Tag Archives: Behind the Curtain

Straight, No Chaser: Questions about "Lazy Eye" (Amblyopia)

November 6, 2015Ophthalmology/Eyes844-SMA-TALK, amblyopia, Behind the Curtain, cataracts, Conditions and Diseases, hyperopia, lazy eye, myopia, ptosis, Sterling Medical Advice, SterlingMedicalAdvice.com, strabismus, Straight No ChaserJeffrey Sterling, MD

We all get concerned when it comes to things that damage or put our vision in danger. As such, you should be aware of the most common condition causing visual problems in children. You know it as lazy eye, but the medical term is amblyopia. This occurs in approximately 2 to 3 of every 100 children. Unfortunately, the issue isn’t just its occurrence in children but its persistence into adulthood. Amblyopia is also the most common cause of visual impairment among young and middle-aged adults affecting one eye.
Here are some questions and answers of concern. These may help you understand some terms your ophthalmologist (eye doctor) or optometrist uses with you.

What exactly is lazy eye?
Amblyopia (aka lazy eye) is the condition that exists when the vision of one eye is reduced due to that eye not working appropriately with the brain. The brain adjusts by favoring the other eye.
Let’s get medical for a moment. Appropriate eye function requires accurate interaction between the eyes and the portions of the brain necessary for vision. Each eye focuses light on the retina, which is located in the back of the eye. Cells within the retina stimulate nerve signals that travel along the optic (eye) nerves to the brain, which interpret and responds to these signals.

What are some common causes of this?
As noted, the correct function and interaction between the eyes and brain are necessary. Many things can go wrong along the way, all of which serve to cause unclear focusing. Here are some examples.

Strabismus: misalignment of the eyes

Cataracts: clouding of the front part of the eye

Nearsightedness (myopia; better focus on closer objects) results from the eye being too long from front to back.

Farsightedness (hyperopia; better focus on objects at a distance) results from the eye being too short from front to back.

Astigmatism: condition associated with irregularly shaped eyes; produces difficulty focusing on both near and far objects

How is lazy eye treated?

Most of the focus on treating amblyopia involves catching it early and treating the child. It is during this time that the eye, the brain and the connections between them are developing, and the opportunity for improvement is greatest. Generally speaking, treatment involves forcing the child to use the eye with weaker vision. There are two common ways to treat lazy eye:

Patching: Placing an adhesive patch on the stronger eye for weeks to months forces the brain/eye apparatus to use the affected eye. This stimulates more complete development of the needed areas in the brain and eye.
Atropine: Using this eye medication causes blurring in the strong eye, forcing use of the affected eye. This works as well as patching.

Is this the same as eye drooping or lid lag?

No. “Lazy” eyelids (aka ptosis) are not the same as malfunctioning eyes. Lazy eye refers to the latter. That said, the two are not mutually exclusive.

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

November 5, 2015Mental Health, Neurology844-SMA-TALK, Alzheimer's disease, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

November is National Alzheimer’s Disease Awareness Month. Each of us has elderly family members for whom we may be concerned about their memory or other possible signs of dementia. You don’t have to stand by powerless and let them dwindle away. Early detection of dementia gives the best chance for a higher quality during the rest of one’s life. Isn’t that how we’d all want our loved ones to spend their golden days? This Straight, No Chaser post adapts information provided by the Alzheimer’s Association. Any positive responses can suggest an issue warranting further investigation. The goal here is straightforward. If any concerns arises after completing this, you should print out the sheet, and take it to your physician, requesting an evaluation.

_____ 1. Memory loss that disrupts daily life. One of the most common signs of Alzheimer’s, especially in the early stages, is forgetting recently learned information. Other signs include forgetting important dates or events; asking for the same information over and over; relying on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own. Typical age-related changes involve sometimes forget names or appointments, especially if you remember them later.
_____ 2. Challenges in planning or solving problems. Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. Typical age-related changes include making an occasional error when balancing a checkbook.
_____ 3. Difficulty completing familiar tasks at home, at work or at leisure.People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. Typical age-related changes include occasionally needing help to use the settings on a microwave or to record a television show.
_____ 4. Confusion with time or place. People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there. Typical age-related changes include occasionally getting confused about the day of the week, especially if s/he figures it out later.
_____ 5. Trouble understanding visual images and spatial relationships. For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not recognize their own reflection. Typical age-related changes of vision changes are related to cataracts and do not indicate Alzheimer’s.
_____ 6. New problems with words in speaking or writing. People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a watch a “hand clock”). Typical age-related changes involve sometimes having trouble finding the right word.
_____ 7. Misplacing things and losing the ability to retrace steps. A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time. It’s more typical to displace things from time to time, such as a pair of glasses or the remote control.
_____ 8. Decreased or poor judgment. People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. It’s less concerning for anyone of any age to make a bad decision once in a while.
_____ 9. Withdrawal from work or social activities. A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced. It’s more typical for anyone of any age to sometimes feel weary of work, family and social obligations.
_____ 10. Changes in mood and personality. The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone. It’s more typical for people as they age to develop very specific ways of doing things and to become irritable when a routine is disrupted.
It is worth restating: early diagnosis provides the best opportunities for treatment, support and future planning. For more information, call the Alzheimer’s Association at 800.272.3900 or your SterlingMedicalAdvice.comexpert consultants.
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: COPD

November 4, 2015Respiratory/Lungs844-SMA-TALK, Behind the Curtain, Chronic bronchitis, COPD, emphysema, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

November is COPD Awareness Month. You already know a lot about COPD without realizing it or even having to think about it. You’ve seen patients walking around with the oxygen tanks or tubes in their noses. However, that’s just the extreme. COPD is the third or fourth leading cause of death in the US depending on the source, with millions of individuals diagnosed. You also know COPD and cancers are why your doctors always warn you against smoking in any form. You know smoking is the leading cause of this. This Straight, No Chaser provides a brief overview of COPD and answers some key questions.

What Is COPD?
Chronic obstructive pulmonary disease is a lung disease that makes it hard to breathe and advances in severity over time.
Appreciate that air goes from your mouth or nose through the windpipe (trachea) through several branches of airways, eventually connecting to blood vessels meant to carry oxygen to the organs of your body. These same blood vessels drop off waste gas known as carbon dioxide, which we exhale with each breath out. In COPD, less air flows in and out of the airways because of one or more of the following:

The airways and air sacs lose their elasticity. Elasticity is the stretchiness your lungs need to fill up with and push out air. In COPD, these sacs act less like a balloon and more like a lead pipe.
The airways make more mucus than usual, which clog them and make breathing more difficult. The inflammation caused by smoke and other irritants produce mucus. It’s not a good thing when instead of breathing air, you’re attempting to breathe a smoke-filled swamp of snot-like material.
The walls of the airways become thick and inflamed. Over time, inflammation can cause permanent changes in the walls of the airways to compensate for the environment you’ve created.
The walls between many of the air sacs are destroyed. Ongoing inflammation overwhelms the body’s ability to repair itself, and eventually sheets of tissue in your airways are destroyed beyond repair, providing you with less tissue to exchange oxygen from the lungs to the blood vessels that carry oxygen through the body.

What causes COPD?
Cigarette smoking is far and away the leading cause of COPD. Most of those with COPD are current or former smokers. Heredity, childhood respiratory infections, and long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust may contribute to or cause COPD.

I’ve been told I have bronchitis. Is that the same thing?
There’s acute bronchitis, and there’s chronic bronchitis. In the US, COPD refers to two separate but similar conditions, emphysema and chronic bronchitis; most with COPD have both conditions. Now if you have acute bronchitis, it means something (like and likely cigarette smoke) is currently inflaming your airways. Over time this can permanently damage the airways and produce an ongoing state of inflammation – chronic bronchitis – with airway wall thickening and increased mucus production within the lungs. Let the smoker beware.
How is this different from emphysema?
In emphysema, the walls between many of the air sacs are damaged, losing their shape and elasticity. This damage also can destroy the walls of the air sacs, leading to fewer, larger and less efficient air sacs instead of many more efficient tiny ones. If this happens, the amount of gas exchange in the lungs is reduced, meaning you’re not getting enough oxygen in you and enough carbon dioxide out of you.

What are some symptoms of COPD?
COPD can cause coughing with mucus production, wheezing, shortness of breath, chest tightness, decreased ability to exert yourself and walk around. Even more symptoms may develop as a result of inadequate oxygen supply and inadequate carbon dioxide disposal.
How can I know if I have COPD?
One big problem with COPD is many have the disease and don’t know it until it starts becoming quite advanced. It’s safe to assume that if you’re a smoker and have difficulty breathing, you’re experiencing changes to your airways that aren’t in your best interest. You are advised to get evaluated. You are best advised to remove yourself from the source of the inflammation (in other words, stop smoking).
How does COPD affect my life?
For starters, it shortens it. It also markedly increases your cancer risk. At some point all the damage and changes to your lungs is going to cause some abnormality. Given this is the area you use to breathe, deliver oxygen to your organs and eliminate toxins from your body, all manners of things can go wrong, and they often do. COPD is a chronic, progressive disease. You may or may not pick up on the slow creep of diminishing ability to perform routine activities, or maybe you’ll just attribute them to aging (COPD occurs most often in middle-aged to elderly individuals). Once severe enough, COPD may prevent you from doing even basic activities like walking, breathing without difficulty, or taking care of yourself.
What’s the cure for this?
Here’s the frightening part: we’re talking about irreversible lung tissue change and destruction. Once layers of your airways have been ripped out (figuratively), they aren’t coming back. The damage is done. Prevention is your best defense.

So how is it treated?
There is no real treatment without removing the trigger feeding the ongoing inflammation. In other words, you’ll have to stop smoking to attempt to arrest the progression. Additional measures involve support.

Supplemental oxygen may be needed to deliver enough oxygen to the tissues as an effort to combat the destruction and inflammation of tissue meant to facilitate oxygen exchange.
Medicines to reduce the inflammation and mucus may be prescribed.
Medicines to better open the airways past the clogging caused by inflammation and mucus may be prescribed.

Your physician will discuss these and other options. The truth is COPD has no cure. Once you’re discovered to have COPD, efforts switch to slowing the progression and implementing measures to improve the quality of your life within the parameters defined by the advancement of your disease.

Here is a short video from the National Institutes of Health.

[youtube https://www.youtube.com/watch?v=BIdHQQEXPDk?version=3&rel=1&fs=1&showsearch=0&showinfo=1&iv_load_policy=1&wmode=transparent]
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 Cancer Prevention Workbook

November 3, 2015General Health and Wellness, Hematology & Oncology/Blood Disorders/Cancer, Health Prevention844-SMA-TALK, Behind the Curtain, Cancer, cancer prevention, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We continue with simple principles to avoid various forms of cancer, but in today’s Straight, No Chaser, we add some detail about the what’s and whys of the conversation. The areas bolded represent summary actions for your benefit.

Take Charge of Your Intake

1. Eat a healthy diet
A healthy diet is a nutritious approach to reducing your cancer risks. Adopt these principles.

Eat plenty of fruits and vegetables. Base your diet on fruits, vegetables and other foods from plant sources — such as whole grains and beans. No, there is not evidence that cancer supplements reduce cancer risks.
Avoid obesity. Avoid high calorie foods such as refined sugars and fat from animal sources.
Limit red meats (beef, pork, lamb) and avoid processed meats. Embrace chicken, seafood and legumes instead.
If you choose to drink alcohol, do so only in moderation. Alcohol intake is associated with multiple forms of cancer, including breast, colon, kidney, liver and lung. Your risk increases with regular intake, the duration of intake and the amount you drink. Practice moderation in general and limit yourself to two drinks a day (if your male; women should limit themselves to one a day) in most settings to obtain a variety of health benefits, including cancer risk reduction.

2. Don’t use tobacco
It is one of the oddest human behaviors to purposely infuse smoke into the area of your body meant to deliver air to the rest of your body, and this is true for cigarettes and cigars. Smoking nearly screams cancer risk; it is linked to cancers of the bladder, cervix, kidney, larynx, lung, mouth, pancreas and throat. Even secondhand smoke exposure is linked to an increased link with lung cancer. Chewing tobacco is associated with cancers of the oral cavity and pancreas. Tobacco is your true “just say no” drug. This is simple. If you don’t smoke, avoid it. If you do smoke, stop.

Take Charge of Your Actions

3. Maintain a healthy weight and stay physically active
A healthy weight is defined by your heart, not your appearance. Being physically active and maintaining a healthy weight might lower the risk of cancers of the breast, colon, kidney, lung and prostate. If you want an amount of activity to use as a target, as a general goal, include at least 30 minutes of physical activity in your day. At least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic physical activity is ideal.
4. Protect yourself from the sun
Skin cancer is one of the most common and preventable forms of cancer. Just be smart about your exposure. Avoid tanning beds, sunlamps, and midday sun. Seek out shade, cover yourself, wear bright or dark colors to reflect the suns rays away and use sunscreen.
5. Avoid risky behaviors
We’ll let rock and roll off the hook, but sex and drugs have direct links to cancer.

Practice safe sex. If you’re not practicing safe sex (by using condoms, abstinence or at least limiting your number of sexual partners), you are more likely to contract HPV and/or HIV. The links of HPV and cancer are noted above; the links of HIV include a higher risk of cancer of the anus, lung and liver.
Don’t share needles. Anyone injecting themselves with needles for illicit drug use should be considered a high risk for HIV and/or hepatitis. Sharing needles with an infected drug user can lead to those diseases. Hepatitis from IV drug use carries an increased risk of liver cancer.

Take Charge of Your Health Maintenance

6. Get immunized
There are two specific immunizations that have definite benefit in cancer prevention.

Immunize against Hepatitis B. Hepatitis B can increase the risk of developing liver cancer. If you are sexually polygamous, have a sexually transmitted infection, are an IV drug user, a healthcare, public safety or other worker who might be exposed to blood or body fluids or are a male who has sex with other men, you are a strong candidate for immunization.
Immunize against HPV (Human papillomavirus). HPV is a sexually transmitted virus that can lead to cervical and other genital cancers as well as cancers of the head and neck. The HPV vaccine is recommended for girls and boys ages 11 and 12. It is also available to both men and women age 26 or younger who didn’t have the vaccine as adolescents. Universal application of the HPV virus would virtually eliminate cervical cancer.

7. Get regular medical care
Learn to screen. Learn to self-exam yourself. Commit to regular evaluations. Even if you don’t prevent cancer, early detection gives you the very best chance of recovery after treatment.
Your health is your choice. Balance your life decisions in a way that allows you to enjoy yourself to the fullest while lowering your risks for cancer. Implementation of these tips will get you there. All things considered, this isn’t very much for you to commit to doing, particularly when you consider the benefits of doing so.
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 Cancer Prevention Checklist

November 2, 2015Detoxification, General Health and Wellness, Hematology & Oncology/Blood Disorders/Cancer, Health Prevention844-SMA-TALK, Behind the Curtain, Cancer, cancer prevention, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I’m going to present this information two separate ways: today a checklist, as simple as possible; and tomorrow with the same information explained briefly but with detail. You likely will find it of interest that many of these considerations are the same healthcare basics that promote good health generally. Always appreciate these considerations aren’t guarantees but reductions of risks.
So… here are three principles and a total of eight tips (in case you remember nothing else, go with the principles).

What you allow to enter your body matters.

Eat healthy foods.
Protect yourself from the sun.
Avoid tobacco of any type.

Strengthen your body.

Maintain a healthy weight.
Be physically active.
Get immunized.

Prevention and early detection are key.

Avoid risky sexual and illicit drug-related behaviors.
Engage in routine medical care, screenings and self-exams.

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: Treating Halloween Mishaps

October 31, 2015General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, choking, food poisoning, Halloween, Sprained ankle, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, SyncopeJeffrey Sterling, MD

In the previous Straight, No Chaser, we offered you tips for a safe Halloween. However, safety tips are only as good as your inclination to use them. Even when an ounce of prevention is worth a pound of cure, you should still have access to that pound. In this post, we remind you of the treatment measures you may need to employ in the event something untoward happens at that Halloween party or while trick or treating.

Upset stomach? There are two pretty big reasons why this happens.

Eating all those sugary treats can cause all types of problems, including an upset stomach. Ration out the treats, especially the first night. You’d do well to make sure the trick-or-treaters have a generous dinner in advance of the activities.
Have you ever thought of all the different hands that touch the contents of those bags? You’d better be sure to wash hands and any foods prior to ingestion, whether wrapped or unwrapped.
If vomiting and diarrhea ensue from any food poisoning, review the linked Straight, No Chaser for treatment considerations.

Sprained ankle?

It can get pretty exciting out there, and kids can easily get distracted. Falls and ankle sprains can be expected on those sugar-induced sprints to the next house.
Review the linked Straight, No Chaser for treatment considerations.

Faints?

Are those tricks too scary? Did the excitement prove too much to handle?
Review the linked Straight, No Chaser for treatment considerations.

Choking?

You must be mindful that all candies are not appropriate for children. Peanuts and candy corn have a nasty habit of getting lodged in the throats of very young children.
Learn what steps to take in the event this happens. Review the linked Straight, No Chaser for treatment considerations.

Keep in mind that common things happen commonly. The horror tales of legend aren’t likely to be a part of your Halloween, nor are you likely to come across any ghouls, goblins, vampires or zombies unless you come across a Thriller reenactment.

Be safe and have a Happy Halloween!
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: Halloween Health Tips

October 30, 2015Diet and Nutrition, Toxicology/Drugs, Health Prevention844-SMA-TALK, Behind the Curtain, Halloween, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Are you taking the young ones trick-or-treating this year? Straight, No Chaserand the Centers for Disease Control and Prevention (CDC) want you to have a safe halloween. Today and tomorrow’s posts will offer safety tips and treatment considerations in the event something goes wrong.

Remember: have a SAFE HALLOWEEN!
Swords, knives, and other costume accessories should be short, soft, and flexible. Objects don’t have to have the consistency of a knife to stab or otherwise impale.
Avoid trick-or-treating alone. Walk in groups or with a trusted adult.
Fasten reflective tape to costumes and bags to help drivers see you.
Examine all treats for choking hazards and tampering before eating them – slow down! Limit the amount of treats you eat.

Hold a flashlight while trick-or-treating to help you see and others see you. Always walk; don’t run from house to house.
Always test make-up in a small area first in case an allergy may been present. Remove it before bedtime to prevent possible skin and eye irritation.
Look both ways before crossing the street, and use crosswalks wherever possible.
Lower your risk for serious eye injury by not wearing decorative contact lenses.
Only walk on sidewalks whenever possible, or on the far edge of the road facing traffic to stay safe.
Wear well-fitting masks, costumes, and shoes. The idea is to avoid blocked vision, trips, and falls.
Eat only factory-wrapped treats, and throw away homemade treats made by strangers.
Enter homes only if you’re with a trusted adult. Only visit well-lit houses. Never accept rides from strangers.
Never walk near lit candles or luminaries. Be sure to wear flame-resistant costumes.

Expecting trick-or-treaters or party guests? Follow these tips to help make the festivities fun and safe for everyone:

Provide healthier treats such as low-calorie treats and drinks. For party guests, offer a variety of fruits, vegetables, and cheeses. Get creative as to keep things festive.
Use party games and trick-or-treat time as an opportunity for participants to get their daily dose of 60 minutes of physical activity.
Be sure walking areas and stairs are well-lit and free of obstacles that could result in falls.
Keep candle-lit jack o’lanterns and luminaries away from doorsteps, walkways, landings, and curtains. Place them on sturdy tables, keep them out of the reach of pets and small children, and never leave them unattended.
Remind drivers to watch out for trick-or-treaters and to drive safely.

Straight, No Chaser: Sensitive Teeth

October 29, 2015Dental844-SMA-TALK, Behind the Curtain, hypersensitivity, root canal, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

What goes through your mind when your teeth hurt (other than whether or not all of that Valentine’s Day candy is worth it)? Is it fleeting or constant? Are you easily agitated by hot and cold stimuli alike? Do you have problems even when you brush and/or floss? These are some of the circumstances those with sensitive teeth have.

Now you would think this is pretty straightforward, right? Your teeth hurt, you stop doing what is making them hurt, and you go to get them evaluated. Unfortunately, it’s never that simple. Sensitive teeth can be a precursor to disease developing, or it can be a symptom of disease that’s established. Examples of causes of sensitive teeth include the following.

Cavities (holes in the teeth)
Decayed and/or fractured teeth
Exposure of the tooth root or nerve endings supplying the teeth
Gum disease
Worn tooth enamel or fillings

A common thread exists in the above listing. Enamel protects healthy teeth at the level of your crowns—the part above the gum line. Cementum protects the tooth root (which lies below the gum line). Underneath both the enamel and the cementum is dentin, a layer of the teeth less dense and more hollow. When the levels of protective covering are eroded and dentin is exposed, foods and other substances may penetrate and reach the nerves within your teeth through these more hollow areas. The increased propensity for this to happen is experienced as hypersensitivity.
Your first challenge is not to let things get out of control. In the event you’re experiencing dental pain for any reason, it needs to be evaluated and addressed. If it’s truly hypersensitivity, your dentist has several options at his or her disposal.

Desensitizing toothpaste contains compounds that help block transmission of sensation from the tooth surface to the nerve. Several applications are usually required before the sensitivity is sufficiently lessened.
Fluoride gel can be applied in the dentist’s office. This serves to strengthen tooth enamel.
Placement of a crown, inlay or bonding may be used to correct a flaw or decay that results in sensitivity.
If gum tissue has been lost from the root, a surgical gum graft will protect the root and reduce sensitivity.
If sensitivity is severe and persistent and cannot be treated by other means, your dentist may recommend a root canal to eliminate the problem.

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

October 28, 2015General Health and Wellness, Dental844-SMA-TALK, Behind the Curtain, dental emergencies, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

The question in real time is “My tooth just fell out. What should I do?” The answer depends on your age and health; the tooth might be able to be placed back into your socket. Today’s Straight, No Chaser gives you tips on how to increase the chances that replantation will be successful.
Which teeth are eligible? Baby teeth (those in children age eight and younger) are usually not replaced. Usually adult teeth can be replanted if appropriately handled.

What can I do?
Follow these steps:

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

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

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

How do I prevent losing a tooth?

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

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

October 27, 2015Diet and Nutrition, Gastrointestinal, Hematology & Oncology/Blood Disorders/Cancer844-SMA-TALK, Behind the Curtain, colorectal cancer, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Perhaps this news will be filed under things you already know, think you know, or know but don’t care enough for it to change your lifestyle (we are a bacon-loving nation), but at least after reading this, you can consider yourself an informed consumer.

What’s the news? The World Health Organization has reaffirmed that processed (and cured) meats cause colorectal cancer. This places these foods in the same category of danger as smoking, alcohol intake and asbestos exposure. Furthermore, red meats such as beef, lamb and pork have been upgraded to “probable” carcinogens, which means the research is mounting in that direction but isn’t yet definitive.

Which meats pose the danger? Bacon, ham, hot dogs and sausage, as well as processed meats like salamis and cold cuts.

Can I trust this information? You should. These recommendations were based on data from over 800 different research studies.
Is this an example of “everything in moderation is ok?” Doesn’t everything cause cancer? If you want to believe that, fine. It’s more accurate to say there are levels of risk at every amount of consumption. However, to quantify the risk for this topic, approximately 3 slices of cooked bacon eaten daily was shown to increase the risk for colorectal (bowel) cancer by 18%. The average American eats about 18 pounds of bacon per year, well above that standard. The difference here is this level of consumption is well within the normal eating habits of Americans, as opposed to theoretical consumptions that aren’t practically realized due to insufficient lifetime exposure.

Straight, No Chaser: How's Your Dental Hygiene?

October 26, 2015Dental, Health Prevention844-SMA-TALK, Behind the Curtain, dental emergencies, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you ignore your teeth, they’ll go away.

Working in an emergency department is interesting for many different reasons. One thing in particular I’ve noticed over the years is how oblivious some people are to their smiles—especially their teeth. We see it all: loose teeth, missing teeth, broken teeth, infected teeth, sensitive teeth, erupted wisdom teeth, gingivitis,bad breath, dental infections (especially abscesses), things stuck in the teeth, mouth cancer, yeast infections, rashes inside the mouth and other conditions. The mouth is the gateway to the body. Through it, you introduce many substances that can infect or otherwise damage you. Clinically, the appearance of your mouth, gums and teeth are often a direct statement about how well you care for the rest of your body.
You would think dental hygiene is an especially difficult proposition, but it’s actually quite simple. According to the American Dental Association (ADA), all you really need to commit to good dental hygiene is less than five minutes at a time, at least twice a day. Surely that’s not too much to ask of yourself for yourself, is it?
Let’s identify three sets of conditions you should be prepared to address with your activities. Each measure contains simple tips and habits you should employ to keep your smile making the right kind of introduction.
1. Prevention and self-maintenance

Brushing and flossing keep your gums and teeth healthy by removing plaque and food particles that can serve as a source for infection and tooth decay. Here are your essentials.

Brush for two minutes at a time.
Brush at least twice a day and preferably after each meal.
Flossing is important. There are particles that collect under the gums and between the teeth that your toothbrush can’t reach.

Avoid the stainers. Tobacco products (e.g., cigarettes, chewing tobacco and cigars), excessive red wine and coffee contain a high quantity of very strong chemicals that stain and damage your teeth. Cranberry and grape juices also may stain teeth if consumed in excess. Besides cosmetic considerations, the staining isn’t the problem as much as fact that the chemicals causing the staining are also damaging your teeth and gums.
2. Prevention and professional maintenance

Do you have a dentist?

Regular dental checkups are very important for the ongoing maintenance of your teeth and the early identification of dental problems—before excessively expensive and painful options are needed.
Dental exams provide an opportunity for identification of several medical conditions and diseases whose symptoms can appear in the oral cavity (mouth).

3. Recognizing possible dental emergencies

It is simultaneously understandable and befuddling that patients go without dental care as long as they do. By the time they come to the ER, invariably, some of these symptoms have been present and were ignored. If you’re experiencing the following symptoms, you’d do well to see the dentist early, before you end up in the ER.

Your teeth have become sensitive to hot or cold stimuli.
Your gums are swollen and/or they bleed with brushing, flossing or eating.
You have continually bad breath or bad taste in your mouth.
You have difficulty chewing or swallowing.
You have pain or swelling in your mouth, face or neck.
You have spots or a sore that doesn’t look or feel right in your mouth and it isn’t going away.
Your jaw sometimes pops or is painful when opening and closing, chewing or when you first wake up.
You have an uneven bite.
Your mouth is becoming unexplainably drier than normal.
You have a medical condition such as diabetes, cardiovascular disease, eating disorder or are HIV positive with new dental problems.
You are undergoing medical treatment such as radiation, chemotherapy or hormone replacement therapy with new dental problems.

Upcoming Straight, No Chaser posts will evaluate individual dental emergencies.
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: Have You Gone Behind the Curtain?

October 23, 2015General Health and Wellness844-SMA-TALK, Behind the Curtain, sanfranciscobookreview.com, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

And now a word from our sponsor! Straight, No Chaser is one of several platforms meant to provide you with information and advice that empowers you to control your health and live a better life. Behind the Curtain, A Peek at Life from within the ER is a more vivid collection of real world illustrations of the positive and negative consequences of your choices. We guarantee you entertainment and education, not just on health but life itself.
As we get started on the second leg of our national tour, allow us to share another 5-star review, this one from San Francisco Book Review. Thank you for your support.
http://www.sanfranciscobookreview.com/2015/10/behind-the-curtain-a-peek-at-life-from-within-the-er/

BEHIND THE CURTAIN: A PEEK AT LIFE FROM WITHIN THE ER

By Jeffrey E. Sterling
Brown Books Publishing Group, $18.95, 184 pages, Format: Trade

(5 / 5)
Dr. Jeffrey Sterling has worked over 20 years as an emergency room physician, and seen everything from cockroaches in the ears – multiple times – to a man with a potato stuck up his behind. He has learned how to keep calm and appear unruffled, in both life threatening situations and cases so hilarious laughter seems the only possible response. In Behind the Curtain, Sterling takes the reader with him through some of his most memorable and definitive cases over the years and the patients they involved.

“Don’t worry; my patient is doing OK. I think he passed out when he first saw the needle.”

Though the book starts out with a few short chapters of explanations of treatment methods and Sterling’s own bugaboo –smoking – it then eases into over 50 mini-chapters of his experiences. Sterling’s sense of humor is dry and incisive providing both chuckles and full on belly laughs, often just at the title of the chapter itself, such as the chapter titled “Why Do You Have Gonorrhea in Your Eye?” The author is careful to explain any medical jargon in laymen’s terms so that the reader also learns something in the process. Though perfect for any audience, this book is especially well suited to those who love to read but don’t have much time. The short chapters are enjoyable quick reads and the writing is top-notch. In Behind the Curtain, Dr. Sterling easily proves that he is at the top of his game as a writer as well as a doctor.
Reviewed by Stacy Shaw
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.

Tips to Avoid Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Deaths (SUID)

October 22, 2015Pediatrics/Kids Health, Health Prevention844-SMA-TALK, Behind the Curtain, SIDS, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, sudden infant death syndrome, sudden unexpected infant deaths, SUIDJeffrey Sterling, MD

Whether you’re expecting, a parent or even a grandparent, most have heard of SIDS (Sudden Infant Death Syndrome). What you’re really concerned about is Sudden Unexpected Infant Deaths (SUID); SIDS is the leading cause of this category. SUID is defined as sudden and unexpected deaths in infants less than 1 year of age whose causes are not immediately apparent. This represents approximately 4,000 infant deaths per year in the U.S. The three most frequently reported causes of SUID are SIDS, cause unknown, and accidental suffocation and strangulation in bed. Approximately half of SUID cases are due to SIDS. This Straight, No Chaser post provides tips for you modified from recommendations by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP); these tips are meant to help you reduce the risk of SIDS and SUID in your home.Consider these tips applicable for the first year:

Place your baby to sleep on his back for every sleep and nap.
Place your baby to sleep on a firm sleep surface. Never put your baby to sleep on a chair, sofa, waterbed, cushion, or sheepskin.
If your baby falls asleep in a car safety seat, stroller, swing, infant carrier, or infant sling he should be moved to a firm sleep surface as soon as possible.

Do not use a crib that is broken or missing parts, or has drop-side rails.
Cover you baby’s mattress with a fitted sheet. Do not put blankets or pillows between the mattress and the fitted sheet.
Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the crib. Pillows, quilts, comforters, sheepskins, bumper pads, and stuffed toys can cause your baby to suffocate.

Place your baby to sleep in the same room where you sleep but not the same bed. Keep the crib or bassinet within an arm’s reach of your bed. You can easily watch or breastfeed your baby by having your baby nearby. Babies who sleep in the same bed as their parents are at risk of SIDS, suffocation, or strangulation. Parents can roll onto babies during sleep or babies can get tangled in the sheets or blankets.

Breastfeed as much and for as long as you can. Studies show that breastfeeding your baby can help reduce the risk of SIDS.
Schedule and go to all well-child visits. Your baby will receive important immunizations. Recent evidence suggests that immunizations may have a protective effect against SIDS.
Keep your baby away from smokers and places where people smoke. Keep your car and home smoke-free. Don’t smoke inside your home or car and don’t smoke anywhere near your baby, even if you are outside.

Do not let your baby get too hot. Keep the room where your baby sleeps at a comfortable temperature. In general, dress your baby in no more than one extra layer than you would wear. Your baby may be too hot if she is sweating or if her chest feels hot.
Offer a pacifier at nap time and bedtime. This helps to reduce the risk of SIDS. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes 3 to 4 weeks.

Do not use home cardiorespiratory monitors to help reduce the risk of SIDS. Home cardiorespiratory monitors can be helpful for babies with breathing or heart problems but they have not been found to reduce the risk of SIDS.
Do not use products that claim to reduce the risk of SIDS. Products such as wedges, positioners, special mattresses, and specialized sleep surfaces have not been shown to reduce the risk of SIDS. In addition, some infants have suffocated while using these products.

Give your baby plenty of “tummy time” when she is awake and you are present. This will help strengthen neck muscles and avoid flat spots on the head. Always stay with your baby during tummy time and make sure she is awake.

If you’re an expectant mom, go to all prenatal doctor visits. Do not smoke, drink alcohol, or use drugs while pregnant and after birth.

Keep these tips handy. We certainly don’t want your sudden bundle of joy to become a victim of Sudden Infant Death Syndrome.
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: New Recommendations for Mammograms

October 21, 2015General Health and Wellness, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, mammograms, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Earlier this week, the American Cancer Society recommended a major adjustment in the scheduling of mammograms. If these recommendations are implemented, the following will be put in place:

Women with an average risk of obtaining breast cancer should get annual mammograms beginning at age 45 (instead of age 40, which is the current recommendation).
Women aged 55 years and older would receive screenings every other year (instead of every year, which is the current recommendation).

Of course, the question is why. As is often the cause, public health initiatives aren’t absolute benefits but are a weighing of the benefits of the services versus the risks. In this example, a major review of mammograms performed in 2009 by the U.S. Preventive Services Task Force found that the risk of false positive mammogram results needlessly exposed women to biopsies and other unnecessary additional testing. These additional procedures were deemed more than was justified by the number of truly positive cancers detected early by mammograms.
What this is really saying is there is a move toward more personalized decisions. If you’re in your 40s and the risks are justified, you will likely continue to receive mammograms earlier than the new recommendations suggest. Discuss this with your physician, and be a partner in your health care decisions.
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: Tetanus (Lockjaw)

October 20, 2015Infectious Disease, Neurology, Skin/Dermatology844-SMA-TALK, Behind the Curtain, clostridium tetani, Conditions and Diseases, lockjaw, rictus sardonicus, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, tetanusJeffrey Sterling, MD

If there could possibly be anything cool about tetanus, it’s that the overwhelming majority of us have never seen it and never will. At first thought, that could seem odd because if you ever end up in an emergency room with a cut or scratch, you’re sure to hear about it. Those two facts are reconciled by knowing there is an incredibly effective vaccine for tetanus, necessary because tetanus is an incredibly dangerous disease. As a result of vaccination, tetanus just doesn’t happen much anymore. Over approximately the last 20 years, less than 30 cases a year have been reported in the United States – nearly all in those either never vaccinated or those not up to date with their tetanus booster shots.
Here are some questions about tetanus to help you understand while this mostly invisible disease is still a major concern.

What causes tetanus?
Tetanus is an infection caused by bacteria named Clostridium tetani. These bacteria are virtually everywhere in the environment, most notably in soil, dust and manure.

How do I catch tetanus?
Tetanus is contracted through your skin, usually via cuts or punctures by contaminated objects. Burns and crush wounds also are prone to delivering tetanus. You catch it primarily if you’re not immunized, and you receive a tetanus-prone wound.
Is tetanus contagious?
Tetanus doesn’t spread between individuals.

What are the symptoms of tetanus?
If you’re old enough, you’ve probably heard of lockjaw, which is a nickname for tetanus and describes the muscle spasms of the jaw that occur and prevent opening of the mouth. Other symptoms include muscle stiffness and spasms, jaw cramping and trouble swallowing. Seizures, headaches, fever, sweating, high blood pressure and a fast heart rate are other common symptoms.
Severe cases of tetanus can produce devastating complications, including fractures, pneumonia, blood clots, involuntary contractions of the vocal cords and breathing difficulties. Up to 20% of cases cause death.

If I got immunized as a child, am I safe?
Full tetanus immunization requires lifelong booster shots every ten years after having received the primary immunization series as a child.

How will I know if I get tetanus?
Your physician will have to make the diagnosis based on your clinical signs and symptoms. There is no quick test available to confirm the disease.
What will happen if I get diagnosed with tetanus?
Regarding treatment, it’s aggressive and includes hospitalization, further immunization, antibiotics and addressing the wound and developing symptoms. Treating tetanus is a race against the clock, and the disease is life threatening.

What’s with the picture of the Joker?
The grimace on his face was modeled after the symptom of tetanus known as rictus sardonicus (roughly translated as scornful laughter), as illustrated in the pictures above of those infected. It’s not a grin or a cry. In tetanus, the sufferer’s face is locked in a painful and often sinister pose that resembles a smile. It results from the spasms causing lockjaw.
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: Questions You Should Ask When You Have a Laceration

October 19, 2015Skin/Dermatology, Trauma844-SMA-TALK, Behind the Curtain, dermabond, lacerations, skin staples, Sterling Medical Advice, SterlingMedicalAdvice.com, stitches, Straight No Chaser, wound dehissence, wound infectionJeffrey Sterling, MD

I wonder if any of us avoid lacerations over the course of our lives. It seems that everyone I know or every patient I have cared for has a scar and a story to accompany it. Fortunately, it’s not as simple (or complicated) as going to the emergency room and getting stitches when a cut (laceration) occurs. Today’s Straight, No Chaser offers you simple facts and questions to ask your physician when you find yourself or someone else you’re caring for needing care for a laceration. Believe me, you want to know the correct questions to ask, and you want to have an understanding of expected outcomes.
When should I deal with these cuts at home?
Remember that a laceration is a manual breakdown of the body’s most basic defense against toxins and other agents entering your body. This creates a significant risk for subsequent infection. In most cases it is advisable to get a laceration at least evaluated, which doesn’t mean you’ll necessarily need stitches.
Are there things I can do at home to help?
We now know that tap water is as effective as the saline used in hospital or clinic settings to clean wounds. If you’re at home, copious rinsing of the wounds with warm water followed by applying clean wrappings is a good idea.
Are there things I shouldn’t do at home in an attempt to help?
Detergents, hydrogen peroxide and povidone-iodine solutions should be avoided, as they can damage the integrity of the skin.
How long after a cut can I get stitches?
This depend on the location of the wound, your health and factors such as mechanism, contamination and risk for subsequent infection. As a rule, you should get lacerations evaluated within 12 hours after the injury. Under all circumstances you should be seen within 24 hours after an injury.
What happens if I come in too late to get stitches?
Depending on circumstances, your physician has additional options that can reduce the infection risk and optimize the cosmetic outcome. Some older wounds may be loosely closed, followed by a definitive repair in a few days if all goes well (i.e. no signs of infection in the interim). Other wounds may be packed with protective gauze as an alternative. Still others will simply need to heal on its own. Your physician can discuss when and why each option is preferable.

Will I always need stitches?
No. Sometimes what appears to be a cut is actually a scratch. Other times, lacerations can or need to be repaired with other options, such as steri-strips (a version of medical taping), tissue adhesive (you call it medical glue) or staples.

What’s the glue that’s being used?
In many circumstances, tissue adhesives not only can be used but should be used. Tissue adhesives have similar results as sutures in cosmetic results (i.e. appearance), breakdown rates, and infection risk. That said, some types of wounds, some situations and some locations prevent the use of tissue adhesives. Ask your physician if a tissue adhesive is a reasonable option.
Can I just use some form of glue at home?
No. It’s not the same, and if you try using some commercial glue, paste or needle and thread on your cuts at home, you’re asking for a ferocious infection in a few days.
Will I always need a shot for my numbing medicine?
No. Ask your physician if a topical medicine option is appropriate, especially in children or those otherwise wanting to avoid needles.

How long do stitches stay in?
Here are some guidelines based on the location of the laceration.

Face	Three to five days
Scalp	Seven to 10 days
Arms	Seven to 10 days
Trunk	10 to 14 days
Legs	10 to 14 days
Hands or feet	10 to 14 days
Palms or soles	14 to 21 days

How do I care for myself after the cut has been fixed?
Follow-up for repaired lacerations is pretty similar regardless of the method used to repair. Consider the following.

Keep the wound clean and dry using a protective dressing for at least 24 hours after the repair, unless tissue adhesive was used, in which case no dressing should be applied.
An antibiotic or white petrolatum ointment can be applied daily to wounds not repaired with tissue adhesives. That’s right, white petroleum ointments are just as effective as antibiotic preparations.
If you’re received a tissue adhesive, you must avoid white petroleum or antibiotic ointments over the wound site, as these can dissolve the tissue adhesive, causing the wound to break open.

Anything else?
Even if you’re not asked, you should always ask if you need a tetanus vaccine after a laceration. The answer will always be yes if it’s been more than 10 years since your last immunization, and in selected cases it will be indicated if it’s been more than 5 years.
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: Patient Psychology, Expectations and Communication

October 16, 2015General Health and Wellness, Public Health844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I’ve always found the psychology of patients to be fascinating. Patients who present to emergency rooms most often are consumed with the fear of the unknown and are ultimately focused on the question of “What’s wrong with me, doc?” Of course in the emergency room (ER), we are less focused on what you have and more focused on the life-threatening conditions that you could have. It always seems to be very unsatisfying for patients when a firm diagnosis isn’t made in the ER, which is very ironic because in many cases, you really don’t want to have what we’re looking to find. The next time your ER physician tells you the tests were normal, and you’ll require more testing by your family physician, take that information and run with it. It usually means that you’ve escaped the clutches of the most immediately life-threatening considerations. Remember, we don’t always give good news.
Still, patients fear the unknown. After all, physicians are sometimes wrong. In other instances, your visit to the ER is just a “snapshot” of your condition. In two days you could look completely different. That nonspecific-appearing rash could bloom into full form. That persistent cold or other viral illness could have sufficiently lowered your immunity such that a bacterial infection could have simultaneously developed. It is very unsatisfying when your physician suggests that you’re ok, when you “know” you’re not. After all, that’s why you came to the ER! Don’t just stand there, doc: Do Something!
Of course, the fear hits the highest levels when it involves children. A parent’s intuition about these things is not to be disregarded. For some, “normal” is usually not good enough (meaning it’s not an acceptable answer).

So my question to you is “What are your expectations?” You would do well to take a deep breath, and think about that before you come in to be seen. In my experience, your concerns usually are among the following types.

Is there a clear but unknown illness or injury, and your concern is making sure the doctor gets the treatment right?
Do you “already know what’s going on,” and just want the doctor to do what will make you feel better?
Are you coming in “just to be sure?”
Do you not have a clue what’s going on but just know “something is wrong?”

Each of the above considerations represent an attitude you’re bringing to the table. If you take the time to identify your expectations, you’ll do a better job in convincing your physician that your desired outcome represents the best course of action. Much has been made of physicians who don’t listen. Resolve to do a better job of making your physician hear you. Also do a better job of asking questions, and take the time to hear what is being said back to you.

The discharge interaction is incredibly important. If you’re not listening or understanding your instructions, you’re not only going to be lost and frustrated, but you’re going to be at risk for worsening of your condition. In many instances, even if nothing was discovered, something could be wrong. In other instances your instructions have to do with handling your surrounding environment. If you’re tuned out because you didn’t get your preferred course of treatment, you will less well equipped to handle the conditions that could produce further injury or illness.
Understanding your own psychology going into a physician interaction is a big part of your health. Try it, communicate it and get better soon. This consideration is actually a big part of personal healthcare consulting. Your Sterling Medical Advice expert consultants work to help you flush out expectations and outcomes. Whether or not you do it with us, learn to make this a part of your self-assessment.
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: Breast Cancer in Men

October 15, 2015Hematology & Oncology/Blood Disorders/Cancer, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I won’t overstate the case, but you should be aware that breast cancer occurs in men. That said it occurs at a much lower rate than it does in women. I know what you may be thinking, but it’s not that obvious. Both males and females have breast tissue. The big difference is women come equipped with a much greater support of certain hormones that stimulate development of breast tissue. You know this to be true because there are circumstances in which males, either through natural occurrence of abnormally high levels of those hormone levels or by stimulation (such as occurs with certain medicines), can develop noticeable sized breasts (called gynecomastia in non-cancerous circumstances and also present in breast cancer). This Straight, No Chaser offers information you should know to avoid a higher risk of developing breast cancer.

How often does breast cancer occur in males?

It is estimated that in 2014, approximately 2500 men are expected to be diagnosed with breast cancer.
Less than 1% of all breast cancers develop in men.

What are the risk factors for breast cancer in men?

Age: Increases in age correspond to an increased risk. In fact, age in the greatest risk for men. In fact, the average age of men diagnosed with breast cancer is about 68.
High estrogen levels: Estrogen stimulates growth of breasts, both in normal and abnormal circumstances. The following are circumstances that can produce high estrogen levels in men.
- Obesity increases estrogen production.
- Certain conditions or treatment with hormonal medicines that include estrogen.
- Heavy alcohol use can damage the liver, which can result in a diminished ability of the liver to regulate estrogen levels.
- Similarly, other causes of liver disease also result in higher estrogen levels.
- You can also get significant estrogen exposure if hormones are used in the beef cattle you eat.

Klinefelter syndrome is a genetic disorder involving the presence of additional X chromosomes (the “female” chromosome). Men with this syndrome have lower levels of male hormones (androgens) and higher levels of female hormones (estrogen), resulting in a higher risk of developing gynecomastia and breast cancer.
Radiation exposure: Receiving radiation therapy to the chest before age 30 (such as occurs with treatment of Hodgkin’s disease) may increase the risk of developing breast cancer.

A family history of breast cancer or genetic alterations: Other men in one’s family with breast cancer, or a breast cancer gene abnormality also increases the risk of breast cancer. Men identified as having certain abnormal genes, including BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk for male breast cancer of 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities. The message here is if you have a family history of breast cancer, consider getting checked for the presence of these genes.

If you are a male with significant risks, your next step is to have a conversation with your physician. In case you haven’t seen the rest of the Straight, No Chaser series on breast cancer, use the following links for information on the rest of the story.

Straight, No Chaser: Five Myths Surrounding Breast Cancer
Straight, No Chaser: Even More Myths Regarding Breast Cancer
Straight, No Chaser: The Reach of Breast Cancer and Your Risk Factors
Straight, No Chaser: This is How You Self-Assess For Breast Cancer, Part 1
Straight, No Chaser: How to Perform the Breast Self-Exam
Straight, No Chaser: Signs, Symptoms and Prognosis of Breast Cancer
Straight, No Chaser: Breast Cancer Treatment Options

Straight, No Chaser: Signs, Symptoms and Prognosis of Breast Cancer

October 13, 2015General Health and Wellness, Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

So, after all we’ve discussed this week, this is what it comes down to: the one in eight lifetime risk has landed at your doorstep. What happens next is very important. The ability to recognize and obtain early treatment for breast cancer (or not) will determine the length and quality of the rest of your life. Remember, most women survive breast cancer; there are approximately 3 million breast cancer survivors in the U.S. That said, also remember that there are about 40,000 annual deaths from breast cancer. The combination of breast self-exams and widespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms. Unfortunately, many others go undetected because of the limitations or failure to engage those two modalities.

I really want you to become familiar with your bodies (in this instance, your breasts). The most common symptom of breast cancer is a new lump, but you should be in tune with any new change or irregularity, including pain, swelling, redness, irritation, nipple inversion or other irregularity. Remember, breast tissue extends into the armpit (axilla), and you may find swollen and tender lymph nodes in the axilla or near the collarbone (clavicle). My bottom line: you be responsible for diligently assessing any abnormalities, and your healthcare team will determine the cause and if it’s cancer.

One more pitch for early detection: if breast cancer is detected prior to spread to the lymph nodes, the 5-year survival rate (with appropriate treatment) is as high as 98%. If it’s reached the lymph nodes, that drops to approximately 84%, and if it has spread to other body parts (e.g. the lungs, liver and bone – this is called metastatic cancer or carcinoma), the average 5-year survival rate drops to 23%.
This represents a drop in mortality rates by about 25% since 1990. Unfortunately, survivors must live with the uncertainties of possible recurrent cancer and some risk for complications from the treatment itself. That said, recurrences of cancer usually develop within 5 years of treatment. About 25% of recurrences and 50% of new cancers in the opposite breast occur after 5 years.

Many of you have asked about tumor ‘predictors’. I’ll end this post with a look at three considerations, although there are many others:
1. Breast cancer cells may contain binding sites for hormones (estrogen and progesterone). When that’s the case, these cells are called hormone receptor-positive; if not, they’re called hormone receptor negative. When cancer cells are hormone receptor positive, they are responsive to certain medications (such as tamoxifen and others). This improves prognosis. These types of cells also happen to grow more slowly, which also helps. On the other hand, hormone receptor-negative cells only respond to chemotherapy.
2. Tumor markers are proteins released from cancer cells that are able to be identified during the disease. They are notable for demonstrating (or predicting) how aggressive one’s cancer may be. The one I will mention (yes, there are others) is the HER2 marker, which is especially quick-growing and aggressive. The American Cancer Society recommends all newly diagnosed women be tested for this. Fortunately, only 20% women with invasive breast cancer are positive for HER2.
3. Curiously, tumor location within the breast has proven to be an important predictor. Tumors in the middle of the breast are most serious than those toward the outside.

I wish all of you breast cancer survivors or those with family members affected all the best with this. I hope these posts have again pointed out the importance of lowering your risk profile and early detection and treatment. This is another illustration of the shortcomings of our typical approach to health care; relying on medical care is not the same as comprehensive healthcare. The time to engage the fight against breast cancer is not in the midst of advanced disease.
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: How to Perform the Breast Self-Exam

October 12, 2015Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, Breast self-examination, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Beginning in their 20s, women should be aware of the benefits and limitations of breast self-exam (BSE). Women should know how their breasts normally look and feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not necessarily mean there is a cancer.

A woman can notice changes by being aware of how her breasts normally look and feel and by feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach (with a BSE) and using a specific schedule to examine her breasts.
If you choose to do BSE, the information below is a step-by-step approach for the exam. The best time for a woman to examine her breasts is when they are not tender or swollen. Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.
Women with breast implants can do BSE, too. It may be helpful to have the surgeon help identify the edges of the implant so that you know what you are feeling. There is some thought that the implants push out the breast tissue and may actually make it easier to examine. Women who are pregnant or breastfeeding can also choose to examine their breasts regularly.
It is acceptable for women to choose not to do BSE or to do BSE once in a while. Women who choose not to do BSE should still be aware of the normal look and feel of their breasts and report any changes to their doctor right away.

How to examine your breasts

Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.

Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.
Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.

While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

This procedure for doing breast self-exam is different from some previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman’s ability to find abnormal areas.
I need to acknowledge and thank the multiple sources that continue to compile and disseminate information to the public, including the Centers for Disease Control and Prevention, the American Cancer Society and the Susan G. Komen Foundation. I have used these and other sources over the course of the week to integrate my practices and have distilled their information in many cases. I highly recommend them should you need additional or more thorough information. I welcome your questions and comments.
[youtube=http://www.youtube.com/watch?v=omfbsthDsbc]
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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BEHIND THE CURTAIN: A PEEK AT LIFE FROM WITHIN THE ER

By Jeffrey E. Sterling Brown Books Publishing Group, $18.95, 184 pages, Format: Trade

How to examine your breasts

By Jeffrey E. Sterling
Brown Books Publishing Group, $18.95, 184 pages, Format: Trade