Tag Archives: Behind the Curtain

Straight, No Chaser: Hirsutism (Abnormal Female Hair Growth)

February 24, 2016Environmental, General Health and Wellness, Obstetrics and Gynecology844-SMA-TALK, Behind the Curtain, cushing's syndrome, hirsutism, polycystic ovary syndrome, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Have you ever wondered how and why some women develop more hair on their face and bodies than other women? That’s called hirsutism and is the topic of this Straight, No Chaser post.
What are the symptoms of hirsutism?
The first thing to appreciate about hirsutism is it doesn’t describe the fine, baby-like hair that normally appears on the body. The hair in hirsutism is thick and dark. It tends to present on the face, chest, back and sometimes on the abdomen. Other symptoms may include acne, decreased breast size, increased musculature, irregular menstruation and voice deepening.

Why do these symptoms present?
Basically, hirsutism is seen in conditions that cause abnormally high levels of male hormones (androgens) in women.
Are there risk factors or medical conditions that make this more likely?

There are greater tendencies for certain ethnicities to experience hirsutism, including women of Middle Eastern, South Asian and Mediterranean descent.
Hirsutism is more likely in women whose mother also have it.
Medical conditions known to increase the level of male hormones in women include Cushing’s syndrome, tumors in the adrenal gland or ovaries, and polycystic ovary syndrome.
Some medications also can cause hirsutism, including anabolic steroids, hormones and danazol (a medicine used to treat endometriosis).

What can I do to get rid of the excess hair?
There actually are a few self-help techniques that work well for hirsutism.

Obesity involves an increased presence of hormones promoting hair growth. Lose weight.

Regarding hair removal, you will have to be careful to not exchange one problem for another. Many efforts used to remove hair lead to either stubble or facial irritation. Here are tips about a few such methods.

Shaving is the safest and easiest way to remove hair. The potential problem with shaving is the development of stubble, which is more likely if you don’t shave daily. Another problem is the level of skin irritation that can occur if you do shave daily.
Hair removal creams (aka depilatories) can be used without fear of stubble. However, these creams may irritate your skin, so it is often recommended to initially test creams for irritation on parts of your skin away from your face.
Bleaching paste may also be used but may also cause skin irritation.
Tweezing is good for removing stray hairs, and waxing is effective for removal larger areas. Waxing is more likely to produce skin irritation.

What are some professionally used methods for hair removal?

Electrolysis is a means of permanent hair removal facilitated by placing an electrical current into the hair follicle, destroying it. Perhaps your biggest risk here is ensuring your operator is licensed and competent prior to the procedure.
Laser hair removal is another means of permanent hair removal. It involves use of a laser light to damage hair follicles. This causes existing hair to fall out and prevents new hairs from growing back. Laser hair removal is expensive and has notable side effects, which may include redness, scarring and skin discoloration.

When should I see my doctor about hirsutism?

A physician visit for hirsutism may be needed in these instances:

If your hirsutism occurs suddenly;
If your hirsutism is accompanied by irregular menstrual periods;
If your hirsutism is accompanied by deepening of your voice; and/or
If other methods of treatment don’t work. In these instances, different medical options may be employed, including prescription of birth control pills or other medications to counteract the male hormones.

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.
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Straight, No Chaser: Why You Get Grey Hair

February 23, 2016General Health and Wellness, Skin/DermatologyBehind the Curtain, Facebook, grey hair, Hair follicle, Human hair color, Melanin, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is a lot simpler than people make it. Gray hair is a happenstance of life. At the end of the day, genetic, racial and chemical considerations determine when you go gray. Let’s briefly look at each and dispel a myth or two along the way.
Chemical: Your hair consists of two parts, a shaft (the visible part above the skin line) and the root (the portion located below the surface). The root contains hair follicles, which contain color-producing cells called melanin (yes, the same melanin that contributes to skin color). Any disruption in melanin production or damage to the hair follicles, such as folliculitis and especially the normal effects of aging, can cause graying. This graying may be physiologic and timely, or it can be premature. An additional consideration to graying can be the physiologic build up of hydrogen peroxide. This naturally occurring chemical actually bleaches the hair.
Racial: Bet you didn’t know that on average, different racial and ethnic groups go gray at different rates. Whites start graying in their mid-30s. Asians begin graying in their late 30s. African-Americans seem to begin graying in their mid to late 40s. Most people will have noticeable and significant graying by age 50.

Genetic: Simply put, graying is predetermined based on your genetic composition. You should already have a good idea if and when you’re going gray by looking at your parents and grandparents.

And now… two questions rolled into one.

Doesn’t stress make you gray? Isn’t that why Presidents go gray while in office?

Presidents go gray in office because they’re at the age when people go gray while in office.
The stress you’re thinking of (‘freaking out’) isn’t the same as physiologic stress, which is a disruption of the body’s normal functions. Such biological stresses can cause disruption of any bodily function. This is why so much confusion exists around ‘stress’. When scientists or your physicians are describing the effects of stress, it’s much deeper than your anxiety attack, which isn’t going to turn you gray overnight.

Straight, No Chaser: About Hair Loss and Male Pattern Baldness – Alopecia

February 22, 2016Skin/Dermatology844-SMA-TALK, alopecia, baldness, Behind the Curtain, male pattern baldness, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I tell people all the time, “I’m shaved, not bald.” Whether or not that’s a distinction without a difference, alopecia (defined as partial or complete hair loss) is a losing proposition. To all the gentlemen asking me if I can predict whether or not they’ll go bald, allow me to answer this as definitively as I can. Yes, I can, and yes, you will. If you want your best guess of how the appearance of your hairline will evolve, take a good look at your father’s (if you still can).
Let’s begin by pointing out two important considerations.

Balding is not usually the result of a disease. It’s a function of aging, heredity and diminishing testosterone levels.
Both male and female-pattern baldness occurs, although this occurs much more often in men. Female-pattern baldness is discussed at www.sterlingmedicaladvice.com.

Here are a few fun facts about your hair:

The average scalp has approximately 100,000 hairs.
You normally lose 100 hairs daily.
Half of men begin the balding process by age 30.
Most men are bald or have a balding pattern by age 60.

Here’s a not-so-fun fact about balding: It’s true that stress contributes to hair loss. Sudden stress can cause loss to up to 3/4 of your hair to shed. That’s what happens when your hair is coming out in clumps when you comb it or run your hands through your hair. Here are some examples of stressors:

Childbirth
Crash diets
Emotional stress
High fever and infections
Major illness and surgeries
Medications
Infections

There are many other causes of hair loss, including many diseases and treatments such as low blood counts (anemia), radiation therapy, lupus, syphilis, ringworm, burns, thyroid disease, hormonal disorders and certain tumors. Even your habits, such as excessive blow-drying, shampooing or hair pulling can contribute to hair loss.

As mentioned, male pattern baldness is related to male hormone levels and heredity. Over time your hair follicles (the holes in your skin that house individual hairs) shrink and stop growing hair. That said, even when this occurs they retain the ability to grow hair if sufficiently stimulated.
This is all fine and good, but what I want you to understand regarding hair loss is what’s abnormal and when you need to seek medical attention.
Here are occurrences that should prompt you to contact your physician:

You are a woman experiencing male pattern baldness.
You are also developing acne, facial hair or abnormal menstrual cycles (women).
You are losing hair in your teens or twenties.
You are losing hair unbelievably fast.
Your hair loss follows medication use.
Your skin is red, tender, expressing pus, scaly or otherwise abnormal under the hair loss.
You’re having pain or excessive itching associated with your hair loss.

Discussion of the effectiveness of medications such as Rogaine and Propecia, as well as discussion of other treatment options, including hair transplantation is available at www.sterlingmedicaladvice.com.
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.
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Straight, No Chaser: When Back Pain Could Be Life Threatening

February 21, 2016Neurology, Orthopedics/Bones844-SMA-TALK, Behind the Curtain, Cauda Equina Syndrome, Conditions and Diseases, low back pain, sciatica, spinal stenosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Back pain hurts, but there are various causes of that pain that will kill or cripple you. Here’s some information on some diseases that present with back pain representing life-threats. Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards. Forewarned is forearmed.
Let’s start where we left off on post discussion general low back pain and identify what I was talking about….
Here are a few clues to help you hone in on whether your back pain requires emergency attention. Remember pain and pathology (serious disease) are two different considerations. I’m describing medical emergencies here and admittedly being overly simplistic.

Direct blow to your back: Think Fracture
- The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back. It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy. That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
Fever and new onset back pain: Think Spinal Epidural Abscess
- A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones. It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood. Antibiotics for about a month and/or surgery may be required.
Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
- There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies. CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects. This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs. Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
New onset back pain after age 65: Think Cancer
- There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer. The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement. Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present. It could represent a significant advancement of disease.
Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
Night-time back pain: Think Metastatic Cancer.
- Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
Sudden sexual dysfunction: See Cauda Equina Syndrome above
Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
Unexplained new weight loss and new onset back pain: Think Cancer
- There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
Work-related back injuries
- This isn’t as much a life-threatening consideration as it is a limb and career-threatening one. Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed. Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs. I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future. The take home consideration here is to use these cues to know when to get rapidly evaluated. Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.
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: Management of Herniated Disks

February 20, 2016General Health and Wellness, Orthopedics/Bones844-SMA-TALK, Behind the Curtain, herniated disk, ruptured disk, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Approximately 40 million Americans have low back pain. Odds are the presence of low back pain is not associated with a herniated disk. Truthfully, herniated disks are more commonly the result of degenerative changes in your spine due to aging and the wear and tear associated with how we live. So, if you really want to decrease your risks, adjust your lifestyle. However, it is important that you appreciate the circumstances under which medical attention is indicated and may make a difference to you.
Today’s post is not a prompt for you to ask your family physician, emergency department or orthopedist for surgery. In fact, the overwhelming majority (approximately nine of 10 patients) of patients who actually have herniated disks are treated conservatively, meaning without surgery. This post is meant to empower you with information about prevention and treatment as well as an overview of medical management principles.
The best approaches to limiting pain associated with herniated disks (or any low back pain for that matter) are prevention in the first place, then prevention of worsening of the situation.

Posture. Posture is important because normal alignment of the spine and back keeps everything working as designed. Good posture limits pressure and reduces the occurrence of injuries. Focus on keeping your back straight. This is so important. Do this when sitting, standing and lifting. Use your legs when lifting and not your back. Find something on which to prop one of your legs when standing.
Exercise. Exercise is all about strengthening your core. You don’t want extra belly girth pulling against your spine. Furthermore, strengthening the abdominal/trunk muscles stabilizes and supports the spine. All those times you slip and don’t injure your back are largely due to this stability.
Weight. Being overweight places excess pressure on the spine and disks and predisposes you to misalignment of your spine. This places you more at risk for herniation.

I’d imagine that most of you with low back pain have sought medical attention at some point. However, there are basic considerations that you can address prior to seeking medical attention. If you haven’t, it’s likely that your first doctor interaction on the subject will simply consist of instructions to perform some of the following steps:

Identify and reduce causes. If you have knowledge of what causes your pain, often the first course of action is to reduce or avoid those triggers. Of course this isn’t always easy when the discomfort is caused by work-related activities.
Reduce your stress. It’s true. Stress does intensify pain. Practice relaxation techniques such as deep breathing, mediation, massage, etc. when your stress level rises.
Consider professional help. The idea here is to change the way you feel about your pain even if you can’t eliminate it or while you’re taking steps to eliminate it. As mentioned, stress increases physical pain. Mental health professionals do wonderful work in this regard and can help you set realistic expectations.
Heat or ice.
Try over-the-counter pain medicines. Acetaminophen, aspirin and anti-inflammatory medicines such as ibuprofen and naproxen have worked for millions. This is an appropriate first step.

There’s a difference between when your pain requires medical attention and when it requires emergency medical attention. Your desire for an explanation, worsening of pain, radiation of your pain from your neck or back to your arm or leg, or the development of weakness, numbness and tingling are generally accepted prompts to seek an evaluation for your pain.
There are also prompts for you to get immediately evaluated because your pain could be life threatening. Such prompts include these symptoms.

Worsening symptoms. “Worsening pain” refers to that pain this renders you unable to work or perform your regular daily activities.
Bladder or bowel dysfunction. If you become unable to control your bladder (either holding your urine or being able to urinate), this needs to be immediately evaluated.
Loss of sensation in certain areas. Loss of sensation in the areas that would touch a saddle (i.e., the back of your legs, your inner thighs, and the areas surrounding your rectum) indicates the possible presence of a specific type of emergency that requires immediate evaluation.

Straight, No Chaser: My Back and Neck Pain Has a Name – Herniated Disks

February 19, 2016Orthopedics/Bones, Musculoskeletal System844-SMA-TALK, Behind the Curtain, herniated disks, low back pain, ruptured disk, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

It’s quite common for someone to come to me and say, “I have a herniated disk.” I used to ask how they knew, but I came to realize the answer to be unimportant. The pain and relative disability of those suffering from low back pain can be dramatic, both physically and emotionally. Being able to place a name of what’s causing that discomfort is meaningful in and of itself.

We’ve discussed low back pain (LBP) before on Straight, No Chaser, but herniated disks are special considerations among its causes. A herniated (aka ruptured or slipped) disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A common and effective way to understand a spinal disk is to picture a jelly donut, with a softer center captured inside of a tougher exterior. A herniated disk occurs when some of the softer portion protrudes through the exterior. Keep in mind that your spinal column runs from your neck down your lower back, so herniation may occur anywhere along the spine, although the low back is the most common site.
Herniated disks may or may not produce symptoms, and you may not even know you have one. Of course, some herniated disks are extremely painful and incapacitating. The problems with herniated disks aren’t just related to the manual eruption of the disk’s contents. You can experience irritation of surrounding nerves, which can produce pain, numbness or weakness in an arm or leg.
The most common signs and symptoms of a herniated disk are relative to the nerves affected by the herniation. Nerves have a distribution (i.e., affected areas of the body) associated with them. The following symptoms can be produced by a herniated disk and will be seen along that distribution.

Arm or leg pain Arm and shoulder pain may result from herniated disks in your neck, including pain that radiates down the arm. Certain motions and actions (e.g., coughing, sneezing and neck rotation) may exacerbate your symptoms. If your herniated disk is in your lower back, intense pain may be present in your buttocks, thigh, calf and part of the foot.
Numbness or tingling
Weakness Similarly, muscles that are served by nerves affected by a herniated disk tend to weaken, and this may cause stumbling and other signs of lessened strength (e.g., decreased ability to lift or hold).

Factors that increase your risk of a herniated disk may include a genetic predisposition, excess weight producing ongoing stress on the apparatus of the back,and various jobs (including those involving heavy or repetitive lifting, bending, twisting, pushing or pulling).
The next post will address treatment options and self-help considerations for herniated disks.
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: Sciatica

February 18, 2016Neurology, Musculoskeletal System844-SMA-TALK, Behind the Curtain, Conditions and Diseases, low back pain, sciatica, spinal stenosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

My pain has a name, and it’s sciatica. There’s always a sense of relief in patients when a name is given to a medical sign or symptom. This Straight, No Chaser places sciatica in context among various problems of the low back and gives you basic information for you to use in seeking solutions.
What is sciatica?

This is important for you to understand. Sciatica is a symptom, not a diagnosis. Sciatica is any of various clinical presentations that result from any injury to or inflammation of the sciatic nerve. The sciatic nerve is a large nerve that extends from the lower back and travels down the back of each of your legs. This nerve provides muscle control and sensation to various parts of your thighs, legs and soles of your feet.
What are the symptoms of sciatica?

Once you know the distribution of the sciatic nerve, the symptoms are pretty self-evident. Simplistically, a nerve is just an electrical conductor sending signals down its distribution. The typical symptoms of sciatica include the following:

Pain (e.g. pins and needles, burning or aching)
Weakness (can progress to an outright inability to move)
Numbness
Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

After sneezing, coughing or laughing
After walking or bending backwards
At night
When standing or sitting

What causes sciatica?

If you ever get diagnosed with sciatica, your immediate next question should be “What’s next?” Be reminded, sciatica is caused by something causing irritation, inflammation or injury to the sciatic nerves. Here are some common and/or important causes of sciatica; feel free to ask your physician if these actual diagnoses are being considered if you’re told you have sciatica.

Bruise or fracture to one of your pelvic bones
Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
Infection (a rare but important cause in those with new fever and back pain)
Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
Pregnancy
Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news).

How is sciatica treated?
If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

In some cases, no treatment is required and recovery occurs on its own.
Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
Reduced and limited activity is best for the first few days. Bed rest is not recommended.

For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.
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: Low Back Pain

February 17, 2016Neurology, Orthopedics/Bones, Musculoskeletal System844-SMA-TALK, Behind the Curtain, Conditions and Diseases, low back pain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

For many, low back pain begins with a slip and subsequently becomes a slippery slope that never seems to end. This Straight, No Chaser will help you understand why you’re having pain.
Lower back pain is a tricky subject for an emergency physician, and it’s seen everyday. In fact, over 40 million Americans suffer from various forms of chronic low back pain. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.

Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):

Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

2. Strains
Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.
3. Fractures
A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.
4. Arthritis and Normal Deterioration (aging)
There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.
Here are a few clues to help you hone in on whether your back pain requires emergency attention:

Direct blow to your back
Fever and new onset back pain
Loss of control of your bowel movements or bladder function
New onset back pain after age 65
Numbness and tingling in both of your legs
Nighttime back pain
Sudden sexual dysfunction
Weakness and/or loss of motion or sensation in your legs
Weight loss and new onset back pain
Work related back injuries

What can you do to prevent or reduce the pain at home?

Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
Wear low-heeled shoes whenever you can, ladies!
Learn how to stretch your back.

Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
Sleep on your side. Try a pillow between your knees.
Walk. Did you know walking is the best (and easiest) exercise for your back?

Straight, No Chaser: Staying Alive – A Ridiculously Simple Approach to CPR

February 15, 2016General Health and Wellness844-SMA-TALK, Behind the Curtain, Cardiopulmonary resuscitation, CPR, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Hopefully, this video is the hokiest thing I’ll ever post, but modern understanding of CPR is such that every single one of you should know exactly how to respond in the event someone collapses near you. Simply put, this is how you save lives. I would think every one who reads this would do well to forward or post this message within your networks.

CPR video

In case the video doesn’t launch for you, here’s your two steps.
1) Have someone call 911.
2) Interlock your hands and fingers (one on top of the other) and use them to apply compression to the center of the affected person’s chest, right between the nipples. Push fast and hard; and yes, the correct rate (100 reps/minute) can be approximated by pump to the beat of The BeeGee’s hit “Staying Alive.” Forgive me, but this is important enough to go there.
You may have noticed the deemphasis of rescue breathing. That makes this process even easier. Combine this with my past comments regarding an AED (automated external defibrillator – click here for details), and you are really giving someone the best opportunity to have a successful outcome.
Don’t worry, in a future post, I’ll address how to get that song out of your head.
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.
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The Straight, No Chaser Comprehensive Safe Sex Guide

February 14, 2016Genital/Urinary, Infectious Disease, Obstetrics and Gynecology, Health PreventionAnal sex, Behind the Curtain, Condom, Dental dam, HIV, Human papillomavirus, National Institutes of Health, Safe sex, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This edition of Straight, No Chaser is a keepsake, whether for your own reference or as a conversation piece/teaching guide for others. I suspect that due to the volume and wealth of information contained within, you’ll refer to this post time and again (or so I hope). For additional information, refer to the U.S. Center for Disease Control and Prevention and/or the National Institutes of Health websites.

STAYING STD-FREE
The best ways to stay STI free is to confirm it and then avoid it. If you want to reduce your risk of acquiring HIV and other STIs (sexually transmitted infections) through sexual contact, here are your options.

Abstain from sex.
Be monogamous.
Prove both you and your partner(s) are negative. Get yourself and your partner(s) tested, preferably prior to engaging in sexual activity and subsequently every three to six months, especially if you and/or your partner have more than one sexual partner.
If and once you establish that you’re STI-free, learn how to use condoms and do so every time you have sex.

A special note about protecting yourself from HIV
HIV can be spread by having unprotected sexual contact with an HIV-positive person. “Unprotected” means any vaginal, anal or oral sex without barrier protection, like a condom or dental dam. Some of the ways to reduce your risk of getting HIV through sexual contact include the following:

Don’t have sex. Abstinence is the best way to be certain that you won’t contract HIV. Although HIV is occasionally transmitted in other ways, vaginal, anal and oral sex are the most common ways that HIV is transmitted.
Be monogamous. To be clear, this means you are in a sexual relationship with only one person and both of you are having sex only with each other. For the purposes of contracting HIV, sex includes vaginal, oral or anal sexual activity. Monogamy is optimally effective if you also confirm early and often that both you and your partner are not infected with HIV.
Get yourself and your sexual partner(s) tested: Knowing your own status is important for both your health and the health of your partner. Talking about your HIV status likely will be difficult and uncomfortable, but it’s important to start the discussion BEFORE you have sex.

FRANKLY, “DON’T ASK, DON’T TELL” IS JUST DUMB WHEN IT COMES TO STIs.
This is actually quite simple. No excuses. You need to ask your sexual partner(s) and any possible future partners the following questions.

Have you been tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
When was the last time you were tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
If you’ve been tested, what were the results of your tests?

SAFER-SEX ACTIVITIES
These activities carry no risk of HIV transmission:

Non-sexual massage
Casual or dry kissing
Masturbation (without your partner’s body fluids)
Frottage—also known as “dry humping” or body-to-body rubbing

You can still contract other STIs, like herpes, HPV, or pubic lice (“crabs”) if you have bare skin-to-skin contact with your partner.

CONDOM USE
Here are two questions for both males and females.

Have you ever learned how to safely and appropriately use condoms?
Do you use condoms consistently?

To maximally reduce your risk of getting HIV or other STIs, you must use a new condom with every act of vaginal, anal or oral sex. If you don’t use them for oral but do for vaginal and anal, you have still lowered your risk, just not as much as you could have. Also, you must use condoms correctly, as depicted in the above diagram, to appropriately reduce your risk. Learning correct usage also will keep condoms from breaking or slipping off, which reintroduces the risks.
I also want you to understand that all condoms are not created equal. Latex condoms are highly effective against HIV and other STIs. Do you or your partner have a latex allergy? If so, the next safest condom choice is a polyurethane or polyisoprene condom. Just tell your pharmacist at the drug store that you’re allergic to latex, and s/he’ll take it from there. On the other hand, lambskin condoms do NOT protect against HIV. The particle size of the virus allows it to maneuver and slip through lambskin.
Condoms alone have never been enough. Did you know that you should always use a water-based lubricant when you use a condom for either vaginal or anal sex? I want to restate this: that’s water, not petroleum jelly. Water-based lubricants reduce friction and help keep the condom from breaking. Do NOT use an oil-based lubricant (such as petroleum jelly, hand lotion or cooking oil). Oil-based lubricants can damage condoms, making them less effective.
Both male condoms and female condoms will help protect you against HIV and other STIs. If you’ve learned to enjoy sex with a male condom, you can learn to enjoy it with a female condom or a dental dam. Additionally, there are many of you who have contracted STIs. If you wish to continue to enjoy a variety of sexual activities, learning to use the full range of barrier protection may be a better option for you and your partner than abstaining.
Condoms do not provide 100% protection against all STIs, but you are always safer using a condom than not. You can get certain STIs, like herpes or HPV, from contact with your partner’s bare skin, even if one of you is wearing a condom, but condoms lessen the risk. Take the time to explore and inspect each other if you’re confused or concerned about the possibility of your partner having an STI.
Spermicides only serve the purpose of reducing the risk of becoming pregnant. They are ineffective in preventing contraction of HIV and other STIs. They actually irritate rectal and vaginal walls, in effect increasing the chances of HIV infection, should infected fluids come into contact with these areas.

ABOUT SEX TOYS
This is pretty straightforward. Using sex toys can be safe, but think of staying clean and “not sharing.”

It is important that you use soap and water to clean your toys after each use. If the instructions allow for a stronger disinfectant, you may do so.
As a rule, don’t share your toys. The nature of how toys are typically used likely increases the risk of vaginal or anal irritation, which increases the risk for HIV or other STI transmission.
If you “must” share your toy with your partner while still trying to be safe, use a condom on the toy before you use it, and change the condom before your partner uses it.

CIRCUMCISION
We’ve discussed circumcision at length in Straight, No Chaser. (Click here for a dedicated post on circumcision.) There has been ongoing interest and research over the past few years about circumcision and its effect on preventing HIV infection. The bottom line? In 2007, the World Health Organization reported that male circumcision reduced the transmission of HIV by 60% from women to men in three randomized, controlled studies in Uganda, Kenya, and South Africa.
There is much less available data for men who have sex with men and how circumcision might affect HIV transmission through anal sex. In addition, recent studies show that circumcision does NOT protect women from contracting HIV from male partners.
Let’s be careful in interpreting the results of these findings.

Circumcision is only additionally effective when earlier preventative efforts have not been taken. Advocating circumcision is not an appropriate substitute for any of the numerous safety measures and habits previously discussed to reduce one’s risk for HIV and other STIs.
Failure to have a circumcision does NOT increase one’s HIV and other STI risk in the presence of appropriate safe-sex activities.

So there you have it. Knowledge is power. We appreciate that this posting was not balanced by the human decisions and passions that come into place with sexual activity. We recommend that you adopt a posture of “safety first” to create that balance! Good luck, and feel free to ask your SMA expert consultant any questions you may have on this topic.
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.
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Straight, No Chaser: The Health Benefits of Dark Chocolate, aka Happy Valentine's Day!

February 14, 2016Cardiology/Heart, Detoxification, Diet and Nutrition, General Health and Wellness, Health Prevention844-SMA-TALK, Antioxidants, Behind the Curtain, dark chocolate, Free radicals, oxidation, phenols, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Valentine's DayJeffrey Sterling, MD

Happy Valentine’s Day! Got Dark Chocolate?

As you may know if you’re a regular reader, Straight, No Chaser is big on you enjoying life and making healthy choices while doing so. In that spirit, on this day of roses and chocolates, we’re here to share with you the benefits of dark chocolate.
That’s right. Chocolate does have health benefits, but all chocolate is not created equal. If your loved one gives you chocolates today, that’s great (if that’s your thing). If s/he gives you dark chocolate, that’s an extra level of loving!
Straight, No Chaser has previously discussed the health benefits of antioxidants. Here’s the thing: antioxidants are substances that prevent or delay cell damage caused by free radicals. Free radicals are molecules that are byproducts of many activities that create cell damage. Think about cigarette smoke, trauma (even excessively vigorous exercise), excessive heat and sunlight (and its radiation), to name a few examples. The process of creating and releasing these molecules is called oxidation. The key point is free radicals are unstable and too many of them lead to a process called oxidative stress. This process is implicated in the development of many illnesses, including Alzheimer’s disease, cancer, cataracts and other eye diseases, cardiovascular diseases, diabetes and Parkinson’s disease. Antioxidants fight this process; this is why foods rich in antioxidants are called superfoods!

Here are the known benefits of dark chocolate:

It lowers blood pressure.
It increases the levels of antioxidants, which reduces the incidence of heart disease of other conditions.
It potential slows the onset of many (if not any) disease made likely by increased levels of free radicals. This points to benefits for brain health, slowing aging, cancer prevention and many other conditions.

Here’s how to enjoy the benefits of dark chocolate:

Remember, it’s dark chocolate (not white chocolate or milk chocolate) that provides these health benefits.
Offset the extra calories you’re ingesting by exercise or otherwise eating less.
Don’t drink milk while enjoying your dark chocolate; it appears to interfere with the body’s absorption of the dark chocolate.
Go for European dark chocolate if available. It’s richer in cocoa phenols (the specific compounds known to lower blood pressure).
Remember that a dark chocolate diet is not a thing! This is you making healthy choices even as you enjoy sweets.

So if you’re going to chomp down on a truffle or bon-bon today, make it dark chocolate. And hold the milk. Happy Valentine’s Day!
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.
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Straight, No Chaser: What Will You Do If Your Baby Starts Choking?

February 13, 2016General Health and Wellness, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Cardiopulmonary resuscitation, choking, CPR, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We’ve previously discussed how to address choking in adults. Today, we address the twin horrors of needing to save a baby’s life (those younger than 12 months old) from choking and how to help yourself if no one else is around to help.
In case you didn’t realize it, infants haven’t had time to accumulate enough disease and toxins to have heart attacks in the way adults do. When they are in a life-threatening situation, it’s far more likely to be from a respiratory cause, such as choking. Infants and young children are exploring their world and seemingly will place most anything near or in their mouths. Too often this leads to choking. Please keep this in mind if you’re ever faced with an infant in danger.
In discussing how to help a child in danger, let’s focus on two considerations: how to assess the situation and how to act.
It is vital to assess these situations accurately. There are important splits in treatment algorithms based on your assessment.
Simply put, the first thing you want to do is determine the infant’s level of responsiveness. For the purposes of this discussion, let’s assume we’re discussing conscious choking.
If an infant is suddenly unable to cough or cry, it’s a reasonable to assume that something may be blocking the airway.

When this is the case, help will be needed getting the object out.

If an infant is coughing or gagging, it’s likely that the airway may be partially blocked.

Coughing is actually the most effective way to dislodge an object, so you shouldn’t interfere in this setting.

If an infant is somewhat responsive in the context of a recent insect bite, bee sting or other possible allergic exposure, the throat could be closing because of an allergic reaction.

When this is the case, you are facing a potential life-threatening emergency. Call 911 immediately.

When you’ve made your assessment, your next step (unless you’re performing CPR, calling 911 or the child is still coughing) is to try to assist in getting the object out. Think “back blows, chest thrusts, repeat unless the infant gets unconscious.” Yes, that was meant to be a jingle.

Back blows:

Hold the infant face up on one forearm, and hold the back of his head with the hand.
Stabilize the infant’s front with your opposite hand and forearm.
Flip the infant face down so that he’s now in the control of the other forearm. Use your thumb and fingers to stabilize the jaw while flipping. Lower your arm onto your thigh; now the baby’s head will be lower than his chest.
Using the heel of your hand, deliver five firm back blows between the infant’s shoulder blades in an effort to dislodge the object. Maintain head and neck support by firmly holding his jaw between your thumb and forefinger.
Finally, place the hand that had been delivering the back blows on the back of the baby’s head with your arm along his back. Carefully, turn him over while keeping your other hand and forearm on his front.
If you have dislodged the object and the infant is responsive and/or coughing, you are done. Otherwise, proceed to chest thrusts.

Chest thrusts

Use your thumb and fingers to hold his jaw while sandwiching him between your forearms to support his head and neck. Lower your arm that is supporting his back onto your opposite thigh, still keeping the baby’s head lower than the rest of his body.
Place the pads of two or three fingers in the center of the baby’s chest, just below an imaginary line running between his nipples. To do a chest thrust, push straight down on the chest about 1 1/2 inches. Then allow the chest to come back to its normal position.
Do five chest thrusts. Keep your fingers in contact with the baby’s breastbone. The chest thrusts should be smooth, not jerky.

Repeat
Continue alternating five back blows and chest thrusts until the object is forced out, the infant starts to cough forcefully, cry, breathe on his own or becomes unconscious. If he’s coughing, allow him to do so.

If the infant becomes unconscious
If a choking infant becomes unconscious, you should proceed to modified CPR as follows:

Open his mouth. If you can see an object, remove it with your little finger.
Give two rescue breaths. If you don’t see the chest rise, tilt his head and try two rescue breaths again.   If his chest still doesn’t rise, do 30 chest compressions.
Check the mouth again, looking for an object. Remove it if seen.
Repeat the cycle with rescue breaths and chest compressions until help arrives.

Regardless of the outcome, the infant will need prompt medical attention.
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.
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Straight, No Chaser: How Can I Save Myself If I’m Choking?

February 12, 2016General Health and Wellness844-SMA-TALK, Behind the Curtain, Heimlich maneuver, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you’re the type that is cool under pressure, you’re well positioned to think your way out of many dangerous situations. If you’re the type that’s inclined to panic, Stop! The life you save may be your own!
At Straight, No Chaser, we’re big on you knowing when to appropriately engage the healthcare system, knowing when you can contact us for advice and information, and knowing simple tips that can help you prolong your life. Here’s a very important example.

Think it through. If it happened today, how would you react if you choked on something and no one else was around?
Can you perform the Heimlich maneuver on yourself?

Here’s what you do.

Make a fist. Place the thumb below your ribs and above your navel.
Grasp your fist with your other hand. Using a quick, upward motion, press your fist the area.

As noted in the diagram, while perform this maneuver you can also lean over a chair, the edge of a table edge, couch or other object of similar height. In this example, you will quickly thrust your upper abdomen against the edge.
You should repeat this motion until the object blocking the airway comes out or until help arrives.
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.
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Straight, No Chaser: What Will You Do If You See Someone Choking?

February 11, 2016Cardiology/Heart, General Health and Wellness, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Cardiopulmonary resuscitation, CPR, Heimlich maneuver, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

So … what would you do if someone around you starting choking. Or if they choked, then lost consciousness? What would you do if you choked and no one else was around? Don’t you think you should know? Read on …
First things first. You’ve all heard of the Heimlich maneuver, even if you don’t know how to do it. My job today is to make this easy for you. My first task will be to pass on the physician’s mantra of “Do No Harm.” To that end, let’s start with things you shouldn’t do.

If the person is able to speak, don’t interfere.
If the person is coughing and still has a normal level of awareness, don’t interfere.
If the person is able to breathe in and out without excessive difficulty, don’t interfere.
If the person is conscious, don’t place anything in his/her mouth trying to extract an object.

Next, let’s review a few quick points to help you understand what could be going on.

Choking is occurring because something is blocking the airway (aka windpipe).
Choking is dangerous because complete blockage will prevent oxygen from circulating thorough the body.
Choking is deadly because without oxygen, permanent brain damage will likely occur in four to six minutes.

Partial blockage isn’t the same as complete blockage. The body has protective reflexes to deal with blockage. That’s what coughing is. Once blockage has become complete, you’re facing a life-threatening emergency, and the risks of doing something outweigh the risks of doing nothing.

It’s not that difficult to know if someone’s choking; they’re likely grabbing their throat. You would do well to know what it looks like if someone has already choked or is choking but can’t use his/her hands. Here are some clues:

Coughing may be increasingly weaker.
They likely will exhibit difficulty breathing.
They may be unable to speak.
Their skin may have a bluish or purplish color.
You may hear high-pitched musical sounds while they’re breathing.
They may have blacked out (from the blockage).

Here are universally accepted steps to the Heimlich maneuver (in someone not obese or pregnant):

Ask the person, “Are you choking?”
Then ask them to speak. If they can speak or are vigorously coughing, you watch and wait. If not, proceed.
Standing behind the person, wrap your arms around his/her waist.
Placing your thumb just above the belly button (navel), make a fist with one hand.
Grasp the fist with your other hand.
Thrust your fist quickly, upward and inward.
Repeat until the person either loses consciousness or the object is dislodged.

If the person is obese or pregnant, wrap your arms around the chest, not the abdomen. Place your fist between the nipples on the middle of the breastbone, and make firm thrusts back toward you.
If the person loses consciousness, there are four steps you must take.

If you see something blocking the airway, try to remove it.
Lower the person to the floor, preferably on his/her side until you start CPR or if vomiting starts.
Have someone call 911.
Begin CPR.

Of course, prevention is key. Take care to chew your food slowly and thoroughly.
Here are three more tips for those most at risk:

Children: Keep them away from small objects that can be placed in their mouths.
Elderly: Make sure their dentures fit appropriately.
Adults: Limit alcohol intake around the time of eating.

In an upcoming Straight, No Chaser, we’ll also add a post for you regarding how to handle yourself and infants (less than one year old) if choking.
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.
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Straight, No Chaser: The Medical Issues You Encounter While Flying

February 10, 2016Head/Eyes/Ears/Nose/Throat, Hematology & Oncology/Blood Disorders/Cancer, Neurology, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Deep vein thrombosis, DVT, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This week’s Straight, No Chaser posts have focused on the dangers presents by blood clots. Flying long distances presents a specific risk for development of blood clots. However, the risks posed by flying aren’t limited to this consideration.
I’ve probably been engaged twenty times on airplanes to provide medical assistance. My favorite incident was when four doctors (and a nurse) simultaneously jumped to assistance as if everyone was some type of superhero. Of course, I wouldn’t be telling the story if I didn’t end up being the last man standing (due to my status as the emergency physician among the group – and yes, the patient was ok). Consider this your handy to do and to don’t if and when you’re traveling by air. You never know!
There are four quick considerations I’d like to share:
Blood clots:

Flights (and especially the long ones) increase your risk for deep venous thrombosis (DVTs). You can reduce this risk by frequently bending and rotating your ankles, drinking water whenever the opportunity presents and getting up intermittently to walk. Prevention is also important – this is why traveling while in the latter stages of pregnancy is especially problematic and why near-term women aren’t allowed to travel – and you thought it only had to do with early deliveries!
Headaches and earaches:

Air in your body (lungs, intestines, sinuses and eardrums, to name a few) expand when your plane ascends and contracts upon descent. The squeeze on descent is actually more frequent of an issue than gases expanding on ascent, but both situations present problems. In addition to exacerbating migraines, your eardrums can rupture from the squeeze. Of course, adults address this by holding their noses and blowing, thus ‘popping’ their ears (actually this equalizes the pressure on both sides of the eardrum, returning things back to normal). Kids suffer just as much as adults, but the younger ones aren’t able to release the pressure as easily. Thus, it’s true that you should allow them to chew or suck on something during descent. The passenger sitting next to you will thank you.
Fainting:

Fainting is a common occurrence on flights for many reasons. Faints and other mental status changes due to low blood sugar (hypoglycemia) are the most common episodes I’ve personally encountered on flights. My best advice here is to stay hydrated (This will help you prevent faints and problems with DVTs.) and if you’re diabetic, eat during the flight. Low sugar reactions are scary in the air, and the pilots are always wondering if they’ll need to do an emergency landing.
Respiratory disease:

This is an important consideration because the potential for bad outcomes are heightened. Those with asthma, blood clots in the lungs (pulmonary emboli) and COPD (chronic obstructive pulmonary disease aka chronic bronchitis and emphysema) need to discuss traveling with their physicians. The high altitude of flights results in thinner air, drier air and increasing viscosity of your blood, which can affect patients suffering from the conditions mentioned. A ruptured lung in a patient with bad COPD is a formula for disaster.
In short, fly smart and fly healthy. An airplane is a horrible place to be in harm’s way. And that doesn’t even include snakes on a plane.

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.
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Straight, No Chaser: Why Are Athletes At Such Risk For Pulmonary Embolus?

February 9, 2016Cardiology/Heart, Respiratory/Lungs844-SMA-TALK, Anderson Varejao, Behind the Curtain, Chris Bosh, Deep vein thrombosis, Derrick Thomas, DVT, Jerome Kersey, Pulmonary embolism, Serena Williams, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Let’s begin today’s Straight, No Chaser by being sure not to overstate the case. All things being equal, young healthy individuals and superbly conditioned athletes have diminished risks for diseases across the board. However, all things aren’t equal. The nature of being a professional athlete and many of the tasks associated with being a professional athlete have resulted in some very high-profile cases of pulmonary emboli (PE).

Former NBA star Jerome Kersey of the Portland Trailblazers died last year from a PE.
NBA stars Chris Bosh of the Miami Heat and Mirza Teletovic of the Brooklyn Nets were diagnosed with pulmonary emboli and missed most of last season.
Former NFL star of the Kansas City Chiefs Derrick Thomas died from a PE in 1989.

Tennis superstar Serena Williams lost a year of her prime (and nearly her life) from a PE in 2010.
Cleveland Cavaliers center Anderson Varejao suffered a similar health scare during the 2012-13 season.

Straight, No Chaser has previously discussed deep vein thrombosis (DVT) and pulmonary embolism. It’s the risks that bear paying attention to; athletes and their activities increase the susceptibility to DVTs and PEs.

Driving or flying long distances. Athletes scan the globe competing. Any activity requiring you to be inactive for greater than four hourly increases the risk of developing a DVT. That risk increases the longer one remains inactive.
Dehydration. The advent of sports and rehydration drinks has reduced this risk, but one should appreciate that with the amount of perspiration occurring during athletic events, the risk of dehydration is present. Dehydration can directly lead to increasing the thickness of blood, which makes the development of clots more likely.
Hormones. Those taking birth control pills that contain estrogen have an increased risk of DVTs and PEs.
Immobilization: Any injury, cast or brace that results in immobility will allow your blood to pool and increase your risk of a DVT or PE.
Injuries. Any injury to a vein or a severe muscle injury can increase the risk for developing DVT.
Surgeries: Surgeries combine a few independent risks for DVTs, such as immobilization, the risks of dehydration and injuries to vein.

All things considered, professional athletes remain young and healthy. The occasional occurrence of these life-threatening conditions serves as a warning for us all to be aware of the risks. If world-class athletes are subject to the above risks, then the rest of us certainly are. Be informed and take appropriate precautions.
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.
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Straight, No Chaser: Pulmonary Embolus (A Blood Clot in the Lungs)

February 8, 2016Cardiology/Heart, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Deep vein thrombosis, DVT, hygiene, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

When I was a young, wide-eyed medical student, I learned that in a large number of cases, when people died from unexplained cases, the autopsies would often show the patient died from a pulmonary embolus. Of course this immediately sent the message that this condition gets missed a lot and is often deadly when missed. In fact, although estimates suggest these conditions affect 300,000 to 600,000 people in the United States, the exact number of people affected by DVT (deep venous thrombosis, discussed in this Straight, No Chaser) and PE isn’t known due to how often these conditions go undiscovered.

The problem is pretty straightforward. Your blood flows throughout the body, delivering oxygen and nutrients to your organs and tissues. This is necessary for normal function. If there’s a disruption in your blood flood, there will be problems. A pulmonary embolism (PE) is a sudden blockage in one or more lung arteries. This typically occurs by a clot that travels through the bloodstream to the lungs from elsewhere in the body (usually the legs, thighs or pelvis), which then gets lodged in the small arteries of the lung.
Pulmonary embolism is a serious, life threatening condition. Basically, if your blood flood through the lungs is blocked, the rest of your blood will be deprived of oxygen.
PEs can cause any or all of the following.

Permanent damage to the lung
Damage to other organs in your body from not getting enough oxygen
Death

The risk of death from PEs should not be underestimated. If left untreated approximately 30% of those with PEs will die. Imagine the horror we’d express we were exposed to an infection that killed 3 of every 10 individuals affected, and the risk was as great as is presented by the frequency of DVTs and PEs.
A particular problem with PEs is our general inclination toward waiting for diseases to appear and then seek treatment, instead of being proactive and pursuing prevention. Half of those with PEs will have no symptoms. Thus if you have risks factors or wait until you have been told you have clots in your legs to start reducing your risk, your exposure is much more dramatic.

If you do have symptoms of a PE, they can include the following: shortness of breath, chest pain or coughing up blood; these symptoms may appear suddenly and severely. Symptoms of a DVT/blood clot (e.g. in your legs) include warmth, swelling, pain, tenderness and redness.
The goal of treatment is to break up the clots and to prevent other clots from forming – this is not the same as dissolving the clots, which is a very aggressive and risky step only taken in certain specific, immediately life-threatening situations. The good news is that a prompt diagnosis and proper treatment can save lives and help prevent the complications of PE. Unfortunately, such success is not guaranteed once a PE develops.
The next Straight, No Chaser will look at the unique risks athletes have that place them at risk for blood clots and PEs.
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.
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Avoiding Sports Injuries

February 7, 2016Sports Medicine, Musculoskeletal System844-SMA-TALK, Achilles tendon, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Introduction

Today is Super Bowl Sunday, a de facto American sports holiday! Last year, over 111 million Americans watched this exhibition of athleticism and violence. In fact, the last four Super Bowls have been the four most watched television programs in the United States. In other words, it’s way beyond popular. Maybe you’ll be tossing a pigskin around today with friends and family. Maybe you’ll play a game before the big game. If so, you should know what you (and they) are up against.

Athletes are at risk for injuries for different reasons than weekend warriors. Although accidents happen to everyone, poor conditioning and training, propensities not to stretch or warm up, relatively poorer playing conditions, and use of inferior equipment (or lack of use of any at all) make your adventures a little more risky. Straight, No Chaser has reviewed many common sports injuries. Links to some are listed below, and others you can read up on just by typing what you’re looking for into the search box on the right.

The Most Common Sports Injuries

The most common sports injuries include the following conditions.

Sprains and strains, particularly ankle sprains
Knee injuries
Bruises (contusions) and other muscle injuries
Achilles tendon injuries
Rotator cuff injuries
Fractures
Dislocations

Of course, the most common aren’t all the rage. Everyone’s concerned about concussions. Here’s a Straight, No Chaser review of concussions.
The weekend warrior is too often engaged in a testosterone fest and doesn’t listen to his body. If you get hurt, stop. If you don’t listen to your body, someone more serious could be on the verge of happening.

Here are some tips to help you avoid sports injuries.

Always warm up, regardless of the sport. It’s especially helpful to stretch the Achilles tendon, hamstring and quadriceps areas and hold the positions without a bouncing motion.
Avoid bending knees past 90 degrees.
Avoid twisting knees. This is best done by keeping your feet as flat as possible during stretches and running.
If you’re jumping, land with your knees bent.
Cool down following vigorous sports. You want your heart rate to come down gradually.
Wear properly fitting shoes. You can avoid stress fractures and sprains by wearing shoes that provide shock absorption and stability.
Avoid running on hard surfaces like asphalt and concrete. It’s preferable to run on softer, flat surfaces. Appreciate that running uphill may increase the stress on the Achilles tendon and the leg itself.
Know when to stop.

We’ve discussed the RICE method of treating strains and sprains in the past. Make a habit of this for even minor ankle, knee, wrist, elbow and shoulder sprains. It helps with pain and swelling, and it also speeds recovery.

Whether you’re enjoying the Big Game or just your game, it’s good to know what you’re looking to avoid. Don’t let a sports injury sneak up behind you. If you are in need of information or advice, contact your personal healthcare consultants at 844-SMA-TALK or www.sterlingmedicaladvice.com. Have a great day, and enjoy the game.

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: Blood Clots in Your Legs – Deep Venous Thrombosis (DVT)

February 6, 2016Cardiology/Heart, Hematology & Oncology/Blood Disorders/Cancer, Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Deep vein thrombosis, DVT, hygiene, Pulmonary embolism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you’re a sports fan, you’re likely aware of the death of a 52-year-old former star of the NBA’s Portland Trailblazers, Jerome Kersey, followed two days after by the discovery of the same condition in a current star of the NBA’s Miami Heat, Chris Bosh. You may also recall tennis superstar Serena Williams’ career was once placed on hold for a year. The condition from which they all suffered was pulmonary embolus (blood clots in the lungs). Straight, No Chaser will discuss those in the next two posts, but today we will address the condition that most often precedes the development of clots in the lungs.

A blood clot represents a blockage of a blood vessel somewhere in the body, usually the lower extremities (legs and thighs), the lungs (pulmonary embolus) or the brain (a stroke). Today we’ll discuss the variety that occurs in the lower extremities, which are generally referred to as deep venous thrombosis (DVTs). In case you’re thinking that a clot in the leg doesn’t sound as bad as a clot in the lungs or the head, you’re correct – until you understand that DVTs break off and travel to other body sites, leading to blockage elsewhere (This is called embolism.).
Today’s challenges are to appreciate the risks of developing DVTs and the symptoms. Risk factors include the following:

Birth control pills or other estrogen use (this combined with cigarette smoking pushes the risk even higher)
Cancer
Cigarette smoking
Family history of blood clots
Obesity
Prolonged immobilization
Recent pelvic or leg fracture
Recent surgery (most often the pelvis or lower extremities)
Recent travel involving long periods of sitting
Certain medical conditions, most notably lupus

Symptoms most commonly are in one leg or the other and reflect the fact that the vein is being blocked. These include pain, swelling, redness and warmth. The above picture is not typical. The presentation is usually much more subtle.
Diagnosis and treatment are relatively straightforward as long as they occur in time (meaning before the clots have broken off). Diagnosis is usually accomplished by an ultrasound of the lower extremities; once discovered, you’ll be placed on blood thinners. It’s important to know that blood thinners prevent the formation of new clots. They do not dissolve existing clots. That’s usually not necessary, as many DVTs simply dissolve. If it doesn’t, DVTs that embolize are life-threatening (more so from the pelvis and thigh than the legs). Unfortunately pulmonary emboli are among the most missed medical diagnoses and causes of death.
Try to manage your controllable risk factors, and be aware – especially when you’re dealing with a risk factor that you can’t control (like surgery).
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 In The News: Zika Virus May Be Sexually Transmitted… And?

February 5, 2016Infectious Disease, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, microencephaly, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Zika virusJeffrey Sterling, MD

In the news is the discovery that the Zika Virus appears to have been sexually transmitted in Dallas County, Texas. There appears to be much angst about this, but let’s offer some perspective.

For starters, review this Straight, No Chaser for a refresher on transmission, symptoms and complications of the Zika Virus.

What’s the particular concern with the news of sexual transmission? Consider that a theoretical question.

One major answer is the risk of birth defects in newborns, particularly microcephaly (an irreversible condition in which infants are born with brains that are both damaged and abnormally small). Well, there are a host of sexually transmitted infections (STI) that are already known to cause birth defects, including toxoplasmosis, syphilis, varicella-zoster (chicken pox), parvovirus B19, cytomegalovirus, rubella and herpes. Does the threat of these diseases cause a widespread increase in use of condoms? Not especially.
How about the notion that the Zika virus is a sexually transmitted disease (STD)? Well, a very large number of the population has grown quite comfortable with the idea of living with HIV, herpes, syphilis, chlamydia, gonorrhea and other illness. To be clear, one in four Americans already lives with an STD/STI. Even the notion that HIV can be deadly, herpes has no cure and pelvic inflammatory disease from chlamydia or gonorrhea can cause sterility in women still doesn’t sufficiently incentivize the population to use condoms.

All of this is to say that it’s not very likely that the introduction of the Zika virus as a sexually transmitted infection would change very much in our habits. That said, you would do quite well to take simple steps to avoid exposure.

Now is not the time to travel to areas in which the Zika virus has taken hold, especially if you’re pregnant or are of child-bearing age – regardless of your immediate intentions about getting pregnant.
Now is the time to consider altering your sexual habits to include condom use, which remains the best way to prevent contracting sexually transmitted infections (other than abstinence).

As spring and warmer climates arrive, be mindful of preventive strategies to avoid mosquito bites and the diseases they bring. And always be smarter than the pack. Use condoms.
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

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