are the three types of injuries.

Nancy May: 00:22:26

And, and the majority of them are from ground level falls.

Nancy May: 00:22:29

Really?

Nancy May: 00:22:30

Okay.

Nancy May: 00:22:30

So they're not falling down the stairs or, out of tall buildings

Nancy May: 00:22:34

single bound or whatever it

Nancy May: 00:22:36

Dr. Shea Gregg: Yeah, exactly.

Nancy May: 00:22:36

No, stairs actually is quite a quite common mechanism.

Nancy May: 00:22:40

Bathroom related falls, um, changes in position where you're going from

Nancy May: 00:22:43

a sitting to a standing position, or you're in a hot shower and you can

Nancy May: 00:22:47

have a vagus episode where you just, get lightheaded and you pass out.

Nancy May: 00:22:50

bathrooms are very popular places to fall.

Nancy May: 00:22:52

Falling down stairs because you're just missing a stair.

Nancy May: 00:22:55

Um, I tend to see a lot of rib fractures in that situation.

Nancy May: 00:22:58

I can see hip fractures.

Nancy May: 00:22:59

where's the breakout on those?

Nancy May: 00:23:01

do you have sort of a percentage breakout of, head versus, rib

Nancy May: 00:23:04

fractures versus hip and leg fractures

Nancy May: 00:23:08

Dr. Shea Gregg: yeah, what I would say is that what would he know is for all

Nancy May: 00:23:11

traumas, all comers, about 50 percent of the traumas that we manage are usually

Nancy May: 00:23:14

head injuries, that's actually all age

Nancy May: 00:23:15

50%?

Nancy May: 00:23:16

Really?

Nancy May: 00:23:17

Dr. Shea Gregg: Yeah, 50 percent of all, as in people who present

Nancy May: 00:23:19

with trauma in a trauma center, about 50 percent are head injuries.

Nancy May: 00:23:22

Um, hip fractures though, I would say would probably be the most, uh, if you

Nancy May: 00:23:27

haven't had a head injury, then you have, you present to a trauma center, we see a

Nancy May: 00:23:31

lot of hip fractures, very, very common.

Nancy May: 00:23:33

and then you're looking at rib fractures, as I would probably

Nancy May: 00:23:35

say is the next level of,

Nancy May: 00:23:37

I would imagine that if you have one, there could be multiple.

Nancy May: 00:23:40

So if you fall and break your hip, you could hit your head

Nancy May: 00:23:42

as well at the same time.

Nancy May: 00:23:43

So there could be more than one situation.

Nancy May: 00:23:46

it's interesting.

Nancy May: 00:23:46

I know somebody who recently had a bad fall, an Alzheimer's patient, sadly.

Nancy May: 00:23:52

And, multiple brain bleeds, which did not end well.

Nancy May: 00:23:56

so that's why I'm asking, and I've also, seen where doctors will say at a

Nancy May: 00:24:00

certain age if a hip fracture happens, the chance of survival for an extended

Nancy May: 00:24:05

period of time is fairly, I've heard the numbers, like six months kind of thing.

Nancy May: 00:24:11

Is that typical or is that not

Nancy May: 00:24:14

Dr. Shea Gregg: um, it's, it's interesting.

Nancy May: 00:24:16

again, I'm going to say it depends.

Nancy May: 00:24:17

I, I've heard is, the 6 months, but really, I've heard 2 years.

Nancy May: 00:24:22

but.

Nancy May: 00:24:23

There are pathways now, and this is so important that we, we as a trauma

Nancy May: 00:24:28

community who takes care of these patients, who know that the mortality

Nancy May: 00:24:33

rate on a yearly basis in the United States on falls over the age of

Nancy May: 00:24:36

65 is about 43 to 45, 000 people.

Nancy May: 00:24:40

if you take, if you add up all your motor vehicle crashes, you add up all

Nancy May: 00:24:43

your, your penetrating trauma, you're getting pretty close to, that number.

Nancy May: 00:24:48

It's slightly above actually for those

Nancy May: 00:24:49

And what, what per, what percentage is that you said 45, 000,

Nancy May: 00:24:53

what percentage of, well, you said it's about 50 percent of the injuries

Nancy May: 00:24:57

are for over 65, it's about hips, hips and legs and, and whatnot, right?

Nancy May: 00:25:02

Dr. Shea Gregg: Yeah, they might be head injuries, they might be hips.

Nancy May: 00:25:04

The three most common under that umbrella, um, at least of people who've died, yeah.

Nancy May: 00:25:09

But we also have to think about what the incidence of fall is,

Nancy May: 00:25:12

which is one in four people over the age of 65 will fall every year.

Nancy May: 00:25:16

really?

Nancy May: 00:25:16

Dr. Shea Gregg: One in four.

Nancy May: 00:25:17

Yeah, that's CDC data, and it used to be one in three, so we're doing something

Nancy May: 00:25:21

right as far as prevention methods.

Nancy May: 00:25:25

But yeah, they say one in four people will actually fall every

Nancy May: 00:25:27

year, according to the CDC.

Nancy May: 00:25:29

And, 20 to 30 percent can actually sustain some sort of injury.

Nancy May: 00:25:34

Um, there's several hospitalizations.

Nancy May: 00:25:36

And it's interesting because that incidence of falls, Is actually

Nancy May: 00:25:40

very similar across the world.

Nancy May: 00:25:42

So if you look at individual studies in throughout Europe, Australia,

Nancy May: 00:25:47

wherever you go, Africa, one in four is a very common number of people who fall over

Nancy May: 00:25:54

the age of 65, which is very interesting.

Nancy May: 00:25:56

Do you think that has to do with, muscle strength or

Nancy May: 00:25:59

osteoporosis as we age or not?

Nancy May: 00:26:02

Dr. Shea Gregg: You're going through the risk factors.

Nancy May: 00:26:04

These are classic risk factors.

Nancy May: 00:26:06

We know that, again,

Nancy May: 00:26:08

Obesity.

Nancy May: 00:26:10

Dr. Shea Gregg: obesity is, but also frailty is the other

Nancy May: 00:26:12

sort of aspect of things.

Nancy May: 00:26:14

Medical conditions that are associated with weakness, which could be anything

Nancy May: 00:26:19

from congestive heart failure, COPD,

Nancy May: 00:26:22

Or medications that they might be taking, other things that are

Nancy May: 00:26:24

causing dizziness or, breathing issues.

Nancy May: 00:26:27

Dr. Shea Gregg: Yeah, and urinary tract infections.

Nancy May: 00:26:28

If you are going to have an infectious cause of a fall, 40 percent of the time,

Nancy May: 00:26:33

in one study, states that it is going to likely be a urinary tract infection.

Nancy May: 00:26:37

Urinary tract infections, can actually either, as we all get older, we all

Nancy May: 00:26:41

get to look forward to in men having larger prostates, and in women.

Nancy May: 00:26:45

Having potentially some bladder laxity, et cetera, with pelvic wall

Nancy May: 00:26:48

and pelvic muscle, musculature laxity.

Nancy May: 00:26:51

So the inability to empty can lead to increased risk of UTIs.

Nancy May: 00:26:55

UTIs has been shown, to have an increased, association with falls.

Nancy May: 00:27:00

And,

Nancy May: 00:27:00

why?

Nancy May: 00:27:00

Because a UTI can cause all sorts of issues that could

Nancy May: 00:27:05

even be mistaken for dementia.

Nancy May: 00:27:07

Correct.

Nancy May: 00:27:07

Dr. Shea Gregg: Absolutely.

Nancy May: 00:27:08

And actually you describe sort of a classic pathway is that when you have

Nancy May: 00:27:12

an untreated infected source anywhere in your body, you know, whether it's a

Nancy May: 00:27:17

kid with appendicitis or, someone even with COVID, there's a variety of sort

Nancy May: 00:27:21

of infectious causes that's untreated.

Nancy May: 00:27:24

You can have mental status changes.

Nancy May: 00:27:26

You can have weakness, you can have instability, you can have dizziness,

Nancy May: 00:27:30

you can have all these things.

Nancy May: 00:27:31

And therefore, based on the literature, and actually, we published some stuff when

Nancy May: 00:27:35

I was at Brown on this about increased mortality associated with UTIs and falls.

Nancy May: 00:27:39

Um, I get a urinalysis on every single person that comes into that

Nancy May: 00:27:43

trauma center, who had a, a fall.

Nancy May: 00:27:46

Based on the data, because if I can actually treat someone and, treat a

Nancy May: 00:27:51

urinary tract infection, for three to seven days, depending on the

Nancy May: 00:27:54

situation, then I have the ability to potentially reduce their fall risk,

Nancy May: 00:27:59

And improve recovery, ultimately for

Nancy May: 00:28:01

everything else that's going

Nancy May: 00:28:02

Dr. Shea Gregg: exactly

Nancy May: 00:28:02

you don't have a, you don't have an infection that's going through the

Nancy May: 00:28:05

body, not just in the bladder area, right?

Nancy May: 00:28:08

Dr. Shea Gregg: You got it.

Nancy May: 00:28:09

And, the whole body can be affected, by a UTI and I've seen

Nancy May: 00:28:13

it over and over and over again.

Nancy May: 00:28:15

actually the way people react to UTIs, I think is rather fascinating

Nancy May: 00:28:18

because it's so easily misdiagnosed as, as other issues that are going on,

Nancy May: 00:28:23

if you're a non medical professional.

Nancy May: 00:28:25

Yeah.

Nancy May: 00:28:26

So that brings us to fall call because, as I understand early on when we first

Nancy May: 00:28:30

met that the falls and the trauma that you saw as a result of falls in

Nancy May: 00:28:36

the work that you do was one of the reasons why you decided to figure out

Nancy May: 00:28:40

is there a solution to this or is there a way to, to deter, accidents from

Nancy May: 00:28:45

happening for anybody, but predominantly those that are, 65 plus, on average.

Nancy May: 00:28:50

Is that correct?

Nancy May: 00:28:51

Dr. Shea Gregg: Yes.

Nancy May: 00:28:52

Yes.

Nancy May: 00:28:53

some very poignant memories of, being back in 2000.

Nancy May: 00:28:58

13, 14, 15, in my sort of middle practice, if you will, years so far, and I remember

Nancy May: 00:29:05

just, I, I would ask people, who are down for long periods of time, two hours,

Nancy May: 00:29:10

three hours, they have pressure ulcers, they've got muscle breakdown, they've

Nancy May: 00:29:13

got all these things and kidney effects from it, and I'll never forget some woman

Nancy May: 00:29:17

who was, who fell, had a medical alert system, it was in her bedroom, But, uh,

Nancy May: 00:29:22

where she was lying, which was under a grandfather clock, for she didn't,

Nancy May: 00:29:27

she couldn't access her medical alert.

Nancy May: 00:29:29

So, she was there, I think, for like seven, eight hours, stuck under a clock.

Nancy May: 00:29:33

She could keep track of the time, but that's how she knew

Nancy May: 00:29:36

how long she was down for.

Nancy May: 00:29:37

But the problem was, is that she couldn't access the medical alerts

Nancy May: 00:29:40

because she was embarrassed to use it.

Nancy May: 00:29:43

And so.

Nancy May: 00:29:44

I said, how can we make this better?

Nancy May: 00:29:48

how can we, A, make, a system that people aren't embarrassed to wear, and B, a

Nancy May: 00:29:52

non stigmatizing system, and B, make it so it has the ability to better detect

Nancy May: 00:29:58

falls, that people aren't afraid to, drop their pendants or whatever else.

Nancy May: 00:30:02

Enter Apple Watch, totally inspired by this device.

Nancy May: 00:30:06

It looked like it was going to be a neat, a decent looking thing, potentially

Nancy May: 00:30:09

have a lot of health capability.

Nancy May: 00:30:11

and early on we, I got access to it and I said this is the

Nancy May: 00:30:15

future of emergency response.

Nancy May: 00:30:17

I found out it had an accelerometer in it and I said I want to build the

Nancy May: 00:30:20

next generation of medical alert where no longer are you going to be tethered

Nancy May: 00:30:24

to a hub that you have to buy for.

Nancy May: 00:30:26

your hardware.

Nancy May: 00:30:27

I wanted to make the mobile phone the hub.

Nancy May: 00:30:30

Now, saying that in 2016, People didn't believe me.

Nancy May: 00:30:33

They're like, yeah, who's going to take up mobile phones, let alone Apple Watches?

Nancy May: 00:30:37

Well, here we are, folks.

Nancy May: 00:30:38

AARP just said, 80 to 90 percent of people over the age of 50, 60, 70, actually

Nancy May: 00:30:43

own a smartphone and use it daily.

Nancy May: 00:30:46

And, watch uptake is actually almost as, in the older adult population is almost

Nancy May: 00:30:51

as quick as, uh, the younger population.

Nancy May: 00:30:53

it's transitioned tremendously.

Nancy May: 00:30:56

that's great to hear.

Nancy May: 00:30:56

I know that there's a, certain percentage of the population

Nancy May: 00:30:59

that won't wear, a watch.

Nancy May: 00:31:01

I, I've got a Fitbit and some other things, so I get it.

Nancy May: 00:31:04

but they just rely on their, phone to check their watch.

Nancy May: 00:31:07

the time or whatever else, or they don't check the time.

Nancy May: 00:31:10

those of us who are time obsessed of getting things done or counting steps

Nancy May: 00:31:15

or heart rate or whatever it is, right?

Nancy May: 00:31:18

But, what I liked about your approach besides the fact that it was easy to

Nancy May: 00:31:24

wear and it didn't look like a medical device, because I know my mom, my mom

Nancy May: 00:31:29

and dad, when they went into a care facility for They, they wanted to go.

Nancy May: 00:31:33

That was their choice.

Nancy May: 00:31:33

we took them out eventually.

Nancy May: 00:31:35

and most people who've heard the podcast understand that story.

Nancy May: 00:31:39

But the last thing my mom wanted to come across on, and certainly

Nancy May: 00:31:44

my dad, is to look frail or old or sick in any way, shape, or form.

Nancy May: 00:31:50

So anything that looked like a, a band aid colored thing with a red

Nancy May: 00:31:54

button on it that's, the old joke, help I've fallen and I can't get up.

Nancy May: 00:31:58

and if you're not going to wear it like this woman said, she's under

Nancy May: 00:32:01

the clock, why would they do that?

Nancy May: 00:32:03

So I think that, what you were doing originally, Was fabulous and have

Nancy May: 00:32:08

attracted along, but now you're also doing attractive pendants.

Nancy May: 00:32:12

They look like fashion designer items

Nancy May: 00:32:15

Dr. Shea Gregg: Yes, it's so again, fulfilling the thought

Nancy May: 00:32:19

process of non stigmatizing,

Nancy May: 00:32:21

or vanity.

Nancy May: 00:32:23

Dr. Shea Gregg: Yeah, yeah.

Nancy May: 00:32:23

Vanity tech, safety depending on what level.

Nancy May: 00:32:25

we partnered with companies looking specifically for things

Nancy May: 00:32:29

that people found attractive.

Nancy May: 00:32:31

In fact, I've done surveys with my, my users and I asked whenever I would

Nancy May: 00:32:35

bring a product online or consider bringing a product, would you use

Nancy May: 00:32:38

this and our, upcoming launch of our fall call pendant was based out of

Nancy May: 00:32:44

the survey data that they said, hey, this is something that is attractive.

Nancy May: 00:32:49

It's non stigmatizing and it actually has fall detection built into it.

Nancy May: 00:32:52

And it has the safety bin, but it's an extension that

Nancy May: 00:32:55

you can use with your phone.

Nancy May: 00:32:56

It's almost like a remote.

Nancy May: 00:32:58

but it was so important to me to bring, stylish accessories that

Nancy May: 00:33:02

fit into your everyday life that didn't make people feel old.

Nancy May: 00:33:06

And, it's one of those things that once you set it up.

Nancy May: 00:33:09

And then you have access to it and use and even more importantly is since I

Nancy May: 00:33:16

don't have all this hardware that I need to sell and install in your house

Nancy May: 00:33:19

that I can charge half the price as

Nancy May: 00:33:21

Oh, even better.

Nancy May: 00:33:22

there's so much out there that's a crazy price.

Nancy May: 00:33:25

And I say, the big business of aging care and younger companies

Nancy May: 00:33:28

are trying to get into this market.

Nancy May: 00:33:31

And I understand.

Nancy May: 00:33:32

it's a growing market, as it is for Fall Call.

Nancy May: 00:33:34

You were, I would say, my take on Fall Call is that you were more mission

Nancy May: 00:33:38

driven I think that's partially what I really liked and it was a doctor,

Nancy May: 00:33:42

especially a trauma doctor, who is specifically looking at solving or

Nancy May: 00:33:46

trying to help solve a problem so

Nancy May: 00:33:49

that, it's easy to use.

Nancy May: 00:34:08

How does it work?

Nancy May: 00:34:09

Because we're on audio right now and I'll, I can put in on a YouTube channel

Nancy May: 00:34:13

a little bit about some of how things work visually, but how would you describe

Nancy May: 00:34:17

this from an audio perspective or a podcast perspective that people, what

Nancy May: 00:34:22

would they see and how does it work?

Nancy May: 00:34:25

Dr. Shea Gregg: Sure.

Nancy May: 00:34:26

The pendant will pair with the app, which is basically you press

Nancy May: 00:34:30

the button on the back of the app.

Nancy May: 00:34:31

And for those, if it does go to video, this is what it looks like.

Nancy May: 00:34:35

It's a very simplified pendant.

Nancy May: 00:34:37

So there's a button on the back of that pendant.

Nancy May: 00:34:40

Dr. Shea Gregg: on the back of it, that is the button.

Nancy May: 00:34:42

So it doesn't even, it doesn't, it's not even bright

Nancy May: 00:34:45

and red or anything like that.

Nancy May: 00:34:46

Dr. Shea Gregg: nope, it is something that basically is supposed to fit in.

Nancy May: 00:34:49

It has a gold chain on it.

Nancy May: 00:34:51

And, and built into this actually is some amazing technology that is, has

Nancy May: 00:34:56

just a button to turn it on in the sense that when you first pair your pendant,

Nancy May: 00:35:01

you actually just go to the screen where it says pair pendant, you tap

Nancy May: 00:35:05

the button on the back of the pendant.

Nancy May: 00:35:07

It will pair.

Nancy May: 00:35:08

You go, you put your address in, you eventually

Nancy May: 00:35:11

your earbuds.

Nancy May: 00:35:11

Same thing.

Nancy May: 00:35:12

Dr. Shea Gregg: It's, it's actually, it's exactly that process.

Nancy May: 00:35:15

and uses but in this case it's, it's beacon based technology,

Nancy May: 00:35:19

which does u utilize Bluetooth.

Nancy May: 00:35:21

And, once you're paired, then, think of it as basically a FAA remote.

Nancy May: 00:35:28

For activating help calls to that, to your phone.

Nancy May: 00:35:32

So, instead of that hub that would be installed as a landline, your

Nancy May: 00:35:36

pendant would attach to, etc.

Nancy May: 00:35:38

Think of your phone as your new hub.

Nancy May: 00:35:41

And so, as they say that 60 percent of falls occur in the house.

Nancy May: 00:35:46

Well, if you wear your pendant, you have your phone with you.

Nancy May: 00:35:48

And let's say you're separated from your phone and you're like 200 feet

Nancy May: 00:35:52

away from it and whether in the grocery store or whatever else and you have a

Nancy May: 00:35:55

fall and maybe you're in the parking lot and this pendant will pick up

Nancy May: 00:35:58

the fall, will let the phone know and basically that will beam the signals

Nancy May: 00:36:03

up through a lot of redundancies up to our central monitor system and

Nancy May: 00:36:07

it'll try to call back the phone.

Nancy May: 00:36:08

But if you're away, say you broke your hip and you're in a Parking lot, then

Nancy May: 00:36:12

it'll actually try to either the central monitor will contact the either the

Nancy May: 00:36:16

primary caregiver or 911, depending on what you designate as the user.

Nancy May: 00:36:20

And, then emergency response will come because we have outstanding GPS capability

Nancy May: 00:36:26

within phones and mobile devices.

Nancy May: 00:36:28

That's the beautiful thing is all these hardware devices that are installed

Nancy May: 00:36:32

by traditional PERS companies, personal emergency response companies.

Nancy May: 00:36:36

They have technology built in, but with the mobile phones,

Nancy May: 00:36:41

it's the latest technology.

Nancy May: 00:36:43

So, location based technology, Bluetooth based technology,

Nancy May: 00:36:47

everything that's in there, it's the latest and greatest 5G speeds.

Nancy May: 00:36:51

And, by that activation, either by the fall or by the button press,

Nancy May: 00:36:56

it could actually activate that.

Nancy May: 00:36:58

Now, what happens if you're wearing the pendant, or your mom's

Nancy May: 00:37:01

wearing the pendant, and she leaves her phone back in, at the house, and

Nancy May: 00:37:07

she's at the grocery store in Falls?

Nancy May: 00:37:10

Dr. Shea Gregg: So, like any pendant, or that's out on the market, with the

Nancy May: 00:37:13

exception of the mobile purse that has, built in 4G, but obviously that has

Nancy May: 00:37:17

limitations as far as the antennas and everything else, then obviously you

Nancy May: 00:37:22

will not have that range unless you, you're within like the 150 to 200 feet.

Nancy May: 00:37:26

but.

Nancy May: 00:37:27

That's where, we have a lot of our users, and as we grow our partnerships, I'm

Nancy May: 00:37:31

more and more excited to introduce other devices that will potentially have that

Nancy May: 00:37:36

cellular connectivity, and, but yet the attractiveness of a non medical device

Nancy May: 00:37:42

or non, traditional medical alert device.

Nancy May: 00:37:44

you could have your phone on your watch, on your Apple Watch,

Nancy May: 00:37:47

and still wear the pendant, or do you need both at the same time?

Nancy May: 00:37:51

Dr. Shea Gregg: well, if you actually If you have your Apple

Nancy May: 00:37:53

Watch, you have everything you need to actually activate a help call.

Nancy May: 00:37:56

I can be wherever, because the way we built the app on Apple Watch is

Nancy May: 00:38:01

that, once you onboard everything, you can turn off your phone and your

Nancy May: 00:38:05

Apple Watch will run fall detection, get the phone calls, you can activate

Nancy May: 00:38:10

help calls, everything from your watch and not be next to your phone at all.

Nancy May: 00:38:15

And the only thing you need to do is make sure it's charged.

Nancy May: 00:38:18

Dr. Shea Gregg: yep, exactly.

Nancy May: 00:38:19

Just make sure it's charged.

Nancy May: 00:38:21

You got it.

Nancy May: 00:38:22

Now, I, I love this, because the watch gives the gentleman, or like

Nancy May: 00:38:26

my dad, if my dad was going to be an option to wear that, cause he's not going

Nancy May: 00:38:30

to wear a pretty attractive pendant.

Nancy May: 00:38:33

at least my dad never would, but he would wear a watch for sure.

Nancy May: 00:38:37

And the other thing that you've done recently is now you have a door lock

Nancy May: 00:38:41

for houses, which I think is phenomenal.

Nancy May: 00:38:45

Because in some states, if a call is made and nobody's home or there's a,

Nancy May: 00:38:51

somebody's checking in and you send the emergency to your parents and the

Nancy May: 00:38:54

front door is locked, there's no way for them to get in unless they bring.

Nancy May: 00:38:59

a police department or a police officer who has approval to enter the house.

Nancy May: 00:39:04

The EMTs typically will not do that if a door is locked

Nancy May: 00:39:08

or even if there's a lock box.

Nancy May: 00:39:10

There's, there are certain parameters, It depends upon the community,

Nancy May: 00:39:14

but generally they don't do that.

Nancy May: 00:39:15

Your system is different.

Nancy May: 00:39:16

It's just replacing the lock that's in the door with the ability to unlock

Nancy May: 00:39:21

it, from any location in the country so that an emergency responder could enter.

Nancy May: 00:39:27

And help a parent or a spouse, whoever it is that needs it.

Nancy May: 00:39:31

Dr. Shea Gregg: Yes, so again, solving real problems that the medical alert

Nancy May: 00:39:38

industry has faced for decades.

Nancy May: 00:39:40

Right.

Nancy May: 00:39:41

Dr. Shea Gregg: One of the biggest challenges is accessing

Nancy May: 00:39:44

patients behind locked doors, as you beautifully framed it.

Nancy May: 00:39:48

And when thinking about this, I actually, again, I have the frontline

Nancy May: 00:39:53

experience of hearing about this, about the broken down doors, etc.

Nancy May: 00:39:57

It doesn't happen often, but it

Nancy May: 00:39:58

Or even a grandchild there who doesn't know how to open the door

Nancy May: 00:40:00

and grandma's falling in the back.

Nancy May: 00:40:02

Um,

Nancy May: 00:40:03

Dr. Shea Gregg: Exactly.

Nancy May: 00:40:04

And the grandchild's scared, etc.

Nancy May: 00:40:06

And I've heard these horrible stories.

Nancy May: 00:40:09

And when we approached Kwikset, with this idea, they immediately embraced it.

Nancy May: 00:40:14

they said, this is a wonderful idea.

Nancy May: 00:40:16

It enhances access.

Nancy May: 00:40:18

And the way that we wanted to make sure we protect the security of a

Nancy May: 00:40:22

home is we know specifically in Fall Call when an ambulance is dispatched.

Nancy May: 00:40:27

At that point, that's when the signal actually will unlock the door.

Nancy May: 00:40:31

Only when an ambulance is dispatched.

Nancy May: 00:40:32

Because the majority of calls to a call center are false alarms.

Nancy May: 00:40:36

So if you aren't dispatching an ambulance, then I'm not going to unlock your door.

Nancy May: 00:40:41

Not me, but my system is not going to unlock the door.

Nancy May: 00:40:44

but if there is a true ambulance emergency, And, then basically

Nancy May: 00:40:49

the door will get unlocked.

Nancy May: 00:40:50

Uh, so when EMS arrives, they will be able to enter and treat that patient.

Nancy May: 00:40:54

And if they are in a situation where they're progressively more unconscious.

Nancy May: 00:40:58

Then you're going to have minutes.

Nancy May: 00:41:01

I mean, sometimes minutes make the difference.

Nancy May: 00:41:03

And even more importantly, which I felt was important, is we know

Nancy May: 00:41:07

when the ambulance crew clears.

Nancy May: 00:41:08

And once we get that all clear, and they actually clear the

Nancy May: 00:41:11

scene, the door will lock again.

Nancy May: 00:41:13

I saw that's, there's a video that I'll put in the, in the episode notes

Nancy May: 00:41:16

so people can see because how this works, it's beautifully demonstrated and just

Nancy May: 00:41:23

watching the video, is peace of mind.

Nancy May: 00:41:25

I wish it was around when my parents were here, because I, I would have installed

Nancy May: 00:41:29

it in a heartbeat, no pun intended.

Nancy May: 00:41:33

What are some of the things that you're looking at?

Nancy May: 00:41:35

I mean, beyond the watch, the pendants, and the lock, are there other things that

Nancy May: 00:41:39

you're looking at in this, fall scenario?

Nancy May: 00:41:42

to really break into new territory or new grounds in this area, because I've, I,

Nancy May: 00:41:47

I'm going to back up a second because what you're doing is, is different and you've

Nancy May: 00:41:51

probably seen as well as I do all, besides the, help I fall and I can't get up,

Nancy May: 00:41:55

there are all sorts of like bumpers that you can blow up that are on waste that

Nancy May: 00:41:58

are, it's like all of a sudden you fall down and it turns into a giant balloon

Nancy May: 00:42:02

on somebody's waist and they fall and it's just like, you've got to be kidding.

Nancy May: 00:42:05

And it's like a bouncy house belt, I call it for fall detection.

Nancy May: 00:42:11

Yeah, airbags.

Nancy May: 00:42:12

Thank you.

Nancy May: 00:42:12

Better description.

Nancy May: 00:42:13

I'm thinking, really?

Nancy May: 00:42:15

I mean, I can see that being a bigger problem more than anything

Nancy May: 00:42:19

else, but, that's, I'm not a

Nancy May: 00:42:21

Dr. Shea Gregg: Yeah, there are options.

Nancy May: 00:42:22

I think that we need to, as an industry, start, getting into the

Nancy May: 00:42:27

business of, preventing falls.

Nancy May: 00:42:30

All right.

Nancy May: 00:42:31

And, and PERS has traditionally been reactive.

Nancy May: 00:42:34

It's time that we become proactive.

Nancy May: 00:42:36

And the beautiful thing about, At least my vantage point is, as a

Nancy May: 00:42:41

physician, I see what the endpoints are, but I also know the risk factors

Nancy May: 00:42:46

for what can cause these things.

Nancy May: 00:42:49

So high heart rates associated with a variety of medical conditions,

Nancy May: 00:42:53

rapid atrial fibrillation, pulmonary embolus, et cetera.

Nancy May: 00:42:57

What we, or, and then irregular heartbeats, new onset atrial fibrillation

Nancy May: 00:43:01

or maybe an arrhythmia, et cetera.

Nancy May: 00:43:03

If I have the ability.

Nancy May: 00:43:06

Which I will and I do have the ability to actually send out a high heart rate

Nancy May: 00:43:11

alert to our monitoring center that the monitoring center could actually come

Nancy May: 00:43:15

back in and call the person say we've reached the caregiver's role would receive

Nancy May: 00:43:19

a high heart rate alert, you know, and we know that high heart rate alert.

Nancy May: 00:43:24

This is based on some technology that Apple's developed.

Nancy May: 00:43:26

We know that that high heart rate alert is usually tracked during low activity

Nancy May: 00:43:31

levels, maybe sitting down, et cetera.

Nancy May: 00:43:33

So it's irregularly high.

Nancy May: 00:43:35

so if we can send out a high heart rate alert to our monitoring center

Nancy May: 00:43:38

will call the person and say, Hey, do you have any, uh, is everything okay?

Nancy May: 00:43:42

Do you have any chest pain?

Nancy May: 00:43:43

Go through the algorithm.

Nancy May: 00:43:44

Do you have any, uh, pressure?

Nancy May: 00:43:45

Do you have any lightheadedness when you stand up, et cetera?

Nancy May: 00:43:48

And they say, yeah, you know, maybe I do.

Nancy May: 00:43:52

Something's not right, um, or they have a fever, which can

Nancy May: 00:43:54

lead to a high heart rate.

Nancy May: 00:43:56

Then all of a sudden you can preemptively, dispatch a crew to check on the

Nancy May: 00:44:00

patient or the person who's calling, maybe send a caregiver over and then

Nancy May: 00:44:04

make a decision and then reactivate it and get the ambulance, et cetera.

Nancy May: 00:44:07

But if we can preemptively discover if someone has irregular heart rates,

Nancy May: 00:44:11

high heart rates, and we're actually developing some technology where we

Nancy May: 00:44:15

know that if you go to the bathroom more than two times a night, actually you

Nancy May: 00:44:19

urinate more than two times a night, you're at an increased risk for UTI.

Nancy May: 00:44:22

And as I mentioned earlier.

Nancy May: 00:44:24

Your increased risk for UTI, you have an increased risk of falling.

Nancy May: 00:44:28

Well, if I can actually figure that out, and actually understand those,

Nancy May: 00:44:31

those motion patterns through machine learning, which I'm, we're training the

Nancy May: 00:44:35

system to do, not out in the market yet internally, then I, if I can diagnose

Nancy May: 00:44:40

the risk of a UTI, or an active high heart rate, or irregular heart rate, then

Nancy May: 00:44:47

I have the ability to prevent a fall.

Nancy May: 00:44:49

Wouldn't that be great?

Nancy May: 00:44:51

It's all coming, Nancy.

Nancy May: 00:44:52

It's all coming.

Nancy May: 00:44:53

And that's so exciting to me because, if you can pick this up,

Nancy May: 00:44:57

then, uh, and intervene early, then you will avoid the hip fracture

Nancy May: 00:45:01

with, say, the atrial fibrillation.

Nancy May: 00:45:03

You know, you'll just have someone with a high heart rate and you'll be

Nancy May: 00:45:07

able to treat that more effectively and hopefully avoid that fall.

Nancy May: 00:45:11

I, I keep saying I love this, you know, I do, there's a, a product

Nancy May: 00:45:15

that you may or may not be aware of called Pixie Pads, which is, yeah, I

Nancy May: 00:45:19

had, I met those folks early on and they were doing UTI, early UTI detections.

Nancy May: 00:45:25

The problem with that and it's not that it's.

Nancy May: 00:45:28

It's a bad product.

Nancy May: 00:45:29

I think it's an excellent product.

Nancy May: 00:45:30

It's kind of, icky.

Nancy May: 00:45:33

I feel like I describe it.

Nancy May: 00:45:35

So by icky, I mean, for those that are listening, it's, it's a,

Nancy May: 00:45:41

it's basically an absorbent pad that goes into the undergarments.

Nancy May: 00:45:46

And so when there's a leakage or pee happens, then, the pixie pad is scanned.

Nancy May: 00:45:54

with a, a phone to determine what are the oxalates in the urine at the time.

Nancy May: 00:46:00

And it's pretty accurate to figure out whether a UTI is coming on.

Nancy May: 00:46:03

But the, the icky part is like, you got to pull this thing

Nancy May: 00:46:06

off and you got to scan it.

Nancy May: 00:46:07

who really wants to do that?

Nancy May: 00:46:09

I mean, really?

Nancy May: 00:46:10

I get it.

Nancy May: 00:46:11

I, I know the importance of doing it, but it's not something

Nancy May: 00:46:14

I personally would want to do.

Nancy May: 00:46:16

although we used them for, for my folks for a while until we

Nancy May: 00:46:20

monitored and figured out what was going on and, we could see that.

Nancy May: 00:46:23

And they were expensive, very expensive to use.

Nancy May: 00:46:26

So, as good as they were, the cost of use was, became a little prohibitive for us.

Nancy May: 00:46:31

for us and I think probably for a lot of other people, but knowing that certain,

Nancy May: 00:46:35

bathroom habits, getting up two or three times in the middle of the night is,

Nancy May: 00:46:39

is something that you want to monitor.

Nancy May: 00:46:40

So I would also think that this is, is very helpful from a GPS perspective,

Nancy May: 00:46:45

if you don't lose a phone for, Alzheimer's and wandering and things

Nancy May: 00:46:49

like that could very much come into play where, um, even in, in time,

Nancy May: 00:46:54

these could be sewn into clothing at some point so that it's easier to.

Nancy May: 00:47:00

To help those folks as well.

Nancy May: 00:47:02

Dr. Shea Gregg: Yeah, we're getting there, Nancy.

Nancy May: 00:47:04

There's so many things I think that are exciting in the future, but if

Nancy May: 00:47:07

we start shifting from reactive to proactive, I think that that is going

Nancy May: 00:47:12

to ultimately really make an impact.

Nancy May: 00:47:15

if we can stabilize.

Nancy May: 00:47:17

The incidence in the, reduce the mortality associated with maybe having

Nancy May: 00:47:22

different admissions for, say, high heart rates or other other risk factors,

Nancy May: 00:47:26

then I think we're doing our job, you

Nancy May: 00:47:28

Well, the whole medical industry, yeah, medical

Nancy May: 00:47:31

and healthcare industry has been working on that for many years.

Nancy May: 00:47:34

And you know as well as I do and many others else, it's, that's a behavioral

Nancy May: 00:47:38

change that sometimes happens in the home.

Nancy May: 00:47:41

And that's the hard part with us as patients or, or individuals, just to

Nancy May: 00:47:45

change our habit patterns and really want to, So we're proactive, not just

Nancy May: 00:47:50

hoping that, uh, like yourself are going to patch us up and turn us into bionic

Nancy May: 00:47:56

creatures so that we can just go off and do the next marathon at 89 years old.

Nancy May: 00:48:01

Dr. Shea Gregg: Yeah, and I'll tell you what I also believe,

Nancy May: 00:48:05

too, is this technology has.

Nancy May: 00:48:07

Technology has the ability, to be in your face, we live in a world of where

Nancy May: 00:48:11

technology wants to be in your face.

Nancy May: 00:48:13

I want our technology to be silent.

Nancy May: 00:48:15

I don't want anybody to do anything to our technology other than maybe put it

Nancy May: 00:48:20

on your wrist, turn it on, And that's it.

Nancy May: 00:48:24

And if I can get an entire, and I can get all these readings, et cetera,

Nancy May: 00:48:29

and send out risk factors, especially when we have, caregiver, crunches,

Nancy May: 00:48:32

the sandwich caregiver who has to deal with kids and parents, et cetera.

Nancy May: 00:48:35

I mean, I'm in that situation now.

Nancy May: 00:48:37

I know what it's like.

Nancy May: 00:48:38

Um, I know what it's like to

Nancy May: 00:48:39

right?

Nancy May: 00:48:40

we've got one aid on average for every 17 residents, which is very typical,

Nancy May: 00:48:44

whether it's a rehab facility, or a hospital, or even a care home.

Nancy May: 00:48:49

that's where this could be coming into play.

Nancy May: 00:48:52

This has been terrific.

Nancy May: 00:48:53

Yeah.

Nancy May: 00:48:54

Thank you.

Nancy May: 00:48:54

Thank you, Shay.

Nancy May: 00:48:55

Thank you so much.

Nancy May: 00:48:56

And thank you for sharing.

Nancy May: 00:48:58

I know that you'll keep us posted on new technology and

Nancy May: 00:49:00

new work that you're working on.

Nancy May: 00:49:01

In the meantime, for everybody who's listening, there will be links to

Nancy May: 00:49:05

everything that we've talked about in this show in the episode notes and

Nancy May: 00:49:09

anything else that I can get my hands on research that might be of help to you.

Nancy May: 00:49:13

We'll be putting there as well as a website that's in the

Nancy May: 00:49:15

process of being put together.

Nancy May: 00:49:17

We're a little slow on that at the podcast has been the primary

Nancy May: 00:49:20

focus and getting the word out.

Nancy May: 00:49:21

The faster we can do it, the more benefit to you.

Nancy May: 00:49:24

so thank you very much, Shae I appreciate you being here with me and with everybody

Nancy May: 00:49:28

else who's listening in as well.

Nancy May: 00:49:30

For

Nancy May: 00:49:30

Dr. Shea Gregg: Thank you so much Nancy

Nancy May: 00:49:32

those who are listening, as you know, I always like to say, please share

Nancy May: 00:49:36

this with a friend, a family member, or maybe even somebody that you're seeing

Nancy May: 00:49:41

at the Dunkin Donuts line who needs a little extra help, whether they're

Nancy May: 00:49:45

taking care of somebody else or they just might need some help themselves.

Nancy May: 00:49:49

Share this with them because it can be your gift to them.

Nancy May: 00:49:53

And it's our gift, Shae's and mine, to you.

Nancy May: 00:49:55

To you.

Nancy May: 00:49:56

We'll see you soon and we'll hear you soon.

Nancy May: 00:49:58

And don't forget to tune into Eldercare Success on YouTube as well.

Nancy May: 00:50:02

Take care.

Nancy May: 00:50:02

Bye bye and stay well and off the floor.