Tag Archives: Behind the Curtain

Straight, No Chaser: Let’s Boost Your Metabolism

February 4, 2016Diet and Nutrition, General Health and Wellness844-SMA-TALK, Behind the Curtain, BMI, Body mass index, health, heart health, mental-health, Mexico, Obesity, Overweight, overweight and obesity, physical attractiveness, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Weight ManagementJeffrey Sterling, MD

It would be improper for me to have dragged you through the mud for three days and depressed you into thinking you can’t improve your situation. Hopefully, you’re not feeling that way. You should now have a better understanding of how the body works, how to count calories and how to compare yourself to a baseline for health. What left is giving your body a leg up on your efforts. Yep, I’m talking about boosting your metabolism. Any of you that have been with me for a while know that means I’m not promoting something you’ll find in a bottle, although there are many good supplements that can assist in that effort. I’ll refer you to your (or my) favorite personal trainer for those considerations. As always, I want to offer you the tools to be self-empowered. To that end, here’s five Quick Tips to boost your metabolism. Why five? Because five is easier to implement than six. Once you get these five down, let me know, and we can get a bit more intricate.

1. Eat smaller meals, and eat more frequently. It’s true. More meals more often is better, but only if they’re smaller. Calorie counting is still a major part of the equation. The point of more frequent meals is preventing the body from going into starvation mode, which slows your metabolism as the body attempts to conserve energy. If you do this, you’ll discover those meals are smaller and you will get closer to eat more appropriate portions than we typically do. Also, make those in-between meals healthy choices like a handful of fruits or nuts.
2. Prime your pump. Remember, it’s all about your heart’s ability to efficiently move blood around the body anyway. The healthier your heart is, the better your metabolism will be. You need aerobic exercise that increases your heart rate for 20-30 minutes at a time. Learn your target heart rate for your age, and exercise to get into that range. Your metabolism will better approximate that of a fine tuned machine rather than a sputtering old car.
3. Weight train. This is very simple. The more muscular you are, the more calories you will burn, especially relative to someone of the same weight who is obese. Not only will you become a finer calorie-burning machine, in this case you actually will look better! Add weight training to your exercise regimen.
4. Choose the fish (and not the fried variety). Fish oil contains substances called omega-3 fatty acids (EPA, DHA) which increases levels of fat-burning enzymes and decreases levels of fat storing enzymes. Daily ingestion has been shown to help by approximately 400 calories a day.
5. Enlist a personal trainer. Everyone needs help and motivation. Some of us need a lot of help and a lot of motivation. We also need expertise. There’s nothing more frustrating than working hard yet not seeing any results because you’re working incorrectly. A good trainer can put you on the path, supervise your regimen, and hold your hand through the process. The minutia of age, sex and body habitus considerations that also play a role in this can be managed by a good trainer. Your ideal trainer will have knowledge of nutrition, wellness and supplements that are tailored to your specific considerations. This will get your metabolism revved up!
By the way, if you’re into green tea, caffeine or spicy/hot peppers, enjoy them for their other benefits, but don’t expect them to contribute significantly to your efforts to improve your metabolism. At least that’s what the consensus in the medical literature points out.

Finally: yes, it’s true that metabolism naturally slows with age (starting as early as age 25); everyone has heard that fact. However, here’s what you don’t usually hear: that’s not inevitable and is more a result of your becoming less physically active than just aging. That demonstrates the need for you to be even more diligent in your efforts. Good luck, and I welcome your questions and comments.
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: Healthy, Sustainable Weight Loss – Let’s Get Started

February 3, 2016Diet and Nutrition, General Health and Wellness844-SMA-TALK, Behind the Curtain, BMI, Body mass index, health, heart health, mental-health, Mexico, Obesity, Overweight, overweight and obesity, physical attractiveness, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Weight ManagementJeffrey Sterling, MD

How to Lose Weight, and What is Healthy Weight Loss (AKA, How Much, How Soon and How)?
Let’s start with the How. Commercial voice: “You should contact your physician before starting any weight loss routine”. We ended things on the last post talking about the caloric balance equation, which (simplified) means you need to get off your derriere, and close your mouth. Without getting too technical, to lose weight, 1 pound equals 3,500 calories, so your net caloric intake must be cut by at least 500 calories per day to lose a pound a week. Here are some Quick Tips to cut calories (and I will not be discussing any of the popular diets or medical remedies (with one exception in the next post); you can see your physician or nutritionist about those. Besides, guess what? Most of you don’t need a fad diet. Keep it simple. And…more importantly, you should be more concerned with healthy regimens that help you keep the weight off, not drastic efforts that have proven to have quick short-term but unsustainable long-term outcomes).

1) Work out: If you can sprint, do so. If you can’t, jog. If you can’t jog, walk. I like working out while watching sports, because my heart’s pumping anyway. Weight training at the same time is even better. Once you hit a good exercise regimen, your metabolism will improve, making weight loss that much easier. By the way, the next post is on metabolism; stay tuned.
2) Hungry? Start counting calories. Use this standard to determine what your daily calorie intake should be. Meal plan so you don’t exceed that level. Remember the caloric equation to lose weight: Amount expended minus the amount eaten should be 500 calories a day. In the next post, I’ll give you a Quick Tip for an extra 400 calories a day you can lose.

3) Still hungry? Try brushing your teeth. Don’t laugh. It actually works. And it gives you nice teeth. Otherwise try drinking water or chewing calorie-free gum. All these are nice, simple inexpensive appetite suppressants.
How Soon? It’s natural for anyone trying to lose weight to want to lose it very quickly. But evidence shows that people who lose weight gradually and steadily (about 1-2 pounds per week) are more successful at keeping weight off. Healthy weight loss isn’t just about a “diet” or “program”. It’s about an ongoing lifestyle that includes long-term changes in daily eating and exercise habits. Think health instead of weight, and the weight will improve.

How Much? If you were my patient (but you’re not!), I’d tell you to forget about ideal body weight and BMI – for now. Focus on a modest weight loss, like 5-10% of your current weight. Even this success will improve your blood pressure, cholesterol and blood sugar levels. Once you accomplish that goal, do it again. So even if the overall goal seems large, see it as a journey rather than just a final destination. Seek to learn new eating and physical activity habits that will help you live a healthier lifestyle. These habits may help you maintain your weight loss over time. To that end, I love healthy challenges. Try a 30-day water instead of pop (soda)/coffee, etc. challenge, or even better, give yourself a 30-day ‘fruit for dessert challenge’ or ‘salad of your choice for lunch’ challenge. When that’s done, immediately do it again. Learn to integrate healthy habits into your quest to lose weight, and you’ll increase the odds of having sustainable weight lost. At the end of the day, it’s been well established that those who maintained a significant weight loss report improvements in not only their physical health, but also their energy levels, physical mobility, general mood, and self-confidence. Good luck, and check back for the next post on how to fine-tune your metabolism!

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 Many Calories Do You Need a Day?

February 2, 2016General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, Calorie, Diet, health, Institute of Medicine, Obesity, Physical exercise, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Weight lossJeffrey Sterling, MD

Let’s put this post (at least the end of it) under the category of things you do but really don’t think about.
How many calories should you take in per day to function (meaning produce the energy you need for your activities of daily living)? It actually depends on your gender, your age and your level of activity. Let me start by defining the types of lifestyles, according to the Institute of Medicine. If you are in the third category (active), I doubt that you’re worried.
Sedentary means a lifestyle that includes only the light physical activity associated with day-to-day living.
Moderately active means a level of physical activity equivalent to walking about 1.5-3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
Active means a level of physical equivalent to walking more than 3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
That breaks down as follows:

For women between 14-50, the number is right about 2000 kcal/day (calories) if you’re moderately active and 1800 if you’re sedentary.
For men between 14-50, there’s some greater variance, but the 2500 kcal/day works if you’re moderately active and 2200 if you’re sedentary.

In short, that averages to about 600-800 calories per meal, with the low-end being for sedentary females and the high-end being for moderately active males.

Now consider, 16% of the calories in the average American diet come from refined sugars. Fully 50% of that total comes from beverages with added sugar.

Every 12 ounces of non-diet of pop/soda you drink contains about 150 calories.

Your average dessert ranges from 300-500 calories.

The most popular one, only one cup of ice cream, contains 270 calories.

I’ll let you take the math forward from there. However, the take home point is obvious. Suffice it to say, the link between pop, deserts and obesity has been well established. Here’s three Quick Tips for you.

Try finding a drink with fewer calories if you want to lose calories (and weight). It’s water, not Coke, that adds life.
Try eating your favorite fruits as dessert.
Also, consider just walking 3-4 miles a day. It’s not that hard, if you just do it.

Straight, No Chaser: The Adverse Health Effects of Obesity and Why You Gain Weight

February 1, 2016General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, BMI, Body mass index, health, heart health, mental-health, Mexico, Obesity, Overweight, overweight and obesity, physical attractiveness, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Weight ManagementJeffrey Sterling, MD

Earlier, we identified the differences between a ‘normal’ weight and being overweight and/or obese. Today’s goal is to help you understand specific risks of carrying extra weight. We’ll also set the table for losing weight by discussing why weight gain occurs. It bears repeating that none of this has anything to do with the perception of one’s physical attractiveness.
Let’s focus on three considerations.
1. What are the health risks?

As body weight increases, so does the risk for several different medical conditions and illnesses, including the following:
• Arthritis
• Cancers (breast, endometrial, and colon)
• Diabetes
• Gynecological problems (abnormal periods, infertility)
• Heart disease (heart attacks, heart failure, hardening of the arteries)
• High cholesterol
• Liver and gallbladder disease (gallstones)
• Sleep apnea and other respiratory problems
• Stroke
In the event that these risks are just words on a page, learning a little bit about some of them might provide the motivation needed to avoid them.
2. What is a realistic goal for weight loss? What’s the balance between family predisposition and the foods I eat?

No matter what I tell you today, it’s unlikely to turn you into a supermodel. The goal (independent of your consultation with your own health care provider) is to get you to optimize your situation based on the things you can control. Yes, genetic factors do play a role in obesity, but beyond that you are more than able to close your mouth and get off your…couch. You are able to limit your fat and caloric intake and put down the salt shaker. Yes, genetics count, but behavior and environmental (culture, socioeconomic status) consideration play at least as much of a role. These latter considerations can even jumpstart your metabolism beyond your genetic predisposition.
3. Why do I gain weight if I’m still active?

The most simple way to answer this is that weight gain occurs from an energy imbalance. You’re taking in too many calories, and/or you’re not engaging in enough physical activity. It’s an equation, and the weight gain occurs when you’re on the wrong side of the equation. It’s not much more complicated than this. Either do less of the eating, more of the activity, or both. I mentioned in a previous post on caloric counting that you must have an excess of 500 more calories expended than you ingest daily every day for a week just to lose one pound. It takes work. This is the simple answer as to why fad diets don’t work long-term. You can’t cheat the equation. The moment you stop being diligent, you’re headed in the wrong direction. Your weight loss plan must include lifestyle changes for the long-term.
In the next post, we’ll identify some very simple methods to combat obesity based on the information provided to this point. Feel free to ask 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: Examining Obesity – Is It Really a Choice Between Health and Happiness

Obesity in the United States places many at a crossroad between self-esteem and health. Often, larger frames are celebrated as more desirable. Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise. Of course, our culture embraces and contributes to obesity. Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport. Tomorrow we’ll discuss the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health. If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed. As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.

Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:

Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.

Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.

‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.

Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
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 Tragedy of Septic Shock

January 31, 2016Cardiology/Heart, Infectious Disease, Medical Treatment844-SMA-TALK, Behind the Curtain, Blood pressure, Conditions and Diseases, health, Intensive-care unit, Septic shock, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

There are bad days and then there are really bad days. In many ways, the occurrence of septic shock is a culmination of a lot of bad things that can happen to you. Septic shock is the condition your body finds itself in as a result, progression and complication of a serious infection. This infection overwhelms your body, producing a massive inflammatory reaction, bringing many complications along. These complications include a significant drop in your blood pressure and can also include organ failure, most notably of the heart and lungs. Septic shock doesn’t occur to just anyone. It most often occurs in those with weakened immunity in one form or other (elderly, immunocompromised, diabetics, recent surgery, infection or prolonged hospital stay, burn victims, newborns and the pregnant), and it is the single most common cause of death in intensive care units in the U.S. The most common cause of septic shock is pneumonia, but urinary tract and abdominal infections are also major causes.
Signs and symptoms are routine and include low blood pressure, confusion or other signs of altered mental status, fever, chills and a fast heart rate, weakness, shortness of breath and noticeably diminished urination. Don’t focus on that list, though. Septic shock is a situation where your physician will know it when s/he sees it. If something like this happened at home, you’d recognize that something horrible was wrong, and you’d find yourself in an emergency room.

In terms of treatment, the ‘when’ is just as the important as ‘how’. The earlier this is diagnosed and treatment is started, the better chances of survival are. And let there be no doubt. Life is in the balance with this condition. Treatment simultaneously seeks to hold the patient up and support him/her while the underlying condition is being addressed. This is when the big guns are pulled in, including major antibiotics, intravenous fluids to rehydrate you, medications to support and enhance blood pressure and possible use of a breathing machine (ventilator) to ensure optimal oxygenation. Even surgery may be necessary to remove dead abdominal tissue, burn tissue or an abscess that may be the source of an infection.

The truth is septic shock carries a death (mortality) rate of 50%. It is always a bad situation and is best viewed as a medical miracle when survived as opposed to a treatment failure when death occurs. I can only wish you and your family the best if you find yourselves in this situation. Time is tissue.
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: Alcoholism and Alcohol-Related Deaths Are on the Rise

January 30, 2016General Health and Wellness, Public Health, Toxicology/Drugs844-SMA-TALK, Alcohol related deaths, Alcoholism, Behind the Curtain, CDC, Centers for Disease Control and Prevention, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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? In the news is reason that should change. According to the Centers for Disease Control and Prevention, alcoholism and the deaths related to it are on the rise. Consider the sum total of the following statistics:

Alcohol is killing Americans at a rate higher than at any time in the last 35 years. In 2014, there were 9.6 deaths from alcohol-induced causes per 100,000 people, representing an increase of 37% since 2002.
Last year, more than 30,700 Americans died from causes directly related to alcohol (e.g. alcohol poisoning and cirrhosis).
In 2014, more people died from alcohol-induced causes (30,722) than from overdoses of prescription painkillers and heroin combined (28,647).

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.
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.

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.
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 In the News: The Zika Virus

January 29, 2016Infectious Disease, Public Health844-SMA-TALK, Behind the Curtain, microcephaly, Sterling Medical Advice, Straight No Chaser, Zika fever, Zika virusJeffrey Sterling, MD

Before the global panic alarm is sounded, allow me to introduce you to the Zika virus with a few questions and answers:

Why do we care about the Zika virus? Zika fever is yet another mosquito-transmitted disease. We care about it because it’s spreading explosively in South and Central America, according to the World Health Organization (WHO). The WHO estimates that approximately 4 million people could be infected by the end of the year.
Does this mean it’s in the US? It’s estimated that up to approximately 1000 cases may occur within the US annually.

What does the illness look like? It’s a mild illness, including such nonspecific symptoms such as fever, joint pain, rash and red eyes. An additional and greater concern involves an apparent (but not yet proven) association with the Zika virus and microcephaly. Microcephaly is a condition in which infants are born with brains that are both damaged and abnormally small. The illness is short-term and resolves within days to weeks.

How is the disease treated and cured? There is no specific treatment for Zika virus. Treatment is supportive and includes rest, pain control, fever control and rehydration.
Should I be concerned about contracting this illness? Here are two thoughts, all of which should assure residents of the United States.
1. First of all, the overwhelming majority of those exposed to the Zika virus actually don’t get sick.
2. The US has effective mosquito control, which dramatically lowers the risk of an outbreak.
What steps can I take to minimize my risk? First and foremost, avoid travel to areas in question. Furthermore, as a general consideration, learning to protect yourself from mosquitos in general is a great way of avoiding all manner of diseases that are transmitted from these insects.

As these things go, routine matters of routine health maintenance will serve you well in avoiding the Zika virus. In the interim, feel free to review this Straight, No Chaser, which discusses mosquito-borne diseases and how to protect yourself.
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: Inappropriate Antibiotic Use

January 28, 2016General Health and Wellness, Infectious Disease, Respiratory/Lungs844-SMA-TALK, American Academy of Pediatrics, Antibacterial, Antibiotic resistance, Behind the Curtain, CDC, Center For Disease Control and Prevention, Common cold, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Streptococcal pharyngitisJeffrey Sterling, MD

Whenever physicians attempt to discuss inappropriate antibiotic use with patients, too often fear replaces logic. These days, antibiotic use is treated as a convenience consideration, regardless if there’s actually a disease present that can be treated by antibiotics. Here are some principles your physician is mindful of when deciding if you actually need antibiotics.
Significant complications exist from missing any disease. If a heart attack is missed, your heart can rupture, and you can die. If a fracture is missed, you can develop necrosis, arthritis and loss of limb. If pneumonia is missed, you can go into respiratory failure and die. Etc., etc. As an emergency physician, my colleagues and I are more in tune than any other specialty of physicians with the risks and consequences of misdiagnosing critical illness; in fact it’s one of the main components of the speciality.
The point is giving medicine is not based on either fear or treating conditions that have a low probability of existing. Any physician is weighing the value of the information you provide to determine what appropriate management will be; that’s the Art of Medicine, and that will always be left to the individual judgment of your treating physician. That said, the days of such absolute power by physicians are going the way of the dinosaur. Evidence-based medicine and outcomes-based medicine are here to stay. Multiple guidelines for best practices exist across many medical conditions, including when to order ankle x-rays and not, when to order neck x-rays and not, when to treat various infections and not. What’s new here is identifying opportunities to avoid exposing patients to unnecessary, costly medical interventions. What’s also new is you the patient can be better empowered and knowledgeable about the conditions you have and the care you receive.

The risk of inappropriate antibiotic use is more real, more present and more important than practicing defensive medicine. There are classes of antibiotics that we can no longer use. I mentioned previously how Staph is resistant to several of the penicillins we’ve used for decades due to resistance, which occurs from overuse and inappropriate use, most frequently seen in treatment of viral illnesses. Yes readers, MRSA stands for methicillin-resistant Staph Aureus, and that’s why it’s known as a ‘super-bug’. Approximately 80% of those ear, nose and throat infections you’re coming to the emergency room for and asking/receiving antibiotics for are viral illness and would be better on their own in 48-72 hours. Similarly, treatment of gonorrhea has recently been revised by the Center for Disease Control and Prevention (CDC) because of the emergence of resistance to the medications used against it. Again, this has resulted from overuse and inappropriate use of these medications, largely in treatment of viral illnesses. One of the more powerful antibiotics we had at our disposal (a member of the fluoroquinolone class) just got pulled back from its 15 different indications for usage due to emerging resistance. This particularly powerful entity, instead of being withheld for serious diseases, was being used for urinary tract infections, minor skin and soft tissue illness and other conditions that eventually led to a loss of effectiveness. Why would such things be done? Profits and defensive medicine are two reasons that rapidly come to mind.
This is a lot more serious than just overusing medications. Sepsis is a condition where an infection overwhelms the body and isn’t just limited to the local site where the infection originated. It can be so devastating that your body goes into shock, losing its ability to function and deliver blood throughout your body. Initial treatment of real illness suffers when we’re using medications that are less effective because bacteria have had time to mutate or otherwise become resistant due to non-lethal exposures.

The CDC and the American Academy of Pediatrics have consistently promoted this philosophy. It’s been included in JAMA, the Journal of the American Medical Association. Inappropriate antibiotic use has consequences!

Consider the following lists of conditions that commonly can be treated without antibiotics.

Common colds and upper respiratory illnesses, including non-strep pharyngitis
Influenza (flu)
Most coughs and bronchitis (chest cold with a cough)
Many ear infections (also called otitis media)
Many skin rashes

To be clear, no one is recommending or promoting inappropriate or less than appropriate treatment of conditions that actually exist. No one is suggesting that anything you read here or anywhere else is more important than the real-time judgement of your physician. Just appreciate that opportunities exist to do the right thing and the wrong thing, and medicine is better with an informed patient.
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 In The News: A Nearly 3% Increase in the Number of Child Abuse Cases

January 27, 2016Pediatrics/Kids Health, Public Health, Trauma844-SMA-TALK, Behind the Curtain, Child abuse, Department of Health and Human Services, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Child Abuse prevention month is in April, and Straight, No Chaser will perform a thorough review of the topic. However, it’s never too early to be aware of important trends. In the news is a report from the US Department of Health and Health and Human Services showed that the estimated number of child abuse victims in fiscal year 2014 was “702,208 – up from 682,307 in 2013.” Additionally, the report also showed that the “estimated fatalities attributable to child abuse and neglect” were “1,580 – up from 1,530 in 2013.”
I will take this space to remind you of a few points.

The developing human body (especially its brain) doesn’t distinguish between what you may describe as discipline and what it receives as assault. A developing body is more susceptible to permanent injury than the adult body, and permanent damage is not influenced by your intent.
If you are aware of environments in which abuse occurs, please get help. In this day and age a nearly 3 percent increase in the number of US children victimized by abuse and neglect should be shocking to us all.

Straight, No Chaser: About Stalking

January 27, 2016Mental Health, Trauma, Health Prevention844-SMA-TALK, Behind the Curtain, femicide, stalking, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Although stalking awareness conversations aren’t held very often, the scope of stalking is such that you should know about it. Stalking is a serious endeavor, and unfortunately it is quite common. This Straight, No Chaser addresses the scope of stalking.
Stalking has many legal definitions, but you really don’t need a legal definition to know it when you experience it. Formally, the varying definitions involve the following considerations:

Stalking involves actions from one individual directed toward another specific individual.
Stalking involves actions that predictably would cause fear in a reasonable person.

Consider the following data from the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention.

An estimated 6.6 million people are stalked per year in the U.S.
Over current lifetimes, 1 in 6 women and 1 in 19 men have experienced stalking victimization, specifically including the fear or belief that they or someone close to them would be harmed or killed. 1 in 4 women and 1 in 13 men report a less severe state of stalking, which includes any amount of fear (i.e., fear, but of a lesser level than a life threatening fear).
66% of female victims and 41% of male victims are stalked by a current or former intimate partner.
In many instances, stalking begins when victims are relatively young. More than half of female victims and more than 1/3 of male victims of stalking indicated that they were stalked before the age of 25. Additionally, about 1 in 5 female victims and 1 in 14 male victims experienced stalking between the ages of 11 and 17.
11% of stalking victims have been stalked for 5 years or more.

Stalking is to be taken seriously. Consider these additional statistics.

76% of intimate partner femicide victims had been stalked by their intimate partner, and 67% had been previously physically abused by their intimate partner.
89% of femicide victims who had been physically assaulted had also been stalked in the 12 months before their murder.
2/3 of stalkers pursue their victims at least once per week, many daily, using more than one method.
78% of stalkers use more than one means of approach.
Weapons are used to harm or threaten victims in 1 out of 5 cases.
Almost 1/3 of stalkers have stalked before.
46% of stalking victims experience at least one unwanted contact per week.

Stalking is incapacitating in many cases.

46% of stalking victims fear not knowing what will happen next.
29% of stalking victims fear the stalking will never stop.
1 in 8 employed stalking victims lose time from work as a direct result of their victimization; more than half of these lose 5 days of work or more.
1 in 7 stalking victims move as a result of their victimization.
Stalking victims suffer from higher levels anxiety, insomnia, social dysfunction, and severe depression than the general population.

Know your rights, and know your options. It would seem there is room for better protection of victims. Although stalking is a crime under the laws of all 50 U.S. states, the District of Columbia, the U.S. Territories and the federal government, less than 1/3 of states classify stalking as a felony upon first offense. Fortunately, more than 1/2 of states classify stalking as a felony upon second or subsequent offense or when the crime involves aggravating factors such as possession of a deadly weapon, violation of a court order or condition of probation/parole, involvement of a victim under 16 years or the same victim as prior occasions. Most unfortunately, 54% of femicide victims reported being stalked to police before they were eventually killed.
Stalking is not an innocent occurrence. You would do well to document your concerns and involve friends, family and the authorities for any instance in which you find yourself violated or in a compromised position.
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: Thyroid Awareness and Neck Self-Examination

January 26, 2016Endocrine/Metabolic, Health Prevention844-SMA-TALK, Behind the Curtain, goiters, Grave's disease, hyperthyroidism, hypothyroidism, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, thyroid awareness, thyroid cancerJeffrey Sterling, MD

Is your thyroid something you know exists but know very little about? Let’s change that. The thyroid gland lives in your neck and produces hormones that help you regular your body’s metabolism. This makes it quite important. Thyroid disease affects approximately 200 million people around the world. You care about this because abnormalities of the thyroid gland can cause real problems and deadly disease. Let’s take a brief look at four types of abnormalities.

Goiters are something you may know of if you’re of a certain age. It’s a condition notable for the presence of a visibly enlarged thyroid gland

Goiters frequently cause difficulty swallowing or breathing.

Hyperthyroidism is a disease resulting from an overactive thyroid

Symptoms of hyperthyroidism are: rapid weight loss, high blood pressure, anxiety and insomnia.

Hypothyroidism is an underactive thyroid.

Symptoms of hypothyroidism are: weak or slow heartbeat; muscular weakness; constant fatigue; weight gain; depression; slow reflexes; sensitivity to cold; thick, puffy, or dry skin; slowed mental processes and poor memory; and constipation.

Thyroid cancer has seen a dramatic increase in the number of cases diagnosed due to increased detection. Of course, early detection and treatment is a good thing for prognosis.

All of these conditions can be discovered if you learn to examine your neck. 15-30 seconds can often help you discover lumps, nodules, goiters and cancers that will signal an immediate need for assessment, confirmation and treatment by a physician. Given the relatively non-specific nature of symptoms related to the thyroid, your role in discovering thyroid disease is an important one. As is the case with other self-exams (e.g. breast, testicles), you will become more familiar with your anatomy and will be most likely to pick up on any changes with repeated exams.

Performing a Neck (Thyroid) Self-Exam:

Grab a mirror, and tip your head back. Your area of interest is the middle area of your neck. Your thyroid gland is located above your collarbones and below the Adam’s apple (larynx).
Take a drink of water and slowly swallow.
As you swallow, check your neck for any bulges, lumps or protrusions. You may want to repeat this process several times.
If you discover any abnormalities, see your physician. You may need to checked for thyroid disease.

Straight, No Chaser: Cervical Health Awareness

January 25, 2016Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, CDC, Center For Disease Control and Prevention, Cervical cancer, HPV, Human papillomavirus, Pap smear, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

January is Cervical Health Awareness Month, and to that end, The Center for Disease Control and Prevention (CDC) boldly proclaims “No woman should die of cervical cancer.”
It’s cervical health month in the United States, and this point has a rather simple message: Cervical cancer is highly preventable and can be cured when discovered and treatment early. Here are some quick tips to help you check this off of your list of concerns.

Every child should get vaccinated at age 11 or 12. Even if you’ve reached age 26 and haven’t been vaccinated, you should discuss options with your physician.
The most important thing you can do to help prevent cervical cancer is to get screened regularly starting at age 21.

The Pap test (or smear) should be performed regularly at age 21. It looks for precancerous changes to the cervix that identify the need for early treatment. In many cases a normal test will eliminate the need for another test for the next three years, but your physician will discuss your individual circumstances in this regard.
The HPV test looks for the virus that is now known to be the cause of cervical cancer. Furthermore, human papillomavirus (HPV) is sexually transmitted. The HPV test can be done at the same time as the Pap test from the same examination.

Hopefully knowing these simple tools will convince you to be attentive to preventing and managing your cervical health. This is a public health success story in that cervical cancer could be eliminated if everyone followed the above steps. The rest is up to you.
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.

Straight, No Chaser: Moving Toward a Vegetarian Diet

January 24, 2016Diet and Nutrition, General Health and Wellness844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, vegetarianJeffrey Sterling, MD

Ok… I’m glad to have finally come across a diet option that has struck a nerve. The post on principles of vegetarianism has raised a lot of questions, and I’ll take this space to answer some of the more common and important ones.

1. I’ve always heard vegetarian diets are low in protein. Is this true?
It’s more correct to say vegetarians need to ensure they are taking enough protein. If you’re not eating red meat, you will still get plenty of protein by eating fish, dairy and eggs. If you are a strict vegan or have mostly eliminated fish, dairy and eggs, protein options include items such as whole grains, nuts and seeds, peanut butter, beans/legumes (e.g., navy beans, split peas and chickpeas) and protein from soy.
2. Can you identify various options for soy protein?
Sure. There’s soy cheese, nuts, milk and tofu products. Veggie burgers and chicken substitutes also will get you there.
3. Any dangers in these substitute foods?
Yes. You still need to limit sugar, salt and fat. Excessive cheese isn’t a good thing. Focus more on the low-fat options such as beans and use cheese for variety.
4. Are vegetarians at nutritional risk beside low protein?
Vegetarians need to focus on eating adequate amounts of iron, calcium, zinc, Vitamin B12 and omega-3 fatty acids. The way foods are fortified now, this isn’t as big of a difference as it once was, although you rarely will go wrong working with a nutritionist as you make this dietary change.

5. Please give examples of various foods that address the nutritional concerns of vegetarians.

Calcium: Sources of this mineral include milk, seeds, beans, nuts, green vegetables, and foods fortified with calcium such as fruit juices.
Vitamin B12: You’ll find adequate amounts in dairy products, eggs and other foods labeled as fortified with B12.
Vitamin D: Vitamin D is found in fatty fish, egg yolks, cereals and soy milk labeled as being fortified with vitamin D.
Zinc: Zinc is abundant in beans and foods labeled as being fortified with zinc, such as milk and cereals.
Iron: Iron is found in beans, green vegetables, and foods labeled as being fortified with iron, such as cereals.
Vitamin C: Vitamin C helps the body increase iron absorption, so eating foods that are high in vitamin C (e.g., bell peppers) at the same meal as iron-rich foods is a good thing.
If you’re serious about making the conversion to a semi- or fully vegetarian diet, discussing your plans with a nutritionist is a good idea. Of course, you can talk to a nutritionist anytime at www.sterlingmedicaladvice.com or 844-SMA-TALK.
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.

Straight, No Chaser: An Introduction to Vegetarian Diets

January 23, 2016Diet and Nutrition844-SMA-TALK, Behind the Curtain, lactovegetarian, ovovegetarian, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, vegan, vegetarianJeffrey Sterling, MD

If you are on a vegetarian diet, congratulations to you, but if you’re not, you still should be interested in the principles that make a vegetarian diet a healthy choice. Even if you think you have no interest in becoming a vegan but still want to eat a healthy diet, you will find yourself inching relatively closer to a vegetarian diet. After all, the various vegetarian diets are just the maximal application of increasing your intake of fruits and vegetables.
Before we even define the different types of vegetarian diets, let’s answer a simple question: “Why in the world would I ever consider being a vegetarian?” The answer to the question is best given by discussing some outcomes of interest.

Vegetarians generally have longer life expectancies than meat eaters.
Vegetarians are less likely to have heart disease.
Vegetarians are less likely to be obese.
Vegetarians are less likely to have high blood pressure.
Vegetarians are less likely to have certain types of diabetes.

The vegetarian diet focuses of the products of plants. These include the following types of foods: fruits, vegetables, seeds, nuts, whole grains and legumes (beans, peas and lentils). There are different types of vegetarian diets (representing levels of strictness), including the following:

Vegan: only plant-based floods (with “nothing from anything with feet”)
Lacto-vegetarian: Plant-based foods with an allowance for some dairy products
Lacto-ovovegetarian: Plant-based foods with an allowance for some dairy products and eggs
Semi- or partial vegetarian: The diet excludes red meat. It includes plant-based foods with an allowance for dairy products, eggs and certain meats (chicken and fish).

If you’re a semi-vegetarian, you may be further categorized based on the meat you eat:

Pescatarians eat fish but not red meat, pork or poultry.
Flexitarians (aka semi-vegetarians) occasionally eat red meat.

Now look back at the last six bullet points. The closer you get to being a strict vegetarian, the lower your risks of high blood pressure, diabetes and other certain other medical conditions. You can think of each bullet point as a stepladder to better health.
The point of this is there’s more than one approach to incorporating the principles of vegetarianism. You don’t have to be an absolutist to make your diet healthier. Just remember, the more plant-based your diet is, the healthier you’ll be. We’ve discussed this previously in the healthy eating plate. The bottom line remains the same. Most of you reading this don’t eat enough fruits, vegetables, whole grains or legumes. The more your diet is tilted away from red meats and toward these options, the healthier you’ll be.

The next Straight, No Chaser will discuss specific concerns of vegetarian diets.
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.

Straight, No Chaser: The Danger of Shoveling Snow and Other Winter Chores

January 22, 2016Cardiology/Heart, Environmental844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

You have probably heard it said, but you’d be surprised to know how often people hurt themselves shoveling snow. Of course, this time of year, people are doing many more strenuous activities than just shoveling snow. There’s walking (through mounds of snow), skiing, cross-county skiing, snow boarding, football in the cold, pushing cars that are stuck, scraping ice off the car and many other activities.
Is this really such a big deal? The important consideration is that you exert a lot of energy doing these activities. If your heart, back or overall health isn’t prepared to handle them, you can suffer debilitating consequences. Would you believe that every year over 11,000 people visit emergency rooms for back injuries related to shoveling snow?
Let’s address this in a way that is easy to understand. Shoveling snow can be even more vigorous than a full aerobic workout. It involves utilization and straining many muscles not often used by many people. It can lead to several ailments, ranging from strains and sprains to a herniated disk or a heart attack. Thus, if you’re going to do it smartly, certain rules should apply.

Understand your risks. These winter activities I mentioned pose higher risks in the following groups, including an advanced rate of having a heart attack.

Individuals leading a sedentary lifestyle
Individuals having had a prior heart attack
Individuals with known heart disease
Individuals with high blood pressure or high cholesterol
Smokers

Here are some quick tips to lower your risk while shoveling:

Discuss your risk level with your doctor.
Wait until the snow has stopped falling.
Stretch and walk for a few minutes before starting. This will loosen and warm up your muscles.
Avoid eating, having sex, exercising or other strenuous activity for at least 30 minutes before shoveling, as your blood (and needed oxygen) will be diverted away from your heart. This is the basis of many heart attacks.
Avoid coffee or smoking for at least one hour before or one hour after shoveling or during breaks. These stimulants increase your heart rate and blood pressure, increasing the level of work your heart does and your heart attack risk.
Drink water before and after shoveling.
Dress warmly; cover your head, mouth and neck. Hypothermia and frostbite are serious issues.
Wear shoes that will prevent you from slipping and falling. Strains, sprains, and broken bones are one faulty step away in many instances.
Your equipment matters. Use a shovel with a bent handle. This angling will relieve the pressure on your back. Use a smaller shovel. It may take longer, but the lowered risk is worth it.
Push snow; try not to lift. If you have to lift, use your knees to take some pressure off your back.

Take your time and take breaks. If your body doesn’t feel right, stop.

Most importantly, KNOW WHEN TO STOP.
Do you know the warning signs of a heart attack? Be quick to seek medical attention if you feel out of sorts.
If you live in certain climates, winter chores are unavoidable. Arm yourself and your loved ones with these precautions. Your Sterling Medical Advice expert consultants are certainly available to answer any questions you have on this topic or when the need arises.

Straight, No Chaser: What You Can Do To Manage Frostbite and Serious Cold Exposure

January 21, 2016Environmental844-SMA-TALK, Behind the Curtain, Frostbite, Frostnip, Hypothermia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I’ll admit that my orientation is different than yours. I’ll argue that your orientation should be closer to mine. What’s the difference, you may ask? I’ve actually seen the consequences of your unfortunate actions, and these consequences occur with a much greater frequency than you may imagine. “An ounce of prevention is worth a pound of cure” isn’t just a catchy quote from Ben Franklin. It’s an “Oops, I should’ve had a V-8 moment” when you’re in front of me, my nurses and big invasive medical treatment options in an emergency room.
Cold exposure is a good example of this. We’ve previously discussed frostbite, but there must be more to the story than frostbite. Frostbite is not a necessary pit stop on the way to very bad things happening due to cold exposure. More importantly, for as bad as frostbite is, there are worse things that can happen to you from cold exposure. This is a relatively important conversation. You need more tools at your disposal than “Just bundle up.” We’ll explore these tools in two parts: basic care and emergency care.
The Basics – Prevention

Layers of loose clothing are better. Wear more than one pair of socks, at least until you’re back indoors.
Use a hat that actually covers your scalp. (Major heat loss occurs through the scalp.)
Use a hat that covers your ears and a scarf that covers your nose. (These areas are prone to frostbite.)
Wear mittens. They are better for protecting your fingers than gloves.
People greatly underestimate the effect of the combinations of being cold and wet or being exposed to cold and windy conditions. If you have water-resistant, wind-proof options, use them.
If you know you’re going to be exposed to the cold for a significant period of time, eat up and rest up beforehand. Avoid alcohol and cigarettes prior to and during such journeys.

Treatment You Can Do If Exposed:

Know what symptoms could be a result of hypothermia. Check previous posts for a refresher.
Your first step is to call 911, especially if any mental status changes (e.g., confusion) are present. Time is of the essence.
Do you know CPR? Refer here for a very easy refresher (you’ll commit it to memory in 2 minutes) of when to use it and how to perform it.
Can you get inside? Cover yourself with warm blankets and drink warm (nonalcoholic) fluids if possible. Remove wet and tight clothing (and cover back up with dry ones if possible).
You’re stuck outside? You should be thinking about reducing exposure to the cold, the wind and any wetness as much as possible. Don’t forget to provide a layer between the backside and the ground. Prioritize covering the scalp.
Think about giving or receiving a hug as a means of warmth. If you have access to warm compresses or towels, preferentially apply to the armpits, groin, neck and chest.

Your take home message is death from hypothermia can be avoided with the knowledge and application of basic fundamental considerations. Even better, you can usually choose to avoid exposure to bitterly cold conditions. I hope you find this information useful and never need to use it.
This is part of a series on medical conditions resulting from cold exposure.

Click here for a discussion of frostbite.
Click here for a discussion of the symptoms of and risks for hypothermia

Straight, No Chaser: The Do’s and Don’ts of Treating Frostbite

January 20, 2016Environmental844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

There’s a cold front coming. You can’t avoid the exposure. Some of you will end up cold as ice (and twice as nice?). Would you really know what to do if you caught frostbite? I thought not, and the bad news is some of your instinctive tendencies are exactly what you ought not to do in this situation. Here are some do’s and don’ts if you ever find yourself or a loved one in this particularly precarious position.

The Do’s
A lot of this depends on the circumstances.

Give warm fluids if possible.
If the person is wet, remove wet clothing.
If s/he is wearing tight clothing, remove whatever’s constricting.
Move to as warm of a climate as feasible; if not possible, then shelter the person from the cold. Avoid movement of the frostbitten parts to the extent possible.
Gently separate affected fingers and toes, and if you can, wrap them loosely in sterile dressing.
If you have transportation, get to an emergency room as soon as possible.
If immediate care or transportation is not available, soak the affected areas in warm (preferably circulating and never hot) water. Alternatively, place warm coverings to affected areas for up to 30 minutes at a time. If skin is soft and feeling returns, you’ve done a good job.
- Be mindful that burning pain and swelling will occur during rewarming.
Apply dry, loose and preferably sterile dressings to the frostbitten areas. Keep frostbitten fingers or toes separated with dressings.
Delay rewarming if you are not in an area safe from the risk of refreezing. Refreezing of thawed extremities is even more dangerous than the initial freeze.

DO NOT

Rub or massage the frostbitten area.
Peel or pop any blisters that may be present.
Use dry heat, such as from a hair dryer, a radiation, heating pad, electric blanket or campfire. These heat source may be ok to keep the rest of you warm (particularly your core), but this type of direct heat can further damage frostbitten tissue.
Rewarm until you can be sure it can stay thawed.
Smoke or drink alcohol during recovery. These activities can interfere with blood circulation and cause additional problems.

Straight, No Chaser: Hypothermia (Low Body Temperature)

January 19, 2016Environmental844-SMA-TALK, Behind the Curtain, Hypothermia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a series on cold-related medical disorders.
Hypothermia is low body temperature. It’s not the “Oh, it’s cold outside” type of cold, but it is the “Oh, your life is in danger!” variety. Medically, hypothermia is a core body temperature below 95 °F (35 °C), and it can be produced by either an absolute cold exposure or sufficient heat loss beyond the body’s ability to generate a response.

What you want to know about hypothermia is the conditions and risks that set you up for it. Anyone can get hypothermia if you’re exposed to bad enough conditions, including the following:

Being outside without sufficient clothing in cold conditions
Being outside with wet clothing in cold and windy conditions
Excessive exertion or insufficient food or fluids while in cold and/or windy conditions
Excessive cold water exposure (e.g. immersion while ice fishing or boating)

Persons most likely to get hypothermic include the very old or young and those who are chronically ill or malnourished. Persons of normal health can get hypothermia if excessively fatigued or under the influence of alcohol or other drugs.
Typical symptoms of hypothermia include weakness, drowsiness, confusion and lack of coordination. Skin becomes cold, pale and frostbitten. Shivering becomes obvious and uncontrollable. Eventually, the heart and breathing rates will slow, and mental ability will progressively fade. Ultimately, the body can go into shock, and the heart and brain can cease functioning. Prolonged exposure will result in death if untreated.
For now I will leave you with the following considerations.

If you find someone in the cold who is not responding, don’t assume s/he’s dead.
Placing someone in direct heat, such as is given via a heating pad or lamp, or in hot water is not the approach and should not be done.
Do not give alcohol to someone exposed to extreme cold.

In the next post in this series we will discuss treatment and prevention strategies for extreme cold exposure.
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.

Straight, No Chaser: A Dream of Equal Access to Health Care – Updated

January 18, 2016General Health and Wellness, Public Health844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

On this national day of celebration, I always reflect on Dr. Martin Luther King, Jr.’s most famous comments on health care in America.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Why would he say such a thing? Injustice in health care has taken many forms and resulted in predictably poor outcomes for those affected; we tend to call these disparities in healthcare. Today, I address the inequity in insurance coverage that formed the premise for the Affordable Care Act (aka Obamacare).
According to the Kaiser Family Foundation, in 2009-2010, when the Affordable Care Act (ACA; aka Obamacare) was signed into law, 41% of low-income adults were uninsured, and 45% of poor adults were uninsured. Contrast this with the fact that only 6% of those who make four or more times the poverty rate were uninsured. This pretty clearly makes the case that health care is a desirable asset for Americans who can afford it, and a choice that too often couldn’t be afforded for others. Now consider that 14% percent of white Americans were uninsured, while 22% of African-Americans were uninsured, and 32% of Hispanic Americans were uninsured. Whether you believe this is just a correlation, coincidence or reflection of something more damning, it is a situation that screamed to be addressed and improved.
Even more recently, the Centers for Disease Control and Prevention released a survey showing that more than 45 million U.S. residents didn’t have health insurance during the first nine months of 2012, immediately prior to implementation of the ACA. Still even more people, 57.5 million, were uninsured for at least part of the 12 months before being polled (Be reminded that the total U.S. population is just over 311 million.).
Please take a moment and ponder the enormity of the numbers just presented. It begs the question “How can such be allowed to exist?” Dr. King’s comment begged the same question. The answer of course lies in the fact that the American health care system isn’t built on producing equality of access or outcomes. You’ve heard me say before that the American health care system remains the only system among all the major industrialized nations on earth that doesn’t ensure access for all its citizens. The American health care system is a business enterprise that has captured approximately $3 trillion annually, representing over 1/6 (17%) of the gross domestic product, and all the while leaving more than 45 million Americans uninsured. We are number one in money spent on health care by a large margin; in fact, the U.S. spends more on people aged over 65 than any other country spends on its entire population. The business of medicine in America is business first. It is largely expected that good health care outcomes will result from good business in the same way that good cars, computers, smartphones, etc. are produced (theoretically). It’s important to note that according to the World Health Organization (the monitor of such things), the U.S. health care system was ranked #38 in the last WHO ranking based on standard health outcomes produced.
President Barack Obama’s health care reform law aims to extend health insurance coverage to a large portion of the uninsured. According to the Congressional Budget Office, health care reform will reduce the number of uninsured people by 27 million between 2014 and 2023. At this point, approximately 18 million Americans can come off the uninsured rolls since the implementation of the The Affordable Care Act (ACA). The ACA targets its assistance to the poor and near-poor who are least likely to have health care coverage. The ACA will provide Medicaid coverage to those with incomes up to 133 percent of the poverty level ($15,282 for a single person this year) — unless their home state opts out of the Medicaid expansion. People who earn between the poverty level and four times that amount will be eligible for tax credits for private health insurance.
Access to health care is the beginning of the process by which health care disparities can be erased. As long as failure to have equal access exists to the extent that it does, the types of disparities in life expectancy, disease rates and disease survival will remain predictably dismal for certain populations. As long as total our population is unhealthy in general and pockets of our population are more disproportionately unhealthy, we will remain less productive and cohesive than we could be, and that will perpetrate a host of additional problems within our society.
Finally and furthermore, the question that still begs to be asked is why does the US choose to remain the only major industrialized nation in the world that fails to provide universal health care for its citizenry? What part of life, liberty and the pursuit of happiness involves doing so without health? How is that Justice?
Happy MLK Day. Remember the Dream, but also remember how that plays out in our lives.
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.
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