Category Archives: General Health and Wellness

Straight, No Chaser: Infection Prevention

sneeze_in_arm

There are things you know, there are things you know but don’t really know, and there are still other things that you think you know that you don’t know at all. When it comes to colds and influenza (both or which are simple to understand, prevent and treat), all of the above apply.

Are you sickly or do you get colds more frequently than others? Respectfully, a big part of that is because you have habits that put you at risk. Common things happen commonly.

germs-on-hands

Of course this is not an actual photo, but it’s a good depiction of what’s happening. Simply put, most of the day, your hands are pretty disgusting. You handle money that’s been handed hundreds if not thousands of times and never cleaned. You grab handles and door knobs all day long. You cough and sneeze throughout the day, spewing germs into the air to be inhaled by others. And you spend time in the restroom. Your unclean hands contribute to many ailments, including colds, influenza, conjunctivitis (pink eye) and gastroenteritis (vomiting and diarrhea) and skin infections.

The important points are there are simple things you can do to lower your risk for infections. First, you have to stop assuming you know more than you do about basic hygiene and allow yourself to start practicing better habits. For example …

  • When you sneeze, do you sneeze into your hands or into the air around you? Please learn the habit covering your mouth and nose when you sneeze or cough by sneezing/coughing into your elbow and not your hands.
  • How often do you wash your hands? You must wash every time you begin to cook, before you eat, after you use the rest room, before you change a diaper and before you apply any topical medicine.
  • Have you ever noticed how much you keep your hands on parts of you that can become infected by doing so? Keep your hands out of your eyes, mouth and nose, and stop picking at your skin!

handwashing2

Yes, you wash your hands, but do you do so effectively and when you need to? Hand washing must be the easiest and most effective ways to prevent disease. Let’s start with this: from now on, whatever you do to clean your hands, do it for twenty seconds. Of course, antimicrobial soap and water are what we all learned to do way back when. It works! If that’s not available, use hand sanitizer or disposable hand wipes. It that’s not available, just rinse your hands! Be sure to rub your hands vigorously during the process as if you’re trying to get someone off of your hands, because you are!

sneeze

 

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under Cardiology/Heart, General Health and Wellness, Health Prevention, Infectious Disease

Straight, No Chaser: What To Do If Your Tooth Comes Out

toothout

There’s nothing pleasant about having a tooth fall out of your mouth (aka avulsed tooth, dislocated tooth). Whether from trauma (e.g. a punch or other facial injury, a fall) or dental disease (e.g. gum or tooth disease), there are cosmetic and practical concerns with not having teeth in your mouth. Additionally, there’s no tooth fairy for adults.

MissingTooth_jpg

The question in real time is “My tooth just fell out. What should I do?” The answer depends on your age and health; the tooth might be able to be placed back into your socket. Today’s Straight, No Chaser gives you tips on how to increase the chances that replantation will be successful.

Which teeth are eligible? Baby teeth (those in children age eight and younger) are usually not replaced. Usually adult teeth can be replanted if appropriately handled.

avulsedtooth

What can I do?

Follow these steps:

  • Act promptly. You’re losing 1% probability that replantation will be successful with each passing minute.
  • If possible, get to a dentist. If you can’t reach a dentist, get to the closest emergency room.

avulsed-tooth

  • Only hold the tooth by its chewing edge (the crown) as shown in the picture, not by the other end (the root). Holding it by the root will damage the ligaments needed to make connections between the tooth and the mouth. Do not brush, clean or scrape the tooth off in an effort to remove dirt, especially at the root. Do not apply alcohol or any other abrasive solution (e.g. peroxide).
  • If it can be done safely, placing the tooth back in the socket from which it came is the right thing to do. If you do this, it needs to be level with other teeth, and you must be positive that you aren’t in a situation that might lead to you swallowing it. This can be facilitated by place a piece of gauze or a tea bag on top of the tooth, biting down and keeping your mouth closed during the trip.

avulsedtooth_milktransport_steps

  • If you have a small container, you can place the tooth in it. Then cover the tooth with a small amount of saliva or whole milk, and put this container in another container that has ice in it. Do not place an avulsed tooth directly on ice.
  • Alternatively you can just place the tooth directly into a small cup of milk or saliva.
  • As still another option, there are actually commercially available tooth-saving storage devices set up for this purpose.
  • If you don’t have a container, your best bet is to carry the tooth in your mouth, keeping it under your tongue or between your lower lips and gum. The same precautions about swallowing the tooth still apply here.

How do I prevent losing a tooth?

  • Avoid fights. It’s not worth losing a tooth.
  • When playing any contact sport, wear a mouth guard. They work.
  • Avoid chewing on bones, stale bread tough bagels and other hard foods, especially if you’re older or have either gum or dental disease.
  • Wear a seatbelt.

There is a fair to pretty good chance your avulsed tooth is accompanied by damaged nerves or a fractured jaw. The force required to traumatically dislodge a tooth is significant. Get seen ASAP if this happens, especially if you’re bleeding, can’t close your jaw or if you became unconscious.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under Dental, General Health and Wellness

Straight, No Chaser: Keys to Mental (Un)Health and (Un)Happiness

Mental-health

Straight, No Chaser is mindful that there are multitudes of us excessively happy and unhappy. Everyone has thoughts about the keys to happiness, but we can objectify the conversation and identify what’s most likely to make you unhappy and lead to depression. You may find this hard to believe, but outside of medical causes of psychiatric illness and factors outside of your control, there are actually three choices we make that most commonly adversely impact your happiness and good mental health. Take it for what you will, but the data is what it is. Stay away from these circumstances, and you’re less likely to be unhappy. Sometimes it’s about addition by subtraction.

HealthIssues

Health Problems: People who are sick or have significant illness in their families generally aren’t happy. Although this may seem obvious and perhaps unfair, given that some illnesses and conditions are inherited or occur haphazardly, be mindful of the things you can control. Of course, this gets to the negative effects of obesity and smoking. More so than any other health-related activities/conditions, these will eventually lead to deteriorating health and subsequent unhappiness.

need-job

Job Problems: You don’t have enough to do with your time? Yep, an idle mind is the Devil’s workshop, as the saying goes. It should be pointed out that neither too much work nor the wrong type of work (i.e., low job satisfaction) seems to promote happiness. On average, people change careers seven times during their lifetimes. It’s often due to a search for happiness and actually is a good thing to do to avoid being stuck in a bad situation. Follow the job you love, and you’re more likely to be both happy and successful.

relationship-problems

Relationship Problems: You make bad relationship choices? Well there’s one specific choice that is shown to be most likely to reduce your happiness—choosing a neurotic partner. What’s neurotic? For one particularly disruptive example, think about the so-called Drama Queen/King. A neurotic partner responds emotionally to events that wouldn’t affect most people, and their reactions tend to be more intense than normal. They’re more likely to interpret minor frustrations as hopelessly difficult. Their negative emotional reactions persist for unusually long periods of time. In short, if you want to be really unhappy, become attached to such a person. They will negatively affect your world, keeping you embroiled in drama and unhappiness, no matter how good the financial, physical, or other parts of your relationship.

Mental Health

Now your results may vary but probably won’t. I’m not make judgements, just sharing the data. Life choices have consequences. Choose wisely!

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under General Health and Wellness, Mental Health, Ophthalmology/Eyes

Straight, No Chaser in the News: Evaluating the Next Version of Trumpcare – The Graham-Cassidy Bill (Includes Numbers for Your Senator)

 

The newest effort to repeal and replace the Affordable Care Act (aka Obamacare, ACA) is called the Graham-Cassidy Bill. Although the actual legislation has been clouded in secrecy, there are a few fundamentals that can be shared, and we’ll present them in Q&A format. Be reminded that this reform is meant to impact approximately 1/6th of the United States economy. We’ve done our best to prevent facts Straight, No Chaser style, so consider points that seem slanted self-evident truths and evaluate your reaction to them.

I. What’s a block grant? Let’s address both the facts and the spin. Block grants are a means for the federal government to cap expenses by taking a fixed amount of funds (typically what’s currently or historically being spent) and offering those same funds to individual states for their management. This isn’t a new idea. Republicans have been pushing block grants for Medicaid since the Reagan administration (1981). Block grants were notably used in converting welfare (Aid to Families with Dependent Children) away from an entitlement program in 1996. The spin (and the danger) is states would be allowed to manage those funds as they saw fit, which allows for either greater or lesser health protections, as well as innovation and restrictions. Simply put, states would be empowered to decide what services are offered and who would qualify for those services.

2. What would happen to Medicaid? In the block grant scenario, the amount would be capped with annual adjustments to account for inflation, but those amounts would not keep pace with the rate of medical inflation. In other words, states would eventually have less money with which to work. Furthermore, the proposal explicitly ends coverage for childless adults and ends the Medicaid expansion that occurred under Obamacare and currently covers 15 million adults. As such, there will be a massive redistribution away from states who opted into the ACA Medicaid expansion toward those that did not. Although the Congressional Budget Office hasn’t yet had time to score the Graham-Cassidy bill, in the past, it has opined that block grant proposals could cut Medicaid spending by as much as a third over the next decade. That’s not all. Most notoriously, the block grant would end after 2026. That’s right, in ten years the federal government would have to renew the grant, or states would need to replace every last federal dollar or roll back coverage even more. In other words, all funds currently assigned to Medicaid and the ACA would no longer be spent by the federal government in ten years under the currently proposed bill. Whether or not you believe in reducing costs, you should be quite concerned about the lack of market stability that represents, much less what’s going to happen to health care in 10 years. A conservative estimate is tens of millions of Americans will lose healthcare under any scenario of Graham-Cassidy.

3. How are preexisting conditions affected? Here’s the facts and the spin. Based on the best information available, states would be required to “offer” services to those with preexisting conditions. However, remember that services are actually provided by insurance companies. This bill neither addresses pricing nor mandates affordability to those covered. Thus, a health service could be offered, but it is probable that the price of coverage will become so high for the high-risk patient and those with preexisting conditions that they’ll either elect to or not be able to pay the cost. The nuances here allow competing interests to claim both that pre-existing conditions are or are not going to be covered.

4. Is this supported by the medical and public health communities? How about the public? Every conceivable apolitical sector, from hospitals, insurance companies, health organizations and the public are speaking out against this proposal. On Saturday, a joint press release was signed by multiple prominent medical organizations and insurance companies, united in opposition to the bill. Signing healthcare entities included the following: American Medical Association, American Academy of Family Physicians, Federation of American Hospitals, American Hospital Association, American Health Insurance Plans and the Blue Cross Blue Shield Association. Here is a quote from the press release: “While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable healthcare market that provides access to high-quality care and affordable coverage for all… The Graham-Cassidy-Heller-Johnson bill does not move us closer to that goal. The Senate should reject it.” Only 24 percent of Americans support Graham-Cassidy, according to a new poll released Thursday by Public Policy Polling. Meanwhile, the public supports retaining the Affordable Care Act over replacing it with the proposed Graham-Cassidy bill by 56-33 percent in a new ABC News/Washington Post poll.

5. What’s going on with Obamacare (Affordable Care Act/ACA) these days? It actually is very much intact, although multiple executive orders have been enacted to weaken it (that will further the appearance and reality that it is flawed). The Trump administration has reduced advertising funds by 90% to announce enrollment, but you should know enrollment for 2018 starts November 1 and ends December 15.

6. Are there any women’s health concerns? It is implicit in the effort to rollback delivery of healthcare to the states that politics will play a role in multiple issues, including those of women’s health. It is explicitly of note that the Graham-Cassidy proposal eliminates federal funding to Planned Parenthood for one year.

7. How can I express my concern? What follows is an exhaustive list of contact numbers for your Senators. Media reporting suggests the number of calls hasn’t been close to that of previous efforts to repeal the ACA, so if you have a voice to share, you have until week’s end (Friday) to be heard.

State Senator Office Location Phone Number
Alabama Strange, Luther Birmingham (205) 731-1500
Alabama Strange, Luther Huntsville (256) 533-0979
Alabama Strange, Luther Mobile (251) 414-3083
Alabama Strange, Luther Montgomery (334) 230-0698
Alabama Strange, Luther Washington, D.C. (202) 224-4124
Alabama Strange, Luther Wiregrass (334) 792-4924
Alabama Shelby, Richard Birmingham (205) 731-1384
Alabama Shelby, Richard Huntsville (256) 772-0460
Alabama Shelby, Richard Mobile (251) 694-4164
Alabama Shelby, Richard Montgomery (334) 223-7303
Alabama Shelby, Richard Tuscaloosa (205) 759-5047
Alabama Shelby, Richard Washington, D.C. (202) 224-5744
Alaska Murkowski, Lisa Anchorage (907) 271-3735
Alaska Murkowski, Lisa Fairbanks (907) 456-0233
Alaska Murkowski, Lisa Juneau (907) 586-7277
Alaska Murkowski, Lisa Kenai (907) 283-5808
Alaska Murkowski, Lisa Ketchikan (907) 225-6880
Alaska Murkowski, Lisa Mat-Su Valley (907) 376-7665
Alaska Murkowski, Lisa Washington, D.C. (202) 224-6665
Alaska Sullivan, Dan Anchorage (907) 271-5915
Alaska Sullivan, Dan Fairbanks (907) 456-0261
Alaska Sullivan, Dan Juneau (907) 586-7277
Alaska Sullivan, Dan Kenai (907) 283-4000
Alaska Sullivan, Dan Ketchikan (907) 225-6880
Alaska Sullivan, Dan Mat-Su Valley (907) 357-9956
Alaska Sullivan, Dan Washington, D.C. (202) 224-3004
Arizona Flake, Jeff Phoenix (602) 840-1891
Arizona Flake, Jeff Tucson (520) 575-8633
Arizona Flake, Jeff Washington, D.C. (202) 224-4521
Arizona McCain, John Phoenix (602) 952-2410
Arizona McCain, John Prescott (928) 445-0833
Arizona McCain, John Tucson (520) 670-6334
Arizona McCain, John Washington, D.C. (202) 224-2235
Arkansas Boozman, John El Dorado (870) 863-4641
Arkansas Boozman, John Fort Smith (479) 573-0189
Arkansas Boozman, John Jonesboro (870) 268-6925
Arkansas Boozman, John Little Rock (501) 372-7153
Arkansas Boozman, John Lowell (479) 725-0400
Arkansas Boozman, John Mountain Home (870) 424-0129
Arkansas Boozman, John Stuttgart (870) 672-6941
Arkansas Boozman, John Washington, D.C. (202) 224-4843
Arkansas Cotton, Tom El Dorado (870) 864-8582
Arkansas Cotton, Tom Jonesboro (870) 933-6223
Arkansas Cotton, Tom Little Rock (501) 223-9081
Arkansas Cotton, Tom Springdale (479) 751-0879
Arkansas Cotton, Tom Washington, D.C. (202) 224-2353
California Feinstein, Dianne Fresno (559) 485-7430
California Feinstein, Dianne Los Angeles (310) 914-7300
California Feinstein, Dianne San Diego (619) 231-9712
California Feinstein, Dianne San Francisco (415) 393-0707
California Feinstein, Dianne Washington, D.C. (202) 224-3841
California Harris, Kamala Fresno (916) 448-2787
California Harris, Kamala Los Angeles (213) 894-5000
California Harris, Kamala Sacramento (916) 448-2787
California Harris, Kamala San Diego (619) 239-3884
California Harris, Kamala San Francisco (213) 894-5000
California Harris, Kamala Washington, D.C. (202) 224-3553
Colorado Bennet, Michael Arkansas Valley (719) 542-7550
Colorado Bennet, Michael Denver Metro (303) 455-7600
Colorado Bennet, Michael Four Corners (970) 259-1710
Colorado Bennet, Michael Northern Colorado (970) 224-2200
Colorado Bennet, Michael Northwest/I-70W (970) 241-6631
Colorado Bennet, Michael Pikes Peak (719) 328-1100
Colorado Bennet, Michael San Luis Valley (719) 587-0096
Colorado Bennet, Michael Washington, D.C. (202) 224-5852
Colorado Gardner, Cory Colorado Springs (719) 632-6706
Colorado Gardner, Cory Denver (303) 391-5777
Colorado Gardner, Cory Fort Collins (970) 484-3502
Colorado Gardner, Cory Grand Junction (970) 245-9553
Colorado Gardner, Cory Greeley (970) 352-5546
Colorado Gardner, Cory Pueblo (719) 543-1324
Colorado Gardner, Cory Washington, D.C. (202) 224-5941
Colorado Gardner, Cory Yuma (970) 848-3095
Connecticut Blumenthal, Richard Bridgeport (203) 330-0598
Connecticut Blumenthal, Richard Hartford (860) 258-6940
Connecticut Blumenthal, Richard Washington, D.C. (202) 224-2823
Connecticut Murphy, Chris Hartford (860) 549-8463
Connecticut Murphy, Chris Washington, D.C. (202) 224-4041
Delaware Carper, Tom Dover (302) 674-3308
Delaware Carper, Tom Georgetown (302) 856-7690
Delaware Carper, Tom Washington, D.C. (202) 224-2441
Delaware Carper, Tom Wilmington (302) 573-6291
Delaware Coons, Chris Dover (302) 736-5601
Delaware Coons, Chris Washington, D.C. (202) 224-5042
Delaware Coons, Chris Wilmington (302) 573-6345
Florida Nelson, Bill Broward (954) 693-4851
Florida Nelson, Bill Fort Myers (239) 334-7760
Florida Nelson, Bill Jacksonville (904) 346-4500
Florida Nelson, Bill Miami-Dade (305) 536-5999
Florida Nelson, Bill Orlando (407) 872-7161
Florida Nelson, Bill Tallahassee (850) 942-8415
Florida Nelson, Bill Tampa (813) 225-7040
Florida Nelson, Bill Washington, D.C. (202) 224-5274
Florida Nelson, Bill West Palm Beach (561) 514-0189
Florida Rubio, Marco Jacksonville (904) 398-8586
Florida Rubio, Marco Miami (305) 418-8553
Florida Rubio, Marco Naples (239) 213-1521
Florida Rubio, Marco Orlando (407) 254-2573
Florida Rubio, Marco Palm Beach (561) 775-3360
Florida Rubio, Marco Pensacola (850) 433-2603
Florida Rubio, Marco Tallahassee (850) 599-9100
Florida Rubio, Marco Tampa (813) 287-5035
Florida Rubio, Marco Washington, D.C. (202) 224-3041
Georgia Isakson, Johnny Atlanta (770) 661-0999
Georgia Isakson, Johnny Washington, D.C. (202) 224-3643
Georgia Perdue, David Atlanta (404) 865-0087
Georgia Perdue, David Washington, D.C. (202) 224-3521
Hawaii Hirono, Mazie Hawaii (808) 522-8970
Hawaii Hirono, Mazie Washington, D.C. (202) 224-6361
Hawaii Schatz, Brian Honolulu (808) 523-2061
Hawaii Schatz, Brian Washington, D.C. (202) 224-3934
Idaho Crapo, Mike Eastern Idaho, North (208) 522-9779
Idaho Crapo, Mike Eastern Idaho, South (208) 236-6775
Idaho Crapo, Mike Idaho State (208) 334-1776
Idaho Crapo, Mike North Idaho (208) 664-5490
Idaho Crapo, Mike North-Central Idaho (208) 743-1492
Idaho Crapo, Mike South-Central Idaho (208) 734-2515
Idaho Crapo, Mike Washington, D.C. (202) 224-6142
Idaho Risch, Jim Boise (208) 342-7985
Idaho Risch, Jim Coeur D’Alene (208) 667-6130
Idaho Risch, Jim Idaho Falls (208) 523-5541
Idaho Risch, Jim Lewiston (208) 743-0792
Idaho Risch, Jim Pocatello (208) 236-6817
Idaho Risch, Jim Twin Falls (208) 734-6780
Idaho Risch, Jim Washington, D.C. (202) 224-2752
Illinois Duckworth, Tammy Chicago (312) 886-3506
Illinois Duckworth, Tammy Washington, D.C. (202) 224-2854
Illinois Durbin, Richard Carbondale (618) 351-1122
Illinois Durbin, Richard Chicago (312) 353-4952
Illinois Durbin, Richard Rock Island (309) 786-5173
Illinois Durbin, Richard Springfield (217) 492-4062
Illinois Durbin, Richard Washington, D.C. (202) 224-2152
Indiana Donnelly, Joe Evansville (812) 425-5813
Indiana Donnelly, Joe Fort Wayne (260) 420-4955
Indiana Donnelly, Joe Hammond (219) 852-0089
Indiana Donnelly, Joe Indianapolis (317) 226-5555
Indiana Donnelly, Joe Jeffersonville (812) 284-2027
Indiana Donnelly, Joe South Bend (574) 288-2780
Indiana Donnelly, Joe Washington, D.C. (202) 224-4814
Indiana Young, Todd Evansville
Indiana Young, Todd Fort Wayne
Indiana Young, Todd Indianapolis (317) 226-6700
Indiana Young, Todd New Albany (812) 542-4820
Indiana Young, Todd Washington, D.C. (202) 224-5623
Iowa Ernst, Joni Cedar Rapids (319) 365-4504
Iowa Ernst, Joni Council Bluffs (712) 352-1167
Iowa Ernst, Joni Davenport (563) 322-0677
Iowa Ernst, Joni Des Moines (515) 284-4574
Iowa Ernst, Joni Sioux City (712) 252-1550
Iowa Ernst, Joni Washington, D.C. (202) 224-3254
Iowa Grassley, Chuck Cedar Rapids (319) 363-6832
Iowa Grassley, Chuck Council Bluffs (712) 322-7103
Iowa Grassley, Chuck Davenport (563) 322-4331
Iowa Grassley, Chuck Des Moines (515) 288-1145
Iowa Grassley, Chuck Sioux City (712) 233-1860
Iowa Grassley, Chuck Washington, D.C. (202) 224-3744
Iowa Grassley, Chuck Waterloo (319) 232-6657
Kansas Moran, Jerry Hays (785) 628-6401
Kansas Moran, Jerry Manhattan (785) 539-8973
Kansas Moran, Jerry Olathe (913) 393-0711
Kansas Moran, Jerry Pittsburg (620) 232-2286
Kansas Moran, Jerry Washington, D.C. (202) 224-6521
Kansas Moran, Jerry Wichita (316) 631-1410
Kansas Roberts, Pat Dodge City (620) 227-2244
Kansas Roberts, Pat Overland Park (913) 451-9343
Kansas Roberts, Pat Topeka (785) 295-2745
Kansas Roberts, Pat Washington, D.C. (202) 224-4774
Kansas Roberts, Pat Wichita (316) 263-0416
Kentucky McConnell, Mitch Bowling Green (270) 781-1673
Kentucky McConnell, Mitch Ft. Wright (859) 578-0188
Kentucky McConnell, Mitch Lexington (859) 224-8286
Kentucky McConnell, Mitch London (606) 864-2026
Kentucky McConnell, Mitch Louisville (502) 582-6304
Kentucky McConnell, Mitch Paducah (270) 442-4554
Kentucky McConnell, Mitch Washington, D.C. (202) 224-2541
Kentucky Paul, Rand Bowling Green (270) 782-8303
Kentucky Paul, Rand Crescent Springs (859) 426-0165
Kentucky Paul, Rand Hopkinsville (270) 885-1212
Kentucky Paul, Rand Lexington (859) 219-2239
Kentucky Paul, Rand Louisville (502) 582-5341
Kentucky Paul, Rand Owensboro (270) 689-9085
Kentucky Paul, Rand Washington, D.C. (202) 224-4343
Lousiana Cassidy, Bill Alexandria (318) 448-7176
Lousiana Cassidy, Bill Baton Rouge (225) 929-7711
Lousiana Cassidy, Bill Lafayette (337) 261-1400
Lousiana Cassidy, Bill Lake Charles (337) 493-5398
Lousiana Cassidy, Bill Metairie (504) 838-0130
Lousiana Cassidy, Bill Monroe (318) 324-2111
Lousiana Cassidy, Bill Shreveport (318) 798-3215
Lousiana Cassidy, Bill Washington, D.C. (202) 224-5824
Lousiana Kennedy, John Washington, D.C. (202) 224-4623
Maine Collins, Susan Augusta (207) 622-8414
Maine Collins, Susan Bangor (207) 945-0417
Maine Collins, Susan Biddeford (207) 283-1101
Maine Collins, Susan Caribou (207) 493-7873
Maine Collins, Susan Lewiston (207) 784-6969
Maine Collins, Susan Portland (207) 780-3575
Maine Collins, Susan Washington, D.C. (202) 224-2523
Maine King, Angus Augusta (207) 622-8292
Maine King, Angus Bangor (207) 945-8000
Maine King, Angus Presque Isle (207) 764-5124
Maine King, Angus Scarborough (207) 883-1588
Maine King, Angus Washington, D.C. (202) 224-5344
Maryland Cardin, Ben Baltimore (410) 962-4436
Maryland Cardin, Ben Bowie (301) 860-0414
Maryland Cardin, Ben Cumberland (301) 777-2957
Maryland Cardin, Ben Rockville (301) 762-2974
Maryland Cardin, Ben Salisbury (410) 546-4250
Maryland Cardin, Ben Southern Maryland (202) 870-1164
Maryland Cardin, Ben Washington, D.C. (202) 224-4524
Maryland Van Hollen, Chris Washington, D.C. (202) 224-4654
Massachusetts Markey, Ed Boston (617) 565-8519
Massachusetts Markey, Ed Fall River (508) 677-0523
Massachusetts Markey, Ed Springfield (413) 785-4610
Massachusetts Markey, Ed Washington, D.C. (202) 224-2742
Massachusetts Warren, Elizabeth Boston (617) 565-3170
Massachusetts Warren, Elizabeth Springfield (413) 788-2690
Massachusetts Warren, Elizabeth Washington, D.C. (202) 224-4543
Michigan Peters, Gary Detroit (313) 226-6020
Michigan Peters, Gary Grand Rapids (616) 233-9150
Michigan Peters, Gary Lansing (517) 377-1508
Michigan Peters, Gary Marquette (906) 226-4554
Michigan Peters, Gary Rochester (248) 608-8040
Michigan Peters, Gary Saginaw (989) 754-0112
Michigan Peters, Gary Traverse City (231) 947-7773
Michigan Peters, Gary Washington, D.C. (202) 224-6221
Michigan Stabenow, Debbie Flint/Saginaw Bay (810) 720-4172
Michigan Stabenow, Debbie Mid-Michigan (517) 203-1760
Michigan Stabenow, Debbie Northern Michigan (231) 929-1031
Michigan Stabenow, Debbie Southeast Michigan (313) 961-4330
Michigan Stabenow, Debbie Upper Peninsula (906) 228-8756
Michigan Stabenow, Debbie Washington, D.C. (202) 224-4822
Michigan Stabenow, Debbie West Michigan (616) 975-0052
Minnesota Franken, Al Duluth (218) 722-2390
Minnesota Franken, Al Moorhead (218) 284-8721
Minnesota Franken, Al Rochester (507) 288-2003
Minnesota Franken, Al Saint Paul (651) 221-1016
Minnesota Franken, Al Washington, D.C. (202) 224-5641
Minnesota Klobuchar, Amy Metro (612) 727-5220
Minnesota Klobuchar, Amy Northeastern (218) 741-9690
Minnesota Klobuchar, Amy Northwestern & Central (218) 287-2219
Minnesota Klobuchar, Amy Southern (507) 288-5321
Minnesota Klobuchar, Amy Washington, D.C. (202) 224-3244
Mississippi Cochran, Thad Gulf Coast (228) 867-9710
Mississippi Cochran, Thad Jackson (601) 965-4459
Mississippi Cochran, Thad Oxford (662) 236-1018
Mississippi Cochran, Thad Washington, D.C. (202) 224-5054
Mississippi Wicker, Roger Gulfport (228) 871-7017
Mississippi Wicker, Roger Hernando (662) 429-1002
Mississippi Wicker, Roger Jackson (601) 965-4644
Mississippi Wicker, Roger Tupelo (662) 844-5010
Mississippi Wicker, Roger Washington, D.C. (202) 224-6253
Missouri Blunt, Roy Cape Girardeau (573) 334-7044
Missouri Blunt, Roy Columbia (573) 442-8151
Missouri Blunt, Roy Kansas City (816) 471-7141
Missouri Blunt, Roy Springfield (417) 877-7814
Missouri Blunt, Roy St. Louis/Clayton (314) 725-4484
Missouri Blunt, Roy Washington, D.C. (202) 224-5721
Missouri McCaskill, Claire Cape Girardeau (573) 651-0964
Missouri McCaskill, Claire Columbia (573) 442-7130
Missouri McCaskill, Claire Kansas City (816) 421-1639
Missouri McCaskill, Claire Springfield (417) 868-8745
Missouri McCaskill, Claire St. Louis (314) 367-1364
Missouri McCaskill, Claire Washington, D.C. (202) 224-6154
Montana Daines, Steve Billings (406) 245-6822
Montana Daines, Steve Bozeman (406) 587-3446
Montana Daines, Steve Great Falls (406) 453-0148
Montana Daines, Steve Hardin (406) 665-4126
Montana Daines, Steve Helena (406) 443-3189
Montana Daines, Steve Kalispell (406) 257-3765
Montana Daines, Steve Missoula (406) 549-8198
Montana Daines, Steve Sidney (406) 482-9010
Montana Daines, Steve Washington, D.C. (202) 224-2651
Montana Tester, Jon Billings (406) 252-0550
Montana Tester, Jon Bozeman (406) 586-4450
Montana Tester, Jon Butte (406) 723-3277
Montana Tester, Jon Glendive (406) 365-2391
Montana Tester, Jon Great Falls (406) 452-9585
Montana Tester, Jon Helena (406) 449-5401
Montana Tester, Jon Kalispell (406) 257-3360
Montana Tester, Jon Missoula (406) 728-3003
Montana Tester, Jon Washington, D.C. (202) 224-2644
Nebraska Fischer, Deb Kearney (308) 234-2361
Nebraska Fischer, Deb Lincoln (402) 441-4600
Nebraska Fischer, Deb Norfolk (402) 200-8816
Nebraska Fischer, Deb Omaha (402) 391-3411
Nebraska Fischer, Deb Scottsbluff (308) 630-2329
Nebraska Fischer, Deb Washington, D.C. (202) 224-6551
Nebraska Sasse, Ben Kearney (308) 233-3677
Nebraska Sasse, Ben Lincoln (402) 476-1400
Nebraska Sasse, Ben Omaha (402) 550-8040
Nebraska Sasse, Ben Scottsbluff (308) 632-6032
Nebraska Sasse, Ben Washington, D.C. (202) 224-4224
Nevada Cortez Masto, Catherine Las Vegas (702) 388-5020
Nevada Cortez Masto, Catherine Reno (775) 686-5750
Nevada Cortez Masto, Catherine Washington, D.C. (202) 224-3542
Nevada Heller, Dean Las Vegas (702) 388-6605
Nevada Heller, Dean Reno (775) 686-5770
Nevada Heller, Dean Washington, D.C. (202) 224-6244
New Hampshire Hassan, Maggie Manchester (603) 622-2204
New Hampshire Hassan, Maggie Washington, D.C. (202) 224-3324
New Hampshire Shaheen, Jeanne Berlin (603) 752-6300
New Hampshire Shaheen, Jeanne Claremont (603) 542-4872
New Hampshire Shaheen, Jeanne Dover (603) 750-3004
New Hampshire Shaheen, Jeanne Keene (603) 358-6604
New Hampshire Shaheen, Jeanne Manchester (603) 647-7500
New Hampshire Shaheen, Jeanne Nashua (603) 883-0196
New Hampshire Shaheen, Jeanne Washington, D.C. (202) 224-2841
New Jersey Booker, Cory Camden (856) 338-8922
New Jersey Booker, Cory Newark (973) 639-8700
New Jersey Booker, Cory Washington, D.C. (202) 224-3224
New Jersey Menendez, Bob Barrington (856) 757-5353
New Jersey Menendez, Bob Newark (973) 645-3030
New Jersey Menendez, Bob Washington, D.C. (202) 224-4744
New Mexico Heinrich, Martin Albuquerque (505) 346-6601
New Mexico Heinrich, Martin Farmington (505) 325-5030
New Mexico Heinrich, Martin Las Cruces (575) 523-6561
New Mexico Heinrich, Martin Roswell (575) 622-7113
New Mexico Heinrich, Martin Santa Fe (505) 988-6647
New Mexico Heinrich, Martin Washington, D.C. (202) 224-5521
New Mexico Udall, Tom Albuquerque (505) 346-6791
New Mexico Udall, Tom Carlsbad (575) 234-0366
New Mexico Udall, Tom Eastside (575) 356-6811
New Mexico Udall, Tom Las Cruces (575) 526-5475
New Mexico Udall, Tom Santa Fe (505) 988-6511
New Mexico Udall, Tom Washington, D.C. (202) 224-6621
New York Gillibrand, Kirsten Albany (518) 431-0120
New York Gillibrand, Kirsten Buffalo (716) 854-9725
New York Gillibrand, Kirsten Hudson Valley (845) 875-4585
New York Gillibrand, Kirsten Long Island (631) 249-2825
New York Gillibrand, Kirsten New York City (212) 688-6262
New York Gillibrand, Kirsten North Country (315) 376-6118
New York Gillibrand, Kirsten Rochester (585) 263-6250
New York Gillibrand, Kirsten Syracuse (315) 448-0470
New York Gillibrand, Kirsten Washington, D.C. (202) 224-4451
New York Schumer, Chuck Albany (518) 431-4070
New York Schumer, Chuck Binghamton (607) 772-6792
New York Schumer, Chuck Buffalo (716) 846-4111
New York Schumer, Chuck Melville (631) 753-0978
New York Schumer, Chuck New York City (212) 486-4430
New York Schumer, Chuck Peekskill (914) 734-1532
New York Schumer, Chuck Rochester (585) 263-5866
New York Schumer, Chuck Syracuse (315) 423-5471
New York Schumer, Chuck Washington, D.C. (202) 224-6542
North Carolina Burr, Richard Asheville (828) 350-2437
North Carolina Burr, Richard Gastonia (704) 833-0854
North Carolina Burr, Richard Rocky Mount (252) 977-9522
North Carolina Burr, Richard Washington, D.C. (202) 224-3154
North Carolina Burr, Richard Wilmington (910) 251-1058
North Carolina Burr, Richard Winston-Salem (336) 631-5125
North Carolina Tillis, Thom Charlotte (704) 509-9087
North Carolina Tillis, Thom Greenville (252) 329-0371
North Carolina Tillis, Thom Hendersonville (828) 693-8750
North Carolina Tillis, Thom High Point (336) 885-0685
North Carolina Tillis, Thom Raleigh (919) 856-4630
North Carolina Tillis, Thom Washington, D.C. (202) 224-6342
North Dakota Heitkamp, Heidi Bismarck (701) 258-4648
North Dakota Heitkamp, Heidi Dickinson (701) 225-0974
North Dakota Heitkamp, Heidi Fargo (701) 232-8030
North Dakota Heitkamp, Heidi Grand Forks (701) 775-9601
North Dakota Heitkamp, Heidi Minot (701) 852-0703
North Dakota Heitkamp, Heidi Washington, D.C. (202) 224-2043
North Dakota Hoeven, John Bismarck (701) 250-4618
North Dakota Hoeven, John Fargo (701) 239-5389
North Dakota Hoeven, John Grand Forks (701) 746-8972
North Dakota Hoeven, John Minot (701) 838-1361
North Dakota Hoeven, John Washington, D.C. (202) 224-2551
North Dakota Hoeven, John Western North Dakota (701) 580-4535
Ohio Brown, Sherrod Cincinnati (513) 684-1021
Ohio Brown, Sherrod Cleveland (216) 522-7272
Ohio Brown, Sherrod Columbus (614) 469-2083
Ohio Brown, Sherrod Lorain (440) 242-4100
Ohio Brown, Sherrod Washington, D.C. (202) 224-2315
Ohio Portman, Rob Cincinnati (513) 684-3265
Ohio Portman, Rob Cleveland (216) 522-7095
Ohio Portman, Rob Columbus (614) 469-6774
Ohio Portman, Rob Toledo (419) 259-3895
Ohio Portman, Rob Washington, D.C. (202) 224-3353
Oklahoma Inhofe, Jim Enid (580) 234-5105
Oklahoma Inhofe, Jim McAlester (918) 426-0933
Oklahoma Inhofe, Jim Oklahoma City (405) 608-4381
Oklahoma Inhofe, Jim Tulsa (918) 748-5111
Oklahoma Inhofe, Jim Washington, D.C. (202) 224-4721
Oklahoma Lankford, James Oklahoma City (405) 231-4941
Oklahoma Lankford, James Tulsa (918) 581-7651
Oklahoma Lankford, James Washington, D.C. (202) 224-5754
Oregon Merkley, Jeff Bend (541) 318-1298
Oregon Merkley, Jeff Eugene (541) 465-6750
Oregon Merkley, Jeff Medford (541) 608-9102
Oregon Merkley, Jeff Pendleton (541) 278-1129
Oregon Merkley, Jeff Portland (503) 326-3386
Oregon Merkley, Jeff Salem (503) 362-8102
Oregon Merkley, Jeff Washington, D.C. (202) 224-3753
Oregon Wyden, Ron Bend (541) 330-9142
Oregon Wyden, Ron Eugene (541) 431-0229
Oregon Wyden, Ron La Grande (541) 962-7691
Oregon Wyden, Ron Medford (541) 858-5122
Oregon Wyden, Ron Portland (503) 326-7525
Oregon Wyden, Ron Salem (503) 589-4555
Oregon Wyden, Ron Washington, D.C. (202) 224-5244
Pennsylvania Casey, Bob Central Pa (814) 357-0314
Pennsylvania Casey, Bob Erie (814) 874-5080
Pennsylvania Casey, Bob Harrisburg (717) 231-7540
Pennsylvania Casey, Bob Lehigh Valley (610) 782-9470
Pennsylvania Casey, Bob Northeastern (570) 941-0930
Pennsylvania Casey, Bob Philadelphia (215) 405-9660
Pennsylvania Casey, Bob Pittsburgh (412) 803-7370
Pennsylvania Casey, Bob Washington, D.C. (202) 224-6324
Pennsylvania Toomey, Pat Allentown/Lehigh Valley (610) 434-1444
Pennsylvania Toomey, Pat Erie (814) 453-3010
Pennsylvania Toomey, Pat Harrisburg (717) 782-3951
Pennsylvania Toomey, Pat Johnstown (814) 266-5970
Pennsylvania Toomey, Pat Philadelphia (215) 241-1090
Pennsylvania Toomey, Pat Pittsburgh (412) 803-3501
Pennsylvania Toomey, Pat Scranton (570) 941-3540
Pennsylvania Toomey, Pat Washington, D.C. (202) 224-4254
Rhode Island Reed, Jack Cranston (401) 943-3100
Rhode Island Reed, Jack Providence (401) 528-5200
Rhode Island Reed, Jack Washington, D.C. (202) 224-4642
Rhode Island Whitehouse, Sheldon Providence (401) 453-5294
Rhode Island Whitehouse, Sheldon Washington, D.C. (202) 224-2921
South Carolina Graham, Lindsey Golden Corner (864) 646-4090
South Carolina Graham, Lindsey Lowcountry (843) 849-3887
South Carolina Graham, Lindsey Midlands (803) 933-0112
South Carolina Graham, Lindsey Pee Dee (843) 669-1505
South Carolina Graham, Lindsey Piedmont (803) 366-2828
South Carolina Graham, Lindsey Upstate (864) 250-1417
South Carolina Graham, Lindsey Washington, D.C. (202) 224-5972
South Carolina Scott, Tim Lowcountry (843) 727-4525
South Carolina Scott, Tim Midlands (803) 771-6112
South Carolina Scott, Tim Upstate (864) 233-5366
South Carolina Scott, Tim Washington, D.C. (202) 224-6121
South Dakota Rounds, Mike Aberdeen (605) 225-0366
South Dakota Rounds, Mike Pierre (605) 224-1450
South Dakota Rounds, Mike Rapid City (605) 343-5035
South Dakota Rounds, Mike Sioux Falls (605) 336-0486
South Dakota Rounds, Mike Washington, D.C. (202) 224-5842
South Dakota Thune, John Aberdeen (605) 225-8823
South Dakota Thune, John Rapid City (605) 348-7551
South Dakota Thune, John Sioux Falls (605) 334-9596
South Dakota Thune, John Washington, D.C. (202) 224-2321
Tennessee Alexander, Lamar Chattanooga (423) 752-5337
Tennessee Alexander, Lamar Jackson (731) 664-0289
Tennessee Alexander, Lamar Knoxville (865) 545-4253
Tennessee Alexander, Lamar Memphis (901) 544-4224
Tennessee Alexander, Lamar Nashville (615) 736-5129
Tennessee Alexander, Lamar Tri-Cities (423) 325-6240
Tennessee Alexander, Lamar Washington, D.C. (202) 224-4944
Tennessee Corker, Bob Chattanooga (423) 756-2757
Tennessee Corker, Bob Jackson (731) 664-2294
Tennessee Corker, Bob Knoxville (865) 637-4180
Tennessee Corker, Bob Memphis (901) 683-1910
Tennessee Corker, Bob Nashville (615) 279-8125
Tennessee Corker, Bob Tri-Cities (423) 753-2263
Tennessee Corker, Bob Washington, D.C. (202) 224-3344
Texas Cornyn, John Central Texas (512) 469-6034
Texas Cornyn, John East Texas (903) 593-0902
Texas Cornyn, John North Texas (972) 239-1310
Texas Cornyn, John South Central Texas (210) 224-7485
Texas Cornyn, John South Texas (956) 423-0162
Texas Cornyn, John Southeast Texas (713) 572-3337
Texas Cornyn, John Washington, D.C. (202) 224-2934
Texas Cornyn, John West Texas (806) 472-7533
Texas Cruz, Ted Central Texas (512) 916-5834
Texas Cruz, Ted East Texas (903) 593-5130
Texas Cruz, Ted North Texas (214) 599-8749
Texas Cruz, Ted South Texas (956) 686-7339
Texas Cruz, Ted South/Central Texas (210) 340-2885
Texas Cruz, Ted Southeast Texas (713) 718-3057
Texas Cruz, Ted Washington, D.C. (202) 224-5922
Utah Hatch, Orrin Cedar City (435) 586-8435
Utah Hatch, Orrin Ogden (801) 625-5672
Utah Hatch, Orrin Provo (801) 375-7881
Utah Hatch, Orrin Salt Lake City (801) 524-4380
Utah Hatch, Orrin St. George (435) 634-1795
Utah Hatch, Orrin Washington, D.C. (202) 224-5251
Utah Lee, Mike Ogden (801) 392-9633
Utah Lee, Mike Salt Lake City (801) 524-5933
Utah Lee, Mike St. George (435) 628-5514
Utah Lee, Mike Washington, D.C. (202) 224-5444
Vermont Leahy, Patrick Burlington (802) 863-2525
Vermont Leahy, Patrick Montpelier (802) 229-0569
Vermont Leahy, Patrick Washington, D.C. (202) 224-4242
Vermont Sanders, Bernie Burlington (802) 862-0697
Vermont Sanders, Bernie St. Johnsbury (802) 748-9269
Vermont Sanders, Bernie Washington, D.C. (202) 224-5141
Virginia Kaine, Tim Abingdon (276) 525-4790
Virginia Kaine, Tim Manassas (703) 361-3192
Virginia Kaine, Tim Richmond (804) 771-2221
Virginia Kaine, Tim Roanoke (540) 682-5693
Virginia Kaine, Tim Virginia Beach (757) 518-1674
Virginia Kaine, Tim Washington, D.C. (202) 224-4024
Virginia Kaine, Tim Washington, D.C. (202) 224-4024
Virginia Warner, Mark Abingdon (276) 628-8158
Virginia Warner, Mark Norfolk (757) 441-3079
Virginia Warner, Mark Richmond (804) 775-2314
Virginia Warner, Mark Roanoke (540) 857-2676
Virginia Warner, Mark Vienna (703) 442-0670
Virginia Warner, Mark Washington, D.C. (202) 224-2023
Washington Cantwell, Maria Everett (425) 303-0114
Washington Cantwell, Maria Richland (509) 946-8106
Washington Cantwell, Maria Seattle (206) 220-6400
Washington Cantwell, Maria Spokane (509) 353-2507
Washington Cantwell, Maria Tacoma (253) 572-2281
Washington Cantwell, Maria Vancouver (360) 696-7838
Washington Cantwell, Maria Washington, D.C. (202) 224-3441
Washington Murray, Patty Everett (425) 259-6515
Washington Murray, Patty Seattle (206) 553-5545
Washington Murray, Patty Spokane (509) 624-9515
Washington Murray, Patty Tacoma (253) 572-3636
Washington Murray, Patty Vancouver (360) 696-7797
Washington Murray, Patty Washington, D.C. (202) 224-2621
Washington Murray, Patty Yakima (509) 453-7462
West Virginia Capito, Shelley Moore Beckley (304) 347-5372
West Virginia Capito, Shelley Moore Charleston (304) 347-5372
West Virginia Capito, Shelley Moore Martinsburg (304) 262-9285
West Virginia Capito, Shelley Moore Morgantown (304) 292-2310
West Virginia Capito, Shelley Moore Washington, D.C. (202) 224-6472
West Virginia Manchin, Joe Charleston (304) 342-5855
West Virginia Manchin, Joe Eastern Panhandle (304) 264-4626
West Virginia Manchin, Joe Fairmont (304) 368-0567
West Virginia Manchin, Joe Washington, D.C. (202) 224-3954
Wisconsin Baldwin, Tammy Eau Claire (715) 832-8424
Wisconsin Baldwin, Tammy Green Bay (920) 498-2668
Wisconsin Baldwin, Tammy La Crosse (608) 796-0045
Wisconsin Baldwin, Tammy Madison (608) 264-5338
Wisconsin Baldwin, Tammy Milwaukee (414) 297-4451
Wisconsin Baldwin, Tammy Washington, D.C. (202) 224-5653
Wisconsin Baldwin, Tammy Wausau (715) 261-2611
Wisconsin Johnson, Ron Milwaukee (414) 276-7282
Wisconsin Johnson, Ron Oshkosh (920) 230-7250
Wisconsin Johnson, Ron Washington, D.C. (202) 224-5323
Wyoming Barrasso, John Casper (307) 261-6413
Wyoming Barrasso, John Cheyenne (307) 772-2451
Wyoming Barrasso, John Riverton (307) 856-6642
Wyoming Barrasso, John Rock Springs (307) 362-5012
Wyoming Barrasso, John Sheridan (307) 672-6456
Wyoming Barrasso, John Washington, D.C. (202) 224-6441
Wyoming Enzi, Michael Casper (307) 261-6572
Wyoming Enzi, Michael Cheyenne (307) 772-2477
Wyoming Enzi, Michael Cody (307) 527-9444
Wyoming Enzi, Michael Gillette (307) 682-6268
Wyoming Enzi, Michael Jackson (307) 739-9507
Wyoming Enzi, Michael Washington, D.C. (202) 224-3424

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

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Straight, No Chaser: Prostate Cancer Screening

prostate-to-do-2

Every so often, controversies regarding medical treatment recommendations get in the news and seemingly only serve to confuse the public. Every blog, article or research paper is a single entity that may or may not adjust the body and weight of evidence on a given topic. Even most well-done research articles do not completely change the standard of care for medical practice. Prostate cancer screening is a great example. At the end of it all, controversies aren’t as important as the consensus recommendations that emerge from medical and public health professionals tasked with reviewing such information.

In this Straight, No Chaser, we will review the 2015 recommendations from the American Cancer Society (ACS) for early detection of prostate cancer. Remember, when you hear dissenting views, consider the source and balance that against the formal recommendations of ACS.

In an earlier Straight, No Chaser, several questions regarding prostate cancer were addressed. However, there is one additional question that is important to review.

Does Everyone With Prostate Cancer Get Treated?


prostate screening risks benefits

This is the source of controversies regarding screening of prostate cancer. Most men diagnosed with prostate cancer do not die from the disease. I mentioned previously that 30,000 men with prostate cancer die of the disease every year. However, over 2.5 million men in the U.S. are currently living with a diagnosis of prostate cancer. Based on these statistics, the question then becomes…

Why Do All Men Need to Be Screened For Prostate Cancer?

A certain stream of logic asks why screening is necessary if most of those who are diagnosed don’t die. Many treatments (e.g. surgery, medications, radiation) have additional risks that could be avoided if interventions were avoided. Similarly, some have taken to asking if any screening program is necessary. The view here is information is empowering. It’s always better to have information regarding the state of your health. Working with your medical team and family, the correct decisions about next steps can be made. This option is only available if you know what’s happening with your health.

How Does Screening Occur?

prostate exam

There are two tests commonly used to screen for prostate cancer.

  • A digital rectal exam (DRE) is when a doctor inserts a gloved, lubricated finger into the rectum and estimates the size of the prostate and assesses it for lumps or other abnormalities.
  • The prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate, and PSA blood levels can be higher in men who have prostate cancer. Unfortunately the PSA level isn’t specific for prostate cancer, as it can be elevated in other conditions that affect the prostate such as age, race, certain medications or medical procedures, prostate enlargement or infection.

So What Are The Current Recommendations for screening?

prostate cancer screening guidelines

The American Cancer Society (ACS) recommends that men get to decide if they want to be screened, based on a recommendation from their physician and having received information about the risks, benefits and uncertainties surrounding screening. In other words, we don’t even talk about screening anymore; now it’s “Who should have a conversation with their physician about getting screened?”

  • If you’re age 50 and have an average risk of prostate cancer and are expected to live at least 10 more years. Because prostate cancer grows slowly, if your life expectancy is less than 10 years, you wouldn’t benefit from screening or treatment for prostate cancer.
  • If you’re age 45 for men and are at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
  • If you’re age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Among these groups, when the decision is made to screen, those men will be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.

Assuming no prostate cancer is found as a result of screening, the need for future screenings depends on the results of the PSA blood test:

  • Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
  • Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.

Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences. Please at least have the conversation with your physician.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Straight, No Chaser: Prostate Cancer – 2017 Update

prostate-cancer_medium

Men (and those who care for men – meaning everyone) should be knowledgeable about prostate cancer. I don’t mean physician-level knowledgeable, but there are just a few facts that you should know that are meaningful. We’ll cover those in this Straight, No Chaser.

Aside from skin cancer, prostate cancer is the most common cancer among men in the U.S. It is also one of the leading causes of cancer death among men of all races. According to the National Cancer Institute, in 2017, there will be over 161,000 new cases and well over 26,000 deaths from prostate cancer. Approximately 11.6% of men will be diagnosed with prostate cancer at some point during their lifetime. Here are some prostate cancer basics.

Prostate NormalCancer

What’s the prostate exactly?

The location and function of the prostate was covered in this previous post.

Who’s at risk for prostate cancer?

  • Age: This is simple. The older you are, the greater your risk of developing prostate cancer.
  • Race: Prostate cancer is more common in certain racial and ethnic groups.
  • Genetics: Your risk is increased, which is not the same as saying you’ll develop it if a family member has. This risk is twice to three times more likely if you have a father, brother or son who has had prostate cancer.

prostate cancer symptoms-of-prostate-cancer-c77ttmeb

What are the symptoms of prostate cancer?

It is of interest that a wide variety of presentations exists in those later diagnosed with prostate cancer. Some men don’t have symptoms (meaning it’s discovered on screening examinations), and other men present with several symptoms, which may include the following.

  • Blood in the urine or semen
  • Difficulty completely emptying the bladder
  • Difficulty starting urination
  • Frequent urination (especially at night)
  • Pain in the back, hips, or pelvis that doesn’t go away
  • Pain or burning during urination
  • Painful ejaculation
  • Weak or interrupted flow of urine

Prostate-Cancer-Treatment

How Is Prostate Cancer Treated?

See the above chart for more detailed information. Optimally, treatment for prostate cancer should take into account

  • Your age and expected life span with and without treatment
  • Other health conditions you have
  • The severity (i.e. stage and grade) of your cancer
  • Your feelings (and your physician’s medical opinion) about the need to treat the cancer
  • The likelihood that treatment will cure your cancer or provide some other measure of benefit
  • Possible side effects from treatment

Different types of established treatments are available for prostate cancer, including the following:

  • Closely monitoring the prostate cancer by performing prostate specific antigen (PSA) and digital rectal exam (DRE) tests regularly, and treating the cancer only if it grows or causes symptoms. This is known as active surveillance.
  • Surgery to remove the prostate and or surrounding tissue. This surgery is called a prostatectomy.
  • Radiation therapy with high-energy rays to kill the cancer..
  • Hormone therapy perhaps could be named “hormone blocking therapy,” because these medicines blocks cancer cells from getting the hormones they need to grow.

The next Straight, No Chaser will provide an update on prostate cancer screening recommendations.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Straight, No Chaser: Ovarian Cancer

 ovarian-cancer

You are likely aware that the ovaries produce a women’s eggs as well as being the main source of the female’s sex hormones. Ovarian cancer is not the most common gynecological cancer. In fact, it only causes approximately 3% of cancers in women. However, it’s an important one to know because it causes more deaths than any other cancer of the female reproductive system. It is impossible to do justice to ovarian cancer in one blog, so this Straight, No Chaser will feature frequently asked questions on the topic.

How serious is ovarian cancer?

Ovarian Cancer_1in71women

Very. According to the American Cancer Society (ACS), in 2014 the following is expected:

  • Approximately 21,980 new cases of ovarian cancer
  • Approximately 14,270 deaths from ovarian cancer

The lifetime risk of dying from invasive ovarian cancer is about 1 in 100.

Who is relatively more likely to obtain ovarian cancer?

  • Ovarian cancer is more common in whites than African-Americans.
  • Approximately half of those diagnosed are 63 years or older.

What increases the risk of developing ovarian cancer?

ovarian-cancer-risk factors

Factors linked to an increase in ovarian cancer risk include the following:

  • Increasing age, particularly after menopause
  • Obesity
  • Breast cancer (those with or have had breast cancer also have a higher risk of ovarian cancer)
  • Family history of ovarian cancer
  • Family history of breast or colorectal cancer

Do any actions reduce the risk of developing ovarian cancer?

This needs to be discussed with your physician, as your individual circumstance has a lot to do with actions you can take to lower your risk. That said, general factors linked to a lower risk of ovarian cancer include the following:

  • Consuming a low-fat diet
  • Having been pregnant
  • Having had a hysterectomy (i.e. uterine removal) without removing the ovaries
  • Having had a tubal ligation (i.e. having had your “tubes tied”)
  • Having engaged in breastfeeding
  • Use of birth control pills
  • Use of the contraceptive injection depot medroxyprogesterone acetate (DMPA or Depo-Provera CI®)

ovarian cancer anatomy

Can ovarian cancer be found early? Are there screening tests?

Only about 1 in 5 ovarian cancers are found at an early stage. Those that do find it early have an improved chance of successful treatment. About 9 out of 10 women treated for early ovarian cancer will live longer than 5 years after the cancer is found. The best way to find ovarian cancer is to have regular women’s health exams and to see the doctor if you have symptoms.

So far, no screening tests have been shown to lower the risk of dying from ovarian cancer, therefore no tests are recommended.

What are the signs and symptoms of ovarian cancer?

ovarian cancer BEAT

Two of the issues in detecting ovarian cancer are symptoms often aren’t present early in the cancer process, and even when symptoms occur, they are easily confused with symptoms more often caused by other things. It’s reasonable to suggest to you that routine evaluation for problems in your gynecological system, particularly those that make you feel different than normal and/or are persistent should prompt an evaluation by a physician.

The most common symptoms are:

  • Abdominal or pelvic pain
  • Abdominal swelling or bloating
  • Difficulty eating and/or a quick sensation of feeling full while eating
  • Frequent and/or urgent urination

Other symptoms can include:

  • Abdominal swelling that is accompanied by weight loss
  • Back pain
  • Constipation
  • Fatigue
  • Menstrual changes
  • Painful sexual intercourse
  • Upset stomach

If you have any of these problems, talk to your doctor so that the cause can be found.

Diagnosis, treatment, staging and recovery considerations are discussed at www.sterlingmedicaladvice.com.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

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Filed under General Health and Wellness, Hematology & Oncology/Blood Disorders/Cancer