Tag Archives: Behind the Curtain

Straight, No Chaser: Seizure First Aid Do’s and Don’ts

January 17, 2016Neurology844-SMA-TALK, Behind the Curtain, First Aid, seizure, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I enjoy empowering you to act. There are many examples of emergency situations in which your actions can be beneficial, including the presence of active seizures. We previously discussed the various causes and symptoms of seizures. Even without understanding all of that, it’s important for you to be aware of some basic first aid maneuvers in the event that you come across someone having a seizure. However, you can’t act irresponsibly; seizures have a high enough incidence of associated injuries that your correct actions can make a world of difference, and the wrong actions can be harmful.
Let’s review the do’s, don’ts and warning signs regarding actions in those early moments when many are inclined to panic.

The Do’s

The first thing I want you to do is to collect yourself. You can’t help anyone unless you’re composed.
Many of the bad things that will happen relate to injuries that can occur during the thrashing around that occurs during a seizure. You want to protect the person from any possible harm. Be mindful not to hurt yourself in the process.
If the person is standing, cushion the body (especially the head) and/or prevent a fall. Try to lower the person onto a soft surface so no head banging happens with any additional seizure activity.
You want to protect the person’s airway and the ability to breath. The best way for you to do this is to turn the person on the side. This will prevent any vomiting or drooling from going into the lungs.
You also want to make sure to loosen constricting clothing, especially around the neck.
Do not leave until professional help arrives.

The Don’ts

Do not try to hold down someone in the midst of an active seizure.
Do not place your fingers or anything else inside someone’s mouth during a seizure, even if you think they’re choking. Wait until the person is completely awake, alert and talking before you attempt to place anything in the mouth.
Do not move a seizing individual unless s/he is in danger or near something hazardous. Even then, you must carefully weigh the risks and benefits of acting.
Do not grab the head or neck of someone seizing in an effort to make it stop. Seizures just don’t work that way, and the person has no control over the seizure.
Do not start CPR in someone actively seizing.
Do not place a child in a cold bath, even if you think the child’s seizure have been described as being due to fevers in the past.

When to See a Physician
Call 911 or get to your nearest emergency room if:

This is the person’s first seizure.
The person does not fully regain consciousness and normal behavior after a seizure.
Another seizure starts soon after a seizure ends.
The seizure lasts more than 5 minutes.
The seizure occurred in water (e.g. bath tub)
The seizure occurred in someone who is pregnant or has diabetes.
The seizure caused an injury.
There is anything different about this seizure.
The person has not been taking seizure medication as prescribed.

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: Seizures

January 16, 2016General Health and Wellness, Neurology844-SMA-TALK, Behind the Curtain, generalized seizures, partial seizures, seizures, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, tonic clonic seizuresJeffrey Sterling, MD

There is so much mystery among the lay population about how the brain works, even under normal circumstances. It is very scary to patients and families when things occur that remove one’s ability to control their own brain and bodily functions. Seizures are a prime example of this. There are so many things about seizures that confuse and scare patients and families. Your questions are diverse, during and after the event…

Is s/he dying?
Is there a brain tumor or an aneurysm?
Will there be brain damage afterwards?
Can s/he drive a car?

And on and on… This Straight, No Chaser will take a look at the causes of seizures. Subsequent posts will address home care, treatment considerations and special circumstances involving seizures.

Here’s an overly simplistic way to understand seizures: Different parts of the brain approximate a map that controls different parts of the body. A seizure results from some abnormal electrical activity occurring after something stimulates a part of the brain. It’s as if the seizure is the scratch to something that made the brain itch.
There are many different conditions that can precipitate a seizure in all its different varieties, including the following:

Abnormal levels of certain normal substances in the blood (e.g. sodium or glucose)
Abnormal levels of many different prescribed medications
Abnormally high blood pressure (malignant hypertension)
Abuse of street drugs (e.g. angel dust (PCP), cocaine, amphetamines)
Alcohol withdrawal (and withdrawal from certain other drugs in those addicted)
Brain infection (e.g. meningitis or encephalitis)
Brain injury that occurs to the baby during labor or childbirth
Brain problems that occur before or during birth (congenital brain defects)
Brain tumor
Electric shock
Epilepsy (the condition of having seizures after underlying issues have been addressed)
Fever (especially in young children)
Head injury
Heart disease
Heat illness (e.g. heat stroke)
High fever
Kidney failure
Liver failure
Phenylketonuria (PKU)
Poisonings
Stroke (cerebrovascular accidents)
Toxemia of pregnancy
Venomous bites and stings (snake bite)

In many instances, seizures occur without an identified cause.

Many of you who have seen seizures are familiar with the uncontrollable shakes with loss of consciousness. It’s important to note there are many other symptoms and varieties of seizures. These correspond to the part of the brain being affected.
Here is a list of common symptoms associated with seizures.

Behavioral and mood changes (sudden anger, unexplainable laughter, fear or panic)
Brief blackout followed by a period of confusion and transient loss of memory
Body shaking, muscle spasms, twitching and jerking of arms and legs, picking at clothing
Drooling or frothing at the mouth
Eye movements, such as twitching
Falling
Grunting and snorting
Loss of bladder or bowel control during the seizure
Tasting a bitter or metallic flavor
Teeth clenching
Temporary stop in breathing

Although there are many types of seizures, it is less important for you to know how to categorize them than to know how to recognize a potential seizure and when to seek help. The next Straight, No Chaser addresses self-help and treatment considerations in the event of a seizure.
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 In The News: A Significant Advance in Alzheimer's Research

January 15, 2016General Health and Wellness, Geriatrics/Elderly Care, Mental Health, Neurology844-SMA-TALK, Alzheimer's disease, Behind the Curtain, microglia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

It isn’t an overstatement to note the search for a cure for Alzheimer’s is the white whale of medical researchers. Alzheimer’s currently affects approximately 5.3 million Americans, the population is aging, and it’s been over a decade since a new medication for dementia has been released onto the market. We have reported previous advancements in medical research (see below), and in the news is another major discovery, courtesy of researchers at the University of Southampton in England.

The bottom line: the presence of products of inflammation in the brain and immune cells known as microglia are not a result of Alzheimer but appear to be causal agents. In other words, the presence of inflammation seems to accelerate brain damage and progression toward Alzheimer’s. Furthermore, researchers have demonstrated that giving substances that reduce the proliferation of microglia slow the progression of Alzheimer’s, while reducing memory loss and behavioral problems (albeit in laboratory animals).
How can you use this information? It’s premature to say, but it is safe to say that engaging in brain-healthy activity (see below) that reduce inflammation is undoubtedly in your best interest.

Feel free to review these additional Straight, No Chaser posts on Alzheimer’s.

Straight, No Chaser: Self-Assessment for Signs of Early Dementia or Alzheimer’s

Straight, No Chaser: In The News – Beating Alzheimer’s and Dementia?

Straight, No Chaser: Questions About Memory Loss and Forgetfulness

Straight, No Chaser In The News: Omega-3 Supplements Do Not Protect Against Dementia

Straight, No Chaser: Dementia – When Brain Health Goes Bad

Straight, No Chase: Brain Health – Foods and Brain Healthy Habits

Straight, No Chaser In The News: New US Dietary Guidelines

January 15, 2016Diet and Nutrition, General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, Department of Health and Human Services, Dietary Guidelines, FDA, Food and Drug Administration, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

In the news are the 2015 guidelines on eating. The recommendations are jointly released every five years by the US Department of Health and Human Services (HHS) and U.S. Department of Agriculture (USDA). Overall, these guidelines advise Americans to follow an eating pattern that includes a variety of fruits and vegetables, grains (at least half of which should be whole), a variety of proteins (including lean meats, seafood, nuts), and oils. However, these recommendations come with a bit of nuance to which you’d be well advised to pay attention.

Here are the details, with simple rationale attached:
Alcohol: Moderate alcohol consumption now can be quantified up to one drink per day for women and up to two drinks per day for men. The recommendation is you stay at or under this amount.
Dairy products: If you’re eating dairy, the guidelines continue to recommend low and no-fat dairy products.
Dietary cholesterol: In a new recommendation, the guidelines no longer recommend a specific limit for dietary cholesterol. Among the foods you may frequently eat, dietary cholesterol is present in eggs and other animal products.
Fruit juice: The guidelines say one cup of 100% fruit juice counts as 1 cup of fruit. However, be advised that fruit juice is lower than whole fruit in dietary fiber and other nutrients, and it is typically very high in sugar, which you are now advised to limit, as noted below.
Red meat and processed meat: In an interesting reversal of the recommendation of its Guidelines Advisory Committee, the final recommendations suggest no limit is recommended for the consumption of red meat or processed meat. Be advised that recent evidence strongly link these foods with heart disease and cancer.
Saturated fats: The guidelines do not encourage a low total fat diet, but do recommend a low saturated fat diet. You should consume less than 10% of your calories per day from saturated fats. The evidence is clear that replacing saturated fat with unsaturated fat is associated with reduced risk of cardiovascular disease.
Sodium (Salt): The guidelines recommend you limit sodium intake to less than 2,300 milligrams (mg) per day.
Sugar: For the first time, the guidelines advise Americans to consume less than 10% of your daily calories from added sugars. You certainly are aware of sugar’s impact on the development of diabetes, high blood pressure and other diseases.

Eat healthy and be healthy. That’s the simplest recommendation I can offer. Here’s to your health!
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: Spice Drugs aka Herbal High aka Synthetic Marijuana

January 14, 2016General Health and Wellness, Toxicology/Drugs844-SMA-TALK, Behind the Curtain, herbal high, marijuana, spice drugs, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

So have you ever wondered why incense seems to relax you so? In our ongoing effort to keep you up to date with the latest drug teens may be using, today’s topic introduces “Spice” aka “herbal high.” Simply put, spice products are an effort to create a legal synthetic marijuana. You may be thinking: “Why wouldn’t they just find some marijuana?” Let’s pose and answer at some questions related to the topic.
How does this work? These drugs are synthetic cannabinoid receptor agonists, meaning these chemical compounds interact (fit into) the receptors where cannabis does, producing similar effects.

So it is the same as marijuana? No. The substances affect other parts of the body than cannabinoid receptors, which is how side effects and other symptoms are produced.
What types of symptoms are produced? Clinical symptoms are variable, but in a majority of cases, altered mental status and rapid heart beats occur, along with the typical high one gets from marijuana. Most patients normalize after 2-4 hours, assuming additional quantities aren’t inhaled. Additional symptoms described have included seizures, hallucinations, anxiety and very vivid dreams.
Is this as safe as marijuana? No. Many of these drugs are much more potent than the active substance in marijuana (delta-9-tetrahydrocannabinol – THC), therefore, the psychoactive dose may be much less. Given that marijuana and these substances aren’t some for effect per se, but habitually and recreationally, the potential for toxic inhalations is more significant. Furthermore, these substances are associated with addiction syndromes and withdrawal symptoms.
Do they show up on drug screens? No, not currently. Therein lies part of the attraction.

How do people obtain these substances? Therein lies more danger. If you’re in the know, you’re in the know. If you’re not, you could be playing with fire (no pun intended). These substances are easily obtainable legally, including on the Internet. The packaging usually refers to the content as herbal incense and “not for human consumption.” Many of these drugs are much more potent than delta-9-tetrahydrocannabinol (THC), therefore, the psychoactive dose may be < 1 mg.^[1,2]
But they’re legal? To be clear, selling and possession of these substances is illegal in the U.S. The Drug Enforcement Agency (DEA) and the US Department of Health and Human Services (DHHS) are currently determining if and how these entities will be permanently controlled in the United States.
The Straight, No Chaser recommendation is to find a way to get high on sunshine.
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: Marijuana Facts and Fiction, Part 2

January 14, 2016General Health and Wellness, Toxicology/Drugs844-SMA-TALK, Behind the Curtain, legalization of marijuana, marijuana, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The issues surrounding marijuana use are serious and need full examination, particularly with decriminalization legislature passing and being considered in various parts of the country. It is very important that you are fully aware of the current level of medical understanding regarding marijuana use. Feel free to ask additional questions, and check here for part one of Marijuana Facts and Fiction.

6. Marijuana leads to more serious illicit drug use.
The premise that marijuana is a “gateway drug” is a horrible one, regardless of your political bent. Here are some facts:

Currently, people use legal drugs–specifically alcohol and tobacco–more widely than marijuana, and use of these legal drugs leads to illicit drug use more often than marijuana use.
Pointing the term “gateway drugs” at marijuana misses the point of how much more dangerous these legal drugs are than marijuana.
The majority of marijuana users never use other illicit drugs, according to the U.S. Department of Health and Human Services. A report by the Institute of Medicine found “no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs.” It is likely more accurate to say that the same factors that drive marijuana use lead to the use of other illicit drugs.
On the other hand, it’s irrelevant that the majority of marijuana users never use other illicit drugs. A statistically significant number do. If their basis for complacency about marijuana use is insignificant ill effect, those individuals will suffer the consequences of their subsequent decision to use. From a public health standpoint, it’s not an either/or proposition.

7. So marijuana doesn’t cause lung cancer?
Regarding medical considerations, heavy use can be harmful. Although marijuana use isn’t conclusively associated with lung cancer, heavy pot smokers are still at risk for some of the same health effects as cigarette smokers, like bronchitis. It would be unfair not to point out that these risks are associated with smoking marijuana, and these effects appear to be due to the smoke and not necessarily the cannabis itself.
8. You can overdose on marijuana.
Simply put, there isn’t a documented case of death directly attributable to marijuana overdose.
9. You can’t become dependent on marijuana.
I’ll resist the urge to make a joke about certain of your favorite celebrities. According to the National Institutes of Health, not only is it possible to become dependent on marijuana, but approximately nine percent of marijuana users became clinically dependent. To put this in perspective, 15% of cocaine users and approximately 25% of heroin users become addicted. By the way, there’s a 30% addiction rate for tobacco users.
10. Does marijuana cause withdrawal symptoms?
Yes, it does. Withdrawal symptoms include anxiety, nausea and insomnia. That said, these are minor compared with tobacco, alcohol, heroin and cocaine. The marijuana withdrawal syndrome is not considered life-threatening.
11. Marijuana has not currently been shown to contribute to traffic accidents and fatalities.
It is next to impossible to conduct a research study that would prove this point. What we do know is that studies have shown that smoking marijuana tends to affect spatial perceptions. If under the influence, drivers can lose concentration and experience slower reaction times, leading to swerving or following other cars too closely. Researchers have concluded that driving while high greatly increases the chances of having an accident, and smoking pot and drinking before driving is a particularly dangerous mix. Because of the varying effects of marijuana on individuals, it is hard to set a blood level that indicates intoxication in the same way as with alcohol.
12. Does marijuana causes criminal behavior?
The problem with that question is the word “cause.” It is true that the rate of pot use is higher among criminals, but that doesn’t mean that pot causes the criminal activity, and there is no compelling evidence to suggest that it does. It’s just as conceivable that criminals tend to engage in illicit drug use. Intuitively, the connection between marijuana and subsequent criminal activity isn’t obvious, given the relaxation that marijuana produces (which sharply distinguishes it from alcohol).
13. What’s the difference between smoking marijuana and consuming it in other ways?
When someone smokes marijuana, its active ingredient moves almost immediately into the bloodstream and to the brain. The effects typically last between one and three hours. When eaten, it can take between 30 and 60 minutes to have an effect, but that effect can last up to four hours.
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: Marijuana Facts and Fiction, Part 1

January 13, 2016General Health and Wellness, Toxicology/Drugs844-SMA-TALK, Behind the Curtain, illicit drugs, legalization of marijuana, marijuana, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The truth of it all is that politicians are generally a terrible source of scientific and medical information. There are actually legitimate concerns about the use and legalization of marijuana. There is also real value to be obtained from the use and legalization of marijuana. This and the next post will provide you information without the bias you’ve become used to. You can check this Straight, No Chaser post for basic information on marijuana use and intoxication.
1. Does the research on marijuana prove that it’s safe?
Of course it’s not “safe.” The air we breathe and the water we drink aren’t “safe.” The better question is “How harmful is it and is that level of harm/risk acceptable?”
Research on marijuana has actually been limited and is largely under the control of the governmental entity charged with identifying risks and harm – instead of benefits. The relative unavailability of marijuana for research has been a source of complaints from the medical community for years, as it has largely limited medically reasonable use and limits.
The research that has been conducted suggests that marijuana is relatively safer than alcohol, tobacco and other illicit drugs. This is not the same as saying it is safe. Marijuana smoke contains carcinogens, just as tobacco smoke does. However, available research concludes that even heavy marijuana use doesn’t lead to lung cancer. Specifically, even the heaviest marijuana smokers don’t seem to consume enough to lead to a positive association with cancer. Any association that does exist with cancer seems to be due to the additives and the smoke itself, not the marijuana.
2. Smoking marijuana really doesn’t place you at risk for harm, does it?
The really big problem with marijuana is you’re doing other things while intoxicated. Car accidents occur in those who drive while high. The fact that it occurs at a lower rate than accidents from drunk drivers should NOT be reassuring. Being intoxicated from marijuana increases risks for many other injuries, which is why users really need to be kept in a safe environment.
Similarly, in the instances when individuals are using marijuana while drinking or using other drugs, the risks for injury and illness become compounded by this simultaneous use. Given that the injuries don’t care where they came from, data gets skewed because of the association with marijuana use.
3. Is it true that more teens smoke pot than cigarettes?
In 2011, for the first time, use of marijuana by teenagers exceeded cigarette use. Overall, one out of every 15 high school students reported they smoke most days.
4. Marijuana doesn’t affect kids any differently than adults, does it?
Teen exposure on a regular basis does appear to lead to a permanent decrease in IQ. The developing brain should not be exposed to it. Given that more teens are now using pot than smoking cigarettes, this is an immediate area of concern.
5. Does marijuana cause mental illness or long-term brain deficits?
This doesn’t appear to be the case, with the caveat that regular exposure to marijuana in the developing brain leads to a permanent decrease in IQ.
6. Marijuana leads to more serious illicit drug use.
The premise that marijuana is a “gateway drug” is a horrible one, regardless as to which side of the political spectrum you reside. Here are some facts:

Currently, legal drugs, specifically alcohol and tobacco, are more widely used and more often lead to use of additional illicit drugs than marijuana. As an additional consideration, talking about “gateway drugs” misses the point when currently legal drugs are much more dangerous than marijuana.
The majority of marijuana users never use other illicit drugs, according to the U.S. Department of Health and Human Services. A report by the Institute of Medicine found “no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs.” It is likely more accurate to say that the same factors that drive marijuana use lead to the use of other illicit drugs.
On the other hand, it’s irrelevant that the majority of marijuana users never use other illicit drugs. A statistically significant number do, and if that’s based on having developed a sense of complacency due to marijuana use without significant ill effect, those individuals will suffer the consequences of that decision. From a public health standpoint, it’s not an either/or consideration.

Check back for questions on addiction, medical complications and other questions regarding marijuana use. Feel free to ask your SMA expert consultant any questions you 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.

Straight, No Chaser In The News: Increased Risk of Miscarriage with Treatment for Yeast Infections

January 12, 2016General Health and Wellness844-SMA-TALK, Behind the Curtain, Conditions and Diseases, diflucan, fluconazole, miscarriage, Sterling Medical Advice, Straight No ChaserJeffrey Sterling, MD

Common things happen commonly. Part of that reality for many women involves the presence of yeast (Candidal) infections. In the news is a report published in the Journal of the American Medical Association that taking oral fluconazole (Diflucan) may increase the risk and rate of miscarriage if taken during early pregnancy. In fact, the rate of miscarriages was 50% higher in those taking fluconazole during early pregnancy.

What do this mean for you? Odds are, you don’t know if you’re pregnant during the times at which you’re most at risk for the effects of medication. The take-home message her is if you have to take medicine for a yeast infection are of child-bearing age, you should probably take a pregnancy test first.
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: Weeding Through the Basics of Marijuana Use and Intoxication

January 12, 2016Toxicology/Drugs844-SMA-TALK, Behind the Curtain, legalization of marijuana, marijuana, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

As we survey the landscape, marijuana use is become legal in more parts of the United States. In this series, we will review the facts (and only the facts) on its clinical effects, the health risks and benefits, intoxication, public health considerations and myths, facts and fiction. Let’s get started.

Marijuana (cannabis) is the most commonly used illegal drug in the U.S. It is estimated that over 100 million Americans have used marijuana. Consumption usually occurs by smoking, which produces a rapid onset of symptoms, but some people eat it.

The “high” of marijuana (intoxication) is typically a euphoric, relaxed state. Other typical side effects include sleepiness and an increased appetite.
Less frequent, more serious and less desirable side effects include the following:

decreased memory
motor skills and perception
dryness of the mouth
dryness and redness of the eyes
panic
paranoia or acute psychosis

Much of the conversation about marijuana involves not just the drug itself but other drugs taken or other activities performed while using marijuana. Along those lines, additional side effects seen in marijuana users not directly attributable to the marijuana itself include abnormal heartbeats and rhythms, chest pain, headache, heart attacks with and without cardiac arrest, high blood pressure, hyperactivity, physical violence, seizures and strokes.
Treatment is largely supportive. It’s necessary to make sure that secondary injuries from irresponsible actions don’t occur. Therefore, it’s important to keep intoxicated individuals in a safe environment. In some instances when medical attention is needed, it is necessary to treat with medicines to combat anxiety and address injuries or side effects that have occurred.

Twenty states and the District of Columbia have enacted medical marijuana laws. Marijuana has been known for thousands of years to have certain medicinal effects, most notably as a treatment for pain and as an appetite stimulant, which has applicability in certain scenarios. Although physicians may not yet prescribe medical marijuana without violating federal law, they may legally recommend it.
Marijuana as treatment for pain has proven useful for patients suffering from the following conditions.

Glaucoma
Nausea
Neuropathic pain (nerve damage)
Movement disorders and spasticity

Marijuana is an appetite stimulant that has been proven useful for patients suffering from the following conditions:

If this part of the conversation seemed simple to you, it’s because marijuana is a rather simple drug on many levels. That said, I know what your questions are! Next up, we’ll address many myths and controversies involving marijuana. Feel free to ask any questions you 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.

Welcome to JeffreySterlingMD.com!

January 11, 2016General Health and Wellness844-SMA-TALK, Behind the Curtain, jeffreysterlingmd.com, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Take a moment and check out the new and improved www.jeffreysterlingmd.com! It is our goal to make it ever easier for you to access the health information and advice you need. The site now includes one-click access to www.sterlingmedicaladvice.com, 844-SMA-TALK, the daily Straight, No Chaser posts, www.jeffreysterlingbooks.com and much more.
For our professional partners, you will find access to our consulting services at www.sterlinginitiatives.com and our emergency department contract services at www.si-stems.com. We’d appreciate your feedback and support, and stay tuned for more service enhancements coming soon.
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: Police Killings are a Public Health Epidemic

January 11, 2016General Health and Wellness, Public Health, Trauma844-SMA-TALK, Behind the Curtain, Black Lives Matter, Harvard School of Public Health, PLOS, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Consider the following statement, ripped from the headlines: “Harvard Study: Police Kill More People Than Pneumonia, Influenza, Measles – Should be Treated as a Public Health Epidemic.”
Pause.
Public health is oblivious to your politics. It views any threat to your health and existence as a problem needing to be quantified and addressed. A statement that police killings are a public health epidemic truly is a measure of how far gone we are as a society, whether you view these killings as justified or not (don’t fool yourself, they’re not, particularly when you can note that African-Americans remain 3 times more likely to be killed by police officers than the general population).

In its review, the Harvard School of Public Health (Go, Crimson!) study notes that as of September 19, 2015, the 842 people killed by police exceeded the total death due to pneumonia and influenza (585), measles (188), malaria (786 cases), and mumps (436 cases), and approached the number of cases of Hepatitis A (890 cases). The toll reached 1000 on November 16, 2015.
Besides acknowledging the massive number of deaths, the point is relatively simple. While simultaneous efforts are made on the political spectrum to demand change, systematic review must occur to quantify the problem as a means of most effectively attacking it. This can lead to better understanding of the areas at highest risk, the most appropriate allocation of resources, and the development of educational tools and disincentives meant to reduce the killings. Here’s a few questions that would be answered by such a review:

Are there actually this many crimes that require use of deadly force? If so, why? What are the root causes, and how can they be addressed?
Are police really unable to control suspects and perpetrators of crimes without use of deadly force? If not, why not?
What explains the disproportionate use of deadly force against African-Americans?
What additional institutional measures need to be implemented to support appropriate police activity and curtail inappropriate police activity?

You may be surprised to know that currently, although the deaths of police officers are counted, there is no reliable source of accounting for the killing of civilians by the police. In this most recent example, researchers actually had to turn to a British newspaper, The Guardian, which had been maintaining an actual tally (it is beyond irony that the tally was double the FBI estimate). Local police departments have not been required to provide such data to the government in the past. The US Attorney General has just announced the intention to change this fact.
It is true that killings of police officers and by police officers bring angst to communities. Regardless of cause, it’s time to acknowledge and own the fact that the rate of occurrence between the two is nowhere near equivalent. It’s past time to put in place appropriate measures to track killings and address those that occur in a criminal manner. The benefit of the doubt law enforcement has historically enjoyed has been lost, and as a public health consideration, it’s time to objectify the conversation. Such measures will protect the innocent civilians and policeman while ensuring otherwise appropriate action is maintained. Two crimes don’t make a right.

This post references the following: “Police killings and police deaths are public health data and can be counted,” Nancy Krieger, Jarvis T. Chen, Pamela D. Waterman, Mathew V. Kiang, and Justin Feldman, PLOS Medicine, December 8, 2015, doi:10.1371/journal.pmed.1001915.

The Straight, No Chaser Guide to Completing Your New Year’s Resolutions

January 10, 2016General Health and Wellness844-SMA-TALK, Behind the Curtain, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We’ve spent the last week addressing your health-related New Year’s resolutions involving healthy eating, exercise routines, smoking cessation and stress reduction. None of these endeavors is easy, and they often involve starts and stops with failure before success. It seems that the take-home messages are pretty clear.

People choose these endeavors because they are the basics to preventing many illnesses and diseases and to enjoying a healthy life.
Pursuing these efforts involves a lifestyle change. Quick fixes just won’t get it done, no matter how sexy or well-marketed the fad or gimmick is.
Many have succeeded in the efforts you’re pursuing. Understand that difficulty, frustration and occasional setbacks are often part of the process but don’t necessary define failure and shouldn’t cause you to give up the pursuit of better health.

If you’re serious about turning your resolutions into completed actions, consider employing some tried and true strategies.

Engage others such as friends and family in your quest. Let them know of your goal. Empower them to support you and hold you accountable. Encourage them to join you.
Plan your strategy. Write it down. Have benchmarks, check-ins and intermittent goals. These lofty goals can’t just be a passing fancy. These are difficult tasks and require a certain amount of serious planning on the front end and diligence along the way.
Reward yourself. This effort can’t just be a chore and something that makes you miserable. This is a big deal and should be treated as such. Plan to celebrate your success, and make it a nice enough reward that its pursuit is worth the efforts you’re going through!

Your final take-home message is one we hope you realize by now. You don’t have to pursue these efforts alone. Your physician’s team should be engaged to help you in these endeavors as needed, but if and when they aren’t, you have an additional team available to you 24/7 at www.sterlingmedicaladvice.com and 844-SMA-TALK. We wish you the best in your pursuit of better health. Happy 2016!
From this week’s posts, here’s your guide to successfully completing your New Year’s Resolutions.
1 – Straight, No Chaser: The Benefits of Exercise and Other Physical Activity
2 – Straight, No Chaser: Here are Steps for You to Take – Get Active!
3 – Straight, No Chaser: Do You Even Know How to Eat Healthy?
4 – Straight, No Chaser: Diet and Nutrition Tips
5 – Straight, No Chaser: Smoking Cessation
6 – Straight, No Chaser: Here’s How You Stop Smoking—Quick Tips to S.T.A.R.T.
7 – Straight, No Chaser: Pass The Stress Test
8 – Straight No Chaser: Your Stress Management Plan
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: Your Stress Management Plan

January 9, 2016General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The path to “Don’t Worry, Be Happy” isn’t as simple as the song suggests, but if the song had a heart, it would be in the right place. Today’s contribution to your New Year’s resolution of less stress in your life is the development of your individual stress management program.
[youtube https://www.youtube.com/watch?v=d-diB65scQU?version=3&rel=1&fs=1&showsearch=0&showinfo=1&iv_load_policy=1&wmode=transparent]YOUR INDIVIDUAL STRESS MANAGEMENT PROGRAM

Learn to smile. Force it if you have to. Wear one when you walk. Your brain receives signals based on your physical appearance.
Learn to be optimistic. Force it if you have to. When you’re in a difficult situation, learn to ask yourself, “What’s the best that could happen?” Let optimism become your goal, and plan with achieving it in mind. Even if you don’t achieve your best, embrace positivity. Focus on the opportunities, not the obstacles.
Learn to have fun. Force yourself to have fun, whatever that is for you. Plan specific activities that will make you smile and laugh. Your brain and body need this outlet.
Learn variety. Force yourself to switch your routine. Even if you’re a workaholic or in a stressful environment, maneuver between activities.
Learn to break. Force yourself to rest, both mentally and physically. Turn it off and recharge. You’ll be more efficient when you return and won’t be as stressed about the activities you must perform.
Learn to add by subtraction. At some point you’ve got to learn to move past those things in your life that produce physical and mental stress. This includes foods, habits and sometimes people. I recently came across this quote:

“Show me your friends, and I’ll show you your future.”
That should either be a ringing endorsement of your choices or a warning sign. Make good choices!

Remember, these activities address both physical and emotional stress.

“Sound mind = sound body” is a real thing!

Physical activity creates good blood flow and healthy muscles and other tissues. This will reduce your levels of stress.

Don’t just sit there. Commit to do something. Commit to a routine.
Strive for 150 minutes/week of aerobic activity.
You’ll perform best with a personal trainer, but you don’t even need to join a gym. If you engage in brisk walking for 20 minutes/day, you’re good.
If you don’t have a trainer, get a workout partner or group. This is using peer pressure in a positive way.

Nutrition is the fuel for your body’s normal functioning. It will keep your brain and body sharp, your immune system powerful and you less susceptible to physical and emotional stress.

Use the food plate guide to facilitate making healthy choices.
Increase the amounts and varieties of fruits and vegetables you eat.
Stop eating when your body tells you that you’re full. Don’t worry so much about “finishing your plate.”
Avoid super-sized anything unless you’re splitting the servings.

Social support—an effective support network—can serve to dissipate your stress. Stress without an outlet is a force multiplier.

Wear a smile as your shield from stress. It invites positivity and positive people. Bringing new friends into your life is exciting for most people. Make an effort to socialize and enjoy the benefits of friendship, family and strong networks.
You are your own best support. If you hardwire positivity into your personality, you will find yourself less stressed. Take care of yourself, and be good to yourself and those around you.

Relaxation is for many people a distant memory that should go high on your New Year’s resolution list.

If you don’t have time to relax, make time. If you can’t make time, take time. Enjoy your family, hobbies and life!
You must learn to connect mentally with your body’s cues. If you’re tired, rest. If you’re in pain, don’t push it. These early signs of physical stress are meant to be warnings. Take heed.
Don’t laugh, but relaxation techniques work! Consider mediation, yoga or just
“resting your eyes.” Appreciate the healing power of music and the arts. The deeper you get into these effects, the better they become at relaxing you.
Sleep is your body’s way to reset and replenish. Good sleep habits are an important way to alleviate your stress.

Professional Support
We multiply our stressors by failing to take advantage of the resources that are available. If your efforts to put a stress management program in place are unsuccessful, and you’re still addressing more than you can handle, you have a wealth of talented caring professionals ready to provide assistance. Licensed social workers, psychologists and psychiatrists can teach you additional stress management techniques and strategies. Nutritionists and personal trainers can fine-tune those factors that may otherwise contribute to physical stress. Your communities likely have resources to help. Of course, you also have access to 844-SMA-TALK and www.sterlingmedicaladvice.com, both of which offer you trained mental health professionals to get you through whatever issues you’re confronting.
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: Pass The Stress Test

January 8, 2016General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Cancer, cancer prevention, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, stuart scottJeffrey Sterling, MD

Let’s agree not to go into the New Year filled with last year’s tension or without a plan to avoid new stress. In fact, let’s take this time to lay the groundwork for one now.
Stress is a feeling of emotional or physical tension. Stress by itself isn’t the problem; in fact, stress can be a powerful motivator. After all, that’s what the “fight or flight” response is – a response to stress. The issue becomes when you can’t manage your stress.

Remember that stress comes in different forms, including emotional and physical. Emotional stress is mental and impacts your ability to respond to situations you find challenging. This type of stress is individualized – what one person considers stressful, someone else might not. Physical stress is the body’s response to triggers. A simple example is what happens if you place your hand in fire. Your body gets burned. That burn is a physical stress on your body. Interestingly, each type of stressor may result in the other. For example, that burn causes you to have emotional pain to accompany the physical pain. In another instance, your emotional stress may produce physical stress such as sweating, vomiting, blackouts or abnormal heartbeats.
You have to get in front of tough situations and learn stress management. You need to learn to reduce, control, defect and channel tension away from its potentially crippling effects. Don’t think it can’t be done: just as the fireman runs into a burning building, the pilot navigates a crashing plane to safety or the emergency physician saves a live without being swallowed up by the magnitude of the moment, you can conquer the challenge confronting you.

Today, I want to focus on 5 factors that play into your development of physical and emotional stress: attitude, diet, physical activity, relaxation habits and support systems. These factors not only work against you if they’re not healthily managed and working to your advantage, but they are the basis for the stress management program we’ll build for you.

Attitude: Your perspective and attitude make you interpret the same situation or trigger either negatively, positively or indifferently. A negative attitude goes along with more stress.
Diet: One’s poor eating habits literally place the body in a state of physical stress and weakens the immune system, resulting in an easier ability to contract a variety of diseases. Poor nutrition eventually will affect the brain and result in additional physical and emotional stress resulting from sub-optimal function of the brain.
Physical activity: Insufficient physical activity will eventually put the body in a stressed state due to diminished blood flow to your organs. Just as a feeling of well-being will reduce stress, being ill and/or out-of-shape will increase stress.
Relaxation: Your inclination and willingness to allow your body to rest and recharge has ramifications for both physical and emotional stress. This involves taking time to sleep as well as enjoy life. If you’re not relaxed, you’re probably going to be stressed.
Support systems: The presence or absence of individuals and groups to help you through potentially stressful situations has the power to diffuse or magnify a situation and its associated stress.

Please take the time between this post and the upcoming post on developing a stress management program for you to assess your own situation, including the factors just mentioned. You’ll learn a lot about yourself and be better prepared for what comes next.
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: Here’s How You Stop Smoking – Quick Tips to START Smoking Cessation

January 7, 2016General Health and Wellness844-SMA-TALK, Behind the Curtain, smoking, Smoking cessation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Don’t pick your birthday to stop when New Year’s has just passed. Do it now. Can’t do it now? Do it Monday. In fact, do it every Monday. It’s a fight. If you fall down, start it back up again. It’s the fight of your life (or should I say for your life)!
Try all of these tips to help you:

If you decide to quit after your current (last) pack, throw away one cigarette for every one you smoke.
Count (figuratively or literally) all the money you’re saving by not smoking.
Throw away (not give away) all cigarettes, cigars, matches, lighters, humidors, cigar cutters and anything else you associate with smoking. You’ll realize how sad it is if and when you find yourself rummaging through the garbage to get a fix.
Tell everyone (loudly) that you’ve quit. Empower them to help and hold you accountable. Enlist another smoker friend to go through the journey with you.
If you do fall off the wagon, smoke a different cigarette brand. Odds are you won’t like it as much, and that will help combat the natural ease you have with smoking.
Contact your physician and ask for help.

Here’s a marvelous best-practices schemata of appropriate interplay between a physician and a patient trying to stop smoking.

If your physician and you decide to place you on a patch or otherwise medicate you, follow instructions carefully and precisely.

More tips:

Practice deep breathing. Part of the euphoria of smoking is nothing more than the physiologic sensations produced by deep inhalations.
Keep other things in your mouth. Mints and chewing gum (low-calorie) are great. Brushing your teeth also serves many purposes. Drinking water when you want to smoke will often remove the urge.
Make it past the first day. Then make it past the first week.

I personally love the START method, which includes several of the above methods. Let me know if it works for any of you.
S: Set a quit date.
T: Tell your friends, family and associates that you’re quitting, and enlist their help.
A: Anticipate and act on the plan you’ve set and challenges you’ll meet.
R: Remove (trash) cigarettes, cigar and other paraphernalia from your environment.
T: Talk with your physician about options and additional support.
For those of you affected (either first or second-hand), this is huge and important. I really wish you all the best. I welcome any comments or questions.

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.

From the Health Library of SterlingMedicalAdvice.com: “If I stop smoking, what does this do to my risk for heart disease and stroke?”

January 6, 2016Cardiology/Heart, General Health and Wellness844-SMA-TALK, Behind the Curtain, cigarette smoking, coronary heart disease, heart attack, Heart disease, smoking, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, StrokeJeffrey Sterling, MD

There are immediate and longterm benefits to smoking cessation that extend beyond just lowering your risk for lung cancer. Consider the following regarding lowering your risk for heart disease and stroke, and make the change to make yourself healthier.

Within 1 year of smoking cessation, your excess risk of coronary heart disease, heart attack, and stroke has dropped to less than half that of a smoker.
Within 5–15 years after stopping, your risk of stroke has declined to that of a non-smoker.
At 15 years after stopping, your risk of coronary heart disease is that of a person who has never smoked.

You can do it. There are many great reasons to. You likely can them family and friends.
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: Smoking Cessation RESOLVED

January 6, 2016General Health and Wellness844-SMA-TALK, Behind the Curtain, smoking, Smoking cessation, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Ok. On our New Year’s resolutions list, we’ve covered diet and exercise. Now what? Of course. Several of you have promised me that you would stop smoking for the new year. (I’ve made my list and am checking it twice.) The thing about smoking is there really is no time like the present to stop.
You’ve all been asked what things you’d take with you on a desert island. I’ll pose and answer the opposite question, but not on an island but regarding your life. Getting you to stop smoking is certainly one of the three gifts I’d offer you if it was within my power. This post won’t be about the dangers of smoking. (I’ll continue to hit you over the head with those at every opportunity.) Given that I’m into producing positive outcomes, I’m going to discuss with you effective means to stop smoking and the benefits of stopping.

The question on your mind is obviously how to stop. Personally, I’m of the Yoda mindset. You know, when he was teaching Luke Skywalker, he famously said, “Do or Do not. There is no try.” I can hear you now, “But Doc, I’m addicted!” Sure you are. There are many things in medicine about which I’m absolutely sure. One of these is the most effective way to stop smoking is to quit. Cold turkey. The moment you’re motivated. Not only is this premise supported by the data, which I’ll discuss momentarily, but here’s the benefit of over 20 years in clinical emergency medicine practice and having seen hundreds of people stop, stay stopped, and letting me know months and years later that they stayed stopped. Despite being addicted, people are amazingly able to quit cold turkey, and they will do it in one of five circumstances.

When they develop the will

After the birth of their first child

After their first heart attack

After their first stroke

When they die

For those of you convinced that you can’t, here’s a fact: Today there are more former smokers than current smokers.

I want to point out that I appreciate the difference between cigarette smoking and nicotine dependence. My particular concern for your health lies in the delivery of smoke (containing over 7,000 other toxins, approximately 70 of which can cause various cancers) into the airway system that is supposed to deliver oxygen throughout your body for the maintenance and health of your organ systems. Still, I want you to know I understand and appreciate the difficulty of smoking cessation.

Nicotine dependence in the most common chemical dependence in the U.S.
Quitting smoking often requires multiple attempts.
Nicotine withdrawal produces bothersome symptoms (e.g., irritability, reduced concentration, increased appetite with possible weight gain and anxiety).

The good news is more than two-thirds of smokers profess a desire to stop smoking, and yearly over half of smokers attempt to stop. That’s likely a result of knowing that no matter when you stop, you will improve your health outcomes. Each incremental inhalation of cigarette and cigar smoke produces damage better left unproduced. Let’s just hope you don’t wait until it sets up permanent damage. Consider a sampling of the following benefits that are sitting there waiting for you.

Reduction of the risk for cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach and cervix, as well as certain leukemias
Reduction of the risk for heart disease, stroke and peripheral vascular disease
Reduction of the risk for COPD (chronic obstructive pulmonary disease)
Reduction of the risk for infertility

In a subsequent post, I’ll review specific methods and tips to help you and/or your loved one stop. Today’s as good of a day as any.
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: Diet and Nutrition Tips

January 5, 2016Diet and Nutrition, General Health and Wellness844-SMA-TALK, Behind the Curtain, diet and nutrition, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you’re serious about keeping your New Year’s resolutions, so are we. Today, we move from explaining how to eat (as we did here), to giving you practical steps and choices to make in several critical areas—intake of fluids, plants, proteins, grains, salt and junk food. The more of these you can check off as part of your dietary inventory, the healthier you’ll be.
Fluids

Drink water as your primary beverage.
Enjoy coffee or tea without excessive sugar or other additives.
Avoid sugary beverages. These are a dangerous source of “empty calories,” meaning they lead to weight gain with little or no nutritional value. This increases your risk of high blood pressure and diabetes.
Drink alcohol in moderation if at all. It is true that alcohol has some health benefits, but moderation is key before you introduce the negative health consequences of overconsumption.
Limit daily intake of dairy products to 1-2 servings/day.
Ease up on juices, as they’re very high in sugar content.

Plants

When in doubt, you won’t go wrong eating plants; a plant-based diet is your healthiest option.
Make half your plate vegetables and fruits.
Learn to cook with healthy plant oils, like olive and canola oil.

Protein

Pick most or all of your protein from healthy choices such as fish, chicken, beans, nuts and seeds, and tofu. Eating these choices in place of red meat and processed meat can lower the risk of heart disease and diabetes.
Avoid burgers and hot dogs.
Limit red meat—beef, pork, or lamb—to twice a week or less (if you must at all).
Replace your red meat intake with seafood.
Avoid processed meats such as bacon, cold cuts and hot dogs. They significantly raise the risk of heart disease, diabetes and colon cancer.

Grains

Grains are not essential for good health.
Any grains you eat should be whole grain. They are not as prone to increasing your risks for diabetes, and they better assist your weight loss efforts.
Whole grains include products such as brown rice, whole wheat bread and whole grain pasta. Whole grains lower the risk of heart disease and diabetes.

Salt

We get more than enough salt in our diets without adding salt. Lose the salt shaker!
Your dietary intake of salt should equal about one teaspoon of table salt a day, which you’ll obtain without thinking about it or ever adding additional salt.
Think you’re a good cook? Prove it. Lose the salt, both when cooking and on the table. Use spices, herbs and oils instead.
Rethink all those condiments. Soy sauce, ketchup, pickles, olives, salad dressing and seasoning packets are typically very high in sodium. Seek out low-fat, low sodium alternatives, or sprinkle enough of the condiments to produce the taste you want instead of using the entire packet.

Calories

We’ve discussed calories and calorie counts at length. Refer to this edition of Straight, No Chaser for a review.

Junk food

In a word, no. See the above discussion on “empty calories”. Junk food (and you should include sugary drinks in this category) contains lots of calories and next to no nutritional value. Furthermore, it doesn’t make you feel full, so you tend to overeat, leading to more calories and more health risks.
Save desserts for special occasions, and eat just enough to enjoy the occasion. Sometimes just a taste will ease that sweet tooth.
Substitute healthy snacks when you have junk food cravings. Fruits, a handful of nuts or whole grain crackers can do the trick if you give them a chance.
Substitute a serving of your favorite fruit for those routine desserts.

Please remember that diet isn’t enough. You must stay active, as discussed here and here. A healthy diet with regular physical activity keeps your weight in check.
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: Do You Even Know How To Eat Healthy?

January 4, 2016Diet and Nutrition, General Health and Wellness844-SMA-TALK, Behind the Curtain, Harvard School of Public Health, healthy eating plate, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We’re still in New Year’s resolutions mode! Previously we introduced you to why you exercise and we discussed how to start. Today’s Straight, No Chaser is about your diet. So many times we hear “Eat Healthy,” as if we actually know what that means. Well today you’ll learn. Of course, whether you choose to do it is up to you!

For many years, pyramids were the way nutritionists would communicate about healthy eating. In case you weren’t aware, there has been a paradigm shift, and plates are in. Of course it seems rather obvious that it’s easier to communicate these things in a way representing how we eat. For the definitive source, I return to the Harvard School of Public Health. See the picture below. (Go Crimson!)
I’m going to make this very simple (or should that have been “digestible”) and simply discuss the contents of your plate.

Here’s your Healthy Eating Plate blueprint for a typical meal:

Fill half of your plate with produce—that means fruits and vegetables. The broader the variety, the better. Sorry, but potatoes and French fries don’t count as vegetables!
Fill a quarter of your plate with whole grains. Whole grain foods help lower the risk of coronary heart disease, stroke, obesity and diabetes. The sure way to know you’re choosing a whole grain food is simply in the name. When you’re grocery shopping, the product will actually say “whole grain.” This is not the same as multigrain.
Fill the rest of your plate with a healthy source of protein such as fish, poultry, beans or nuts.
You may have noticed a glass bottle in the picture. This is meant to represent a reminder to use healthy oils—such as olive and canola—when cooking, on salad, and at the table. You’ll notice the absence of butter and fatty salad dressings on the plate.
Regarding beverages, do yourself a favor. Try to drink water, and rediscover how refreshing it is. You don’t have to pay for another beverage just because you’re used to doing so. Tea or coffee is healthy options if you use little or no sugar. Milk and other dairy products should be limited to one to two servings a day.

In a subsequent post, we provide a series of healthy eating and dieting tips to get you through your days. I hope you take the time to integrate this basic scheme into your eating habits. If you do, you will be well on your way to a sustainable lifestyle change that should have been the basis of any diet-related New Year’s resolution!
Feel free to ask your SMA expert consultant any questions you 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
Copyright © 2008. For more information about The Healthy Eating Pyramid, please see The Nutrition Source, Department of Nutrition, Harvard School of Public Health, www.thenutritionsource.org, and Eat, Drink, and Be Healthy, by Walter C. Willett, M.D., and Patrick J. Skerrett (2005), Free Press/Simon & Schuster Inc.

Straight, No Chaser: Here’s Steps For You To Take – Get Active!

January 3, 2016General Health and Wellness, Personal Training844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Here’s how you get started with a work out regimen. Joining me in this conversation is another SMA expert consultant, Fitness Guru and owner of Loving The New Me Fitness, Shina Michelle.
As we left off in the previous post, fitness is for everyone. If you’re currently inactive, worried about becoming active or worried about boosting your level of physical activity because you’re afraid of getting hurt, fear not. Moderate-intensity aerobic activity (e.g., brisk walking) is generally safe for most people, and even if it’s been a long time and/or you have medical problems, the health benefits of being active are far greater than the risks of getting hurt and the consequences of remaining inactive.

First things first: Get cleared by your physician.
If you have a chronic medical illness like diabetes, heart or vascular disease, arthritis or asthma/COPD, talk with your physician about your ability to be active. Your doctor will work with you to develop a plan matching your capabilities, and you or you and your personal trainer can execute it. You’d be surprised how much health can be generated with a reasonable amount of effort. As little as 60 minutes a week of moderate-intensity aerobic activity (e.g., brisk walking) produces measurable health benefits. The key is to avoid being inactive.
You’re not going to run a marathon on your first day back working out.
Strokes and heart attacks are rare during physical activity. The risk that does exist comes from someone who figuratively goes from 0–60. Don’t go from inactive to hyperactive, engaging in vigorous-intensity aerobics (e.g., that includes shoveling snow, running stairs, etc.). It’s a good idea to work with a personal trainer if it’s within your means. You need to have a plan in place to get from zero to hero.
We’ve previously discussed losing weight in the context of the caloric index. Just remember that in order to lose one pound, you need to burn an average of 500 more calories per day than you eat or drink—for an entire week. We’ll get back to the dietary consideration in an upcoming post, but for now let’s focus on the exercise/activity component of the equation.

To translate what “500 more calories per day than you eat or drink” looks like, follow these tips:

Strive for 150 minutes/week of moderate-intensity aerobic activity (e.g., brisk walking) or
Strive for 75 minutes/week of vigorous-intensity aerobic activity or
Strive for an equivalent mix of the two

Be advised that your metabolism may play a role on whether you need more or less aerobic activity to accomplish your goal.
Now these aerobic recommendations represent a minimal amount likely to help you maintain your current weight. Increase these amounts and/or use the dietary intake side of the equation to help you lose weight. Check back tomorrow for a review of those.
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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