How to Lose Weight, and What is Healthy Weight Loss (AKA, How Much, How Soon and How)?
Let’s start with the How. Commercial voice: “You should contact your physician before starting any weight loss routine”. We ended things on the last post talking about the caloric balance equation, which (simplified) means you need to get off your derriere, and close your mouth. Without getting too technical, to lose weight, 1 pound equals 3,500 calories, so your net caloric intake must be cut by at least 500 calories per day to lose a pound a week. Here are some Quick Tips to cut calories (and I will not be discussing any of the popular diets or medical remedies (with one exception in the next post); you can see your physician or nutritionist about those. Besides, guess what? Most of you don’t need a fad diet. Keep it simple. And…more importantly, you should be more concerned with healthy regimens that help you keep the weight off, not drastic efforts that have proven to have quick short-term but unsustainable long-term outcomes).
1) Work out: If you can sprint, do so. If you can’t, jog. If you can’t jog, walk. I like working out while watching sports, because my heart’s pumping anyway. Weight training at the same time is even better. Once you hit a good exercise regimen, your metabolism will improve, making weight loss that much easier. By the way, the next post is on metabolism; stay tuned.
2) Hungry? Start counting calories. Use this standard to determine what your daily calorie intake should be. Meal plan so you don’t exceed that level. Remember the caloric equation to lose weight: Amount expended minus the amount eaten should be 500 calories a day. In the next post, I’ll give you a Quick Tip for an extra 400 calories a day you can lose.
3) Still hungry? Try brushing your teeth. Don’t laugh. It actually works. And it gives you nice teeth. Otherwise try drinking water or chewing calorie-free gum. All these are nice, simple inexpensive appetite suppressants.
How Soon? It’s natural for anyone trying to lose weight to want to lose it very quickly. But evidence shows that people who lose weight gradually and steadily (about 1-2 pounds per week) are more successful at keeping weight off. Healthy weight loss isn’t just about a “diet” or “program”. It’s about an ongoing lifestyle that includes long-term changes in daily eating and exercise habits. Think health instead of weight, and the weight will improve.
How Much? If you were my patient (but you’re not!), I’d tell you to forget about ideal body weight and BMI – for now. Focus on a modest weight loss, like 5-10% of your current weight. Even this success will improve your blood pressure, cholesterol and blood sugar levels. Once you accomplish that goal, do it again. So even if the overall goal seems large, see it as a journey rather than just a final destination. Seek to learn new eating and physical activity habits that will help you live a healthier lifestyle. These habits may help you maintain your weight loss over time. To that end, I love healthy challenges. Try a 30-day water instead of pop (soda)/coffee, etc. challenge, or even better, give yourself a 30-day ‘fruit for dessert challenge’ or ‘salad of your choice for lunch’ challenge. When that’s done, immediately do it again. Learn to integrate healthy habits into your quest to lose weight, and you’ll increase the odds of having sustainable weight lost. At the end of the day, it’s been well established that those who maintained a significant weight loss report improvements in not only their physical health, but also their energy levels, physical mobility, general mood, and self-confidence. Good luck, and check back for the next post on how to fine-tune your metabolism!
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
All posts by Jeffrey Sterling, MD
Straight, No Chaser: Healthy, Sustainable Weight Loss – Let's Get Started
Straight, No Chaser: The Adverse Health Effects of Obesity and Why You Gain Weight
Earlier, we identified the differences between a ‘normal’ weight and being overweight and/or obese. Today’s goal is to help you understand specific risks of carrying extra weight. We’ll also set the table for losing weight by discussing why weight gain occurs. It bears repeating that none of this has anything to do with the perception of one’s physical attractiveness.
Let’s focus on three considerations.
1. What are the health risks?
As body weight increases, so does the risk for several different medical conditions and illnesses, including the following:
• Arthritis
• Cancers (breast, endometrial, and colon)
• Diabetes
• Gynecological problems (abnormal periods, infertility)
• Heart disease (heart attacks, heart failure, hardening of the arteries)
• High cholesterol
• Liver and gallbladder disease (gallstones)
• Sleep apnea and other respiratory problems
• Stroke
In the event that these risks are just words on a page, learning a little bit about some of them might provide the motivation needed to avoid them.
2. What is a realistic goal for weight loss? What’s the balance between family predisposition and the foods I eat?
No matter what I tell you today, it’s unlikely to turn you into a supermodel. The goal (independent of your consultation with your own health care provider) is to get you to optimize your situation based on the things you can control. Yes, genetic factors do play a role in obesity, but beyond that you are more than able to close your mouth and get off your…couch. You are able to limit your fat and caloric intake and put down the salt shaker. Yes, genetics count, but behavior and environmental (culture, socioeconomic status) consideration play at least as much of a role. These latter considerations can even jumpstart your metabolism beyond your genetic predisposition.
3. Why do I gain weight if I’m still active?
The most simple way to answer this is that weight gain occurs from an energy imbalance. You’re taking in too many calories, and/or you’re not engaging in enough physical activity. It’s an equation, and the weight gain occurs when you’re on the wrong side of the equation. It’s not much more complicated than this. Either do less of the eating, more of the activity, or both. I mentioned in a previous post on caloric counts that you must have an excess of 500 more calories expended than you ingest daily every day for a week just to lose one pound. It takes work. This is the simple answer as to why fad diets don’t work long-term. You can’t cheat the equation. The moment you stop being diligent, you’re headed in the wrong direction. Your weight loss plan must include lifestyle changes for the long-term.
In the next post, we’ll identify some very simple methods to combat obesity based on the information provided to this point. Feel free to ask any questions or submit any comments you have.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Earlier, we identified the differences between a ‘normal’ weight and being overweight and/or obese. Today’s goal is to help you understand specific risks of carrying extra weight. We’ll also set the table for losing weight by discussing why weight gain occurs. It bears repeating that none of this has anything to do with the perception of one’s physical attractiveness.
Let’s focus on three considerations.
1. What are the health risks?
As body weight increases, so does the risk for several different medical conditions and illnesses, including the following:
• Arthritis
• Cancers (breast, endometrial, and colon)
• Diabetes
• Gynecological problems (abnormal periods, infertility)
• Heart disease (heart attacks, heart failure, hardening of the arteries)
• High cholesterol
• Liver and gallbladder disease (gallstones)
• Sleep apnea and other respiratory problems
• Stroke
In the event that these risks are just words on a page, learning a little bit about some of them might provide the motivation needed to avoid them.
2. What is a realistic goal for weight loss? What’s the balance between family predisposition and the foods I eat?
No matter what I tell you today, it’s unlikely to turn you into a supermodel. The goal (independent of your consultation with your own health care provider) is to get you to optimize your situation based on the things you can control. Yes, genetic factors do play a role in obesity, but beyond that you are more than able to close your mouth and get off your…couch. You are able to limit your fat and caloric intake and put down the salt shaker. Yes, genetics count, but behavior and environmental (culture, socioeconomic status) consideration play at least as much of a role. These latter considerations can even jumpstart your metabolism beyond your genetic predisposition.
3. Why do I gain weight if I’m still active?
The most simple way to answer this is that weight gain occurs from an energy imbalance. You’re taking in too many calories, and/or you’re not engaging in enough physical activity. It’s an equation, and the weight gain occurs when you’re on the wrong side of the equation. It’s not much more complicated than this. Either do less of the eating, more of the activity, or both. I mentioned in a previous post on caloric counts that you must have an excess of 500 more calories expended than you ingest daily every day for a week just to lose one pound. It takes work. This is the simple answer as to why fad diets don’t work long-term. You can’t cheat the equation. The moment you stop being diligent, you’re headed in the wrong direction. Your weight loss plan must include lifestyle changes for the long-term.
In the next post, we’ll identify some very simple methods to combat obesity based on the information provided to this point. Feel free to ask any questions or submit any comments you have.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: The United States of Obesity – The Crossroads Between Health and Happiness
Obesity in the United States places many at a crossroad between self-esteem and health. Often, larger frames are celebrated as more desirable. Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise. Of course, our culture embraces and contributes to obesity. Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport. I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health. If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed. As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:
Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.
Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.
‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Obesity in the United States places many at a crossroad between self-esteem and health. Often, larger frames are celebrated as more desirable. Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise. Of course, our culture embraces and contributes to obesity. Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport. I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health. If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed. As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:
Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.
Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.
‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight No Chaser: The United States of Obesity – The Crossroads Between The Pursuit of Health and Happiness
Straight No Chaser: The United States of Obesity – The Crossroads Between The Pursuit of Health and Happiness
Obesity in the United States places many at a crossroad between self-esteem and health. Often, larger frames are celebrated as more desirable. Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise. Of course, our culture embraces and contributes to obesity. Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport. I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health. If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed. As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:
Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.
Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.
‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Obesity in the United States places many at a crossroad between self-esteem and health. Often, larger frames are celebrated as more desirable. Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise. Of course, our culture embraces and contributes to obesity. Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport. I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health. If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed. As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:
Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.
Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.
‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Here's How You Stop Smoking – Quick Tips to START Smoking Cessation
- Don’t pick your birthday or NYE to stop. Do it now. Can’t do it now? Do it Monday. In fact, do it every Monday. It’s a fight. If you fall down, start it back up again. It’s the fight of your life (or should I say for your life?).
- If you decide to quit after your current (last) pack, throw away one cigarette for every one you smoke.
- Count (figuratively or literally) all the money you’re saving by not smoking.
- Throw away (not give away) all cigarettes, cigars, matches, lighters, humidors, cigar cutters and anything else you associate with smoking. You’ll realize how sad it is if and when you find yourself rummaging through the garbage to get a fix.
- Tell everyone (loudly) that you’ve quit. Empower them to help and hold you accountable. Enlist another smoker friend to go through the journey with you.
- If you do fall off the wagon, smoke a different cigarette brand. Odds are you won’t like it as much, and that will help combat the natural ease you have with smoking.
- Contact your physician, and ask for help. Here’s a marvelous best-practices schemata of appropriate interplay between a physician and a patient trying to stop smoking.
- If your physician and you decide to place you on a patch or otherwise medicate you, follow instructions carefully and precisely.
- Practice deep breathing. Part of the euphoria of smoking is nothing more than the physiologic sensations produced by deep inhalations.
- Keep other things in your mouth. Mints and chewing gum (low-calorie) are great. Brushing your teeth also serves many purposes. Drinking water when you want to smoke will often remove the urge.
- Make it past the first day. Then make it past the first week.
I personally love the START method, which includes several of the above methods. Let me know if it works for any of you.
S: Set a quit date.
T: Tell your friends, family and associates that you’re quitting, and enlist their help.
A: Anticipate and act on the plan you’ve set and challenges you’ll meet.
R: Remove (trash) cigarettes, cigar and other paraphernalia from your environment.
T: Talk with your physician about options and additional support.
For those of you affected (either first or second-hand), this is huge and important. I really wish you all the best. I welcome any comments or questions.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
- Don’t pick your birthday or NYE to stop. Do it now. Can’t do it now? Do it Monday. In fact, do it every Monday. It’s a fight. If you fall down, start it back up again. It’s the fight of your life (or should I say for your life?).
- If you decide to quit after your current (last) pack, throw away one cigarette for every one you smoke.
- Count (figuratively or literally) all the money you’re saving by not smoking.
- Throw away (not give away) all cigarettes, cigars, matches, lighters, humidors, cigar cutters and anything else you associate with smoking. You’ll realize how sad it is if and when you find yourself rummaging through the garbage to get a fix.
- Tell everyone (loudly) that you’ve quit. Empower them to help and hold you accountable. Enlist another smoker friend to go through the journey with you.
- If you do fall off the wagon, smoke a different cigarette brand. Odds are you won’t like it as much, and that will help combat the natural ease you have with smoking.
- Contact your physician, and ask for help. Here’s a marvelous best-practices schemata of appropriate interplay between a physician and a patient trying to stop smoking.
- If your physician and you decide to place you on a patch or otherwise medicate you, follow instructions carefully and precisely.
- Practice deep breathing. Part of the euphoria of smoking is nothing more than the physiologic sensations produced by deep inhalations.
- Keep other things in your mouth. Mints and chewing gum (low-calorie) are great. Brushing your teeth also serves many purposes. Drinking water when you want to smoke will often remove the urge.
- Make it past the first day. Then make it past the first week.
I personally love the START method, which includes several of the above methods. Let me know if it works for any of you.
S: Set a quit date.
T: Tell your friends, family and associates that you’re quitting, and enlist their help.
A: Anticipate and act on the plan you’ve set and challenges you’ll meet.
R: Remove (trash) cigarettes, cigar and other paraphernalia from your environment.
T: Talk with your physician about options and additional support.
For those of you affected (either first or second-hand), this is huge and important. I really wish you all the best. I welcome any comments or questions.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Smoking Cessation
You’ve all been asked what things you’d take with you on a desert island. I’ll pose and answer the opposite question, but not on an island but regarding your life. Getting you to stop smoking is certainly one of the three gifts I’d offer you if it was within my power. This post won’t be about the dangers of smoking – I’ll continue to hit you over the head with those at every opportunity. Given that I’m into producing positive outcomes, I’m going to discuss with you effective means of smoking cessation and the benefits of stopping.
The question on your mind is obviously how to stop. Personally, I’m of the Yoda mindset. You know, when he was teaching Luke Skywalker, he famously said “Do or Do not. There is no try.” I can hear you now, “But Doc, I’m addicted…” Sure you are. There are many things in medicine about which I’m absolutely sure. One of these is the most effective way to stop smoking is to quit. Cold turkey. The moment you’re motivated. Not only is this premise supported by the data, which I’ll discuss momentarily, but here’s the benefit of over 20 years in clinical emergency medicine practice and having seen hundreds of people stop, stay stopped, and letting me know months and years later that they stayed stopped. Despite being addicted, people are amazingly able to quit cold turkey, and they will do it in one of five circumstances.
When they develop the will
After the birth of their first child
After their first heart attack
After their first stroke
When they die
For those of you convinced that you can’t, here’s a fact: today there are more former smokers than current smokers.
I want to point out that I appreciate the difference between cigarette smoking and nicotine dependence. My particular concern for your health lies in the delivery of smoke (containing over 7000 other toxins, approximately 70 of which can cause various cancers) into the airway system that is supposed to deliver oxygen throughout your body for the maintenance and health of your organ systems. Still I want you to know I understand and appreciate the difficulty of smoking cessation.
- Nicotine dependence in the most common chemical dependence in the U.S.
- Quitting smoking often requires multiple attempts.
- Nicotine withdrawal produces bothersome symptoms (e.g. irritability, reduced concentration, increased appetite with possible weight gain, and anxiety)
The good news is more than two-thirds of smokers profess a desire to stop smoking, and yearly over half of smokers attempt to stop. That’s likely a result of knowing that no matter when you stop, you will improve your health outcomes. Each incremental inhalation of cigarette and cigar smoke produces damage better left unproduced. Let’s just hope you don’t wait until permanent damage has set in. Consider a sampling of the following benefits that are sitting there waiting for you.
- Reduction of the risk for cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach and cervix, as well as certain leukemias.
- Reduction of the risk for heart disease, stroke and peripheral vascular disease.
- Reduction of the risk for COPD (chronic obstructive pulmonary disease)
- Reduction of the risk for infertility
In my next post, I’ll review specific methods and tips to help you and/or your loved one stop. Today’s as good of a day as any.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
You’ve all been asked what things you’d take with you on a desert island. I’ll pose and answer the opposite question, but not on an island but regarding your life. Getting you to stop smoking is certainly one of the three gifts I’d offer you if it was within my power. This post won’t be about the dangers of smoking – I’ll continue to hit you over the head with those at every opportunity. Given that I’m into producing positive outcomes, I’m going to discuss with you effective means of smoking cessation and the benefits of stopping.
The question on your mind is obviously how to stop. Personally, I’m of the Yoda mindset. You know, when he was teaching Luke Skywalker, he famously said “Do or Do not. There is no try.” I can hear you now, “But Doc, I’m addicted…” Sure you are. There are many things in medicine about which I’m absolutely sure. One of these is the most effective way to stop smoking is to quit. Cold turkey. The moment you’re motivated. Not only is this premise supported by the data, which I’ll discuss momentarily, but here’s the benefit of over 20 years in clinical emergency medicine practice and having seen hundreds of people stop, stay stopped, and letting me know months and years later that they stayed stopped. Despite being addicted, people are amazingly able to quit cold turkey, and they will do it in one of five circumstances.
When they develop the will
After the birth of their first child
After their first heart attack
After their first stroke
When they die
For those of you convinced that you can’t, here’s a fact: today there are more former smokers than current smokers.
I want to point out that I appreciate the difference between cigarette smoking and nicotine dependence. My particular concern for your health lies in the delivery of smoke (containing over 7000 other toxins, approximately 70 of which can cause various cancers) into the airway system that is supposed to deliver oxygen throughout your body for the maintenance and health of your organ systems. Still I want you to know I understand and appreciate the difficulty of smoking cessation.
- Nicotine dependence in the most common chemical dependence in the U.S.
- Quitting smoking often requires multiple attempts.
- Nicotine withdrawal produces bothersome symptoms (e.g. irritability, reduced concentration, increased appetite with possible weight gain, and anxiety)
The good news is more than two-thirds of smokers profess a desire to stop smoking, and yearly over half of smokers attempt to stop. That’s likely a result of knowing that no matter when you stop, you will improve your health outcomes. Each incremental inhalation of cigarette and cigar smoke produces damage better left unproduced. Let’s just hope you don’t wait until permanent damage has set in. Consider a sampling of the following benefits that are sitting there waiting for you.
- Reduction of the risk for cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach and cervix, as well as certain leukemias.
- Reduction of the risk for heart disease, stroke and peripheral vascular disease.
- Reduction of the risk for COPD (chronic obstructive pulmonary disease)
- Reduction of the risk for infertility
In my next post, I’ll review specific methods and tips to help you and/or your loved one stop. Today’s as good of a day as any.
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Straight, No Chaser: 5 Questions on High Blood Pressure You Must Be Able to Answer
Straight, No Chaser: High Blood Pressure
High blood pressure is called the silent killer. It’s common for me to see someone who thought they were ‘fine’ drop dead from its effects, never knowing it was about to happen and not having been aware of the warning signs and risk factors.
In lay terms, your heart is just a muscular pump pushing blood (containing oxygen and nutrients) around the body keeping stuff alive. The more you poison that pump (by ingesting unhealthy foods and inhaling other toxins) and strain the muscle by adding weight and clogging its vessels so it has to pump against more force (by being obese, not exercising and engaging in other unhealthy behaviors), the more likely that muscle is to strain until it gives out. Once it does, blood isn’t delivering what’s needed to your vital organs, and that’s when bad stuff happens.
The vital organs in question and those bad effects include the following:
• The heart itself (no blood flow and no oxygen = heart attack; when the heart’s not strong enough to pump blood around the body = congestive heart failure)
• The blood vessels, especially the heart’s main offshoot, the aorta (too much strain = aneurysm, an outpouching from the main tubular system, stealing valuable blood from the rest of the body)
• The brain (no blood flow and no oxygen = stroke; aneursyms also occur in the brain)
• The kidneys (not enough blood flow or adequate enough function to clear the toxins from the kidney = renal failure)
• The eyes (poor blood flow and/or diseased eye blood vessels leads to vision loss)
Bottom line: The heart is a muscle best thought of as a machine. Here’s three easy things you can do to reduce your risks.
• Get off your butt. Any exercise helps to get your heart pumping and blood flowing; strive for 20” three times a week at the very least.
• Close your mouth. Everything in moderation is cool, but introduce some fruits and vegetables into your life.
• Lose the salt shaker. At least taste your food first. It’s likely the food was already prepared with salt.
Did I mention stop smoking? Any questions?
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
High blood pressure is called the silent killer. It’s common for me to see someone who thought they were ‘fine’ drop dead from its effects, never knowing it was about to happen and not having been aware of the warning signs and risk factors.
In lay terms, your heart is just a muscular pump pushing blood (containing oxygen and nutrients) around the body keeping stuff alive. The more you poison that pump (by ingesting unhealthy foods and inhaling other toxins) and strain the muscle by adding weight and clogging its vessels so it has to pump against more force (by being obese, not exercising and engaging in other unhealthy behaviors), the more likely that muscle is to strain until it gives out. Once it does, blood isn’t delivering what’s needed to your vital organs, and that’s when bad stuff happens.
The vital organs in question and those bad effects include the following:
• The heart itself (no blood flow and no oxygen = heart attack; when the heart’s not strong enough to pump blood around the body = congestive heart failure)
• The blood vessels, especially the heart’s main offshoot, the aorta (too much strain = aneurysm, an outpouching from the main tubular system, stealing valuable blood from the rest of the body)
• The brain (no blood flow and no oxygen = stroke; aneursyms also occur in the brain)
• The kidneys (not enough blood flow or adequate enough function to clear the toxins from the kidney = renal failure)
• The eyes (poor blood flow and/or diseased eye blood vessels leads to vision loss)
Bottom line: The heart is a muscle best thought of as a machine. Here’s three easy things you can do to reduce your risks.
• Get off your butt. Any exercise helps to get your heart pumping and blood flowing; strive for 20” three times a week at the very least.
• Close your mouth. Everything in moderation is cool, but introduce some fruits and vegetables into your life.
• Lose the salt shaker. At least taste your food first. It’s likely the food was already prepared with salt.
Did I mention stop smoking? Any questions?
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Breaking News You Can Use – Sarin Nerve Gas Poisoning in Syria
Just when I thought I was done with toxins for a while… U.S. Secretary of State John Kerry has announced that autopsies of victims in Syria are testing positive for the presence of Sarin, a powerful and volatile nerve agent created around the time of WWII in Germany.
Nerve agents fall into a category of substances known as anticholinesterase inhibitors. These chemicals are known best to the public as either nerve gas or insecticides.
Here’s what you need to know about sarin and other agents like it:
- Anticholinesterase is necessary for proper nerve function by regulating how much gets used. Inhibiting anticholinesterase results in overstimulation of various muscles, most importantly, the ones we use to breathe. Think (very coarsely) of the cartoon about getting your finger stuck in an electrical outlet, and you can’t stop jerking. Something like that is occurring on a cellular level inside you.
- Sarin is powerful. It’s 500 times more toxic than cyanide poisoning and can kill you in a minute. It rapidly gets converted from liquid to gas forms, which makes it even more dangerous. You don’t even need to touch the stuff; inhalation gets it well inside of you.
- This class of toxins makes you overload in fluid production. Although initial symptoms include small pupils (miosis), chest tightness and an excessively runny nose, soon to follow will be excessive production and flow of saliva, tears, urine and stool, and vomiting. Death typically occurs by lung spasm and production of lots of watery sputum, leading to asphyxiation (inability to breathe). Typically, no physical wounds will be noted.
- There’s a high rate of secondary contamination, so if this gets on your clothes and skin, and you’re subsequently touched by an unsuspecting helper, it will be passed on.
- Fortunately, there’s an antidote, but you must receive it rapidly (The treatment is use of atropine plus pralidoxime, aka 2-PAM).
- Sarin has been used in wars against the Kurds and against U.S. troops fighting in Iraq. During wartime, it can be weaponized and distributed via aerosols, with subsequent inhalation or skin contact.
So that’s the short version. It’s a horrible way to die and an effective way to commit mass murder. This should help understand some of the international uproar about a government that would do such a thing to its people, assuming that proves to be the case.
Just when I thought I was done with toxins for a while… U.S. Secretary of State John Kerry has announced that autopsies of victims in Syria are testing positive for the presence of Sarin, a powerful and volatile nerve agent created around the time of WWII in Germany.
Nerve agents fall into a category of substances known as anticholinesterase inhibitors. These chemicals are known best to the public as either nerve gas or insecticides.
Here’s what you need to know about sarin and other agents like it:
- Anticholinesterase is necessary for proper nerve function by regulating how much gets used. Inhibiting anticholinesterase results in overstimulation of various muscles, most importantly, the ones we use to breathe. Think (very coarsely) of the cartoon about getting your finger stuck in an electrical outlet, and you can’t stop jerking. Something like that is occurring on a cellular level inside you.
- Sarin is powerful. It’s 500 times more toxic than cyanide poisoning and can kill you in a minute. It rapidly gets converted from liquid to gas forms, which makes it even more dangerous. You don’t even need to touch the stuff; inhalation gets it well inside of you.
- This class of toxins makes you overload in fluid production. Although initial symptoms include small pupils (miosis), chest tightness and an excessively runny nose, soon to follow will be excessive production and flow of saliva, tears, urine and stool, and vomiting. Death typically occurs by lung spasm and production of lots of watery sputum, leading to asphyxiation (inability to breathe). Typically, no physical wounds will be noted.
- There’s a high rate of secondary contamination, so if this gets on your clothes and skin, and you’re subsequently touched by an unsuspecting helper, it will be passed on.
- Fortunately, there’s an antidote, but you must receive it rapidly (The treatment is use of atropine plus pralidoxime, aka 2-PAM).
- Sarin has been used in wars against the Kurds and against U.S. troops fighting in Iraq. During wartime, it can be weaponized and distributed via aerosols, with subsequent inhalation or skin contact.
So that’s the short version. It’s a horrible way to die and an effective way to commit mass murder. This should help understand some of the international uproar about a government that would do such a thing to its people, assuming that proves to be the case.
Straight, No Chaser: The Week In Review
Based on the response to this week’s posts, I’d say it was an informative week for you. Remember to click the underlined topics to go to the mentioned post. Let’s recap the week.
On Sunday, we reviewed night terrors and differentiated them from nightmares. Remember, if your child develops these, it’s very important to protect them from harm during the episode, and try to identify the source of any increased stress.
On Monday, we reviewed the late Dr. Martin Luther King, Jr.’s comments on healthcare and its relevance today. Injustice in healthcare is still shocking and inhuman, as health care disparities abound. Monday also brought a review of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. As the time of implementation gets closer, I will revisit implementation of the ACA, particularly health care exchanges, what your options are, and what’s to be done with the 20 million Americans who will still be uninsured. I will also be discussing how this blog and my national efforts will dovetail into these considerations. Stay tuned.
On Tuesday, we began our series on toxins and detoxification. The first post discussed the power our body naturally and normally has to detoxify and to defend us from harm. The second post offered specific, natural Quick Tips to enhance your body’s capabilities. Taken together, I strongly recommend you internalize this information (no put intended). All the other exotic methods typically promoted are, at best, enhancements to what we already do unless disease limits us. At worst, they can cause damage themselves.
On Wednesday, we looked at some of the environmentally toxic dangers to our bodies, focusing on various toxins affecting our lungs, skin, kidneys, liver and intestines. If knowledge is power, your brain should be stuffed after reading that post. Stop smoking (Yes, you.). Wednesday also brought a review of detox diets. My advice is simple. Proceed with caution, and don’t expect any miracle cures. In fact, the better course of action is to use any such efforts as a launch into a more modest long-term regimen of healthy diet and exercise.
On Thursday, we reviewed colon cleansing, looking at oral solutions and rectal colonics. These were turbulent topics, to say the least. Please consult your physician before starting any of these diets or cleansing programs. They are not without risk and consequence in certain patients. Thursday also brought a review and wrap-up of the toxin/detoxification series. I enjoyed your questions, comments and thoughts.
On Friday, we reviewed insomnia. Do you remember the difference between primary and secondary insomnia? There are important treatment considerations attached to each, so consider reviewing. I also gave you 10 Quick Tips to help your difficulty sleeping and answered your questions.
On Saturday, we peeled back the brains of physicians and taught you how we decide if and when ankle x-rays are needed. I really do want your feedback when you mention the Ottawa Ankle Rules to your physicians. I’m sure you’ll have stories about hearing them muttering “Damn internet!” under their breath! Saturday also brought a review of a normal calorie intake. I think this is a pretty important topic for several reasons. I hope you learned the different between sedentary, moderately active and active lifestyles. Also, many of us have no idea how much we should be eating and how many calories we should have daily. Also, this will serve as a nice launching pad for my review of obesity next week.
Speaking of the next two weeks, I will be focusing on revisiting some fundamental bread and butter topics (no pun intended). I continue to hope you enjoy Straight, No Chaser and appreciate your supporting this blog, which has now reached readers in 60 countries around the world in every continent. I’ll keep bringing the information, and you keep taking advantage of it.
Based on the response to this week’s posts, I’d say it was an informative week for you. Remember to click the underlined topics to go to the mentioned post. Let’s recap the week.
On Sunday, we reviewed night terrors and differentiated them from nightmares. Remember, if your child develops these, it’s very important to protect them from harm during the episode, and try to identify the source of any increased stress.
On Monday, we reviewed the late Dr. Martin Luther King, Jr.’s comments on healthcare and its relevance today. Injustice in healthcare is still shocking and inhuman, as health care disparities abound. Monday also brought a review of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. As the time of implementation gets closer, I will revisit implementation of the ACA, particularly health care exchanges, what your options are, and what’s to be done with the 20 million Americans who will still be uninsured. I will also be discussing how this blog and my national efforts will dovetail into these considerations. Stay tuned.
On Tuesday, we began our series on toxins and detoxification. The first post discussed the power our body naturally and normally has to detoxify and to defend us from harm. The second post offered specific, natural Quick Tips to enhance your body’s capabilities. Taken together, I strongly recommend you internalize this information (no put intended). All the other exotic methods typically promoted are, at best, enhancements to what we already do unless disease limits us. At worst, they can cause damage themselves.
On Wednesday, we looked at some of the environmentally toxic dangers to our bodies, focusing on various toxins affecting our lungs, skin, kidneys, liver and intestines. If knowledge is power, your brain should be stuffed after reading that post. Stop smoking (Yes, you.). Wednesday also brought a review of detox diets. My advice is simple. Proceed with caution, and don’t expect any miracle cures. In fact, the better course of action is to use any such efforts as a launch into a more modest long-term regimen of healthy diet and exercise.
On Thursday, we reviewed colon cleansing, looking at oral solutions and rectal colonics. These were turbulent topics, to say the least. Please consult your physician before starting any of these diets or cleansing programs. They are not without risk and consequence in certain patients. Thursday also brought a review and wrap-up of the toxin/detoxification series. I enjoyed your questions, comments and thoughts.
On Friday, we reviewed insomnia. Do you remember the difference between primary and secondary insomnia? There are important treatment considerations attached to each, so consider reviewing. I also gave you 10 Quick Tips to help your difficulty sleeping and answered your questions.
On Saturday, we peeled back the brains of physicians and taught you how we decide if and when ankle x-rays are needed. I really do want your feedback when you mention the Ottawa Ankle Rules to your physicians. I’m sure you’ll have stories about hearing them muttering “Damn internet!” under their breath! Saturday also brought a review of a normal calorie intake. I think this is a pretty important topic for several reasons. I hope you learned the different between sedentary, moderately active and active lifestyles. Also, many of us have no idea how much we should be eating and how many calories we should have daily. Also, this will serve as a nice launching pad for my review of obesity next week.
Speaking of the next two weeks, I will be focusing on revisiting some fundamental bread and butter topics (no pun intended). I continue to hope you enjoy Straight, No Chaser and appreciate your supporting this blog, which has now reached readers in 60 countries around the world in every continent. I’ll keep bringing the information, and you keep taking advantage of it.
Straight, No Chaser: How Many Calories Do You Need a Day?
Let’s put this post (at least the end of it) under the category of things you do but really don’t think about.
How many calories should you take in per day to function (meaning produce the energy you need for your activities of daily living)? It actually depends on your gender, your age and your level of activity. Let me start by defining the types of lifestyles, according to the Institute of Medicine. If you are in the third category (active), I doubt that you’re worried.
Sedentary means a lifestyle that includes only the light physical activity associated with day-to-day living.
Moderately active means a level of physical activity equivalent to walking about 1.5-3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
Active means a level of physical equivalent to walking more than 3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
That breaks down as follows:
- For women between 14-50, the number is right about 2000 kcal/day (calories) if you’re moderately active and 1800 if you’re sedentary.
- For men between 14-50, there’s some greater variance, but the 2500 kcal/day works if you’re moderately active and 2200 if you’re sedentary.
In short, that averages to about 600-800 calories per meal, with the low end being for sedentary females and the high end being for moderately active males.
Now consider, 16% of the calories in the average American diet come from refined sugars. Fully 50% of that total comes from beverages with added sugar.
Every 12 ounces of non-diet of pop/soda you drink contains about 150 calories.
Your average dessert ranges from 300-500 calories.
The most popular one, only one cup of ice cream, contains 270 calories.
I’ll let you take the math forward from there. However, the take home point is obvious. Suffice it to say, the link between pop, deserts and obesity has been well established. Here’s three Quick Tips for you.
- Try finding a drink with fewer calories if you want to lose calories (and weight). It’s water, not Coke, that adds life.
- Try eating your favorite fruits as dessert.
- Also, consider just walking 3-4 miles a day. It’s not that hard, if you just do it.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Let’s put this post (at least the end of it) under the category of things you do but really don’t think about.
How many calories should you take in per day to function (meaning produce the energy you need for your activities of daily living)? It actually depends on your gender, your age and your level of activity. Let me start by defining the types of lifestyles, according to the Institute of Medicine. If you are in the third category (active), I doubt that you’re worried.
Sedentary means a lifestyle that includes only the light physical activity associated with day-to-day living.
Moderately active means a level of physical activity equivalent to walking about 1.5-3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
Active means a level of physical equivalent to walking more than 3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
That breaks down as follows:
- For women between 14-50, the number is right about 2000 kcal/day (calories) if you’re moderately active and 1800 if you’re sedentary.
- For men between 14-50, there’s some greater variance, but the 2500 kcal/day works if you’re moderately active and 2200 if you’re sedentary.
In short, that averages to about 600-800 calories per meal, with the low end being for sedentary females and the high end being for moderately active males.
Now consider, 16% of the calories in the average American diet come from refined sugars. Fully 50% of that total comes from beverages with added sugar.
Every 12 ounces of non-diet of pop/soda you drink contains about 150 calories.
Your average dessert ranges from 300-500 calories.
The most popular one, only one cup of ice cream, contains 270 calories.
I’ll let you take the math forward from there. However, the take home point is obvious. Suffice it to say, the link between pop, deserts and obesity has been well established. Here’s three Quick Tips for you.
- Try finding a drink with fewer calories if you want to lose calories (and weight). It’s water, not Coke, that adds life.
- Try eating your favorite fruits as dessert.
- Also, consider just walking 3-4 miles a day. It’s not that hard, if you just do it.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: How I Know If Your Ankle is Broken Without X-Rays – The Ottawa Ankle Rules
There are medical secrets, and there are tips. Then there are initiatives that help the public better understand what’s going on, like the big initiatives on heart attacks and strokes. I wonder why there’s never been a push to teach the public how to better deal with strains and sprains. The cumulative radiation exposure and the expense of coming to the emergency room are sufficiently high enough that we should want patients not to expect as many unwarranted x-rays as you end up receiving. Truthfully, the overwhelming majority of ankle sprains (consistently estimated at 85%) don’t have associated fractures. The initial research done in developing what are known as the Ottawa Ankle Rules demonstrated a complete absence of ankle fractures in the absence of certain exam findings.
An ankle X-ray is only required if any of the following are present (Doctor version).
- Inability to bear weight for four steps (both immediately and in the emergency room);
- Bony tenderness along the posterior edge of the distal 6 cm (almost 3 inches) of either the lateral or medial malleolus;
- Point tenderness over the proximal base of the 5th metatarsal; or
- Point tenderness over the navicular bone.
Now that was the medical terminology (I bet you thought I’d lost it for a second!). Here’s the same information translated for you.
- Inability to bear weight for four steps (both immediately and in the emergency room);
- Bony tenderness along the back of those big bones sticking out of either side of your ankle (A and B in the diagram above);
- Point tenderness right about the middle of your foot down from your pinky toe (C in the diagram); or
- Point tenderness over top of the middle of your foot (D in the diagram).
These rules aren’t applied to those under 18, intoxicated or otherwise distracted, say from another injury.
What does this mean?
- More than a third of ankle x-rays can be eliminated by applying these rules, saving you money and radiation exposure.
- If you find your physician asking you if you’d like to not have an x-ray done, you know this is what s/he’s thinking. Several major studies showed application of these rules had a 100% sensitivity. In other words, you don’t need the x-ray.
- All of you playing with your ankles have made me smile.
What this doesn’t mean for you…
- You can play doctor at home.
Finally, don’t forget about RICE, remember? That’s how you treat your ankle sprain.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
There are medical secrets, and there are tips. Then there are initiatives that help the public better understand what’s going on, like the big initiatives on heart attacks and strokes. I wonder why there’s never been a push to teach the public how to better deal with strains and sprains. The cumulative radiation exposure and the expense of coming to the emergency room are sufficiently high enough that we should want patients not to expect as many unwarranted x-rays as you end up receiving. Truthfully, the overwhelming majority of ankle sprains (consistently estimated at 85%) don’t have associated fractures. The initial research done in developing what are known as the Ottawa Ankle Rules demonstrated a complete absence of ankle fractures in the absence of certain exam findings.
An ankle X-ray is only required if any of the following are present (Doctor version).
- Inability to bear weight for four steps (both immediately and in the emergency room);
- Bony tenderness along the posterior edge of the distal 6 cm (almost 3 inches) of either the lateral or medial malleolus;
- Point tenderness over the proximal base of the 5th metatarsal; or
- Point tenderness over the navicular bone.
Now that was the medical terminology (I bet you thought I’d lost it for a second!). Here’s the same information translated for you.
- Inability to bear weight for four steps (both immediately and in the emergency room);
- Bony tenderness along the back of those big bones sticking out of either side of your ankle (A and B in the diagram above);
- Point tenderness right about the middle of your foot down from your pinky toe (C in the diagram); or
- Point tenderness over top of the middle of your foot (D in the diagram).
These rules aren’t applied to those under 18, intoxicated or otherwise distracted, say from another injury.
What does this mean?
- More than a third of ankle x-rays can be eliminated by applying these rules, saving you money and radiation exposure.
- If you find your physician asking you if you’d like to not have an x-ray done, you know this is what s/he’s thinking. Several major studies showed application of these rules had a 100% sensitivity. In other words, you don’t need the x-ray.
- All of you playing with your ankles have made me smile.
What this doesn’t mean for you…
- You can play doctor at home.
Finally, don’t forget about RICE, remember? That’s how you treat your ankle sprain.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Your Rebuttals and Questions about Insomnia
You are certainly an entertaining group behind the scenes. Here are some of your questions on insomnia. Be reminded that should you want to leave me a private question, just go to the Home Page, or type https://jeffreysterlingmd.com into your browser. Here’s five questions from this morning’s post on insomnia.
1. Aw, hell! You’re telling me I can be dying from something causing insomnia?
- It’s way more likely that level of stress you’re displaying is keeping you awake at night.
2. How is it that sex makes you sleepy?
- When you do exert yourself vigorously, the greater utilization of muscles will deplete glycogen (energy) stores and make you drowsy. Also, it’s well established that certain hormones (e.g. prolactin, GABA and oxytocin) that promote sleep are released after an orgasm.
3. You mentioned tea. A good cup of tea at bedtime helps me sleep.
- If that works for you, go for it. Some people have paradoxical effects to stimulants (In fact, stimulants are the most common treatment for ADHD – a topic for another day.)
4. What about giving my baby Benadryl?
I’m giving information here, not practicing medicine, so that’s a question for your physician. I will say there are many drugs (most notably those in the anticholingeric class) that have drowsiness as a side effect, and many emergency departments will give Benadryl to adults for that purpose. That said, these medications are not primarily used for drowsiness, and you’ll have to deal with other drug effects (such as the intended purpose for the medication) in addition to any possible drowsiness that occurs.
5. Sex at night keeps me wide awake.
That’s why a lot of you are shy about putting comments in the inbox… Sorry, but the answer to that question was not meant for public consumption.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
You are certainly an entertaining group behind the scenes. Here are some of your questions on insomnia. Be reminded that should you want to leave me a private question, just go to the Home Page, or type https://jeffreysterlingmd.com into your browser. Here’s five questions from this morning’s post on insomnia.
1. Aw, hell! You’re telling me I can be dying from something causing insomnia?
- It’s way more likely that level of stress you’re displaying is keeping you awake at night.
2. How is it that sex makes you sleepy?
- When you do exert yourself vigorously, the greater utilization of muscles will deplete glycogen (energy) stores and make you drowsy. Also, it’s well established that certain hormones (e.g. prolactin, GABA and oxytocin) that promote sleep are released after an orgasm.
3. You mentioned tea. A good cup of tea at bedtime helps me sleep.
- If that works for you, go for it. Some people have paradoxical effects to stimulants (In fact, stimulants are the most common treatment for ADHD – a topic for another day.)
4. What about giving my baby Benadryl?
I’m giving information here, not practicing medicine, so that’s a question for your physician. I will say there are many drugs (most notably those in the anticholingeric class) that have drowsiness as a side effect, and many emergency departments will give Benadryl to adults for that purpose. That said, these medications are not primarily used for drowsiness, and you’ll have to deal with other drug effects (such as the intended purpose for the medication) in addition to any possible drowsiness that occurs.
5. Sex at night keeps me wide awake.
That’s why a lot of you are shy about putting comments in the inbox… Sorry, but the answer to that question was not meant for public consumption.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Insomnia – You are Not Getting Sleepy…
Talking about insomnia makes me well, tired. You know what the problem is. You either can’t fall asleep, or you can’t stay asleep. You’re tired when you wake and all throughout the day. Lack of sleep saps your energy and your productivity.
Insomnia really isn’t very cool to deal with, either as a person or as a physician. Patients are frustrated and sometimes cranky from being tired, or they can be extremely nervous and stressed, which will perpetuate a vicious cycle. There are so many mental factors that can disrupt your ability to sleep.
Medical professionals tend to think of insomnia in two forms for purposes of evaluation. Either the insomnia is the main problem (primary insomnia), or it’s secondary to another condition (secondary insomnia) such as reflux, uncontrolled asthma, arthritis or other pain syndromes. It could be due to medications, depression or just stress. It could be due to some undiagnosed condition, such as cancer, an enlarged prostate (making you have to get up to urinate throughout the night), thyroid disease or sleep apnea. Then there’s the caffeine (coffee/tea), nicotine (cigarettes) and drunk scene (alcohol).
The thing is, whether acute, intermittent or chronic, any insomnia really is an inconvenience and can even be incapacitating. Before you subject yourself to a million dollar medical workup, just remember, if it’s secondary insomnia, and you know (for example) that your pain is keeping you awake, try dealing with the primary issue. Alternatively, if it’s primary insomnia, there are a lot of things you might consider trying. In fact, consider this my Top Ten Tips, presented in the order you might consider implementing them.
- Good diet and exercise habits make your body perform as they should and will clean up a lot of potential problems that will affect sleep.
- Avoid naps during the day. You want to be good, tired and ready to sleep when night comes.
- Develop the habit of only using your bed for sleep or sex. That conditions your body to be ready to sleep when confronted with the stimulus of your bed.
- Get your snoring partner some help if s/he is part of what keeps you awake. Check here for tips to deal with snoring.
- Try not to eat for several (3-4) hours before you sleep. Nothing says ‘no sleep’ like heartburn all night (By the way, this is the real reason you shouldn’t eat after a certain hour – not concerns about your weight.).
- Similarly, avoid nighttime stimulants (e.g. cigarettes, coffee, tea and exercise close to the time you want to sleep, if this proves to be a problem).
- Although alcohol is a sedative, it’s also on the don’t-do list because it can cause restless sleep and interrupt the sleep cycle.
- Find a way to relax before sleep. Consider a bath, sex, a book or soothing music. Or all of them.
- Set the alarm for the morning, then hide your clock. You don’t need to have a clock to remind you that you aren’t sleeping all night.
- Use ‘white noise’ for background if you’re bothered by other sounds.
Here’s a bonus tip: If you fell asleep during the reading of this post, keep it for future reference.
As Edward R. Murrow used to say (well before I was born): Good night, and good luck.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Talking about insomnia makes me well, tired. You know what the problem is. You either can’t fall asleep, or you can’t stay asleep. You’re tired when you wake and all throughout the day. Lack of sleep saps your energy and your productivity.
Insomnia really isn’t very cool to deal with, either as a person or as a physician. Patients are frustrated and sometimes cranky from being tired, or they can be extremely nervous and stressed, which will perpetuate a vicious cycle. There are so many mental factors that can disrupt your ability to sleep.
Medical professionals tend to think of insomnia in two forms for purposes of evaluation. Either the insomnia is the main problem (primary insomnia), or it’s secondary to another condition (secondary insomnia) such as reflux, uncontrolled asthma, arthritis or other pain syndromes. It could be due to medications, depression or just stress. It could be due to some undiagnosed condition, such as cancer, an enlarged prostate (making you have to get up to urinate throughout the night), thyroid disease or sleep apnea. Then there’s the caffeine (coffee/tea), nicotine (cigarettes) and drunk scene (alcohol).
The thing is, whether acute, intermittent or chronic, any insomnia really is an inconvenience and can even be incapacitating. Before you subject yourself to a million dollar medical workup, just remember, if it’s secondary insomnia, and you know (for example) that your pain is keeping you awake, try dealing with the primary issue. Alternatively, if it’s primary insomnia, there are a lot of things you might consider trying. In fact, consider this my Top Ten Tips, presented in the order you might consider implementing them.
- Good diet and exercise habits make your body perform as they should and will clean up a lot of potential problems that will affect sleep.
- Avoid naps during the day. You want to be good, tired and ready to sleep when night comes.
- Develop the habit of only using your bed for sleep or sex. That conditions your body to be ready to sleep when confronted with the stimulus of your bed.
- Get your snoring partner some help if s/he is part of what keeps you awake. Check here for tips to deal with snoring.
- Try not to eat for several (3-4) hours before you sleep. Nothing says ‘no sleep’ like heartburn all night (By the way, this is the real reason you shouldn’t eat after a certain hour – not concerns about your weight.).
- Similarly, avoid nighttime stimulants (e.g. cigarettes, coffee, tea and exercise close to the time you want to sleep, if this proves to be a problem).
- Although alcohol is a sedative, it’s also on the don’t-do list because it can cause restless sleep and interrupt the sleep cycle.
- Find a way to relax before sleep. Consider a bath, sex, a book or soothing music. Or all of them.
- Set the alarm for the morning, then hide your clock. You don’t need to have a clock to remind you that you aren’t sleeping all night.
- Use ‘white noise’ for background if you’re bothered by other sounds.
Here’s a bonus tip: If you fell asleep during the reading of this post, keep it for future reference.
As Edward R. Murrow used to say (well before I was born): Good night, and good luck.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight No Chaser: Top Seven Facts You Should Know About the Affordable Care Act (Obamacare)
In general, the Patient Protection and Affordable Care Act (ACA) attempts a nifty set of tricks: it aims to add over 30 million currently uncovered Americans to insurance rolls while slowing the rate of growth of health care costs, then ultimately reduce the costs of care. This simultaneously makes insurance providers huge winners and slight losers (30 million new customers but less profit per customer), as well as hospitals, physicians and pharmaceutical companies, who are meant to make a little more money while working a lot harder for it. The basic premise is there’s already plenty of money in the system (America spends over 17% of the gross domestic product – over $2 trillion annually on health care; no other country spends more than about 11% of GDP on health care) to provide what we need.
The ACA was truly a Republican initiative at birth, for those keeping score. It was born out of the Heritage Foundation (a conservative think-tank) and is more or less a combination of plans proposed by Bob Dole and executed by Mitt Romney in Massachusetts. It does not provide universal coverage or even “Medicare for all” (those would have been current Democratic ideas, although Richard Nixon proposed the same) or allow a governmental takeover of hospitals, insurance companies or physician practices (those would be socialized medicine). At it’s simplest, it’s a capitalist give to insurance companies of 30 million new patients with enhanced governmental oversight.
Here’s those 7 positive facts:
1) The 80/20 rule: The law requires insurers to spend at least 80% of premiums on direct medical care. This nearly doubles historical trends. This is meant to expand care greatly in certain areas such as prevention and mental health. If and when this doesn’t happen, you’ll get a rebate check.
2) Preventative care is being emphasized: you likely won’t have to pay a co-payment, co-insurance or deductible to receive services such as screenings, vaccinations and counseling.
3) Preexisting conditions: Health plans can’t limit or deny benefits or coverage to anyone under age 19 because of the existence of pre-existing conditions. These protections will be extended to all ages beginning in 2014.
4) Choice and ER access: You choose your own doctor. You don’t need a referral from your primary care doctor to see an Ob-Gyn doctor. You don’t need pre-approval to seek ER services outside of your plan’s network (e.g. when you’re out of town). This means those ridiculous out of network charges should go away.
5) Young Adult Coverage: If your plan covers children, you can add or keep your kids on your policy until they turn 26, even if they’re married, don’t live with you or are otherwise eligible to have their own plan.
6) Consumer Assistance Program: This strengthens your ability to appeal and fight decisions made by your insurance provider and guarantees your right to appeal denials of payment.
7) End on Annual and Lifetime Limits on Coverage for all new health insurance plans by 2014.
The bottom line is 30 million American are being formally brought under the umbrella of the health care instead of relying on emergency departments or going without care. Despite not being a perfect solution, if we were to list societal priorities, closing this gap to this extent is high enough on the list that the downstream consequences are less important as considerations. As a public health initiative, this act will accomplish many things, including putting in motion changes in health care disparities due to the lack of access to care. I would challenge all the critics of the ACA to answer one question whenever they have an argument about why they continue to oppose implementation of the ACA: “Is your concern worth leaving 30 million Americans without structured healthcare?”
I welcome your comments and questions.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
In general, the Patient Protection and Affordable Care Act (ACA) attempts a nifty set of tricks: it aims to add over 30 million currently uncovered Americans to insurance rolls while slowing the rate of growth of health care costs, then ultimately reduce the costs of care. This simultaneously makes insurance providers huge winners and slight losers (30 million new customers but less profit per customer), as well as hospitals, physicians and pharmaceutical companies, who are meant to make a little more money while working a lot harder for it. The basic premise is there’s already plenty of money in the system (America spends over 17% of the gross domestic product – over $2 trillion annually on health care; no other country spends more than about 11% of GDP on health care) to provide what we need.
The ACA was truly a Republican initiative at birth, for those keeping score. It was born out of the Heritage Foundation (a conservative think-tank) and is more or less a combination of plans proposed by Bob Dole and executed by Mitt Romney in Massachusetts. It does not provide universal coverage or even “Medicare for all” (those would have been current Democratic ideas, although Richard Nixon proposed the same) or allow a governmental takeover of hospitals, insurance companies or physician practices (those would be socialized medicine). At it’s simplest, it’s a capitalist give to insurance companies of 30 million new patients with enhanced governmental oversight.
Here’s those 7 positive facts:
1) The 80/20 rule: The law requires insurers to spend at least 80% of premiums on direct medical care. This nearly doubles historical trends. This is meant to expand care greatly in certain areas such as prevention and mental health. If and when this doesn’t happen, you’ll get a rebate check.
2) Preventative care is being emphasized: you likely won’t have to pay a co-payment, co-insurance or deductible to receive services such as screenings, vaccinations and counseling.
3) Preexisting conditions: Health plans can’t limit or deny benefits or coverage to anyone under age 19 because of the existence of pre-existing conditions. These protections will be extended to all ages beginning in 2014.
4) Choice and ER access: You choose your own doctor. You don’t need a referral from your primary care doctor to see an Ob-Gyn doctor. You don’t need pre-approval to seek ER services outside of your plan’s network (e.g. when you’re out of town). This means those ridiculous out of network charges should go away.
5) Young Adult Coverage: If your plan covers children, you can add or keep your kids on your policy until they turn 26, even if they’re married, don’t live with you or are otherwise eligible to have their own plan.
6) Consumer Assistance Program: This strengthens your ability to appeal and fight decisions made by your insurance provider and guarantees your right to appeal denials of payment.
7) End on Annual and Lifetime Limits on Coverage for all new health insurance plans by 2014.
The bottom line is 30 million American are being formally brought under the umbrella of the health care instead of relying on emergency departments or going without care. Despite not being a perfect solution, if we were to list societal priorities, closing this gap to this extent is high enough on the list that the downstream consequences are less important as considerations. As a public health initiative, this act will accomplish many things, including putting in motion changes in health care disparities due to the lack of access to care. I would challenge all the critics of the ACA to answer one question whenever they have an argument about why they continue to oppose implementation of the ACA: “Is your concern worth leaving 30 million Americans without structured healthcare?”
I welcome your comments and questions.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: A Dream of Equal Access to Health Care
This weekend marked the celebrations of the 50th anniversary of the famous March on Washington. During this weekend’s remembrances, I couldn’t help but reflect back on Dr. Martin Luther King, Jr.’s most famous comments on health care in America.
“Of all the forms of inequality, injustice in health care is the most shocking and inhuman.”
Why would he say such a thing? Injustice in health care has taken many forms and resulted in predictably poor outcomes for those affected. I will be frequently reviewing these considerations and addressing health care disparities in this blog. Today, I will address the inequity in insurance coverage that formed the premise for the Affordable Care Act (aka Obamacare).
According to the Kaiser Family Foundation, in 2009-2010, 41% of low-income adults were uninsured, and 45% of poor adults were uninsured. Contrast this with the fact that only 6% of those who make four or more times the poverty rate were uninsured. This pretty clearly makes the case that health care is a desirable asset for Americans who can afford it, and a choice that too often can’t be afforded for others. Now consider that 14% percent of white Americans were uninsured, while 22% of African-Americans were uninsured, and 32% of Hispanic Americans were uninsured. Whether you believe this is just a correlation, coincidence or reflection of something more damning, it is a situation that screaming to be addressed and improved.
Even more recently, the Centers for Disease Control and Prevention released a survey showing that more than 45 million U.S. residents didn’t have health insurance during the first nine months of last year. Still even more people, 57.5 million, were uninsured for at least part of the 12 months before being polled (Be reminded that the total U.S. population is just over 311 million.).
Please take a moment and ponder the enormity of the numbers just presented. It begs the question “How can such be allowed to exist?” Dr. King’s comment begged the same question. The answer of course lies in the fact that the American health care system isn’t built on producing equality of access or outcomes. You’ve heard me say before that the American health care system remains the only system among all the major industrialized nations on earth that doesn’t ensure access for all its citizens. The American health care system is a business enterprise that has captured over $2 trillion annually, representing over 1/6 (17%) of the gross domestic product, and all the while leaving more than 45 million Americans uninsured. We are number one in money spent on health care by a large margin; in fact, the U.S. spends more on people aged over 65 than any other other country spends on its entire population. The business of medicine in America is business first. It is largely expected that good health care outcomes will result from good business in the same way that good cars, computers, smartphones, etc. are produced (theoretically). It’s important to note that according to the World Health Organization (the monitor of such things), the U.S. health care system was ranked #38 in the last WHO ranking based on standard health outcomes produced.
President Barack Obama’s health care reform law aims to extend health insurance coverage to a large portion of the uninsured. According to the Congressional Budget Office, health care reform will reduce the number of uninsured people by 27 million between 2014 and 2023. The Affordable Care Act (ACA) targets its assistance to the poor and near-poor who are least likely to have health care coverage. The ACA will provide Medicaid coverage to those with incomes up to 133 percent of the poverty level ($15,282 for a single person this year) — unless their home state opts out of the Medicaid expansion. People who earn between the poverty level and four times that amount will be eligible for tax credits for private health insurance.
Access to health care is the beginning of the process by which health care disparities can be erased. As long as failure to have equal access exists to the extent that it does, the types of disparities in life expectancy, disease rates and disease survival will remain predictably dismal for certain populations. This afternoon I will revisit the Affordable Care Act and it’s efforts to improve the current system. I welcome any questions or comments.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
This weekend marked the celebrations of the 50th anniversary of the famous March on Washington. During this weekend’s remembrances, I couldn’t help but reflect back on Dr. Martin Luther King, Jr.’s most famous comments on health care in America.
“Of all the forms of inequality, injustice in health care is the most shocking and inhuman.”
Why would he say such a thing? Injustice in health care has taken many forms and resulted in predictably poor outcomes for those affected. I will be frequently reviewing these considerations and addressing health care disparities in this blog. Today, I will address the inequity in insurance coverage that formed the premise for the Affordable Care Act (aka Obamacare).
According to the Kaiser Family Foundation, in 2009-2010, 41% of low-income adults were uninsured, and 45% of poor adults were uninsured. Contrast this with the fact that only 6% of those who make four or more times the poverty rate were uninsured. This pretty clearly makes the case that health care is a desirable asset for Americans who can afford it, and a choice that too often can’t be afforded for others. Now consider that 14% percent of white Americans were uninsured, while 22% of African-Americans were uninsured, and 32% of Hispanic Americans were uninsured. Whether you believe this is just a correlation, coincidence or reflection of something more damning, it is a situation that screaming to be addressed and improved.
Even more recently, the Centers for Disease Control and Prevention released a survey showing that more than 45 million U.S. residents didn’t have health insurance during the first nine months of last year. Still even more people, 57.5 million, were uninsured for at least part of the 12 months before being polled (Be reminded that the total U.S. population is just over 311 million.).
Please take a moment and ponder the enormity of the numbers just presented. It begs the question “How can such be allowed to exist?” Dr. King’s comment begged the same question. The answer of course lies in the fact that the American health care system isn’t built on producing equality of access or outcomes. You’ve heard me say before that the American health care system remains the only system among all the major industrialized nations on earth that doesn’t ensure access for all its citizens. The American health care system is a business enterprise that has captured over $2 trillion annually, representing over 1/6 (17%) of the gross domestic product, and all the while leaving more than 45 million Americans uninsured. We are number one in money spent on health care by a large margin; in fact, the U.S. spends more on people aged over 65 than any other other country spends on its entire population. The business of medicine in America is business first. It is largely expected that good health care outcomes will result from good business in the same way that good cars, computers, smartphones, etc. are produced (theoretically). It’s important to note that according to the World Health Organization (the monitor of such things), the U.S. health care system was ranked #38 in the last WHO ranking based on standard health outcomes produced.
President Barack Obama’s health care reform law aims to extend health insurance coverage to a large portion of the uninsured. According to the Congressional Budget Office, health care reform will reduce the number of uninsured people by 27 million between 2014 and 2023. The Affordable Care Act (ACA) targets its assistance to the poor and near-poor who are least likely to have health care coverage. The ACA will provide Medicaid coverage to those with incomes up to 133 percent of the poverty level ($15,282 for a single person this year) — unless their home state opts out of the Medicaid expansion. People who earn between the poverty level and four times that amount will be eligible for tax credits for private health insurance.
Access to health care is the beginning of the process by which health care disparities can be erased. As long as failure to have equal access exists to the extent that it does, the types of disparities in life expectancy, disease rates and disease survival will remain predictably dismal for certain populations. This afternoon I will revisit the Affordable Care Act and it’s efforts to improve the current system. I welcome any questions or comments.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser – The Week In Review
I hope this was another week of good health for you. Let’s review how Straight, No Chaser tried to contribute to your health and wellness. Don’t forget to click on any of the underlined topics for links to the original posts.
On Sunday, we reviewed eye emergencies. Don’t forget that even transient vision loss could be a stroke in progress, and certain causes of vision loss have a limited window of time in which treatment must occur. Act quickly! By the way, I didn’t mention this information that occurs more commonly than you’d think: If you ever have eye discharge so copious that it seems like you’re tearing pus, this is probably gonorrhea. Get it treated, lest you could lose an eye. Now that I have your attention…
On Monday, we reviewed syncope (aka fainting) in two parts, talking about the entity (click here) and the life-threatening conditions associated with faints. You’re way too cavalier with faints; please get them evaluated. Faints can either be the result of significant disease or can secondarily produce significant head and neck injuries from the falls. Stop going to the bathroom (with all the hard stuff in there) when you’re feeling dizzy. That’s not a good place to black out!
On Tuesday, we discussed suicide and depression in-depth, reviewing demographic information, information for your self-assessment, and tips on how to recognize when help is needed (and how you can avoid depression). I’m pleased that you’ve made these topics the most read topics yet, and I sincerely hope this information helps some of you.
On Wednesday, we reviewed the overuse of the emergency room, which will become a major theme of this blog. Those creature comfort visits are 8 times more expensive than the same visits done at a primary care physician’s office. In Texas, the average ER cost is $1020. Just because you’re not necessarily paying up front doesn’t mean the hospital won’t ensure you’ll pay eventually. Remember, hospital bills are the #1 cause of personal bankruptcy in the U.S. Straight, No Chaser was created to point you toward better options. Stick around, and we’ll get you there. Wednesday also brought a review of vomiting and diarrhea (viral gastroenteritis). Learn about oral rehydration therapy. Viral gastroenteritis is a good example of something that feels really… bad but is usually self-limited and will go away on its own, as long as you stay hydrated.
On Thursday, we reviewed end of life decision-making. I know this struck home for a lot of you, bringing back not so fond memories. That said, you must begin to think about how you want to be treated in your last days. There are many tragedies during this time that tear families apart. Use the tools discussed on the post on living wills, power of attorney designations and DNR considerations to make sure your interests are the only consideration being addressed when the time comes.
On Friday, we seemed to prick a nerve or two (no pun intended) discussing circumcision. If nothing else, be an educated consumer. Even now, considerations are perhaps best summed up by the posture of the American Academy of Pediatrics, which declines to recommend routine circumcisions for all newborns but notes that if you are inclined to get the procedure (which should be a big if), the benefits outweigh the risks. Friday afternoon, we reviewed hearing loss and the damage the activities of daily living produce. This is a pretty good example of how we take our health for granted. Just a little bit of protection and prevention over the first 40 years of your life will make a big difference later on.
Saturday, we discussed two different types of sounds that come out of you. First, we discussed snoring (which is always annoying but never boring) and gave you some Quick Tips to overcome it. We also discussed hiccups, which everyone gets at some point, but no one ever wants. We also gave you Quick Tips on hiccup cures here. Remember those ABCDEs!
We continue to listen to your comments and feedback, and over the next few months, some major changes will be occurring. Please continue to forward your topic requests. I promise I’ll get to them all eventually. Maybe I’ll start doing reader submission posts. As we continue to grow, your support, referrals and follows are much appreciated. Have a happy and healthy week.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
I hope this was another week of good health for you. Let’s review how Straight, No Chaser tried to contribute to your health and wellness. Don’t forget to click on any of the underlined topics for links to the original posts.
On Sunday, we reviewed eye emergencies. Don’t forget that even transient vision loss could be a stroke in progress, and certain causes of vision loss have a limited window of time in which treatment must occur. Act quickly! By the way, I didn’t mention this information that occurs more commonly than you’d think: If you ever have eye discharge so copious that it seems like you’re tearing pus, this is probably gonorrhea. Get it treated, lest you could lose an eye. Now that I have your attention…
On Monday, we reviewed syncope (aka fainting) in two parts, talking about the entity (click here) and the life-threatening conditions associated with faints. You’re way too cavalier with faints; please get them evaluated. Faints can either be the result of significant disease or can secondarily produce significant head and neck injuries from the falls. Stop going to the bathroom (with all the hard stuff in there) when you’re feeling dizzy. That’s not a good place to black out!
On Tuesday, we discussed suicide and depression in-depth, reviewing demographic information, information for your self-assessment, and tips on how to recognize when help is needed (and how you can avoid depression). I’m pleased that you’ve made these topics the most read topics yet, and I sincerely hope this information helps some of you.
On Wednesday, we reviewed the overuse of the emergency room, which will become a major theme of this blog. Those creature comfort visits are 8 times more expensive than the same visits done at a primary care physician’s office. In Texas, the average ER cost is $1020. Just because you’re not necessarily paying up front doesn’t mean the hospital won’t ensure you’ll pay eventually. Remember, hospital bills are the #1 cause of personal bankruptcy in the U.S. Straight, No Chaser was created to point you toward better options. Stick around, and we’ll get you there. Wednesday also brought a review of vomiting and diarrhea (viral gastroenteritis). Learn about oral rehydration therapy. Viral gastroenteritis is a good example of something that feels really… bad but is usually self-limited and will go away on its own, as long as you stay hydrated.
On Thursday, we reviewed end of life decision-making. I know this struck home for a lot of you, bringing back not so fond memories. That said, you must begin to think about how you want to be treated in your last days. There are many tragedies during this time that tear families apart. Use the tools discussed on the post on living wills, power of attorney designations and DNR considerations to make sure your interests are the only consideration being addressed when the time comes.
On Friday, we seemed to prick a nerve or two (no pun intended) discussing circumcision. If nothing else, be an educated consumer. Even now, considerations are perhaps best summed up by the posture of the American Academy of Pediatrics, which declines to recommend routine circumcisions for all newborns but notes that if you are inclined to get the procedure (which should be a big if), the benefits outweigh the risks. Friday afternoon, we reviewed hearing loss and the damage the activities of daily living produce. This is a pretty good example of how we take our health for granted. Just a little bit of protection and prevention over the first 40 years of your life will make a big difference later on.
Saturday, we discussed two different types of sounds that come out of you. First, we discussed snoring (which is always annoying but never boring) and gave you some Quick Tips to overcome it. We also discussed hiccups, which everyone gets at some point, but no one ever wants. We also gave you Quick Tips on hiccup cures here. Remember those ABCDEs!
We continue to listen to your comments and feedback, and over the next few months, some major changes will be occurring. Please continue to forward your topic requests. I promise I’ll get to them all eventually. Maybe I’ll start doing reader submission posts. As we continue to grow, your support, referrals and follows are much appreciated. Have a happy and healthy week.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Quick Tips – Learn the ABCDEs of Hiccups
Three question sets on hiccups of all things
Why do I get hiccups?
You get hiccups because everyone gets them. You get them because basically you’ve agitated your main breathing muscle (You have one on both sides, between the chest and abdominal cavities.). Something’s caused it to spasm, which produces a reflex vocal cord closure. That sound you hear is the reflex air going down your windpipe. Here’s some of those ‘somethings’…
You smoke too much.
You’re overstressed.
You’re agitating your stomach.
- You eat too much too quickly.
- You drink too much.
- You swallow too much air.
- You alternative between hot and cold foods too quickly.
Are hiccups ever serious?
Absolutely. In fact, hiccups can go on for more than 48 hours. In these instances, you need to get evaluated. Several things can cause this, but I’ll be particularly worried about your nerves and nervous system.
What about all those hiccup cures?
Some things never hurt to try. What you’re actually trying to accomplish through multiple variations of the same theme is to increase your carbon dioxide level (the gas you exhale in breathing), which tends to stop the hiccups. Here’s a few oldies but goodies – think ABCDE.
- Achoo! Sneeze even if you don’t need to. It may additionally stimulate the diaphragm out of hiccupping.
- Breathe into a paper bag for 30-60 seconds.
- Count to 10 while holding your breath.
- Drink a cold glass of water – fast (Notice you’re holding your breath while doing this, and no, you don’t need a pencil in your mouth.).
- Eat a teaspoon of sugar or honey.
Three question sets on hiccups of all things
Why do I get hiccups?
You get hiccups because everyone gets them. You get them because basically you’ve agitated your main breathing muscle (You have one on both sides, between the chest and abdominal cavities.). Something’s caused it to spasm, which produces a reflex vocal cord closure. That sound you hear is the reflex air going down your windpipe. Here’s some of those ‘somethings’…
You smoke too much.
You’re overstressed.
You’re agitating your stomach.
- You eat too much too quickly.
- You drink too much.
- You swallow too much air.
- You alternative between hot and cold foods too quickly.
Are hiccups ever serious?
Absolutely. In fact, hiccups can go on for more than 48 hours. In these instances, you need to get evaluated. Several things can cause this, but I’ll be particularly worried about your nerves and nervous system.
What about all those hiccup cures?
Some things never hurt to try. What you’re actually trying to accomplish through multiple variations of the same theme is to increase your carbon dioxide level (the gas you exhale in breathing), which tends to stop the hiccups. Here’s a few oldies but goodies – think ABCDE.
- Achoo! Sneeze even if you don’t need to. It may additionally stimulate the diaphragm out of hiccupping.
- Breathe into a paper bag for 30-60 seconds.
- Count to 10 while holding your breath.
- Drink a cold glass of water – fast (Notice you’re holding your breath while doing this, and no, you don’t need a pencil in your mouth.).
- Eat a teaspoon of sugar or honey.
Straight, No Chaser: Quick Tips – You Snore Too Much
You snore too much. What this means is your breathing is intermittently partially obstructed while you’re sleeping. Snoring is the sound of air moving past that obstruction. Whether serious or not, first you should know it’s common, occurring in about 50% of adults. It could be serious or just positional. Here are some Quick Tips for you.
- Sleep on your side. This should remove the tongue as a cause of a partial obstruction.
- Avoid sedatives if possible. Sedatives cause significant enough relaxation to the tissues in your throat to cause that partial obstruction.
- Limit alcohol before sleeping (by about two hours). Alcohol is a sedative.
- Elevate the head of your bed or prop your head up by about 4-6 inches. This should manually move partially obstructing tissue out of the way.
- Fix what ails your nose. If you have chronic problems with nasal obstruction or a deviated nasal septum, you’re more inclined to breathe through your mouth. This will increase the chances that you snore. Similarly, those nasal strips you may have seen work (when they do) by increase the area in the nose through which they can breathe.
- Finally, losing weight (if you have it to lose) works by reducing the tissues in and around your throat that cause snoring.
It’s time to see your physician if you find yourself awakening from sleep choking, gasping or otherwise short of breath. This could be an indicator of a serious condition, including sleep apnea. Additionally, you may want to seek care if your sleeping causes functional problems (e.g. you or your partner have difficulty sleeping as a result of your snoring).
This is a significant enough issue that I will revisit it in the future. In the meantime, sleep well.
You snore too much. What this means is your breathing is intermittently partially obstructed while you’re sleeping. Snoring is the sound of air moving past that obstruction. Whether serious or not, first you should know it’s common, occurring in about 50% of adults. It could be serious or just positional. Here are some Quick Tips for you.
- Sleep on your side. This should remove the tongue as a cause of a partial obstruction.
- Avoid sedatives if possible. Sedatives cause significant enough relaxation to the tissues in your throat to cause that partial obstruction.
- Limit alcohol before sleeping (by about two hours). Alcohol is a sedative.
- Elevate the head of your bed or prop your head up by about 4-6 inches. This should manually move partially obstructing tissue out of the way.
- Fix what ails your nose. If you have chronic problems with nasal obstruction or a deviated nasal septum, you’re more inclined to breathe through your mouth. This will increase the chances that you snore. Similarly, those nasal strips you may have seen work (when they do) by increase the area in the nose through which they can breathe.
- Finally, losing weight (if you have it to lose) works by reducing the tissues in and around your throat that cause snoring.
It’s time to see your physician if you find yourself awakening from sleep choking, gasping or otherwise short of breath. This could be an indicator of a serious condition, including sleep apnea. Additionally, you may want to seek care if your sleeping causes functional problems (e.g. you or your partner have difficulty sleeping as a result of your snoring).
This is a significant enough issue that I will revisit it in the future. In the meantime, sleep well.
