Tag Archives: Alcohol intoxication

National Drug and Alcohol Facts Week

Introduction

It’s National Drug and Alcohol Facts Week. Accordingly, this Straight, No Chaser post provides information you need to know!

drug and alcohol facts week

Let’s start with this simple fact.

Alcohol kills more people each year than all illegal drugs combined.

We have already extensively reviewed the various components of alcohol use, abuse, benefits and disease. Therefore, use this post as a guide to obtain whatever additional information you need. Click the links provided for additional blog posts with up-to-date information on various topics related to alcohol. Also, ask us questions!

Follow us!

Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering 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 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.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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

Copyright ©2013- 2019 · Sterling Initiatives, LLC · Powered by WordPress

Eliminating Alcohol from the Body

Introduction

This Straight, No Chaser post is about eliminating alcohol from the body.

vomiting and eliminating alcohol

We get questions from you all the time. In preparation for New Year’s Eve, here’s an example: “How can I eliminate alcohol from the body quicker if I get drunk?”

It’s a frequent misconception that there are a ton of remedies you can take to help you eliminate alcohol quicker or get less drunk. Alcohol is eliminated by a process called zero-order kinetics. In other words, alcohol is eliminated from the body at fixed amount per hour. Nothing you do is going to make you less intoxicated (referral to the legal definition of how much you have in your system). This includes coating your stomach, eating (including a cheese tray) or drinking coffee.

This being said, being less dehydrated does help the blood alcohol concentration. Also, drinking coffee or another stimulant can counter the depressant effects of alcohol and may make you feel more alert. However, my best advice for you is to sleep it off. Of course, if you’re intoxicated to the point that you need medical attention, doing so should be your immediate action.

Bonus question: “Does vomiting help?”

Vomiting is only of value in eliminating alcohol that hasn’t yet been absorbed into the bloodstream. Once alcohol is in your system, it is eliminated as discussed.

For further details on the initiatives listed above, please visit Straight, No Chaser at www.jeffreysterlingmd.com and type any desired topic into the search engine.

Follow us!

Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering 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 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.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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

Copyright © 2019 · Sterling Initiatives, LLC · Powered by WordPress

Your Questions on The Health Benefits of Red Wine

Introduction

This Straight, No Chaser post answers your questions about the health benefits of red wine.

So alcohol is good for me now (especially after all those other blog posts)?

red-wine-health-benefits

Red wine has been known to provide specific health benefits for at least 10 years now. Of course, you have to interact with it in a certain way to receive these benefits. More on that in a bit, but yes, moderate alcohol consumption (especially red wine) does have a direct, beneficial effect on the heart.

Can you be more specific?

red-wine-and-heart-health

Ok. The skin and seeds of red grapes contain substances called flavonoids. Flavonoids reduce bad cholesterol (LDL) production, increase good cholesterol (HDL) production and reduce blood clotting, all of which are significant risks leading to many instances of heart disease. Each of these actions by flavonoids independently reduce the risk of heart disease.

Ok. So how much wine should I be drinking per day? 

If you’re drinking “for the health benefits,” a four-ounce serving is generally what’s recommended for women, and 4-8 ounces works for men. Higher levels of daily consumption than this introduce health risks that offset any benefits.

Is this true for all wines?

redwine-ecg

Unfortunately, not to the same extent. Here are two simple (and admittedly overly simplistic) rules regarding the number of healthy flavonoids in wine.

  • Red wines are better than whites.
  • Bitter red wines are better than sweet wines.

The best red wines have been found to be Cabernet Sauvignon, Petit Syrah and Pinot Noir.

So should I start drinking if I don’t already?

red-wine-ink-heart

Probably not. Most drinkers don’t have the discipline to limit their consumption to just one 4-8 ounce serving of red wine a day, and alcohol comes with too many other health risks to offset the benefits of not drinking at all. This is especially true in those with existing health conditions such as hypertension, pancreatitis, depression, high cholesterol/triglycerides or congestive heart failure. Besides, grape juice offers the same benefits!
Enjoy your week and your glass of wine. Just remember (as I always say): good health isn’t found at the bottom of a bottle!

Follow us!

Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering 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 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.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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

Copyright © 2019 · Sterling Initiatives, LLC · Powered by WordPress

Alcoholism and Alcohol-Related Deaths Are on the Rise

Introduction

This Straight, No Chaser post reviews the rate of rise of alcohol-related deaths.

alcoholaddictionchains

Does it seem that alcoholism isn’t discussed much anymore, or is it that the public health community has focused more on overdose deaths from heroin and prescription painkillers of late? According to the Centers for Disease Control and Prevention, alcoholism and the deaths related to it are on the rise.

Alcohol-related deaths

Consider the sum total of the following statistics:

alcohol_risk

  • Alcohol is killing Americans at a rate higher than at any time in the last 35 years. In 2015, there were 10.3 thousand deaths from alcohol-induced causes per 100,000 people, representing an increase of 47% since 2002.
  • During 2014, alcohol-impaired driving fatalities accounted for 9,967 deaths (31 percent of overall driving fatalities).
  • In 2014, more people died from alcohol-induced causes (30,722) than from overdoses of prescription painkillers and heroin combined (28,647).

alcohol-related deaths

In reality, the annual number of deaths directly or indirectly caused by alcohol is closer to 90,000, as the official count of alcohol-induced fatalities excludes deaths from drunk driving, other accidents, and homicides committed under the influence of alcohol. This makes alcohol related deaths the 3rd leading cause of preventable deaths in the United States.

Where do you fit in this equation? Here’s the deal: 30% of American adults don’t drink at all. Another 30% consume less than one drink per week (on average). On the other hand, the top 10% of American adults (approximately 24 million people) consume an average of 74 drinks per week, or a little more than 10 drinks per day. The heaviest drinkers are at the greatest risk for the alcohol-induced causes of death.

alcohol abuse

An easy way to minimize your risk, assuming you’re going to drink, is to restrict your alcohol intake at any one time to 2 drinks per day. The especially good news is that level – defined as moderate alcohol consumption – is actually associated with a decreased risk of mortality.

Follow us!

Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering 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 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.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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

Copyright © 2019 · Sterling Initiatives, LLC · Powered by WordPress

Self-Assessment of Alcohol Dependency

Introduction

This Straight, No Chaser post focuses on your self-assessment of alcohol dependency.

alcoholaddictionchains
The number one response to the post on acute alcohol poisoning was pretty simple: “How can I tell if I’m drinking too much over the long haul?” And so it’s back to back the Straight, No Chaser (literally) days. The problems with most intoxicating substances involve 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 again. The difference with alcohol abuse is that alcohol is legal and comparatively inexpensive, so you get to keep trying without much fuss (at least initially).

The spectrum from drinking to dependency

Let’s set the stage by standardizing some terms:

ALCOHOLICtendencies

  • Intoxication: You’re drunk and under the influence of alcohol.
  • Abuse: Your drinking habits are unhealthy, resulting in bad consequences (e.g., at work, in your relationships, with the law).
  • 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 “I can handle my liquor” or “I can stop anytime I 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.

Self-Assessment of Alcohol Dependency

Are you this guy or gal? (Keep in mind a standard drink is defined as one 12 ounce can of beer, one glass of wine or one mixed drink.)

Self assessment of alcohol dependency

  • Women having more than three drinks at one time or more than seven drinks a week
  • Men having more than four drinks at one time or more than 14 drinks a week

If so, you’re causing damage.  We’ve discussed the damage in these additional Straight, No Chaser posts.

Dependency

Now 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.”)
  • Withdrawal symptoms (discussed earlier) present 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?

Unfortunately, I’m pretty sure no one is giving up alcohol by reading this. 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 hit you. Then we’re having a completely different conversation.

Follow us!

Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering 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 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.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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

Copyright © 2019 · Sterling Initiatives, LLC · Powered by WordPress

Alcohol Abuse and Alcoholism

Introduction

This Straight, No Chaser post discusses problem drinking, alcohol abuse and alcoholism.

Signs-That-You-are-Probably-An-Alcoholic

With all the focus of late on other forms of drug use and abuse (e.g., methamphetamine, marijuana, opiates), alcohol abuse seems to be lacking the attention it deserves. Fully one in six people in the United States has a drinking problem. In this segment of the Straight, No Chaser series on alcohol, we will explore problem drinking.

Problem Drinking vs Alcoholism

“Problem drinking” is a way of describing alcohol intake that causes problems with your functioning. Alcohol abuse is an episode or continued excessive alcohol consumption that causes problems with your daily living activities, such as family or job responsibilities. Of course, a single episode of alcohol abuse can cost you your life if you’re an impaired driver who runs into a tree or some other calamity befalls you.

alcohol abuse and alcoholism

Alcoholism is alcohol dependence. It has two separate considerations:

  • Physical addiction to a drug is defined by tolerance and withdrawal symptoms. Tolerance is when you become acclimated to the same dose of drug, meaning, in this case, the same amount of liquor no longer gives you the same buzz. Withdrawal symptoms occur when you experience effects from no longer having the drug in your system.
  • Mental addiction to alcohol is illustrated by its increasingly prominent role in your life. Your life becomes centered around the pursuit and consumption of alcohol. It creates problems with your physical, mental and social health, controlling your life and relationships.

Heredity and Environmental risks in alcoholism

Many of you ask if alcoholism is hereditary. Hereditary means a specific thing medically, so the answer is no. However, we believe genes play a role and increase the risk of alcoholism. It is most likely that genetics “load the gun,” but environment “pulls the trigger.”

AlcoholicGrayscaleDiagram2

Environmental risks

Regarding environment, there’s no fixed equation to if and when you’ll become dependent, but there is a correlation with certain activity and an increased risk. Consider the following activities as suggestive of a significant risk for development alcoholism:

  • Men who have 15 or more drinks a week (One drink is either a 12-ounce bottle of beer, a 5-ounce glass of wine or a 1.5 ounce shot of liquor.)
  • Women who have 12 or more drinks a week
  • Anyone who has five or more drinks at a time at least once a week
  • Anyone who has a parent with alcoholism

Here are some less hard signs, but these situations also have been shown to increase risk, according to the National Institutes of Health:

  • You are a young adult under peer pressure
  • Presence of a behavioral health disorder such as depression, bipolar disorder, anxiety disorders, or schizophrenia
  • Easy access to alcohol
  • Low self-esteem
  • Problems with relationships
  • Living a stressful lifestyle
  • Living in a culture in which alcohol use is more common and accepted

Follow us!

Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering 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 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.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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

Copyright © 2019 · Sterling Initiatives, LLC · Powered by WordPress

How Alcohol Toxicity and Poisoning Becomes Deadly

Introduction

alcohol abuse

Does the thought of alcohol toxicity creep into your mind during a massive party or celebration? Well, forewarned is forearmed. It’s not my intention to spoil the “buzz” of enjoying good times with your friends, but allow me to provide some liquor for thought. Most everyone knows the effects of getting drunk. What most seem to forget is that alcohol has a continuum of effects that isn’t restricted to becoming “buzzed,” intoxicated or just drunk. Alcohol poisoning also includes effects such as coma and death.

Some of you may be reflecting on the times when you felt most intoxicated. Perhaps it was a college event, a New Year’s Eve party or a sports event (or all of the above). Your first take home message of the day is alcohol poisoning isn’t about how you feel. It’s simply about the concentration of alcohol in your blood and the effects that amount of alcohol will have on your system. This is commonly described as BAC – blood alcohol content.

As BAC increases, so do the effects of alcohol. Let’s quantify the amount of alcohol that is associated with danger, how symptoms progress with alcohol poisoning and the different BAC levels that are associated with danger.

alctox

Amount

We’re talking about acute alcohol toxicity and poisoning. This is typically brought on via a large intake of alcohol (e.g., binge drinking). Bingeing is generally regarded as at least four to five drinks (for women and men, respectively) within two hours. This level of drinking will raise your BAC into the “legally drunk” level and increase the risk of adverse consequences. Such amounts can overwhelm the body’s metabolism and elimination of alcohol from the blood.  When this occurs, further alcohol intake will rapidly increase BAC and impair bodily functions, most notably those of the brain.

Note the following chart, which gives a rough estimate of the general effects of different amounts of alcohol based on your weight. It is very important to realize that weight, age, sex and other considerations play into the individual effects of alcohol on you.

bac

Symptoms of Alcohol Poisoning

Alcohol poisoning occurs when there is so much alcohol in the bloodstream that it is able to affect and shut down areas of the brain controlling basic life-support functions (i.e., breathing, heart rate, and regulation of your core temperature). Symptoms of alcohol poisoning include confusion, difficulty breathing and remaining conscious, vomiting, seizures, slowed heart rate, clammy skin, dulled responses, such as no gag reflex (which prevents choking) and an extremely low body temperature.

BAC can continue to rise even when a person is unconscious. Alcohol in the stomach and intestine continues to enter the bloodstream and circulate throughout the body. This makes “sleeping it off” a very dangerous proposition, and you should not assume one will be better by doing so. Alcohol is a depressant to the brain. Among its activities is dulling the gag reflex. Coupling that with alcohol’s irritant effects on the stomach, a person who drinks to the point of passing out is in danger of choking on vomit, which in turn could lead to death by asphyxiation (inadequate oxygenation). Even survival can leave a victim of an alcohol overdose with brain damage.

Effects

alcohol toxicity chart

The above charts approximate the BACs that occur with varying numbers of drinks. Let’s continue to think about binge drinking, focusing on the following male/female charts after one hour of drinking. Although there is individual variation in the clinical effects of the number of drinking one may have, the clinical effects of alcohol are rather consistent at various BACs. These levels eventually reach a point of toxicity known as alcohol poisoning. This designation is particularly meaningful in that it reflects the level at which the level of alcohol in the blood begins to shut down areas of the brain controlling basic life-support functions (i.e., breathing, heart rate, and regulation of core temperature).

Clinical Effects at Various BACs

This next section is at a level of specificity that you won’t remember, but I want to go through the detail to demonstrate the increasing dangers seen with increasing levels of intoxication. Don’t be lulled into comfort by the lower levels. Even small levels of alcohol in the system affect judgment and coordination. Increased amounts affect the body and mind more dramatically, leading to the ability to kill.

The following effects of different levels of BAC are approximations. Individual reactions vary, sometimes widely.

BAC .02 percent to .04 percent

This level tends to produce mild relaxation, loosened inhibitions and some lightheadedness. Prevailing moods may intensify.

BAC .05 percent to .07 percent 

This level tends to intensification and exaggeration of emotions and behavior. Euphoria may begin, and a feeling of relation and warmth may overcome you.

BAC .08 percent to .09 percent

At this level you’re losing an ability to accurate assess your level of functioning. You may have slurred speech, impaired motor skills and a degree of imbalance. Your sense of seeing and hearing clearly are diminished, and your reduced judgment often leads to continued drinking when this would actually be a good time to stop. This level corresponds to a diminished ability to evaluate sexual situations.

BAC .10 percent to .12 percent

At this level, you are clearly suffering. You have diminished motor skills, coordination, balance, judgment and memory. Emotions become even more exaggerated at both extremes. Some people become loud, aggressive or belligerent, and others may seem depressed. This BAC level also corresponds to when men may have trouble getting an erection.

BAC .14 percent to .17 percent

At this level euphoria may give way to unpleasant feelings. You have difficulty talking, walking or even standing up. Your judgment and perception are severely impaired. You may become more aggressive and are at increased risk of accidentally injuring yourself or others. A blackout may occur at this level.

BAC .20 percent

At this point, neurologic effects are present. You may feel confused, dazed or otherwise disoriented and may need help to stand up or walk. If you are injured, you probably won’t realize it because you won’t feel pain, and if you do realize it, you may be inclined not to do anything about it. At this point you may experience nausea and start vomiting. Your gag reflex is impaired, so you could choke if you throw up. Since blackouts are likely at this level, you may not remember any of this.

BAC .25 percent

At this point, all mental, physical and sensory functions are severely impaired. You’re emotionally numb. There’s an increased risk of death due to asphyxiation (inadequate oxygen) caused by choking on vomit and of seriously injuring yourself by falling or other accidents.

BAC .30 percent

You’re probably in a stupor. You have little comprehension of where you are or what’s really going on around you. You may suddenly pass out and be difficult to awaken.

BAC .35 percent

This blood alcohol concentration is similar to the physical effects of surgical anesthesia. You may stop breathing.

BAC .40 percent to .50 percent

You are probably in a coma. The nerve centers controlling your heartbeat and respiration are slowing down, and it’s a miracle if you survive.

Let’s bring things full circle. Someone weighing 100 pounds who has consumed 9-10 drinks in less than an hour is at risk of death. Here’s how. The term “lethal dose” (LD) is used to describe the blood concentration that produces death from drugs (in this case, alcohol) in half the population. Most authorities agree that BACs in the 0.40 percent to 0.50 percent range meet the requirement. That percent is an average, not an absolute standard. Fatal overdoses from alcohol at BACs lower than 0.40 percent have been documented, as have cases of survivors at BACs higher than 0.50 percent. If you refer to the above chart correlating number of drinks, weight and BAC levels, you can now figure out how dangerous different numbers of drinks can be.

Alcohol_Abuse_Project_3_by_TomBod

Here’s a final take home message for you. Alcohol poisoning is a life-threatening condition and requires immediate medical attention. You don’t have time for cold showers, hot coffee or walking. Not only will these not reverse the effects of alcohol overdose, but they could actually make things worse.

Follow us!

Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering 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 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.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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

Copyright © 2019 · Sterling Initiatives, LLC · Powered by WordPress

Reviewing Alcohol Facts vs. Fiction

Introduction

This Straight, No Chaser reviews common alcohol facts and fiction.

alcohol and carbohydrates
Today’s Straight, No Chaser puts a personal spin on an old favorite because well, frankly some of you drink too much. Here is your six-pack (plus one for the road) of common myths that are just waiting to be busted.

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.

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.

Drinking coffee sobers me up.

  • FALSE. Alcohol is eliminated from the body by a certain fixed percentage per hour. This is true regardless of height, weight, age or sex.  Nothing you’re doing, including drinking coffee or taking a cold shower is accelerating that process.

alcohol facts and fiction

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.

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.  Tolerance is an indication of dependency – in other words, a progression toward alcoholism.

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 is above the normal limit. Furthermore, it is high enough to get you put behind bars if something happens and you’re tested. How you ‘feel’ is irrelevant.

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.

alcoholicdrunk
If you have any other questions or myths you’d like busted, tee them up for me, and I’ll address them.  Cheers!

Follow us!

Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering 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 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.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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

Copyright © 2019 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Do You Drink Too Much?

drinks
It’s one of those Straight, No Chaser (literally) days.  Lets address substance abuse. 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.
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 © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Health Benefits of Red Wine

It’s the weekend, and we’re coming off a lot of Straight, No Chaser posts on alcohol, so let’s just address some questions you’ve asked about the benefits of alcohol.
So alcohol is good for me now (especially after all those other blog posts)?
red-wine-health-benefits

Red wine has been known to provide specific health benefits for at least 10 years now. Of course, you have to interact with it in a certain way to receive these benefits. More on that in a bit, but yes, moderate alcohol consumption (especially red wine) does have a direct, beneficial effect on the heart.

Can you be more specific?

red-wine-and-heart-health

Ok. The skin and seeds of red grapes contain substances called flavonoids. Flavonoids reduce bad cholesterol (LDL) production, increase good cholesterol (HDL) production and reduce blood clotting, all of which are significant risks leading to many instances of heart disease. Each of these actions by flavonoids independently reduce the risk of heart disease.
Ok. So how much wine should I be drinking per day? 
If you’re drinking “for the health benefits,” a four-ounce serving is generally what’s recommended for women, and 4-8 ounces works for men. Higher levels of daily consumption than this introduce health risks that offset any benefits.
Is this true for all wines?

redwine-ecg

Unfortunately, not to the same extent. Here are two simple (and admittedly overly simplistic) rules regarding the number of healthy flavonoids in wine.

  • Red wines are better than whites.
  • Bitter red wines are better than sweet wines.

The best red wines have been found to be Cabernet Sauvignon, Petit Syrah and Pinot Noir.
So should I start drinking if I don’t already?

red-wine-ink-heart

Probably not. Most drinkers don’t have the discipline to limit their consumption to just one 4-8 ounce serving of red wine a day, and alcohol comes with too many other health risks to offset the benefits of not drinking at all. This is especially true in those with existing health conditions such as hypertension, pancreatitis, depression, high cholesterol/triglycerides or congestive heart failure. Besides, grape juice has been shown to offer the same benefits!
Enjoy your weekend, just remember (as I always say): good health isn’t found at the bottom of a bottle!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life at jeffreysterlingbooks.com or Amazon.com.
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

Straight, No Chaser: Self Assessment of Alcohol Dependency

alcoholaddictionchains
The number one response to the post on acute alcohol poisoning was pretty simple: “How can I tell if I’m drinking too much over the long haul?” And so it’s back to back the Straight, No Chaser (literally) days. The problems with most intoxicating substances involve 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 again. The difference with alcohol abuse is that alcohol is legal and comparatively inexpensive, so you get to keep trying without much fuss (at least initially).
Let’s set the stage by standardizing some terms:

ALCOHOLICtendencies

  • 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 “I can handle my liquor” or “I can stop anytime I 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, one glass of wine or one mixed drink.)

alcohol_risk

  • Women having more than three drinks at one time or more than seven drinks a week
  • Men having more than four drinks at one time or more than 14 drinks a week

If so, you’re causing damage.  We’ve discussed the damage in these additional Straight, No Chaser posts.

Now 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?
Unfortunately, I’m pretty sure no one is giving up alcohol by reading this. 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 hit you. Then we’re having a completely different conversation.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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

Straight, No Chaser: Alcohol Facts vs. Fiction

alcohol and carbohydrates
Today’s Straight, No Chaser puts a personal spin on an old favorite because well, frankly some of you drink too much. Here’s your six-pack (plus one for the road) of common myths that are 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 is 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.

myths-facts-300x300

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, which is an indication of dependency – in other words, a progression toward alcoholism.

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.

alcoholicdrunk
If you have any other questions or myths you’d like busted, tee them up for me, and I’ll address them.  Cheers!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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

Straight, No Chaser: When Alcohol Becomes Toxic – Or Deadly

alcohol abuse

Enjoy your weekend? Hopefully you’re not hung over. Today, I’d like to provide some words to sober you up. Most everyone knows the effects of getting drunk. What most seem to forget is that alcohol has a continuum of effects that isn’t restricted to becoming “buzzed,” intoxicated or just drunk. Alcohol poisoning also includes effects such as coma and death.
Some of you may be reflecting on the times when you felt most intoxicated. Perhaps it was a college event, a New Year’s Eve party or a sports event (or all of the above). Your first take home message of the day is alcohol poisoning isn’t about how you feel. It’s simply about the concentration of alcohol in your blood and the effects that amount of alcohol will have on your system. This is commonly described as BAC – blood alcohol content.
As BAC increases, so do the effects of alcohol. Let’s quantify the amount of alcohol that is associated with danger, how symptoms progress with alcohol poisoning and the different BAC levels that are associated with danger.

alctox

Amount
We’re talking about acute alcohol toxicity and poisoning. This is typically brought on via a large intake of alcohol (e.g., binge drinking). Bingeing is generally regarded as at least four to five drinks (for women and men, respectively) within two hours. This level of drinking will raise your BAC into the “legally drunk” level and increase the risk of adverse consequences. Such amounts can overwhelm the body’s metabolism and elimination of alcohol from the blood.  When this occurs, further alcohol intake will rapidly increase BAC and impair bodily functions, most notably those of the brain.
Note the following chart, which gives a rough estimate of the general effects of different amounts of alcohol based on your weight. It is very important to realize that weight, age, sex and other considerations play into the individual effects of alcohol on you.

bac

Symptoms of Alcohol Poisoning
Alcohol poisoning occurs when there is so much alcohol in the bloodstream that it is able to affect and shut down areas of the brain controlling basic life-support functions (i.e., breathing, heart rate, and regulation of your core temperature). Symptoms of alcohol poisoning include confusion, difficulty breathing and remaining conscious, vomiting, seizures, slowed heart rate, clammy skin, dulled responses, such as no gag reflex (which prevents choking) and an extremely low body temperature.
BAC can continue to rise even when a person is unconscious. Alcohol in the stomach and intestine continues to enter the bloodstream and circulate throughout the body. This makes “sleeping it off” a very dangerous proposition, and you should not assume one will be better by doing so. Alcohol is a depressant to the brain. Among its activities is dulling the gag reflex. Coupling that with alcohol’s irritant effects on the stomach, a person who drinks to the point of passing out is in danger of choking on vomit, which in turn could lead to death by asphyxiation (inadequate oxygenation). Even survival can leave a victim of an alcohol overdose with brain damage.
Effects
The following charts approximate the BACs that occur with varying numbers of drinks. Let’s continue to think about binge drinking, focusing on the following male/female charts after one hour of drinking. Although there is individual variation in the clinical effects of the number of drinking one may have, the clinical effects of alcohol are rather consistent at various BACs. These levels eventually reach a point of toxicity known as alcohol poisoning. This designation is particularly meaningful in that it reflects the level at which the level of alcohol in the blood begins to shut down areas of the brain controlling basic life-support functions (i.e., breathing, heart rate, and regulation of core temperature).

Clinical Effects at Various BACs
This next section is at a level of specificity that you won’t remember, but I want to go through the detail to demonstrate the increasing dangers seen with increasing levels of intoxication. Don’t be lulled into comfort by the lower levels. Even small levels of alcohol in the system affect judgment and coordination. Increased amounts affect the body and mind more dramatically, leading to the ability to kill.
The following effects of different levels of BAC are approximations. Individual reactions vary, sometimes widely.

  • BAC .02 percent to .04 percent
    This level tends to produce mild relaxation, loosened inhibitions and some light-headedness. Prevailing moods may intensify.
  • BAC .05 percent to .07 percent 
    This level tends to intensification and exaggeration of emotions and behavior. Euphoria may begin, and a feeling of relation and warmth may overcome you.
  • BAC .08 percent to .09 percent
    At this level you’re losing an ability to accurate assess your level of functioning. You may have slurred speech, impaired motor skills and a degree of imbalance. Your sense of seeing and hearing clearly are diminished, and your reduced judgment often leads to continued drinking when this would actually be a good time to stop. This level corresponds to a diminished ability to evaluate sexual situations.
  • BAC .10 percent to .12 percent
    At this level you’re clearly suffering. You have diminished motor skills, coordination, balance, judgment and memory. Emotions become even more exaggerated at both extremes. Some people become loud, aggressive or belligerent, and others may seem depressed. This BAC level also corresponds to when men may have trouble getting an erection.
  • BAC .14 percent to .17 percent
    At this level euphoria may give way to unpleasant feelings. You have difficulty talking, walking or even standing up. Your judgment and perception are severely impaired. You may become more aggressive and are at increased risk of accidentally injuring yourself or others. A blackout may occur at this level.
  • BAC .20 percent
    At this point, neurologic effects are present. You may feel confused, dazed or otherwise disoriented and may need help to stand up or walk. If you are injured, you probably won’t realize it because you won’t feel pain, and if you do realize it, you may be inclined not to do anything about it. At this point you may experience nausea and start vomiting. Your gag reflex is impaired, so you could choke if you throw up. Since blackouts are likely at this level, you may not remember any of this.
  • BAC .25 percent
    At this point, all mental, physical and sensory functions are severely impaired. You’re emotionally numb. There’s an increased risk of death due to asphyxiation (inadequate oxygen) caused by choking on vomit and of seriously injuring yourself by falling or other accidents.
  • BAC .30 percent
    You’re probably in a stupor. You have little comprehension of where you are or what’s really going on around you. You may suddenly pass out and be difficult to awaken.
  • BAC .35 percent
    This blood alcohol concentration is similar to the physical effects of surgical anesthesia. You may stop breathing.
  • BAC .40 percent to .50 percent
    You are probably in a coma. The nerve centers controlling your heartbeat and respiration are slowing down, and it’s a miracle if you survive.

Let’s bring things full circle. Someone weighing 100 pounds who has consumed 9-10 drinks in less than an hour is at risk of death. Here’s how. The term “lethal dose” (LD) is used to describe the blood concentration that produces death from drugs (in this case, alcohol) in half the population. Most authorities agree that BACs in the 0.40 percent to 0.50 percent range meet the requirement. That percent is an average, not an absolute standard. Fatal overdoses from alcohol at BACs lower than 0.40 percent have been documented, as have cases of survivors at BACs higher than 0.50 percent. If you refer to the above chart correlating number of drinks, weight and BAC levels, you can now figure out how dangerous different numbers of drinks can be.

Alcohol_Abuse_Project_3_by_TomBod

Here’s a final take home message for you. Alcohol poisoning is a life-threatening condition and requires immediate medical attention. You don’t have time for cold showers, hot coffee or walking. Not only will these not reverse the effects of alcohol overdose, but they could actually make things worse.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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

Straight, No Chaser: The Health Benefits of Red Wine

We’re approaching the weekend, and we’re coming off a lot of Straight, No Chaser posts on alcohol, so let’s just address some questions you’ve asked about the benefits of alcohol.
So alcohol is good for me now (especially after all those other blog posts)?
red-wine-health-benefits

Red wine has been known to provide specific health benefits for at least 10 years now. Of course, you have to interact with it in a certain way to receive these benefits. More on that in a bit, but yes, moderate alcohol consumption (especially red wine) does have a direct, beneficial effect on the heart.

Can you be more specific?

red-wine-and-heart-health

Ok. The skin and seeds of red grapes contain substances called flavonoids. Flavonoids reduce bad cholesterol (LDL) production, increase good cholesterol (HDL) production and reduce blood clotting, all of which are significant risks leading to many instances of heart disease. Each of these actions by flavonoids independently reduce the risk of heart disease.
Ok. So how much wine should I be drinking per day? 
If you’re drinking “for the health benefits,” a four-ounce serving is generally what’s recommended for women, and 4-8 ounces works for men. Higher levels of daily consumption than this introduce health risks that offset any benefits.
Is this true for all wines?

redwine-ecg

Unfortunately, not to the same extent. Here are two simple (and admittedly overly simplistic) rules regarding the number of healthy flavonoids in wine.

  • Red wines are better than whites.
  • Bitter red wines are better than sweet wines.

The best red wines have been found to be Cabernet Sauvignon, Petit Syrah and Pinot Noir.
So should I start drinking if I don’t already?

red-wine-ink-heart

Probably not. Most drinkers don’t have the discipline to limit their consumption to just one 4-8 ounce serving of red wine a day, and alcohol comes with too many other health risks to offset the benefits of not drinking at all. This is especially true in those with existing health conditions such as hypertension, pancreatitis, depression, high cholesterol/triglycerides or congestive heart failure. Besides, grape juice has been shown to offer the same benefits!
Enjoy your weekend, just remember (as I always say): good health isn’t found at the bottom of a bottle!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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 © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Self Assessment of Alcohol Dependency

alcoholaddictionchains
The number one response to the post on acute alcohol poisoning was pretty simple: “How can I tell if I’m drinking too much over the long haul?” And so it’s back to back the Straight, No Chaser (literally) days. The problems with most intoxicating substances involve 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 again. The difference with alcohol abuse is that alcohol is legal and comparatively inexpensive, so you get to keep trying without much fuss (at least initially).
Let’s set the stage by standardizing some terms:

ALCOHOLICtendencies

  • 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 “I can handle my liquor” or “I can stop anytime I 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, one glass of wine or one mixed drink.)

alcohol_risk

  • Women having more than three drinks at one time or more than seven drinks a week
  • Men having more than four drinks at one time or more than 14 drinks a week

If so, you’re causing damage.  We’ve discussed the damage in these additional Straight, No Chaser posts.

Now 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?
Unfortunately, I’m pretty sure no one is giving up alcohol by reading this. 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 hit you. Then we’re having a completely different conversation.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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 © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Alcohol Facts vs. Fiction

alcohol and carbohydrates
Today’s Straight, No Chaser puts a personal spin on an old favorite because well, frankly some of you drink too much. Here’s your six-pack (plus one for the road) of common myths that are 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 is 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.

myths-facts-300x300

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, which is an indication of dependency – in other words, a progression toward alcoholism.

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.

alcoholicdrunk
If you have any other questions or myths you’d like busted, tee them up for me, and I’ll address them.  Cheers!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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 © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: When Alcohol Becomes Toxic – Or Deadly

alcohol abuse

Ok. We now know the teams playing in the NCAA college basketball championship game. Maybe you’ve already begun planning the party or have identified where you’ll be watching. Well, forewarned is forearmed. It’s not my intention to spoil the “buzz” of March Madness, but allow me to provide some liquor for thought. Most everyone knows the effects of getting drunk. What most seem to forget is that alcohol has a continuum of effects that isn’t restricted to becoming “buzzed,” intoxicated or just drunk. Alcohol poisoning also includes effects such as coma and death.
Some of you may be reflecting on the times when you felt most intoxicated. Perhaps it was a college event, a New Year’s Eve party or a sports event (or all of the above). Your first take home message of the day is alcohol poisoning isn’t about how you feel. It’s simply about the concentration of alcohol in your blood and the effects that amount of alcohol will have on your system. This is commonly described as BAC – blood alcohol content.
As BAC increases, so do the effects of alcohol. Let’s quantify the amount of alcohol that is associated with danger, how symptoms progress with alcohol poisoning and the different BAC levels that are associated with danger.

alctox

Amount
We’re talking about acute alcohol toxicity and poisoning. This is typically brought on via a large intake of alcohol (e.g., binge drinking). Bingeing is generally regarded as at least four to five drinks (for women and men, respectively) within two hours. This level of drinking will raise your BAC into the “legally drunk” level and increase the risk of adverse consequences. Such amounts can overwhelm the body’s metabolism and elimination of alcohol from the blood.  When this occurs, further alcohol intake will rapidly increase BAC and impair bodily functions, most notably those of the brain.
Note the following chart, which gives a rough estimate of the general effects of different amounts of alcohol based on your weight. It is very important to realize that weight, age, sex and other considerations play into the individual effects of alcohol on you.

bac

Symptoms of Alcohol Poisoning
Alcohol poisoning occurs when there is so much alcohol in the bloodstream that it is able to affect and shut down areas of the brain controlling basic life-support functions (i.e., breathing, heart rate, and regulation of your core temperature). Symptoms of alcohol poisoning include confusion, difficulty breathing and remaining conscious, vomiting, seizures, slowed heart rate, clammy skin, dulled responses, such as no gag reflex (which prevents choking) and an extremely low body temperature.
BAC can continue to rise even when a person is unconscious. Alcohol in the stomach and intestine continues to enter the bloodstream and circulate throughout the body. This makes “sleeping it off” a very dangerous proposition, and you should not assume one will be better by doing so. Alcohol is a depressant to the brain. Among its activities is dulling the gag reflex. Coupling that with alcohol’s irritant effects on the stomach, a person who drinks to the point of passing out is in danger of choking on vomit, which in turn could lead to death by asphyxiation (inadequate oxygenation). Even survival can leave a victim of an alcohol overdose with brain damage.
Effects
The following charts approximate the BACs that occur with varying numbers of drinks. Let’s continue to think about binge drinking, focusing on the following male/female charts after one hour of drinking. Although there is individual variation in the clinical effects of the number of drinking one may have, the clinical effects of alcohol are rather consistent at various BACs. These levels eventually reach a point of toxicity known as alcohol poisoning. This designation is particularly meaningful in that it reflects the level at which the level of alcohol in the blood begins to shut down areas of the brain controlling basic life-support functions (i.e., breathing, heart rate, and regulation of core temperature).
Male BAC
BAC Female
Clinical Effects at Various BACs
This next section is at a level of specificity that you won’t remember, but I want to go through the detail to demonstrate the increasing dangers seen with increasing levels of intoxication. Don’t be lulled into comfort by the lower levels. Even small levels of alcohol in the system affect judgment and coordination. Increased amounts affect the body and mind more dramatically, leading to the ability to kill.
The following effects of different levels of BAC are approximations. Individual reactions vary, sometimes widely.

  • BAC .02 percent to .04 percent
    This level tends to produce mild relaxation, loosened inhibitions and some lightheadedness. Prevailing moods may intensify.
  • BAC .05 percent to .07 percent 
    This level tends to intensification and exaggeration of emotions and behavior. Euphoria may begin, and a feeling of relation and warmth may overcome you.
  • BAC .08 percent to .09 percent
    At this level you’re losing an ability to accurate assess your level of functioning. You may have slurred speech, impaired motor skills and a degree of imbalance. Your sense of seeing and hearing clearly are diminished, and your reduced judgment often leads to continued drinking when this would actually be a good time to stop. This level corresponds to a diminished ability to evaluate sexual situations.
  • BAC .10 percent to .12 percent
    At this level you’re clearly suffering. You have diminished motor skills, coordination, balance, judgment and memory. Emotions become even more exaggerated at both extremes. Some people become loud, aggressive or belligerent, and others may seem depressed. This BAC level also corresponds to when men may have trouble getting an erection.
  • BAC .14 percent to .17 percent
    At this level euphoria may give way to unpleasant feelings. You have difficulty talking, walking or even standing up. Your judgment and perception are severely impaired. You may become more aggressive and are at increased risk of accidentally injuring yourself or others. A blackout may occur at this level.
  • BAC .20 percent
    At this point, neurologic effects are present. You may feel confused, dazed or otherwise disoriented and may need help to stand up or walk. If you are injured, you probably won’t realize it because you won’t feel pain, and if you do realize it, you may be inclined not to do anything about it. At this point you may experience nausea and start vomiting. Your gag reflex is impaired, so you could choke if you throw up. Since blackouts are likely at this level, you may not remember any of this.
  • BAC .25 percent
    At this point, all mental, physical and sensory functions are severely impaired. You’re emotionally numb. There’s an increased risk of death due to asphyxiation (inadequate oxygen) caused by choking on vomit and of seriously injuring yourself by falling or other accidents.
  • BAC .30 percent
    You’re probably in a stupor. You have little comprehension of where you are or what’s really going on around you. You may suddenly pass out and be difficult to awaken.
  • BAC .35 percent
    This blood alcohol concentration is similar to the physical effects of surgical anesthesia. You may stop breathing.
  • BAC .40 percent to .50 percent
    You are probably in a coma. The nerve centers controlling your heartbeat and respiration are slowing down, and it’s a miracle if you survive.

Let’s bring things full circle. Someone weighing 100 pounds who has consumed 9-10 drinks in less than an hour is at risk of death. Here’s how. The term “lethal dose” (LD) is used to describe the blood concentration that produces death from drugs (in this case, alcohol) in half the population. Most authorities agree that BACs in the 0.40 percent to 0.50 percent range meet the requirement. That percent is an average, not an absolute standard. Fatal overdoses from alcohol at BACs lower than 0.40 percent have been documented, as have cases of survivors at BACs higher than 0.50 percent. If you refer to the above chart correlating number of drinks, weight and BAC levels, you can now figure out how dangerous different numbers of drinks can be.

Alcohol_Abuse_Project_3_by_TomBod

Here’s a final take home message for you. Alcohol poisoning is a life-threatening condition and requires immediate medical attention. You don’t have time for cold showers, hot coffee or walking. Not only will these not reverse the effects of alcohol overdose, but they could actually make things worse.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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 © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Health Benefits of Red Wine  

We’re approaching the weekend, and we’re coming off a lot of Straight, No Chaser posts on alcohol, so let’s just address some questions you’ve asked about the benefits of alcohol.
So alcohol is good for me now (especially after all those other blog posts)?
red-wine-health-benefits

Red wine has been known to provide specific health benefits for at least 10 years now. Of course, you have to interact with it in a certain way to receive these benefits. More on that in a bit, but yes, moderate alcohol consumption (especially red wine) does have a direct, beneficial effect on the heart.

Can you be more specific?

red-wine-and-heart-health

Ok. The skin and seeds of red grapes contain substances called flavonoids. Flavonoids reduce bad cholesterol (LDL) production, increase good cholesterol (HDL) production and reduce blood clotting, all of which are significant risks leading to many instances of heart disease. Each of these actions by flavonoids independently reduce the risk of heart disease.
Ok. So how much wine should I be drinking per day?
If you’re drinking “for the health benefits,” a four-ounce serving is generally what’s recommended for women, and 4-8 ounces works for men. Higher levels of daily consumption than this introduce health risks that offset any benefits.
Is this true for all wines?

redwine-ecg

Unfortunately, not to the same extent. Here are two simple (and admittedly overly simplistic) rules regarding the number of healthy flavonoids in wine.

  • Red wines are better than whites.
  • Bitter red wines are better than sweet wines.

The best red wines have been found to be Cabernet Sauvignon, Petit Syrah and Pinot Noir.
So should I start drinking if I don’t already?

red-wine-ink-heart

Probably not. Most drinkers don’t have the discipline to limit their consumption to just one 4-8 ounce serving of red wine a day, and alcohol comes with too many other health risks to offset the benefits of not drinking at all. This is especially true in those with existing health conditions such as hypertension, pancreatitis, depression, high cholesterol/triglycerides or congestive heart failure. Besides, grape juice has been shown to offer the same benefits!
Enjoy your weekend, just remember (as I always say): good health isn’t found at the bottom of a bottle!
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, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Self Assessment of Alcohol Dependency

alcoholaddictionchains
The number one response to the post on acute alcohol poisoning was pretty simple: “How can I tell if I’m drinking too much over the long haul?” And so it’s back to back the Straight, No Chaser (literally) days. The problems with most intoxicating substances involve 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 again. The difference with alcohol abuse is that alcohol is legal and comparatively inexpensive, so you get to keep trying without much fuss (at least initially).
Let’s set the stage by standardizing some terms:

ALCOHOLICtendencies

  • 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 “I can handle my liquor” or “I can stop anytime I 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, one glass of wine or one mixed drink.)

alcohol_risk

  • Women having more than three drinks at one time or more than seven drinks a week
  • Men having more than four drinks at one time or more than 14 drinks a week

If so, you’re causing damage.  We’ve discussed the damage in these additional Straight, No Chaser posts.

Now 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?
Unfortuantely, I’m pretty sure no one is giving up alcohol by reading this. 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 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) and 844-SMA-TALK offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Alcohol Facts vs. Fiction

alcohol and carbohydrates
Today’s Straight, No Chaser puts a personal spin on an old favorite because well, frankly some of you drink too much. Here’s your six-pack (plus one for the road) of common myths that are 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 is 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.

myths-facts-300x300

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, which is an indication of dependency – in other words, a progression toward alcoholism.

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.

alcoholicdrunk
If you have any other questions or myths you’d like busted, tee them up for me, and I’ll address them.  Cheers!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress.

Page 1 of 2
1 2