Peptic ulcer disease (PUD) has an increasing incidence in the general population and particularly so in the elderly, due to a liberal use of NSAIDs (non-steroidal anti-inflammatory agents, such as ibuprofen, aspirin, naproxen). These painful sores in the lining of the stomach or first part of the small intestine make for many a bad day (and night). That ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum.
What you didn’t know is a bacterial is responsible for most cases. I’ll come back to that.
You’re predisposed to PUD if you smoke or drink, use NSAIDs or take steroids.
Complications abound. PUD is actually the #1 cause of abdominal organ rupture. Other complications include bleeding and obstructions (that you’ll recognize as nausea and vomiting to accompany the pain).
Here we go again with prevention. If you don’t want an ulcer, or if you want your ulcer to be better, stop the habits that produce it. I’m talking about smoking, drinking alcohol and taking the pain pills. Let me be clear: ALL patients with peptic ulcer disease should stop smoking, stop drinking alcohol and avoid NSAIDs.
Severe ulcers are treated with surgery or by endoscopy (which is also the method of diagnosing ulcers – this involves placing a tube down your throat to directly visualize the areas and possibly repairing damage if it’s amenable to that).
Less severe ulcers may be treated with various medications called proton pump inhibitors. You’ll recognize these acid reducers by names such as aciphex, nexium, prevacid, prilosec and protonix. If you are discovered to have an infection, antibiotic combinations can be given for one to two weeks for the involved bacteria (Helicobacter pylori) in addition to the proton pump inhibitors. None of these will address the situation if you don’t make those lifestyle adjustments.
Questions or comments?
All posts by Jeffrey Sterling, MD
Straight, No Chaser: Ulcers – I Can’t Believe You Ate the Whole Thing…
Straight, No Chaser: Golf Injuries
We’re in the middle of summer, which for many of us means a lot of golf (at least on the weekends). You should be aware that golf-related injuries continue to be on the rise. I’m not talking about the struck by lightning, hit by a golf ball or club, driving your cart into the adjacent lake or being bit by a crocodile variety. I’m talking about overuse of specific parts of your body that are involved in the golf swing. 80% of golf-related injuries are reportedly due to such overuse considerations. It’s also estimated that 40% of amateurs and 60% of professionals will experience an injury related to such overuse. It should be intuitive and is certainly true that the risk for such injuries increase with age.
Here are the three most common sets of golf injuries in amateurs (professionals have slightly different injury patterns and frequencies). I’ll also address how they occur and what you can do to prevent them. Keep it in the short grass.
1. Lumbar Strain/Development of Low Back Pain: We spend so much time learning to extend the club, coil and uncoil while swinging a golf club about 100 MPH (some of us, myself included, at an ever faster rate; professionals average speeds of approximately 120 MPH). The very premise of doing this for three and a half to five and a half hours at a time (shame on you, slow golfers!) is not the most natural consideration based on our bodies’ design. Studies of professionals show that about 1/3 of them have experienced significant low back pain of at least two weeks’ duration. And they know what they’re doing!
- What to do? This may be close to blasphemy to many golfers, but studies show that not carrying your golf bag (i.e. using a caddy or a golf cart) cuts the rate of golf injuries in half. That’s not saying don’t walk! Even the pros don’t carry their own bags. A second consideration (or perhaps it should be first) is learning proper technique. Additionally, flexibility training that increases the range of motion of the lumbar spine and extension and rotation of the lead hip (left hip in right-handed golfers) should decrease low back pain. Personally, I’ve had great success with golf-tailored stretching exercises and modified yoga techniques. Try it. The only thing you have to lose is the pain and maybe a few strokes.
2. Elbow Injuries – Medial and Lateral Epicondylitis: Consider these the plague of the hacker. Both conditions are inflammatory problems involving tendons of the elbow. Medial epicondylitis is known as ‘golfer’s elbow’, although it occurs in other sports such as bowling, lifting weights and sports involving throwing. It’s typically associated with those times that you (excuse me, your playing partners…) hit the ground before the hitting the ball, and you feel that shiver in your elbow. Lateral epicondylitis is known as ‘tennis elbow’, although golfers may be affected on the lateral side as well. This typically occurs when you over-involve your right hand in your swing; eventually the overuse will produce inflammation in that tendon. Similar conditions exist in the wrist as well.
- What to do? Get better, for starters! Proper swing mechanics reduce the incidence of both golfer’s and tennis elbow. Additionally, good health (including an exercise regimen inclusive of strength training and stretching) and pre-round stretching maneuvers help to reduce the likelihood of these conditions presenting during your round. Additionally, if the situation becomes truly painful, typical treatments include recommendations to rest, use ice and anti-inflammatory medications, and to immobilize the involved area.
3. Shoulder Injuries – Failure to have proper mechanics also rears its ugly head and affects the lead shoulder in golfers. Strains, bursitis, tendonitis and eventually arthritis are all frequently seen problems in golfers.
- What to do? Again, it’s about prevention, strengthening and stretching the muscles and tendons in and around your rotator cuff and developing good technique that reduces undue strain on your areas being called into action during the swing.
If I had one tip to give you, I’d recommend that you always take at least 10 minutes before your round to stretch. Doing so will reduce your injury risk by half. Yet, only 10-20% of golfers actually consistently do this. Jumping from a cramped car to swinging a golf club 100 MPH is a formula for disaster.
If I had one piece of advice to give you, it’s simply to discover an exercise regimen that includes strengthening (muscles and core), flexibility and cardiovascular considerations. Obviously, the second would be to get lessons, which by itself will improve your risk profile.
I hope this information proves to be of some use to you. I welcome any questions or comments.
We’re in the middle of summer, which for many of us means a lot of golf (at least on the weekends). You should be aware that golf-related injuries continue to be on the rise. I’m not talking about the struck by lightning, hit by a golf ball or club, driving your cart into the adjacent lake or being bit by a crocodile variety. I’m talking about overuse of specific parts of your body that are involved in the golf swing. 80% of golf-related injuries are reportedly due to such overuse considerations. It’s also estimated that 40% of amateurs and 60% of professionals will experience an injury related to such overuse. It should be intuitive and is certainly true that the risk for such injuries increase with age.
Here are the three most common sets of golf injuries in amateurs (professionals have slightly different injury patterns and frequencies). I’ll also address how they occur and what you can do to prevent them. Keep it in the short grass.
1. Lumbar Strain/Development of Low Back Pain: We spend so much time learning to extend the club, coil and uncoil while swinging a golf club about 100 MPH (some of us, myself included, at an ever faster rate; professionals average speeds of approximately 120 MPH). The very premise of doing this for three and a half to five and a half hours at a time (shame on you, slow golfers!) is not the most natural consideration based on our bodies’ design. Studies of professionals show that about 1/3 of them have experienced significant low back pain of at least two weeks’ duration. And they know what they’re doing!
- What to do? This may be close to blasphemy to many golfers, but studies show that not carrying your golf bag (i.e. using a caddy or a golf cart) cuts the rate of golf injuries in half. That’s not saying don’t walk! Even the pros don’t carry their own bags. A second consideration (or perhaps it should be first) is learning proper technique. Additionally, flexibility training that increases the range of motion of the lumbar spine and extension and rotation of the lead hip (left hip in right-handed golfers) should decrease low back pain. Personally, I’ve had great success with golf-tailored stretching exercises and modified yoga techniques. Try it. The only thing you have to lose is the pain and maybe a few strokes.
2. Elbow Injuries – Medial and Lateral Epicondylitis: Consider these the plague of the hacker. Both conditions are inflammatory problems involving tendons of the elbow. Medial epicondylitis is known as ‘golfer’s elbow’, although it occurs in other sports such as bowling, lifting weights and sports involving throwing. It’s typically associated with those times that you (excuse me, your playing partners…) hit the ground before the hitting the ball, and you feel that shiver in your elbow. Lateral epicondylitis is known as ‘tennis elbow’, although golfers may be affected on the lateral side as well. This typically occurs when you over-involve your right hand in your swing; eventually the overuse will produce inflammation in that tendon. Similar conditions exist in the wrist as well.
- What to do? Get better, for starters! Proper swing mechanics reduce the incidence of both golfer’s and tennis elbow. Additionally, good health (including an exercise regimen inclusive of strength training and stretching) and pre-round stretching maneuvers help to reduce the likelihood of these conditions presenting during your round. Additionally, if the situation becomes truly painful, typical treatments include recommendations to rest, use ice and anti-inflammatory medications, and to immobilize the involved area.
3. Shoulder Injuries – Failure to have proper mechanics also rears its ugly head and affects the lead shoulder in golfers. Strains, bursitis, tendonitis and eventually arthritis are all frequently seen problems in golfers.
- What to do? Again, it’s about prevention, strengthening and stretching the muscles and tendons in and around your rotator cuff and developing good technique that reduces undue strain on your areas being called into action during the swing.
If I had one tip to give you, I’d recommend that you always take at least 10 minutes before your round to stretch. Doing so will reduce your injury risk by half. Yet, only 10-20% of golfers actually consistently do this. Jumping from a cramped car to swinging a golf club 100 MPH is a formula for disaster.
If I had one piece of advice to give you, it’s simply to discover an exercise regimen that includes strengthening (muscles and core), flexibility and cardiovascular considerations. Obviously, the second would be to get lessons, which by itself will improve your risk profile.
I hope this information proves to be of some use to you. I welcome any questions or comments.
Straight, No Chaser: Emergency Room Adventures – The Risk of Rabies
You can’t make this stuff up. It’s another busy night in the ER, and back-to-back patients come in, not related but dealing with the same issue. One’s a child bitten over the eye by a family dog with no shots. The next is a teenager attacked by a possum, which he decided to kick in the mouth, and of course he ends up being bitten. Both of these situations hold a certain risk of rabies exposure.
Rabies is a viral disease transmitted to humans through the bite (or scratch) of an infected animal. It infects the central nervous system, initially producing a multitude of symptoms that resemble the flu (fatigue, headaches, fever, malaise) and then progressing to exotic symptoms (including fear of water, increase in saliva, hallucinations, confusion and partial paralysis) culminating in death within days.
There is no cure for rabies once symptoms appear, so prevention is critical.
Animals that are especially likely to transmit rabies include bats (the most common culprit in the U.S.), foxes, raccoons, skunks and most other carnivores.
- Bites from these animals are regarded as rabid unless proven otherwise by lab tests. These animals must be killed and tested as soon as possible.
Animals that have been reported to transmit rabies include dogs, cats and ferrets.
- If bitten from these animals, and it appears rabid, treatment must begin immediately.
- If the biting animal appears healthy and can be observed for 10 days, then do so, but the animal must be euthanized at the first sign of rabies.
Others bites to consider include bites from rodents (woodchucks, beavers and smaller rodents), rabbits and hares, which almost never require post-exposure prophylaxis unless the area is a high rabies exposure area. In these instances decisions will be made in consultation with local public health officials.
So what should you do if bitten?
- Remember, there will be no immediate symptoms, so you can’t trust that you’re ok just because you’re feeling ok.
- Make every effort to secure the animal.
- Even if the animal isn’t available, go to the nearest emergency room as soon as possible after contact with a suspect animal.
What can you expect?
- Vigorous wound cleaning
- Assessment for and possible administration of two different types of vaccinations. These regimens can prevent the onset of rabies in virtually 100% of cases, one of which needs to be administered in five separate doses over a month’s time.
- Additional vaccination for tetanus, if appropriate
- Antibiotics if appropriate.
Remember, rabies is a fatal disease. It is meant to be avoided, but if you can’t avoid it, you need to get assessed as rapidly as possible. I hope this information helps you make correct decisions if you’re ever confronted with a rabies prone animal, and for goodness’ sake, please get any house pets all appropriate vaccines.
You can’t make this stuff up. It’s another busy night in the ER, and back-to-back patients come in, not related but dealing with the same issue. One’s a child bitten over the eye by a family dog with no shots. The next is a teenager attacked by a possum, which he decided to kick in the mouth, and of course he ends up being bitten. Both of these situations hold a certain risk of rabies exposure.
Rabies is a viral disease transmitted to humans through the bite (or scratch) of an infected animal. It infects the central nervous system, initially producing a multitude of symptoms that resemble the flu (fatigue, headaches, fever, malaise) and then progressing to exotic symptoms (including fear of water, increase in saliva, hallucinations, confusion and partial paralysis) culminating in death within days.
There is no cure for rabies once symptoms appear, so prevention is critical.
Animals that are especially likely to transmit rabies include bats (the most common culprit in the U.S.), foxes, raccoons, skunks and most other carnivores.
- Bites from these animals are regarded as rabid unless proven otherwise by lab tests. These animals must be killed and tested as soon as possible.
Animals that have been reported to transmit rabies include dogs, cats and ferrets.
- If bitten from these animals, and it appears rabid, treatment must begin immediately.
- If the biting animal appears healthy and can be observed for 10 days, then do so, but the animal must be euthanized at the first sign of rabies.
Others bites to consider include bites from rodents (woodchucks, beavers and smaller rodents), rabbits and hares, which almost never require post-exposure prophylaxis unless the area is a high rabies exposure area. In these instances decisions will be made in consultation with local public health officials.
So what should you do if bitten?
- Remember, there will be no immediate symptoms, so you can’t trust that you’re ok just because you’re feeling ok.
- Make every effort to secure the animal.
- Even if the animal isn’t available, go to the nearest emergency room as soon as possible after contact with a suspect animal.
What can you expect?
- Vigorous wound cleaning
- Assessment for and possible administration of two different types of vaccinations. These regimens can prevent the onset of rabies in virtually 100% of cases, one of which needs to be administered in five separate doses over a month’s time.
- Additional vaccination for tetanus, if appropriate
- Antibiotics if appropriate.
Remember, rabies is a fatal disease. It is meant to be avoided, but if you can’t avoid it, you need to get assessed as rapidly as possible. I hope this information helps you make correct decisions if you’re ever confronted with a rabies prone animal, and for goodness’ sake, please get any house pets all appropriate vaccines.
Straight, No Chaser: Quick Tips for The Newborn Addition to Your Family
You’re excited. You have a newborn, or maybe you’re a new grandparent caring for the baby for the first time. I get more ‘deer in the headlight’ looks from these folks than perhaps any others. Here’s some Quick Tips for you new parents and family members:
- Your child doesn’t have a fully developed immune system yet and won’t until s/he begins receiving immunizations. This is a major reason why breastfeeding is so heavily recommended. Mothers transfer levels of immunity to the baby through this process. It’s not just about bonding.
- Your baby is spitting up? Welcome to the club! As long as s/he is gaining weight and is comfortable, there’s not much cause for concern. It’s likely a measure of eating too much and/or too quickly. Acid reflux and or gastroesophageal reflux occurs in about ½ of infants. Again, the baby needs time to have its protective mechanisms fully develop. Speaking of breastfeeding, here’s some more food for thought (no pun intended). Kids who aren’t being breastfed tend to spit up more. Expect it.
- I know this is hard and perhaps impractical in many instances, but hold off on multiple family visits for the first month while that immune system is maturing. Exposing them to dozens of relatives is a pretty good way to get a sick baby. Unfortunately, during those first 30 days, babies don’t confine illnesses very well, and even a little cold or ear infection can rapidly spread throughout the body. This could lead to meningitis and someone like me having to perform a lumbar puncture (i.e. spinal tap) on your newborn.
- Colic drives parents crazy! Crying newborns obviously are trying to tell you something, and maybe it’s as simple as wanting to be fed, but here’s an important tip for you: check under the diaper. There are multiple issues that present there. Here are three of them:
- Anal fissure – hard stools can cause a scratch near the anal opening. Fissures are painful, and whenever stool passes by or anything touches that area, it’s going to hurt! There may be blood associated with this as well; perhaps you’ll notice it on the diaper or streaking along the stool.
- Diaper rash – rashes can cause inflammation and infection. They are irritating and painful. New parents must be diligent in getting wet and/or stooled diapers changed with appropriate frequency. After all, wouldn’t you yell if you had to keep that stuff in your undergarments?
- Loose hairs – You’d be surprised how often I see loose hairs wrapped around a newborn or infant’s penis, doing it’s best to choke it off. I’m not joking. If the child isn’t circumcised, be sure to retract the foreskin to check and allow look over the testes. This could be dangerous.
I mean no disrespect when I say this, but call your primary doctor before bringing your colicky newborn to the ER during those first 30 days of life. The main reason I say this is for your further protection. The ER is where a lot of bad microorganisms live, and although we never mind seeing you, we want to coordinate when it’s appropriate for you to have to expose your baby to the environment.
You’re excited. You have a newborn, or maybe you’re a new grandparent caring for the baby for the first time. I get more ‘deer in the headlight’ looks from these folks than perhaps any others. Here’s some Quick Tips for you new parents and family members:
- Your child doesn’t have a fully developed immune system yet and won’t until s/he begins receiving immunizations. This is a major reason why breastfeeding is so heavily recommended. Mothers transfer levels of immunity to the baby through this process. It’s not just about bonding.
- Your baby is spitting up? Welcome to the club! As long as s/he is gaining weight and is comfortable, there’s not much cause for concern. It’s likely a measure of eating too much and/or too quickly. Acid reflux and or gastroesophageal reflux occurs in about ½ of infants. Again, the baby needs time to have its protective mechanisms fully develop. Speaking of breastfeeding, here’s some more food for thought (no pun intended). Kids who aren’t being breastfed tend to spit up more. Expect it.
- I know this is hard and perhaps impractical in many instances, but hold off on multiple family visits for the first month while that immune system is maturing. Exposing them to dozens of relatives is a pretty good way to get a sick baby. Unfortunately, during those first 30 days, babies don’t confine illnesses very well, and even a little cold or ear infection can rapidly spread throughout the body. This could lead to meningitis and someone like me having to perform a lumbar puncture (i.e. spinal tap) on your newborn.
- Colic drives parents crazy! Crying newborns obviously are trying to tell you something, and maybe it’s as simple as wanting to be fed, but here’s an important tip for you: check under the diaper. There are multiple issues that present there. Here are three of them:
- Anal fissure – hard stools can cause a scratch near the anal opening. Fissures are painful, and whenever stool passes by or anything touches that area, it’s going to hurt! There may be blood associated with this as well; perhaps you’ll notice it on the diaper or streaking along the stool.
- Diaper rash – rashes can cause inflammation and infection. They are irritating and painful. New parents must be diligent in getting wet and/or stooled diapers changed with appropriate frequency. After all, wouldn’t you yell if you had to keep that stuff in your undergarments?
- Loose hairs – You’d be surprised how often I see loose hairs wrapped around a newborn or infant’s penis, doing it’s best to choke it off. I’m not joking. If the child isn’t circumcised, be sure to retract the foreskin to check and allow look over the testes. This could be dangerous.
I mean no disrespect when I say this, but call your primary doctor before bringing your colicky newborn to the ER during those first 30 days of life. The main reason I say this is for your further protection. The ER is where a lot of bad microorganisms live, and although we never mind seeing you, we want to coordinate when it’s appropriate for you to have to expose your baby to the environment.
Straight, No Chaser: The Week In Review and Your Take Home Messages
Well, it was a busy week. Let’s look at what you may have missed.
On Sunday, we started with reviewing the important of National Minority Organ Donor Awareness Month. Over 56% of people on the national organ transplant waiting list are minorities. Consider checking in at http://organdonor.gov/becomingdonor/stateregistries.html.
On Monday, we reviewed human bites, which involve any lesion caused by your teeth that breaks the skin. These range from over aggressive hickeys to the Mike Tyson variety to lesions caused by punching someone in the teeth. We posted your FAQs separately here. My bottom line is you need to get evaluated every bite (that breaks the skin) every time.
On Tuesday, we reviewed alcohol intoxication, abuse and dependency and gave you the tools to assess that all important question: Do You Drink Too Much? We included a special Alcohol Facts and Fiction post for your consideration. In case you were wondering, that beer belly isn’t from your beer and is the least of your worries, either from the alcohol or the belly sides of the equation.
On Wednesday, we went Back to the Future in discussing low back pain and identified life-threatening conditions associated with low back pain. Remember to lift with your knees instead of your back, and beware of night-time back pain or loss of motion, sensation, bowel and/or bladder control. You probably heard the word Cauda Equina for the first time.
On Thursday, we discussed spider bites, focusing on the Black Widow and Brown Recluse spiders. Do you remember what a volcano lesion is? We also discussed shingles and answered a lot of questions about the chickenpox and shingles vaccines. The Straight, No Chaser recommendation is to get them (the vaccines, not the diseases)!
On Friday, we busted a few myths about migraine headaches and discussed life-threatening conditions associated with headaches. I want you to remember the association between migraines, heart attacks and strokes. Review the list of ‘headache plus’ symptoms to prompt you to get immediately evaluated.
On Saturday, we taught you how to fall. Do you remember what FOOSH stands for? We also reviewed the causes and treatment of ingrown toenails. Sometimes the simplest advice is the best. Stop biting your toenails!
Thanks to all of you who have filled out the Straight, No Chaser survey. I hope you’re seeing improvements to your satisfaction. The Week in Review post is a direct result of your feedback. We have 500 followers now in a month, which isn’t bad for a blog on a topic that can be a boring as health and medicine. Thanks for your support and continued feedback.
Jeffrey E. Sterling, MD
Well, it was a busy week. Let’s look at what you may have missed.
On Sunday, we started with reviewing the important of National Minority Organ Donor Awareness Month. Over 56% of people on the national organ transplant waiting list are minorities. Consider checking in at http://organdonor.gov/becomingdonor/stateregistries.html.
On Monday, we reviewed human bites, which involve any lesion caused by your teeth that breaks the skin. These range from over aggressive hickeys to the Mike Tyson variety to lesions caused by punching someone in the teeth. We posted your FAQs separately here. My bottom line is you need to get evaluated every bite (that breaks the skin) every time.
On Tuesday, we reviewed alcohol intoxication, abuse and dependency and gave you the tools to assess that all important question: Do You Drink Too Much? We included a special Alcohol Facts and Fiction post for your consideration. In case you were wondering, that beer belly isn’t from your beer and is the least of your worries, either from the alcohol or the belly sides of the equation.
On Wednesday, we went Back to the Future in discussing low back pain and identified life-threatening conditions associated with low back pain. Remember to lift with your knees instead of your back, and beware of night-time back pain or loss of motion, sensation, bowel and/or bladder control. You probably heard the word Cauda Equina for the first time.
On Thursday, we discussed spider bites, focusing on the Black Widow and Brown Recluse spiders. Do you remember what a volcano lesion is? We also discussed shingles and answered a lot of questions about the chickenpox and shingles vaccines. The Straight, No Chaser recommendation is to get them (the vaccines, not the diseases)!
On Friday, we busted a few myths about migraine headaches and discussed life-threatening conditions associated with headaches. I want you to remember the association between migraines, heart attacks and strokes. Review the list of ‘headache plus’ symptoms to prompt you to get immediately evaluated.
On Saturday, we taught you how to fall. Do you remember what FOOSH stands for? We also reviewed the causes and treatment of ingrown toenails. Sometimes the simplest advice is the best. Stop biting your toenails!
Thanks to all of you who have filled out the Straight, No Chaser survey. I hope you’re seeing improvements to your satisfaction. The Week in Review post is a direct result of your feedback. We have 500 followers now in a month, which isn’t bad for a blog on a topic that can be a boring as health and medicine. Thanks for your support and continued feedback.
Jeffrey E. Sterling, MD
Straight, No Chaser: Lactose Intolerance – It's Explosive!
So I’m at dinner with a group of friends, and somehow the topic gets to lactose intolerance. For 15 minutes. They were really into it. At dinner! You know what it is. Everyone seemingly knows someone who has it, even if (hopefully) you aren’t reminded of it too often. Lactose intolerance is a state where you simply have difficulty digesting lactose (one of the sugars we consume, most notably in milk and other dairy products) because of a deficiency in the enzyme that breaks it down, called lactase. Lactose intolerance occurs more often in Black, Asian, Hispanic and Native Americans, but that doesn’t mean your body read that book.
So by now you may be thinking “What is there to discuss besides the odoriferous emanations produced?” (In case you didn’t get the reference that’s from an old Right Guard commercial featuring Charles Barkley.) Well, the biggest concern from a health standpoint is to ensure you’re still getting enough calcium to keep your bones strong and enough Vitamin D. Here are 3 sets of practical facts to help you get through it all.
1. If you’re lactose intolerant, that doesn’t mean you’re allergic to dairy products.
- This is an important distinction. There’s nothing immediately life-threatening about the ingestion of dairy products if you’re lactose intolerant, as there might be if you were allergic. Just be aware of the cramping, bloating, flatulence, nausea, vomiting, diarrhea and gas that may ensue.
2. If you’re lactose intolerant, that doesn’t mean you can’t necessarily have any dairy or won’t ever be able to have dairy.
- Lactose intolerance occurs in many shades of grey. Some people get worse with age; others get better as they learn to work around it. Some develop lactose intolerance at birth, others later in life, and others develop it after injury or surgery to the small intestine (which is where lactase is normally produced). Some can ingest small amounts of certain products without symptoms. In the privacy of your own surroundings, you should discover for yourself if you’re affected every time you have daily or whether or not only large amounts of certain products cause symptoms (e.g. Try not to eat the entire gallon of ice cream.). You should also gauge your response to daily after taking various lactase-containing supplements.
3. If you’re lactose intolerant, you still can get adequate calcium. Here’s a few suggestions.
- Soy and rice products have exploded (in a different way) on the market. Consider soy milk, soybeans and tofu.
- Many juice, bread and cereal makers have taken to providing calcium.
- Some fruits and veggies are great sources. Consider broccoli, collard and turnip greens, kale, okra, pinto beans, rhubarb, and spinach. Oranges are a good source of calcium.
- Other great foods include almonds, salmon, sardines and tuna.
If you have any questions or comments (I’m sure you’re busting at the gut to discuss this topic), let ’em rip…
So I’m at dinner with a group of friends, and somehow the topic gets to lactose intolerance. For 15 minutes. They were really into it. At dinner! You know what it is. Everyone seemingly knows someone who has it, even if (hopefully) you aren’t reminded of it too often. Lactose intolerance is a state where you simply have difficulty digesting lactose (one of the sugars we consume, most notably in milk and other dairy products) because of a deficiency in the enzyme that breaks it down, called lactase. Lactose intolerance occurs more often in Black, Asian, Hispanic and Native Americans, but that doesn’t mean your body read that book.
So by now you may be thinking “What is there to discuss besides the odoriferous emanations produced?” (In case you didn’t get the reference that’s from an old Right Guard commercial featuring Charles Barkley.) Well, the biggest concern from a health standpoint is to ensure you’re still getting enough calcium to keep your bones strong and enough Vitamin D. Here are 3 sets of practical facts to help you get through it all.
1. If you’re lactose intolerant, that doesn’t mean you’re allergic to dairy products.
- This is an important distinction. There’s nothing immediately life-threatening about the ingestion of dairy products if you’re lactose intolerant, as there might be if you were allergic. Just be aware of the cramping, bloating, flatulence, nausea, vomiting, diarrhea and gas that may ensue.
2. If you’re lactose intolerant, that doesn’t mean you can’t necessarily have any dairy or won’t ever be able to have dairy.
- Lactose intolerance occurs in many shades of grey. Some people get worse with age; others get better as they learn to work around it. Some develop lactose intolerance at birth, others later in life, and others develop it after injury or surgery to the small intestine (which is where lactase is normally produced). Some can ingest small amounts of certain products without symptoms. In the privacy of your own surroundings, you should discover for yourself if you’re affected every time you have daily or whether or not only large amounts of certain products cause symptoms (e.g. Try not to eat the entire gallon of ice cream.). You should also gauge your response to daily after taking various lactase-containing supplements.
3. If you’re lactose intolerant, you still can get adequate calcium. Here’s a few suggestions.
- Soy and rice products have exploded (in a different way) on the market. Consider soy milk, soybeans and tofu.
- Many juice, bread and cereal makers have taken to providing calcium.
- Some fruits and veggies are great sources. Consider broccoli, collard and turnip greens, kale, okra, pinto beans, rhubarb, and spinach. Oranges are a good source of calcium.
- Other great foods include almonds, salmon, sardines and tuna.
If you have any questions or comments (I’m sure you’re busting at the gut to discuss this topic), let ’em rip…
Straight, No Chaser: Learn The Physical Signs of Child Abuse
We need an army to protect children against child abuse. I will intermittently be discussing various forms of abuse, but to start with, I’d like to help you recognize physical signs I tend to look for to potentially identify victims of abuse.
Symptoms include:
- Black eyes
![physical_2[1]](https://e2wefe.p3cdn1.secureserver.net/wp-content/uploads/2013/08/physical_21.jpg?w=300)
- Broken bones that are unusual and unexplained
- Bruise marks or lashes shaped like hands, fingers, or objects (such as a belt)
- Bruises in areas where normal childhood activities would not usually result in bruising
- Bite marks
- Bulging soft spot (fontanelle) or separations in an infant’s skull
- Burn marks, usually seen on the hands, arms, or buttocks
- Choke marks around the neck
- Cigarette burns on exposed areas or on the genitals
- Circular marks around the wrists or ankles (signs of twisting or tying up)
- Unexplained unconsciousness in an infant
If you ever see such things in children, be suspicious, be involved and get help. There are always ‘explanations’ for why things happen to children, but they too frequently seem to defy logic. Of course you can call 911 or the Childhelp National Child Abuse Hotline (1-800-4-A-CHILD). You could save a life.
We need an army to protect children against child abuse. I will intermittently be discussing various forms of abuse, but to start with, I’d like to help you recognize physical signs I tend to look for to potentially identify victims of abuse.
Symptoms include:
- Black eyes
![physical_2[1]](https://e2wefe.p3cdn1.secureserver.net/wp-content/uploads/2013/08/physical_21.jpg)
- Broken bones that are unusual and unexplained
- Bruise marks or lashes shaped like hands, fingers, or objects (such as a belt)
- Bruises in areas where normal childhood activities would not usually result in bruising
- Bite marks
- Bulging soft spot (fontanelle) or separations in an infant’s skull
- Burn marks, usually seen on the hands, arms, or buttocks
- Choke marks around the neck
- Cigarette burns on exposed areas or on the genitals
- Circular marks around the wrists or ankles (signs of twisting or tying up)
- Unexplained unconsciousness in an infant
If you ever see such things in children, be suspicious, be involved and get help. There are always ‘explanations’ for why things happen to children, but they too frequently seem to defy logic. Of course you can call 911 or the Childhelp National Child Abuse Hotline (1-800-4-A-CHILD). You could save a life.
Straight, No Chaser: Quick Tips – Rashes on Your Palms and Soles – Pay Attention!
In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles. However, there are a few of note, so here’s some Quick Tips to point you in the right direction.
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus. It’s rather benign.
If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii). If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.
If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease. This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.
Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.
And yes, secondary syphilis presents with rashes on the palms and soles. The real take home message is this. Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed. Trust me, you want to get treated before tertiary syphilis develops. Here’s what that rash looks like.
The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.
In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles. However, there are a few of note, so here’s some Quick Tips to point you in the right direction.
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus. It’s rather benign.
If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii). If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.
If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease. This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.
Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.
And yes, secondary syphilis presents with rashes on the palms and soles. The real take home message is this. Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed. Trust me, you want to get treated before tertiary syphilis develops. Here’s what that rash looks like.
The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.
Straight, No Chaser: Find Something Better to Chew On! Ingrown Toenails
The overwhelming majority of cases of ingrown toenails I see come from people chewing on their toenails. So the really, really Quick Tip is keep your feet out of your mouth. If only it was that simple.
Ingrown toenails themselves aren’t the problem. The resulting skin infection and pain are what bring you in to see me. Remember that the ingrown toenail is caused by the nail burrowing into the skin of the toe instead of growing out and over it. I’ve always found it interesting that people wait so long for such things, but in this instance, if you are going to wait, there actually are things you can do to potentially make it better. You’ll know you need to do this if you have a red, swollen, painful toe and especially short toenails.
- Soak your feet two-three times a day for 15 minutes at a time.
- Attempt to lift the nail by placing cotton or dental floss under the toenail after you soak. The goal is to get that nail corner above the skin.
- Wear open-toed shoes. This is not the time when you’d want to have any pressure on your toes.
- Place a topical antibiotic on the area.
Have you ever seen a bad ingrown toenail get removed? If you have, you’ll likely agree that it’s a deterrent to having another one. Treatment usually involves lots of local anesthesia (i.e. needles) and partial manual removal of the toenail. It’s not a good day when this has to happen.
So, you can avoid this fate. Just follow a few simple steps to avoid it in the first place.
- Don’t bite your nails. As discussed in the human bites blog post, you’ve just added really bad bacterial to the mix for when the infection occurs.
- Don’t cut your toenail so short that you can’t see some of the white tips. Be sure to let the corners extend past the skin.
- Don’t wear excessively tight shoes that literally smash your toes onto themselves.
Here’s a final note: if you’re diabetic or otherwise immunocompromised, these infections can spread rapidly and extend into the bone – these infections are very serious. In some cases this has led to amputated toes. If an ingrown toenail happens to you, I’d suggest getting seen sooner rather than later.
The overwhelming majority of cases of ingrown toenails I see come from people chewing on their toenails. So the really, really Quick Tip is keep your feet out of your mouth. If only it was that simple.
Ingrown toenails themselves aren’t the problem. The resulting skin infection and pain are what bring you in to see me. Remember that the ingrown toenail is caused by the nail burrowing into the skin of the toe instead of growing out and over it. I’ve always found it interesting that people wait so long for such things, but in this instance, if you are going to wait, there actually are things you can do to potentially make it better. You’ll know you need to do this if you have a red, swollen, painful toe and especially short toenails.
- Soak your feet two-three times a day for 15 minutes at a time.
- Attempt to lift the nail by placing cotton or dental floss under the toenail after you soak. The goal is to get that nail corner above the skin.
- Wear open-toed shoes. This is not the time when you’d want to have any pressure on your toes.
- Place a topical antibiotic on the area.
Have you ever seen a bad ingrown toenail get removed? If you have, you’ll likely agree that it’s a deterrent to having another one. Treatment usually involves lots of local anesthesia (i.e. needles) and partial manual removal of the toenail. It’s not a good day when this has to happen.
So, you can avoid this fate. Just follow a few simple steps to avoid it in the first place.
- Don’t bite your nails. As discussed in the human bites blog post, you’ve just added really bad bacterial to the mix for when the infection occurs.
- Don’t cut your toenail so short that you can’t see some of the white tips. Be sure to let the corners extend past the skin.
- Don’t wear excessively tight shoes that literally smash your toes onto themselves.
Here’s a final note: if you’re diabetic or otherwise immunocompromised, these infections can spread rapidly and extend into the bone – these infections are very serious. In some cases this has led to amputated toes. If an ingrown toenail happens to you, I’d suggest getting seen sooner rather than later.
Straight, No Chaser: Orthopedics Quick Tips – Learn How to Fall – The FOOSH injury
We use a lot a acronyms in the Emergency Room, many of which can’t be repeated in polite company. Orthopedics and Trauma seem to lend themselves to a few. There’s GTSBOOM (got the stuff beat out of me, which is an all too common occurrence) and there’s FOOSH. FOOSH stands for ‘fell on outstretched hand’.
I bring this up because you need to learn how to fall. FOOSH injuries predictably cause fractures of the distal radius and ulnar (the two bones of the forearm), usually down by the wrist. These injuries are incredibly common and avoidable. The most notable injury is the Colles fracture, which is a distal radius fracture. You’ll know you have it after a fall when your wrist assumes the typical ‘dinner-fork deformity’.
So next time you fall, try to make it a glancing blow and avoid placing the full weight of your body on those wrists. Try to land and roll when you hit – but be extra careful to avoid bumping your head by doing this. If you get this right, it could save you 6 weeks in a splint, cast or in some cases a trip to the operating room.
We use a lot a acronyms in the Emergency Room, many of which can’t be repeated in polite company. Orthopedics and Trauma seem to lend themselves to a few. There’s GTSBOOM (got the stuff beat out of me, which is an all too common occurrence) and there’s FOOSH. FOOSH stands for ‘fell on outstretched hand’.
I bring this up because you need to learn how to fall. FOOSH injuries predictably cause fractures of the distal radius and ulnar (the two bones of the forearm), usually down by the wrist. These injuries are incredibly common and avoidable. The most notable injury is the Colles fracture, which is a distal radius fracture. You’ll know you have it after a fall when your wrist assumes the typical ‘dinner-fork deformity’.
So next time you fall, try to make it a glancing blow and avoid placing the full weight of your body on those wrists. Try to land and roll when you hit – but be extra careful to avoid bumping your head by doing this. If you get this right, it could save you 6 weeks in a splint, cast or in some cases a trip to the operating room.
Straight, No Chaser: When That Headache is More Serious Than a Migraine
All headaches are not created equal. Earlier we discussed migraines, but there’s a lot more to headaches than those. In fact, when you come to an emergency room with a history of migraines and tell us you’re having a migraine, we still aren’t thinking about migraines as the first consideration. It’s all about the life-threats. The lead picture suggests items to avoid if you’d like to improve your prognosis for headaches in general and especially certain ones like brain aneurysms.
Secondary headaches are those related to some other illness or condition that produces headaches as a symptom. These are much more common causes of headaches than migraines. They’re even more important because they could represent life-threatening conditions. So we’ll put aside the headaches caused by things like panic attacks and hyperventilation, influenza, dental pain, sinusitis, ear infections, eye strain, dehydration, hangovers, hunger and ‘brain-freeze’ (Yes, ‘ice-cream headaches’ really are a thing!), and point you to some conditions about which you should be concerned (I’m intentionally leaving out many especially uncommon and otherwise esoteric conditions. I wouldn’t want to encourage any hypochondriacs out there.).
- AVM (arteriovenous malformation): an abnormal formation of blood vessels inside your brain
- Concussions and post-concussive syndrome
- Brain aneurysm: a ballooning of one of your brain’s arteries
- Brain tumor
- Carbon monoxide poisoning
- Encephalitis/Meningitis: inflammation and/or infection of different components of your brain
- Subarachnoid hemorrhage: and other intracranial hemorrhages
- Stroke
- Temporal arteritis: inflammation of an important forehead artery with potentially devastating consequences to your sight.
Given that I’ve blogged on several of these already (you can always enter the term in the search box on the right for more details), I’m going to focus on the symptoms you may have that may suggest your headache is different enough to get evaluated for a possible life-threat.
Consider this a ‘headache plus this symptom = go to the emergency room’ list
- Altered mental status
- Confusion
- Difficulty standing or walking (different from baseline)
- Fainting after a headache
- High fever, greater than 102 F to 104 F (39 C to 40 C)
- Nausea or vomiting that’s not hangover related
- Numbness, weakness or paralysis on one side of your body
- Slurred speech
- Stiff neck
- Vision disturbances (blurred or inability to see)
All headaches are not created equal. Earlier we discussed migraines, but there’s a lot more to headaches than those. In fact, when you come to an emergency room with a history of migraines and tell us you’re having a migraine, we still aren’t thinking about migraines as the first consideration. It’s all about the life-threats. The lead picture suggests items to avoid if you’d like to improve your prognosis for headaches in general and especially certain ones like brain aneurysms.
Secondary headaches are those related to some other illness or condition that produces headaches as a symptom. These are much more common causes of headaches than migraines. They’re even more important because they could represent life-threatening conditions. So we’ll put aside the headaches caused by things like panic attacks and hyperventilation, influenza, dental pain, sinusitis, ear infections, eye strain, dehydration, hangovers, hunger and ‘brain-freeze’ (Yes, ‘ice-cream headaches’ really are a thing!), and point you to some conditions about which you should be concerned (I’m intentionally leaving out many especially uncommon and otherwise esoteric conditions. I wouldn’t want to encourage any hypochondriacs out there.).
- AVM (arteriovenous malformation): an abnormal formation of blood vessels inside your brain
- Concussions and post-concussive syndrome
- Brain aneurysm: a ballooning of one of your brain’s arteries
- Brain tumor
- Carbon monoxide poisoning
- Encephalitis/Meningitis: inflammation and/or infection of different components of your brain
- Subarachnoid hemorrhage: and other intracranial hemorrhages
- Stroke
- Temporal arteritis: inflammation of an important forehead artery with potentially devastating consequences to your sight.
Given that I’ve blogged on several of these already (you can always enter the term in the search box on the right for more details), I’m going to focus on the symptoms you may have that may suggest your headache is different enough to get evaluated for a possible life-threat.
Consider this a ‘headache plus this symptom = go to the emergency room’ list
- Altered mental status
- Confusion
- Difficulty standing or walking (different from baseline)
- Fainting after a headache
- High fever, greater than 102 F to 104 F (39 C to 40 C)
- Nausea or vomiting that’s not hangover related
- Numbness, weakness or paralysis on one side of your body
- Slurred speech
- Stiff neck
- Vision disturbances (blurred or inability to see)
Straight No Chaser: Myth Busters Edition – Migraine Headaches Fact vs. Fiction
There are 30 million migraine sufferers in the U.S. alone. Women are thrice as likely to have them, but both sexes have to address the issues raised by them. Here are some important facts regarding migraines and myths surrounding them, based on questions I’ve actually been asked. And yes, regarding the lead picture, I refuse to say she’s lion.
Myth #1: I can’t help if I get migraines. They’re hereditary, right?
There are a few things about being predisposed to having migraines I want you to know.
- If you have one parent with migraines, there’s a 50% chance you’ll have them.
- If both your parents have migraines, there’s a 75% chance you also will.
- 4 of 5 migraine sufferers have a relative with migraines.
These facts represent a predisposition. In order to have migraines, you must have triggers that will set off the migraine. That’s a vital consideration in your effort to prevent, reduce and effectively treat your migraines.
Myth #2: This is a woman’s disease. They stress out more and are more emotional. That’s why they get headaches.
It is true that there is a strong hormonal component to migraines, particularly regarding estrogen and progesterone. In fact, the incidence of migraines between the sexes is pretty equal until puberty. Migraines are increased during pre-menstruation, when hormone levels are high. Menopause may ease migraines. All of this said, men still get migraines as well because of the presence of other triggers. It certainly does not appear to be true that women suffer stress at a disproportionate rate sufficient to claim it as more of a trigger in women than in men. Both sexes’ stress responses include release of substances that expands blood vessels, causing migraines.
Myth #3: My migraines won’t get any easier as I get older.
Along the same lines as Myth #2, diminished hormone production that accompanies aging may help explain how most migraine sufferers have less frequent and less intense migraines after age 40. Because of hormonal fluctuations during perimenopause, this reduction may not be seen.
- Most people who get migraines have fewer headaches and their headaches aren’t as strong once they hit 40. However, this may not be the case for women going through perimenopause. If hormones are a trigger for a woman’s migraines, then she could have more headaches during the period around menopause.
Myth #4: Once I’m diagnosed with migraines, only narcotics will help.
First of all, trigger identification and prevention is vital. Migraine trigger management and treatment is a topic unto itself, but I’d like to point out a few important considerations.
- Think triggers first and last. The list of triggers includes foods (think chocolate, alcohol, aged cheese and caffeine; results vary with the individual), cold, stress, smoking and certain medications. Alterations in mealtimes, exercise and sleep patterns must be monitored as well, these tend to exacerbate migraines. Migraine sufferers are advised to maintain a headache log to identify triggers as things occur.
- A special comment about caffeine: It helps some people, but for others it’s a migraine trigger, particularly if you’re a heavy user. If you don’t drink many caffeinated beverages, one may help if you’re having a less than severe migraine. If you’re taking enough in to create a caffeine dependency, overnight withdrawal may be enough to trigger a morning migraine.
Patients must become their own experts on how and when you use different medications.
- I hope you and your primary care physician have discussed and have you focusing on your abortive medications. These medicines can stop further progression of migraines if used early enough at the first sign of a migraine.
- Painkillers have consequences. As tolerance to and dependence on narcotics develop, withdrawal symptoms become more prominent. Rebound headaches are a major component of these symptoms. That’s a vicious cycle that doesn’t have a happy ending. It’s important to note that your health care professionals do appreciate there is a difference between being drug seeking and drug dependent.
Myth #5: Migraines really don’t cause problems beyond the headaches, right?
Wrong. If you have migraines, take special care to ensure you have a healthy heart and a low risk for strokes. Refer to the Straight, No Chaser archives (or just type in the search engine to the right) for information on stroke recognition and heart attack recognition. If you’re a female and have migraines with aura (certain warning symptoms that precede you migraine like nausea, dizziness, light sensitivity, and seeing zig-zag lines), your heart attack risk climbs by over 90% and your stroke risk more than doubles (increases by up to 108%). The presence of migraines without aura also raises the risk of heart attack and stroke but by lesser amounts.
As per routine at Straight, No Chaser, the message is simple, but execution is key. Prevention is protection, and knowledge is power. Check back this afternoon for life threatening causes of headaches, and feel free to send questions and comments. Take good care.
There are 30 million migraine sufferers in the U.S. alone. Women are thrice as likely to have them, but both sexes have to address the issues raised by them. Here are some important facts regarding migraines and myths surrounding them, based on questions I’ve actually been asked. And yes, regarding the lead picture, I refuse to say she’s lion.
Myth #1: I can’t help if I get migraines. They’re hereditary, right?
There are a few things about being predisposed to having migraines I want you to know.
- If you have one parent with migraines, there’s a 50% chance you’ll have them.
- If both your parents have migraines, there’s a 75% chance you also will.
- 4 of 5 migraine sufferers have a relative with migraines.
These facts represent a predisposition. In order to have migraines, you must have triggers that will set off the migraine. That’s a vital consideration in your effort to prevent, reduce and effectively treat your migraines.
Myth #2: This is a woman’s disease. They stress out more and are more emotional. That’s why they get headaches.
It is true that there is a strong hormonal component to migraines, particularly regarding estrogen and progesterone. In fact, the incidence of migraines between the sexes is pretty equal until puberty. Migraines are increased during pre-menstruation, when hormone levels are high. Menopause may ease migraines. All of this said, men still get migraines as well because of the presence of other triggers. It certainly does not appear to be true that women suffer stress at a disproportionate rate sufficient to claim it as more of a trigger in women than in men. Both sexes’ stress responses include release of substances that expands blood vessels, causing migraines.
Myth #3: My migraines won’t get any easier as I get older.
Along the same lines as Myth #2, diminished hormone production that accompanies aging may help explain how most migraine sufferers have less frequent and less intense migraines after age 40. Because of hormonal fluctuations during perimenopause, this reduction may not be seen.
- Most people who get migraines have fewer headaches and their headaches aren’t as strong once they hit 40. However, this may not be the case for women going through perimenopause. If hormones are a trigger for a woman’s migraines, then she could have more headaches during the period around menopause.
Myth #4: Once I’m diagnosed with migraines, only narcotics will help.
First of all, trigger identification and prevention is vital. Migraine trigger management and treatment is a topic unto itself, but I’d like to point out a few important considerations.
- Think triggers first and last. The list of triggers includes foods (think chocolate, alcohol, aged cheese and caffeine; results vary with the individual), cold, stress, smoking and certain medications. Alterations in mealtimes, exercise and sleep patterns must be monitored as well, these tend to exacerbate migraines. Migraine sufferers are advised to maintain a headache log to identify triggers as things occur.
- A special comment about caffeine: It helps some people, but for others it’s a migraine trigger, particularly if you’re a heavy user. If you don’t drink many caffeinated beverages, one may help if you’re having a less than severe migraine. If you’re taking enough in to create a caffeine dependency, overnight withdrawal may be enough to trigger a morning migraine.
Patients must become their own experts on how and when you use different medications.
- I hope you and your primary care physician have discussed and have you focusing on your abortive medications. These medicines can stop further progression of migraines if used early enough at the first sign of a migraine.
- Painkillers have consequences. As tolerance to and dependence on narcotics develop, withdrawal symptoms become more prominent. Rebound headaches are a major component of these symptoms. That’s a vicious cycle that doesn’t have a happy ending. It’s important to note that your health care professionals do appreciate there is a difference between being drug seeking and drug dependent.
Myth #5: Migraines really don’t cause problems beyond the headaches, right?
Wrong. If you have migraines, take special care to ensure you have a healthy heart and a low risk for strokes. Refer to the Straight, No Chaser archives (or just type in the search engine to the right) for information on stroke recognition and heart attack recognition. If you’re a female and have migraines with aura (certain warning symptoms that precede you migraine like nausea, dizziness, light sensitivity, and seeing zig-zag lines), your heart attack risk climbs by over 90% and your stroke risk more than doubles (increases by up to 108%). The presence of migraines without aura also raises the risk of heart attack and stroke but by lesser amounts.
As per routine at Straight, No Chaser, the message is simple, but execution is key. Prevention is protection, and knowledge is power. Check back this afternoon for life threatening causes of headaches, and feel free to send questions and comments. Take good care.
Straight, No Chaser: Can You Get Chicken Pox Twice? Emergency Room Adventures: Introducing Shingles
It’s another interesting night in the ER. My nurses are hounding me because there’s a patient with a rash, and they don’t know what it is. They’re so good that they rarely get stumped, and they get excited when they are. The patient had a pretty impressive cluster of little blisters called vesicles (see the picture above) under one eye with significant reddening of the skin under the cluster. Unknown to them, their problem with this patient is she’s African-American. Many healthcare professionals have difficulty identifying common rashes in dark-skinned individuals.
I wonder if any of you haven’t had chickenpox. That’s a question that never would have been asked a few decades ago. Chickenpox is caused by the Varicella Zoster virus, which is one of the Herpes viruses (No not that one; we’ll discuss that next week.). Repeat infections or reactivation of the virus that went dormant inside of you causes shingles. When I was younger, no one ever got shingles because no one got chickenpox twice. Chickenpox was something you got as a child, and when you contracted it, everyone in the neighborhood would bring the kids by so everyone could get it and be done with it. The first case of shingles I actually remember seeing was during residency in a HIV+ patient who actually died from it (Herpes Zoster pneumonia; I was told it happened to the elderly or patients with lowered immunity).
Then an odd thing happened. A chickenpox vaccine came out. Chickenpox started being seen in older individuals, because all the kids were immunized, and the loss of the ‘herd immunity’ phenomenon allowed some individuals to sneak by without getting chickenpox as a child, only to develop it at an older age. Then shingles started being seen more often.
The shingles rash is classically a group of lesions stretched around a single dermatome (an area of skin corresponding to the distribution a specific nerve root), usually in the abdomen or back, but seen with some frequency on the face and involving the nose and around the eyes. Infection begins with general nonspecific symptoms like headache, light sensitivity, pain, itching and burning in the area a few days before the rash appears. The pain should be emphasized, as it can last for a year after the rash (which typically lasts for 2-4 weeks). Amazingly 30 out of 100 Americans will now develop this illness at some point in their lives.
Anyone who has had chickenpox may get shingles. However, you can now get a shingles vaccine, which serves two purposes: it may prevent shingles, but if it doesn’t it can make the episode less painful. If you’re 50, you can get vaccinated, and it can cut the risk of contracting shingles in half. Please discuss this with your physician. If you’re eligible, you’ll thank me; if you don’t get vaccinated and contract shingles, you’ll wish you had.
Quick Tips:
- If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from blisters in both conditions is contagious and can cause chickenpox in these groups.
- If you have shingles, avoid close contact with people until after the rash blisters heal.
- Certain people are at heightened risk from chickenpox and shingles, including anyone pregnant, elderly, ill or with a diminished immune system.
I welcome your questions, comments or stories. For the sports fans out there, this pictorial trivia question shouldn’t be hard to answer? Who’s this famous manager pictured here with shingles?
It’s another interesting night in the ER. My nurses are hounding me because there’s a patient with a rash, and they don’t know what it is. They’re so good that they rarely get stumped, and they get excited when they are. The patient had a pretty impressive cluster of little blisters called vesicles (see the picture above) under one eye with significant reddening of the skin under the cluster. Unknown to them, their problem with this patient is she’s African-American. Many healthcare professionals have difficulty identifying common rashes in dark-skinned individuals.
I wonder if any of you haven’t had chickenpox. That’s a question that never would have been asked a few decades ago. Chickenpox is caused by the Varicella Zoster virus, which is one of the Herpes viruses (No not that one; we’ll discuss that next week.). Repeat infections or reactivation of the virus that went dormant inside of you causes shingles. When I was younger, no one ever got shingles because no one got chickenpox twice. Chickenpox was something you got as a child, and when you contracted it, everyone in the neighborhood would bring the kids by so everyone could get it and be done with it. The first case of shingles I actually remember seeing was during residency in a HIV+ patient who actually died from it (Herpes Zoster pneumonia; I was told it happened to the elderly or patients with lowered immunity).
Then an odd thing happened. A chickenpox vaccine came out. Chickenpox started being seen in older individuals, because all the kids were immunized, and the loss of the ‘herd immunity’ phenomenon allowed some individuals to sneak by without getting chickenpox as a child, only to develop it at an older age. Then shingles started being seen more often.
The shingles rash is classically a group of lesions stretched around a single dermatome (an area of skin corresponding to the distribution a specific nerve root), usually in the abdomen or back, but seen with some frequency on the face and involving the nose and around the eyes. Infection begins with general nonspecific symptoms like headache, light sensitivity, pain, itching and burning in the area a few days before the rash appears. The pain should be emphasized, as it can last for a year after the rash (which typically lasts for 2-4 weeks). Amazingly 30 out of 100 Americans will now develop this illness at some point in their lives.
Anyone who has had chickenpox may get shingles. However, you can now get a shingles vaccine, which serves two purposes: it may prevent shingles, but if it doesn’t it can make the episode less painful. If you’re 50, you can get vaccinated, and it can cut the risk of contracting shingles in half. Please discuss this with your physician. If you’re eligible, you’ll thank me; if you don’t get vaccinated and contract shingles, you’ll wish you had.
Quick Tips:
- If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from blisters in both conditions is contagious and can cause chickenpox in these groups.
- If you have shingles, avoid close contact with people until after the rash blisters heal.
- Certain people are at heightened risk from chickenpox and shingles, including anyone pregnant, elderly, ill or with a diminished immune system.
I welcome your questions, comments or stories. For the sports fans out there, this pictorial trivia question shouldn’t be hard to answer? Who’s this famous manager pictured here with shingles?
Straight, No Chaser: Spider Bites – Emergency Room Adventures, Part I
And I thought I was done with stuff biting you for a while… Everything’s bigger in Texas, they say. I recall the first time I saw a banana spider. The thing seemed to be as big as my fist. The only thing more surprising than that was discovering that wasps actually kill and eat spiders. I thought it was supposed to be the other way around… Anyway, I’m typing this immediately after seeing a patient who’s working around the house (or farm or barn as the case is around here), and he put his hand in the woodshed and got bit by a big spider with a red hourglass appearance. Of course, the mother’s excited and wants to know if he’s going to die. The father’s not too concerned because he was just in Missouri a month ago and was bitten by a spider that looked like it had a violin on its back (You can’t make this stuff up!).
Not a day goes by when I don’t see several patients bitten or stung by various insects, including fire ants, mosquitos, bees, wasps, ticks, scorpions and spiders. Usually everyone’s worried about a Staph infection. It’s important to note that only four American species of spiders are known to be dangerous to humans. However, there are only two types of spiders that are worth mentioning as a cause of significant disease.
Black widow spider bites are even more interesting when they’re not eating their mates after procreation (fun fact: North American black widow spiders don’t usually do that; it’s actually the Australian brand that does). They prefer to avoid humans, hanging out in outhouses, garages and the like. They become aggressive when disturbed (particularly if there’s an egg sac around), and if you’ve been bitten, it was by a female. You’ll know it was a black widow because of its red hourglass underside.
The black widow spider injects a powerful nerve toxin into humans. Once bitten, you’ll feel pain, but the real symptoms are likely to start about 20” later. Among other things, this venom produces symptoms that mimic appendicitis. Patients can develop abdominal pain and rigidity, tremor, weakness, chest pain, shortness of breath, dizziness and fainting. People at the extremes of age are more at risk for serious complications. Otherwise, reactions are rarely life threatening.
The brown recluse spider is native to the Midwest and Southeastern U.S. You’ll recognize this one by its distinctive violin pattern on its back near where its legs attach. As the name suggests, they’re not at all aggressive and tend to bite only when it’s pressed against its victim’s skin. These spiders like warm and dry environments (think attics, closets, basements, porches, barns and woodpiles).
The Brown recluse also injects a powerful venom – more so than a rattlesnake – who’s lethality is only limited because it’s such a small creature. Its venom rapidly destroys the cells it’s injected into, causing necrosis and tissue death (This is decreased as having a ‘volcano-like’ appearance at the bite site. The lead picture is a demonstration of this.). This destruction has secondary effects in humans, including kidney damage and failure, red blood cell and platelet (your clotting cells) destruction, formation of blood clots, coma and death (rarely). Deaths have only been reported in children less than age seven by the brown recluse.
Here’s your Quick Tip do’s and no’s for Spider Bites:
Do’s
- Get to the ER. Not your Doctor’s office. Not the Urgent Care.
- Elevate the area above your heart.
- Wash with soap and cool water.
- Tylenol for pain.
- Apply ice.
No’s
- No waiting to see if it gets better.
- No heat.
- No suction.
- No cutting away tissue.
- No tourniquets.
And I thought I was done with stuff biting you for a while… Everything’s bigger in Texas, they say. I recall the first time I saw a banana spider. The thing seemed to be as big as my fist. The only thing more surprising than that was discovering that wasps actually kill and eat spiders. I thought it was supposed to be the other way around… Anyway, I’m typing this immediately after seeing a patient who’s working around the house (or farm or barn as the case is around here), and he put his hand in the woodshed and got bit by a big spider with a red hourglass appearance. Of course, the mother’s excited and wants to know if he’s going to die. The father’s not too concerned because he was just in Missouri a month ago and was bitten by a spider that looked like it had a violin on its back (You can’t make this stuff up!).
Not a day goes by when I don’t see several patients bitten or stung by various insects, including fire ants, mosquitos, bees, wasps, ticks, scorpions and spiders. Usually everyone’s worried about a Staph infection. It’s important to note that only four American species of spiders are known to be dangerous to humans. However, there are only two types of spiders that are worth mentioning as a cause of significant disease.
Black widow spider bites are even more interesting when they’re not eating their mates after procreation (fun fact: North American black widow spiders don’t usually do that; it’s actually the Australian brand that does). They prefer to avoid humans, hanging out in outhouses, garages and the like. They become aggressive when disturbed (particularly if there’s an egg sac around), and if you’ve been bitten, it was by a female. You’ll know it was a black widow because of its red hourglass underside.
The black widow spider injects a powerful nerve toxin into humans. Once bitten, you’ll feel pain, but the real symptoms are likely to start about 20” later. Among other things, this venom produces symptoms that mimic appendicitis. Patients can develop abdominal pain and rigidity, tremor, weakness, chest pain, shortness of breath, dizziness and fainting. People at the extremes of age are more at risk for serious complications. Otherwise, reactions are rarely life threatening.
The brown recluse spider is native to the Midwest and Southeastern U.S. You’ll recognize this one by its distinctive violin pattern on its back near where its legs attach. As the name suggests, they’re not at all aggressive and tend to bite only when it’s pressed against its victim’s skin. These spiders like warm and dry environments (think attics, closets, basements, porches, barns and woodpiles).
The Brown recluse also injects a powerful venom – more so than a rattlesnake – who’s lethality is only limited because it’s such a small creature. Its venom rapidly destroys the cells it’s injected into, causing necrosis and tissue death (This is decreased as having a ‘volcano-like’ appearance at the bite site. The lead picture is a demonstration of this.). This destruction has secondary effects in humans, including kidney damage and failure, red blood cell and platelet (your clotting cells) destruction, formation of blood clots, coma and death (rarely). Deaths have only been reported in children less than age seven by the brown recluse.
Here’s your Quick Tip do’s and no’s for Spider Bites:
Do’s
- Get to the ER. Not your Doctor’s office. Not the Urgent Care.
- Elevate the area above your heart.
- Wash with soap and cool water.
- Tylenol for pain.
- Apply ice.
No’s
- No waiting to see if it gets better.
- No heat.
- No suction.
- No cutting away tissue.
- No tourniquets.
Straight, No Chaser: When That Back Pain is the Least of Your Problems
Back pain hurts, but there are various causes of that pain that will kill or cripple you. Here’s some information on some diseases that present with back pain representing life-threats. Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards. Forewarned is forearmed.
Let’s start where we left off on the last post and identify what I was talking about….
Here are a few clues to help you hone in on whether your back pain requires emergency attention. Remember pain and pathology (serious disease) are two different considerations. I’m describing medical emergencies here and admittedly being overly simplistic.
- Direct blow to your back: Think Fracture
- The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back. It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy. That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
- Fever and new onset back pain: Think Spinal Epidural Abscess
- A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones. It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood. Antibiotics for about a month and/or surgery may be required.
- Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
- There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies. CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects. This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs. Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
- New onset back pain after age 65: Think Cancer
- There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer. The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement. Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present. It could represent a significant advancement of disease.
- Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
- Night-time back pain: Think Metastatic Cancer.
- Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer.
- Sudden sexual dysfunction: See Cauda Equina Syndrome above
- Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
- Unexplained new weight loss and new onset back pain: Think Cancer
- There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
- Work-related back injuries
- This isn’t as much a life-threatening consideration as it is a limb and career-threatening one. Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed. Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.
Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs. I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future. The take home consideration here is to use these cues to know when to get rapidly evaluated. Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.
Back pain hurts, but there are various causes of that pain that will kill or cripple you. Here’s some information on some diseases that present with back pain representing life-threats. Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards. Forewarned is forearmed.
Let’s start where we left off on the last post and identify what I was talking about….
Here are a few clues to help you hone in on whether your back pain requires emergency attention. Remember pain and pathology (serious disease) are two different considerations. I’m describing medical emergencies here and admittedly being overly simplistic.
- Direct blow to your back: Think Fracture
- The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back. It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy. That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
- Fever and new onset back pain: Think Spinal Epidural Abscess
- A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones. It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood. Antibiotics for about a month and/or surgery may be required.
- Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
- There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies. CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects. This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs. Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
- New onset back pain after age 65: Think Cancer
- There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer. The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement. Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present. It could represent a significant advancement of disease.
- Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
- Night-time back pain: Think Metastatic Cancer.
- Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer.
- Sudden sexual dysfunction: See Cauda Equina Syndrome above
- Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
- Unexplained new weight loss and new onset back pain: Think Cancer
- There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
- Work-related back injuries
- This isn’t as much a life-threatening consideration as it is a limb and career-threatening one. Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed. Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.
Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs. I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future. The take home consideration here is to use these cues to know when to get rapidly evaluated. Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.
Straight, No Chaser: Back Pain to The Future
Over 40 million Americans suffer from various forms of chronic low back pain. We must work really hard.
Lower back pain is a tricky subject for an emergency physician. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.
Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):
- Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
- Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.
2. Strains
Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.
3. Fractures
A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.
4. Arthritis and Normal Deterioration (aging)
There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.
Here are a few clues to help you hone in on whether your back pain requires emergency attention:
- Direct blow to your back
- Fever and new onset back pain
- Loss of control of your bowel movements or bladder function
- New onset back pain after age 65
- Numbness and tingling in both of your legs
- Nighttime back pain
- Sudden sexual dysfunction
- Weakness and/or loss of motion or sensation in your legs
- Weight loss and new onset back pain
- Work related back injuries
What can you do to prevent or reduce the pain at home?
- Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).
- Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
- Wear low-heeled shoes whenever you can, ladies!
- Learn how to stretch your back.
- Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
- Sleep on your side. Try a pillow between your knees.
- Walk. Did you know walking is the best (and easiest) exercise for your back?
I’ll be back later (no pun intended) with your questions and more.
Over 40 million Americans suffer from various forms of chronic low back pain. We must work really hard.
Lower back pain is a tricky subject for an emergency physician. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.
Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):
- Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
- Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.
2. Strains
Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.
3. Fractures
A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.
4. Arthritis and Normal Deterioration (aging)
There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.
Here are a few clues to help you hone in on whether your back pain requires emergency attention:
- Direct blow to your back
- Fever and new onset back pain
- Loss of control of your bowel movements or bladder function
- New onset back pain after age 65
- Numbness and tingling in both of your legs
- Nighttime back pain
- Sudden sexual dysfunction
- Weakness and/or loss of motion or sensation in your legs
- Weight loss and new onset back pain
- Work related back injuries
What can you do to prevent or reduce the pain at home?
- Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).
- Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
- Wear low-heeled shoes whenever you can, ladies!
- Learn how to stretch your back.
- Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
- Sleep on your side. Try a pillow between your knees.
- Walk. Did you know walking is the best (and easiest) exercise for your back?
I’ll be back later (no pun intended) with your questions and more.
Straight, No Chaser: Alcohol Facts and Fiction – The Myth Busters Edition
I’m going to put my personal spin on an old favorite: Alcohol Facts vs. Fiction. Here’s your six-pack (plus one for the road) of common myths just waiting to be busted.
1. If I drink too much, I’ll get a beer belly.
- FALSE: Any ‘belly’ is caused by poor dietary intake and insufficient exercise. A beer drinker who’s otherwise in shape won’t have a beer belly. The young lady in the picture above is more likely to get a beer belly from the potato chips than the booze, which will give her plenty else about which to be concerned.
2. I get drunker from mixing dark liquor and light liquor, or from switching between beers and wines.
- FALSE: You’re drunk exclusively because of the concentration of alcohol in your body. Nothing more or less.
3. Drinking coffee sobers me up.
- FALSE: Alcohol in eliminated from the body by a certain fixed percentage per hour, regardless of height, weight, age or sex. Nothing you’re doing, including drinking coffee or taking a cold shower is accelerating that process.
4. A man of the same height and weight as a woman can more easily tolerate the same amount of liquor.
- TRUE: Women tend to get more affected by liquor than men because women (on average) have a higher proportion of fat stores than men. This allows the blood alcohol concentrate to become higher in women quicker when consuming the same amounts.
5. Drinking more frequently helps me ‘hold my liquor’ better.
- TRUE OR FALSE, YOU SHOULD BE CONCERNED IF THIS IS HAPPENING. If you find yourself better able to hold your liquor, your first concern should be whether or not you’re exhibiting signs of alcohol tolerance, with is an indication of dependency.
6. I can drive home because one or two drinks don’t make me drunk.
- FALSE: For your purposes, drunk is a legal definition based on your blood alcohol concentration (BAC). Even if you feel fine, after a single drink, your BAC will be high enough to get you put behind bars if something happens and you’re tested, regardless as to how you ‘feel’.
7. I’m not an alcoholic, I’m a drunk. Alcoholics go to meetings. Drunks go to parties.
- FALSE and only FUNNY until someone dies.
- Actually, you both go to the emergency room. And to jail. Way too often. Like this guy arrested for a DWI after crashing into a cop car while wearing the shirt. Stay classy.
If you have any other questions or myths you’d like busted, tee them up for me, and I’ll address them. Cheers!
I’m going to put my personal spin on an old favorite: Alcohol Facts vs. Fiction. Here’s your six-pack (plus one for the road) of common myths just waiting to be busted.
1. If I drink too much, I’ll get a beer belly.
- FALSE: Any ‘belly’ is caused by poor dietary intake and insufficient exercise. A beer drinker who’s otherwise in shape won’t have a beer belly. The young lady in the picture above is more likely to get a beer belly from the potato chips than the booze, which will give her plenty else about which to be concerned.
2. I get drunker from mixing dark liquor and light liquor, or from switching between beers and wines.
- FALSE: You’re drunk exclusively because of the concentration of alcohol in your body. Nothing more or less.
3. Drinking coffee sobers me up.
- FALSE: Alcohol in eliminated from the body by a certain fixed percentage per hour, regardless of height, weight, age or sex. Nothing you’re doing, including drinking coffee or taking a cold shower is accelerating that process.
4. A man of the same height and weight as a woman can more easily tolerate the same amount of liquor.
- TRUE: Women tend to get more affected by liquor than men because women (on average) have a higher proportion of fat stores than men. This allows the blood alcohol concentrate to become higher in women quicker when consuming the same amounts.
5. Drinking more frequently helps me ‘hold my liquor’ better.
- TRUE OR FALSE, YOU SHOULD BE CONCERNED IF THIS IS HAPPENING. If you find yourself better able to hold your liquor, your first concern should be whether or not you’re exhibiting signs of alcohol tolerance, with is an indication of dependency.
6. I can drive home because one or two drinks don’t make me drunk.
- FALSE: For your purposes, drunk is a legal definition based on your blood alcohol concentration (BAC). Even if you feel fine, after a single drink, your BAC will be high enough to get you put behind bars if something happens and you’re tested, regardless as to how you ‘feel’.
7. I’m not an alcoholic, I’m a drunk. Alcoholics go to meetings. Drunks go to parties.
- FALSE and only FUNNY until someone dies.
- Actually, you both go to the emergency room. And to jail. Way too often. Like this guy arrested for a DWI after crashing into a cop car while wearing the shirt. Stay classy.
If you have any other questions or myths you’d like busted, tee them up for me, and I’ll address them. Cheers!
Straight, No Chaser: Do You Drink Too Much?
It’s one of those Straight, No Chaser (literally) days. I haven’t addressed substance abuse much yet (and you know I will), but the problems with most intoxicating substances revolve around the same consideration. You had the most incredible time and got the most incredible high the first time, and you spend the rest of your life chasing the joy of that first buzz, which for most drugs you’ll never get. The difference with alcohol abuse is that alcohol is legal and comparatively inexpensive, so you get to keep trying without much fuss (or at least initially).
Let’s set the stage by standardizing some terms:
- Alcohol intoxication: You’re drunk and under the influence of alcohol.
- Alcohol abuse: Your drinking habits are unhealthy, resulting in bad consequences (e.g. at work, in your relationships, with the law).
- Alcohol dependency: You’re physically and/or mentally addicted to alcohol. You crave liquor and seemingly can’t do without it. Dependency involves withdrawal symptoms when alcohol is not in your system. These symptoms may include anxiety, nausea, sweating, jitteriness, shakes and even withdrawal seizures.
Alcoholism is a chronic disease. Unfortunately, some of us start with a predisposition based on genes and strong influences based on family and cultural considerations. It is so much more than either a lack of willpower or an inability to quit. This disease has a predictable course and defined effects on various parts of the body, leading to specific means of death if unaddressed. Because I’m Straight, No Chaser, I’m not going to deal with the subjective thoughts you offer about whether or not you can ‘handle your liquor’ or whether you believe ‘you can stop anytime you want’. I’m going to give you some medical data that defines when you’re doing damage to your body. It’s actually pretty simple.
Are you this guy or gal (keep in mind a standard drink is defined as one 12 ounce can of beer, 1 glass of wine or 1 mixed drink)?
- Women having more than 3 drinks at one time or more than 7 drinks a week.
- Men having more than 4 drinks at one time or more than 14 drinks a week.
If so, you’re causing damage. We’ll get into the specifics at another time.
That’s damage. Let’s discuss dependency. Consider the possibility that you may be dependent on alcohol if you have any of these problems over the course of a year:
- While you’re drinking, you can’t quit or control how much you drink.
- You have tried to quit drinking or to cut back the amount you drink but can’t.
- You need to drink more to get a previous effect (This is called ‘tolerance’.).
- You have withdrawal symptoms (discussed earlier) when you stop.
- You spend a lot of your time either drinking, recovering from drinking, or giving up other activities so you can drink.
- You continue to drink even though it harms your relationships and causes physical problems.
So What?
No one is giving up alcohol by reading this, I’m sure. I haven’t even touched to the harsh realities of alcoholism (yet). Alcohol is part of the American social fabric. We live, celebrate and commemorate milestones with it. It’s glamorized throughout society. It’s constitutionally approved. I appreciate that. In moderation, it’s a good time. Just understand that it’s not a free ride. The danger is in the insidious nature of this disease, meaning issues may creep up on you before you ever know what’s about to hit you. Then we’re having a completely different conversation.
I look forward to any questions or thoughts on the topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
It’s one of those Straight, No Chaser (literally) days. I haven’t addressed substance abuse much yet (and you know I will), but the problems with most intoxicating substances revolve around the same consideration. You had the most incredible time and got the most incredible high the first time, and you spend the rest of your life chasing the joy of that first buzz, which for most drugs you’ll never get. The difference with alcohol abuse is that alcohol is legal and comparatively inexpensive, so you get to keep trying without much fuss (or at least initially).
Let’s set the stage by standardizing some terms:
- Alcohol intoxication: You’re drunk and under the influence of alcohol.
- Alcohol abuse: Your drinking habits are unhealthy, resulting in bad consequences (e.g. at work, in your relationships, with the law).
- Alcohol dependency: You’re physically and/or mentally addicted to alcohol. You crave liquor and seemingly can’t do without it. Dependency involves withdrawal symptoms when alcohol is not in your system. These symptoms may include anxiety, nausea, sweating, jitteriness, shakes and even withdrawal seizures.
Alcoholism is a chronic disease. Unfortunately, some of us start with a predisposition based on genes and strong influences based on family and cultural considerations. It is so much more than either a lack of willpower or an inability to quit. This disease has a predictable course and defined effects on various parts of the body, leading to specific means of death if unaddressed. Because I’m Straight, No Chaser, I’m not going to deal with the subjective thoughts you offer about whether or not you can ‘handle your liquor’ or whether you believe ‘you can stop anytime you want’. I’m going to give you some medical data that defines when you’re doing damage to your body. It’s actually pretty simple.
Are you this guy or gal (keep in mind a standard drink is defined as one 12 ounce can of beer, 1 glass of wine or 1 mixed drink)?
- Women having more than 3 drinks at one time or more than 7 drinks a week.
- Men having more than 4 drinks at one time or more than 14 drinks a week.
If so, you’re causing damage. We’ll get into the specifics at another time.
That’s damage. Let’s discuss dependency. Consider the possibility that you may be dependent on alcohol if you have any of these problems over the course of a year:
- While you’re drinking, you can’t quit or control how much you drink.
- You have tried to quit drinking or to cut back the amount you drink but can’t.
- You need to drink more to get a previous effect (This is called ‘tolerance’.).
- You have withdrawal symptoms (discussed earlier) when you stop.
- You spend a lot of your time either drinking, recovering from drinking, or giving up other activities so you can drink.
- You continue to drink even though it harms your relationships and causes physical problems.
So What?
No one is giving up alcohol by reading this, I’m sure. I haven’t even touched to the harsh realities of alcoholism (yet). Alcohol is part of the American social fabric. We live, celebrate and commemorate milestones with it. It’s glamorized throughout society. It’s constitutionally approved. I appreciate that. In moderation, it’s a good time. Just understand that it’s not a free ride. The danger is in the insidious nature of this disease, meaning issues may creep up on you before you ever know what’s about to hit you. Then we’re having a completely different conversation.
I look forward to any questions or thoughts on the topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Your Questions about Human Bites
It seems that you found today’s post, well… biting. Here’s your questions and answers about human bites:
1) If human bites are so dangerous, why do women love Dracula so much?
- Seriously? Let’s just ascribe it to the neck being an erogenous zone and move on…
2) What’s a Boxer’s Fracture?
- A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.
3) Is a human’s mouth really dirtier than a goat’s mouth?
- It’s correct to say the bacteria in a human’s mouth cause more disease.
4) Is a bite the same as a puncture wound?
- The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).
5) I received a bite and didn’t get stitched up. Why?
- This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
- Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
- It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.
6) Why didn’t Dracula ever get Hepatitis or HIV?
- Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for awhile in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.
It seems that you found today’s post, well… biting. Here’s your questions and answers about human bites:
1) If human bites are so dangerous, why do women love Dracula so much?
- Seriously? Let’s just ascribe it to the neck being an erogenous zone and move on…
2) What’s a Boxer’s Fracture?
- A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.
3) Is a human’s mouth really dirtier than a goat’s mouth?
- It’s correct to say the bacteria in a human’s mouth cause more disease.
4) Is a bite the same as a puncture wound?
- The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).
5) I received a bite and didn’t get stitched up. Why?
- This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
- Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
- It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.
6) Why didn’t Dracula ever get Hepatitis or HIV?
- Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for awhile in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.
Straight No Chaser: Human Bites
I have had weird experiences with humans biting humans, as have most physicians. There are several different types of human bites, which can range from harmless to surgically serious, but as an emergency physician knowing the dangers of the bacteria inhabiting your mouth, I tend to assume the worst until proven otherwise. Your first Quick Tip is to do the same.
Maybe it’s where I’m located, but I tend to see way more ‘fight bites’ than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who ‘won’ the fight being the one who has to come in for medical treatment. He will have cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize how concentrated all of the structures (tendons, blood vessels, muscles and bones) are in the hand. He also doesn’t know that they’re confined to a very limited space, and seeding an infection in that space makes things really bad really quick. These guys are very dangerous because they tend to deny ever getting into the fight, ascribing the injury to something else (like punching a tree) – at least until I ask him why a tooth is inside his hand.
Then there’s the “Yes, I was bitten” variety, including activity where the teeth engaged the victim instead of the fist engaging a tooth. Think of the above Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears and other unmentionables)! Children sometimes need to learn to stop biting as a behavior. Biting is sometimes seen in sexual assault, physical abuse and in self-mutilating behavior or with mentally handicapped individuals.
A third type is the ‘We love too much!’ variety. These may include hickeys (that actually break the skin), folks biting off their hangnails, and individuals who create skin infections by biting their toenails and fingernails. Yes, it happens more than you’d think.
The commonality to all of these scenarios is saliva found its way through the skin. Because of the virulence of those bacteria contained within, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness and possibly pus from the wound and fever develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, you need to be evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop, and in fact these bites require immunization for tetanus. Bottom line: there’s no reason not to get evaluated if you develop those signs of infection I mentioned, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.
So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies, peroxide, alcohol and anything else that burns. You’re making things worse for yourself (those agents cause skin damage more than they’re ‘cleaning’ the area).
2) Apply ice – never directly to the wound, but in a towel. Use for 15 minutes off then 15 minutes on.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
I have had weird experiences with humans biting humans, as have most physicians. There are several different types of human bites, which can range from harmless to surgically serious, but as an emergency physician knowing the dangers of the bacteria inhabiting your mouth, I tend to assume the worst until proven otherwise. Your first Quick Tip is to do the same.
Maybe it’s where I’m located, but I tend to see way more ‘fight bites’ than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who ‘won’ the fight being the one who has to come in for medical treatment. He will have cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize how concentrated all of the structures (tendons, blood vessels, muscles and bones) are in the hand. He also doesn’t know that they’re confined to a very limited space, and seeding an infection in that space makes things really bad really quick. These guys are very dangerous because they tend to deny ever getting into the fight, ascribing the injury to something else (like punching a tree) – at least until I ask him why a tooth is inside his hand.
Then there’s the “Yes, I was bitten” variety, including activity where the teeth engaged the victim instead of the fist engaging a tooth. Think of the above Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears and other unmentionables)! Children sometimes need to learn to stop biting as a behavior. Biting is sometimes seen in sexual assault, physical abuse and in self-mutilating behavior or with mentally handicapped individuals.
A third type is the ‘We love too much!’ variety. These may include hickeys (that actually break the skin), folks biting off their hangnails, and individuals who create skin infections by biting their toenails and fingernails. Yes, it happens more than you’d think.
The commonality to all of these scenarios is saliva found its way through the skin. Because of the virulence of those bacteria contained within, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness and possibly pus from the wound and fever develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, you need to be evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop, and in fact these bites require immunization for tetanus. Bottom line: there’s no reason not to get evaluated if you develop those signs of infection I mentioned, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.
So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies, peroxide, alcohol and anything else that burns. You’re making things worse for yourself (those agents cause skin damage more than they’re ‘cleaning’ the area).
2) Apply ice – never directly to the wound, but in a towel. Use for 15 minutes off then 15 minutes on.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
