Tag Archives: CDC

Straight, No Chaser: Cervical Health Awareness

cervical_health_awareness_month

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

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

pap smear

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

Hopefully knowing these simple tools will convince you to be attentive to preventing and managing your cervical health. This is a public health success story in that cervical cancer could be eliminated if everyone followed the above steps. The rest is up to you.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Alcoholism and Alcohol-Related Deaths Are on the Rise

alcoholaddictionchains

Does it seem that alcoholism isn’t discussed much anymore, or is it that the public health community has focused more on overdose deaths from heroin and prescription painkillers of late? In the news is reason that should change. According to the Centers for Disease Control and Prevention, alcoholism and the deaths related to it are on the rise. Consider the sum total of the following statistics:

alcohol_risk

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

alcoholrisedeaths

In reality, the annual number of deaths directly or indirectly caused by alcohol is closer to 90,000, as the official count of alcohol-induced fatalities excludes deaths from drunk driving, other accidents, and homicides committed under the influence of alcohol.
Where do you fit in this equation? Here’s the deal: 30% of American adults don’t drink at all. Another 30% consume less than one drink per week (on average). On the other hand, the top 10% of American adults (approximately 24 million people) consume an average of 74 drinks per week, or a little more than 10 drinks per day. The heaviest drinkers are at the greatest risk for the alcohol-induced causes of death.

alcohol abuse

An easy way to minimize your risk, assuming you’re going to drink, is to restrict your alcohol intake at any one time to 2 drinks per day. The especially good news is that level – defined as moderate alcohol consumption – is actually associated with a decreased risk of mortality.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Consequences of Inappropriate Antibiotic Use

Introduction

This Straight, No Chaser discusses inappropriate antibiotic use.

inappropriate antibiotic use

Whenever physicians attempt to discuss inappropriate antibiotic use with patients, too often fear replaces logic. These days, antibiotic use is treated as a convenience consideration, regardless if there’s actually a disease present that can be treated by antibiotics. Here are some principles your physician is mindful of when deciding if you actually need antibiotics.

We Want to Treat You!

Significant complications exist from missing any disease. If a heart attack is missed, your heart can rupture, and you can die. When a fracture is missed, you can develop necrosis, arthritis and loss of limb. If pneumonia is missed, you can go into respiratory failure and die. Etc., etc. As an emergency physician, my colleagues and I are more in tune than any other specialty of physicians with the risks and consequences of misdiagnosing critical illness; in fact it’s one of the main components of the speciality.

The point is giving medicine is not based on either fear or treating conditions that have a low probability of existing. Any physician is weighing the value of the information you provide to determine what appropriate management will be; that’s the Art of Medicine, and that will always be left to the individual judgment of your treating physician.

That said, the days of such absolute power by physicians are going the way of the dinosaur. Evidence-based medicine and outcomes-based medicine are here to stay. Multiple guidelines for best practices exist across many medical conditions, including when to order ankle x-rays and not, when to order neck x-rays and not, when to treat various infections and not. What’s new here is identifying opportunities to avoid exposing patients to unnecessary, costly medical interventions. What’s also new is you the patient can be better empowered and knowledgeable about the conditions you have and the care you receive.
abx

Antibiotics Come with Risks!

The risk of inappropriate antibiotic use is more real, more present and more important than practicing defensive medicine. 

There are classes of antibiotics that we can no longer use. I mentioned previously how Staph is resistant to several of the penicillins we’ve used for decades due to resistance, which occurs from overuse and inappropriate use, most frequently seen in treatment of viral illnesses. Yes readers, MRSA stands for methicillin-resistant Staph Aureus, and that’s why it’s known as a ‘super-bug’. Approximately 80% of those ear, nose and throat infections you’re coming to the emergency room for and asking/receiving antibiotics for are viral illness and would be better on their own in 48-72 hours.

Have you heard about what happened to gonorrhea due to inappropriate antibiotic use?

Similarly, treatment of gonorrhea has recently been revised by the Center for Disease Control and Prevention (CDC) because of the emergence of resistance to the medications used against it. Again, this has resulted from overuse and inappropriate use of these medications, largely in treatment of viral illnesses. One of the more powerful antibiotics we had at our disposal (a member of the fluoroquinolone class) just got pulled back from its 15 different indications for usage due to emerging resistance. This particularly powerful entity, instead of being withheld for serious diseases, was being used for urinary tract infections, minor skin and soft tissue illness and other conditions that eventually led to a loss of effectiveness. Why would such things be done? Profits and defensive medicine are two reasons that rapidly come to mind.

This is a lot more serious than just overusing medications. Sepsis occurs when an infection overwhelms the body and isn’t just limited to the local site where the infection originated. It can be so devastating that your body goes into shock, losing its ability to function and deliver blood throughout your body. Initial treatment of real illness suffers when we’re using medications that are less effective because bacteria have had time to mutate or otherwise become resistant due to non-lethal exposures.

getsmart_16_3731609472

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

Illnesses that Don’t Need Antibiotics

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

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

To be clear, no one is recommending or promoting inappropriate or less than appropriate treatment of conditions that actually exist. No one is suggesting that anything you read here or anywhere else is more important than the real-time judgement of your physician. Just appreciate that opportunities exist to do the right thing and the wrong thing, and medicine is better with an informed patient.

Follow us!

Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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

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Straight, No Chaser In the News: Zika Virus Update

zika pregnancy-button

The Zika virus continues to be in the news, especially regarding its effects on newborns. According to the Centers for Disease Control and Prevention (CDC), the number of pregnant women in the United States reported to have the Zika virus has increased from 48 to 157. Unfortunately and more importantly, that has now translated in up to a dozen babies or fetuses who have already suffered the consequences of Zika infection, with the obvious possibility of more to come. The most notable consequence is the condition known as microcephaly, representing a reduction in the size of the skull and the brain, causing developmental delays and defects.

zika-x

Here’s one simple point for you to know. Not a single person is known to have contracted Zika from a mosquito bite in the U.S. The CDC has been clear in two specific warnings:

  • Do not travel to countries where Zika is endemic
  • Wear condoms when engaged in sexual intercourse with male who have traveled to such an area (Zika can be passed on through sperm).

Your travel to these areas pose specific risks even if you’re not a female of childbearing age. Such travel increases the risk of being infected without showing symptoms, spreading the disease and contributing to a worldwide expansion of the Zika virus. In fact the World Health Organizations notes that Zika virus is now poised to invade Africa, having spread to the African nation of Cabo Verde (Cape Verde). Your actions pose risks to others. 
Review this Straight, No Chaser for a refresher on transmission, symptoms and complications of the Zika Virus.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Rapid Explosion of Autism Diagnoses – A Good or Bad Thing?

autism-hands

Sometimes it’s really good to be a physician, especially when it comes to care of children. Just yesterday I saved myself a few thousands of dollars in costs by being able to address a situation at home. I can recall two instances in which poorly qualified, non-physician professionals tried to label my children with specific diagnoses. After my then three-year-old son defended himself from a child trying to take a toy from him, one consulting counselor suggested that I pay $200/hour to get him help for his “aggressive tendencies.” (His “symptoms” remarkably disappeared when I removed him from the environment.) When my otherwise normal daughter displayed signs of delaying speaking, another “professional” immediately wanted to label her autistic. In case you’re wondering, I’m not the guy who marches into everyone’s office and announces that I’m a physician. It’s much more interesting to observe the difference in the first and second conversations (you know, the one after they discover you know something…).
Regarding autism, it is a condition that strikes fear into the heart of many, not just because of the condition itself. It’s the lack of knowledge about the condition. It’s the uncertainty about whether a newborn child will be affected just because we’re having children at older ages. It’s the possibility that common environmental exposures could be contributing to the increase in the condition.

autism-in-toddlers

I’m going to approach this two-part series on autism in reverse order. Instead of simply discussing the basics about autism, I’m going to discuss the recent increases in autism rates. It is very important that you read past the headlines on this. Hopefully you’ll come to a better understanding.
In March of 2012, the Centers for Disease Control and Prevention (CDC) estimated that one of 88 eight-years-olds would have one of the various forms of autism spectrum disorder. Another CDC study that was just released reveals that autism rates now affect one of every 68 eight-year-old children. This is a 30% increase in just two years!
Many of you are aware of some of the controversial claims about possible causes of autism. Regardless of the believability of unproven claims, it is entirely probable that some good has come from shining a spotlight on autism. It is without question that the enhanced attention has resulted in more attention being paid to children with suggestive symptoms. This recent trend in more aggressive diagnoses is resulting in more attention being given to those in need with better outcomes over the long haul.
There is no cure for autism. This may be true and depressing, but it doesn’t have to be. Generally, interventions tend to focus on eliminating symptoms and producing desired outcomes (such as those that will increase independent living and functioning). Coordination of strategies is important, so the use of multiple professionals working as a team is common. The good news is, for many children, symptoms improve with early treatment and with age.  Those with one of the forms of autism will usually continue to need services and supports throughout their lives, but many are able to work successfully and live independently or within a supportive environment. Also, please note: The earlier the diagnosis is made and treatment is started, the better one’s outcome is likely to be.
I have just understated a point that I will take a few words to revisit. There is no cure for autism. Please don’t fall prey to claims of therapies and interventions that promise a quick fix. These claims are invariably are not supported by scientific studies. They are acting on your hopes and preying on your fears. The details of treatment strategies are further discussed at www.sterlingmedicaladvice.com.
The next post will focus on the diagnosis and symptoms of autism.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Alcoholism and Alcohol-Related Deaths Are on the Rise

alcoholaddictionchains

Does it seem that alcoholism isn’t discussed much anymore, or is it that the public health community has focused more on overdose deaths from heroin and prescription painkillers of late? In the news is reason that should change. According to the Centers for Disease Control and Prevention, alcoholism and the deaths related to it are on the rise. Consider the sum total of the following statistics:

alcohol_risk

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

alcoholrisedeaths

In reality, the annual number of deaths directly or indirectly caused by alcohol is closer to 90,000, as the official count of alcohol-induced fatalities excludes deaths from drunk driving, other accidents, and homicides committed under the influence of alcohol.
Where do you fit in this equation? Here’s the deal: 30% of American adults don’t drink at all. Another 30% consume less than one drink per week (on average). On the other hand, the top 10% of American adults (approximately 24 million people) consume an average of 74 drinks per week, or a little more than 10 drinks per day. The heaviest drinkers are at the greatest risk for the alcohol-induced causes of death.

alcohol abuse

An easy way to minimize your risk, assuming you’re going to drink, is to restrict your alcohol intake at any one time to 2 drinks per day. The especially good news is that level – defined as moderate alcohol consumption – is actually associated with a decreased risk of mortality.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Inappropriate Antibiotic Use

antibiotics

Whenever physicians attempt to discuss inappropriate antibiotic use with patients, too often fear replaces logic. These days, antibiotic use is treated as a convenience consideration, regardless if there’s actually a disease present that can be treated by antibiotics. Here are some principles your physician is mindful of when deciding if you actually need antibiotics.
Significant complications exist from missing any disease. If a heart attack is missed, your heart can rupture, and you can die. If a fracture is missed, you can develop necrosis, arthritis and loss of limb. If pneumonia is missed, you can go into respiratory failure and die. Etc., etc. As an emergency physician, my colleagues and I are more in tune than any other specialty of physicians with the risks and consequences of misdiagnosing critical illness; in fact it’s one of the main components of the speciality.
The point is giving medicine is not based on either fear or treating conditions that have a low probability of existing. Any physician is weighing the value of the information you provide to determine what appropriate management will be; that’s the Art of Medicine, and that will always be left to the individual judgment of your treating physician. That said, the days of such absolute power by physicians are going the way of the dinosaur. Evidence-based medicine and outcomes-based medicine are here to stay. Multiple guidelines for best practices exist across many medical conditions, including when to order ankle x-rays and not, when to order neck x-rays and not, when to treat various infections and not. What’s new here is identifying opportunities to avoid exposing patients to unnecessary, costly medical interventions. What’s also new is you the patient can be better empowered and knowledgeable about the conditions you have and the care you receive.
abx
The risk of inappropriate antibiotic use is more real, more present and more important than practicing defensive medicine. There are classes of antibiotics that we can no longer use. I mentioned previously how Staph is resistant to several of the penicillins we’ve used for decades due to resistance, which occurs from overuse and inappropriate use, most frequently seen in treatment of viral illnesses. Yes readers, MRSA stands for methicillin-resistant Staph Aureus, and that’s why it’s known as a ‘super-bug’. Approximately 80% of those ear, nose and throat infections you’re coming to the emergency room for and asking/receiving antibiotics for are viral illness and would be better on their own in 48-72 hours. Similarly, treatment of gonorrhea has recently been revised by the Center for Disease Control and Prevention (CDC) because of the emergence of resistance to the medications used against it. Again, this has resulted from overuse and inappropriate use of these medications, largely in treatment of viral illnesses. One of the more powerful antibiotics we had at our disposal (a member of the fluoroquinolone class) just got pulled back from its 15 different indications for usage due to emerging resistance. This particularly powerful entity, instead of being withheld for serious diseases, was being used for urinary tract infections, minor skin and soft tissue illness and other conditions that eventually led to a loss of effectiveness. Why would such things be done? Profits and defensive medicine are two reasons that rapidly come to mind.
This is a lot more serious than just overusing medications. Sepsis is a condition where an infection overwhelms the body and isn’t just limited to the local site where the infection originated. It can be so devastating that your body goes into shock, losing its ability to function and deliver blood throughout your body. Initial treatment of real illness suffers when we’re using medications that are less effective because bacteria have had time to mutate or otherwise become resistant due to non-lethal exposures.

getsmart_16_3731609472

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

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

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

To be clear, no one is recommending or promoting inappropriate or less than appropriate treatment of conditions that actually exist. No one is suggesting that anything you read here or anywhere else is more important than the real-time judgement of your physician. Just appreciate that opportunities exist to do the right thing and the wrong thing, and medicine is better with an informed patient.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Cervical Health Awareness

cervical_health_awareness_month

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

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

pap smear

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

Hopefully knowing these simple tools will convince you to be attentive to preventing and managing your cervical health. This is a public health success story in that cervical cancer could be eliminated if everyone followed the above steps. The rest is up to you.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Flu Myths and Questions

Flu season ahead
Every year 36,000 people die and over 200,000 are hospitalized each year due to the flu—in the U.S. alone. If you’re not getting a vaccine every year, you are subjecting yourself to a significantly higher risk and allowing fears and myths to get the better of you. Knowledge is power. Learn the facts.
Does the flu shot give you the flu?
No, no, no. The influenza vaccine cannot cause flu illness. There are vaccines that involve the delivery of live virus, including mumps, measles, rubella, chicken pox and polio. Influenza is not in that category. Flu shots are made either with ‘inactivated’ vaccine viruses that are not infectious or they contain no flu vaccine viruses at all (and instead have recombinant particles that serve to stimulate your immune system).
The most common side effects from the influenza shot are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur. These symptoms are among the same symptoms you see with influenza, so it’s easy to confuse them as flu symptoms. They are not.
Controlled medical studies have been performed on humans in which some people received flu shots and others received shots containing salt water. There were no differences in symptoms other than increased redness and soreness at the injection site for those receiving influenza vaccine. The flu shot does not give you the flu.
flu-shot-myth
I swear I’ve gotten the flu right after getting the flu shot! How is that possible if I can’t get the flu from the flu shot?
I always remind people that the flu vaccine does an even better job of preventing you from dying from the flu than it does in preventing you from catching the flu (and it does that at a 70–90% rate).  It primes your immune system to better fight off the influenza virus when you’re exposed to it.
There are several reasons why someone still might get a flu-like illness after being vaccinated against the flu:

  • Influenza is just one group of respiratory viruses. There are many other viruses that cause similar symptoms including the common cold, which is also most commonly seen during “flu season.” The flu vaccine only protects against influenza, so any other infection timed correctly can give you similar symptoms.
  • When you get immunized against influenza, it takes the body up to two weeks to obtain the desired level of protection. There is nothing preventing you from having been infected before or during the period immediately before immunity sets in. Such an occurrence will result in your obtaining the flu despite being vaccinated.
  • An additional reason why some people may experience flu-like symptoms despite getting vaccinated is that they may have been exposed to a strain of influenza that is different from the viruses against which the vaccine is designed to protect. The ability of a flu vaccine to protect a person depends largely on the match between the viruses selected to make the vaccine and those causing illness among the population that same year.
  • It is also the case that the flu vaccine doesn’t always provide adequate protection against the flu. This is more likely to occur among people who have weakened immune systems or people age 65 and older. Even if the vaccine is 90% effect, some individuals will contact the flu despite having been vaccinated.

Please don’t get the wrong message from this section. These explanations are the exceptions, not the rule. In the overwhelming number of cases, the influenza vaccine does an excellent job of protecting against and prevent disease from the influenza virus.
Is it better to get the flu than the flu vaccine?
No. Influenza causes tens of thousands of deaths every year. If you have asthma, diabetes, heart disease or are especially young or old, you are placing yourself at significant risk by not getting vaccinated. Even if you aren’t in one of the above categories and are otherwise healthy, a flu infection can cause serious complications, including hospitalization or death.

flu-vaccine-facts-myths

Why do I need a flu vaccine every year?
The Center for Disease Control and Prevention (CDC) recommends a yearly flu vaccine for just about everyone six months and older. Once vaccinated, your immune protection decreases over time. These boosters are scheduled and dosed to help you maintain the best level of protection against influenza. Additionally, the virus mutates (changes) every year, so what you were covered for this year may not apply next year.
You can make a decision not to get vaccinated, but frankly, that’s accepts a risk that you flies in the face of a reasonable risk/benefit analysis, and you would be doing so in the face of the solid consensus of medical evidence and research. You should seriously question the motives or knowledge of someone who suggests that you should not get vaccinate for influenza, particularly if they profess to be involved in healthcare. Get vaccinated.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, AmazonBarnes 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 © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Traumatic Brain Injuries (Concussion), Part II

concussionboxing_facial__4_

Your son is a star in Friday Night Lights (actually football, not the TV show) and has been concussed.  Amazingly, the most common question I get asked is not “Will he be ok?”, but “When will he be able to get back on the field?” My answer, coming out the ER, is never going to be less than two weeks, and I won’t be the one who provides medical clearance.  It’ll either be your family doctor or preferably, a neurologist.  Don’t just take my word for it.  Consider the following Quick Tips from the Center for Disease Control and Preventions.
CDC’s Discharge Instructions

  • You may experience a range of symptoms over the next few days, such as difficulty concentrating, dizziness or trouble falling asleep.  These symptoms can be part of the normal healing process, and most go away over time without any treatment.
  • Return immediately to the ED if you have worsening or severe headache, lose consciousness, increased vomiting, increasing confusion, seizures, numbness or any symptom that concerns you, your family, or friends.
  • Tell a family member or friend about your head injury and ask them to help monitor you for more serious symptoms.  Get plenty of rest and sleep, and return gradually and slowly to your usually routines.  Don’t drink alcohol.  Avoid activities that are physically demanding or require a lot of concentration.
  • If you don’t feel better after a week, see a doctor who has experience treating brain injuries.
  • Don’t return to sports before talking to your doctor.  A repeat blow to your head-before your brain has time to heal-can be very dangerous and may slow recovery or increase the chance for long-term problems.

Finally, there are two particularly impactful consequences about which you should be aware.

Impact-Syndrome616x314new

  • The ‘second impact syndrome’ is irreversible brain injury triggered by a fairly routine second head impact after a prior concussion.  You must take the time off needed for the brain to heal.  I care more about your child’s mental future than the upcoming playoff game.
  • The ‘post-concussive syndrome’ represents long-term neurologic and psychologic consequences of the head injury.  It includes such symptoms as inability to sleep, irritability, inability to concentrate, headache, dizziness and anxiety.

Post Concussion Syndrome 3D cube Word Cloud Concept with great terms such as brain, injury, trauma and more.
There are no definitive treatments for concussions other than prevention of an additional injury, and that fact should be chilling to you.  Be mindful of the risks involved in choosing to engage in activities putting the brain at risk.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, AmazonBarnes 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, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: The Rapid Explosion of Autism Diagnoses – A Good or Bad Thing?

autism-hands

Sometimes it’s really good to be a physician, especially when it comes to care of children. Just yesterday I saved myself a few thousands of dollars in costs by being able to address a situation at home. I can recall two instances in which poorly qualified, non-physician professionals tried to label my children with specific diagnoses. After my then three-year-old son defended himself from a child trying to take a toy from him, one consulting counselor suggested that I pay $200/hour to get him help for his “aggressive tendencies.” (His “symptoms” remarkably disappeared when I removed him from the environment.) When my otherwise normal daughter displayed signs of delaying speaking, another “professional” immediately wanted to label her autistic. In case you’re wondering, I’m not the guy who marches into everyone’s office and announces that I’m a physician. It’s much more interesting to observe the difference in the first and second conversations (you know, the one after they discover you know something…).
Regarding autism, it is a condition that strikes fear into the heart of many, not just because of the condition itself. It’s the lack of knowledge about the condition. It’s the uncertainty about whether a newborn child will be affected just because we’re having children at older ages. It’s the possibility that common environmental exposures could be contributing to the increase in the condition.

autism-in-toddlers

I’m going to approach this two-part series on autism in reverse order. Instead of simply discussing the basics about autism, I’m going to discuss the recent increases in autism rates. It is very important that you read past the headlines on this. Hopefully you’ll come to a better understanding.
In March of 2012, the Centers for Disease Control and Prevention (CDC) estimated that one of 88 eight-years-olds would have one of the various forms of autism spectrum disorder. Another CDC study that was just released reveals that autism rates now affect one of every 68 eight-year-old children. This is a 30% increase in just two years!
Many of you are aware of some of the controversial claims about possible causes of autism. Regardless of the believability of unproven claims, it is entirely probable that some good has come from shining a spotlight on autism. It is without question that the enhanced attention has resulted in more attention being paid to children with suggestive symptoms. This recent trend in more aggressive diagnoses is resulting in more attention being given to those in need with better outcomes over the long haul.
There is no cure for autism. This may be true and depressing, but it doesn’t have to be. Generally, interventions tend to focus on eliminating symptoms and producing desired outcomes (such as those that will increase independent living and functioning). Coordination of strategies is important, so the use of multiple professionals working as a team is common. The good news is, for many children, symptoms improve with early treatment and with age.  Those with one of the forms of autism will usually continue to need services and supports throughout their lives, but many are able to work successfully and live independently or within a supportive environment. Also, please note: The earlier the diagnosis is made and treatment is started, the better one’s outcome is likely to be.
I have just understated a point that I will take a few words to revisit. There is no cure for autism. Please don’t fall prey to claims of therapies and interventions that promise a quick fix. These claims are invariably are not supported by scientific studies. They are acting on your hopes and preying on your fears. The details of treatment strategies are further discussed at www.sterlingmedicaladvice.com.
The next post will focus on the diagnosis and symptoms of autism.
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Straight, No Chaser In The News: 2015 Influenza Update and Supplemental Means of Protection

flu prevention honey

Snatched from the headlines and the American Medical Association:

From The Centers for Disease Control and Prevention (CDC): “Flu sending US seniors to the hospital in highest rate in a decade.”
From The CBS Evening News (1/30, lead story, 2:25, Pelley): “The CDC said that the flu season in much of the country appears to have peaked.” However, “the flu is now widespread in all but six states and it’s sending Americans 65 and older to the hospital at the highest rate in at least a decade.”
From The NBC Nightly News (1/31, story 3, 0:25, Williams): The high number of hospitalizations is “…being blamed on this particularly nasty strain of flu this year and a vaccine that, sadly, has proven only about 23 percent effective.”
From The Associated Press (1/31, Stobbe): Approximately “…198 out of every 100,000 people 65 and older have been hospitalized with flu-related illness this flu season. That’s roughly 86,000, according to the CDC.”
From Bloomberg News (1/31, Cortez): “The annual outbreak, already in its 10th week, has extended beyond the lower bound of a normal flu season and isn’t showing signs of easing,” said Lyn Finelli, chief of surveillance and outbreak response at the CDC. In a telephone interview, she explained, “‘While the flu may have peaked in many areas of the country, there is a surge in other areas, including New England, the Northeast and the West Coast.”
From Medscape (1/31, Lowes): The CDC “issued a letter to clinicians urging them to treat patients promptly with antiviral drugs when they suspect influenza, without any confirmatory testing.” That letter, cosigned by leaders of the American Medical Association, the American Academy of Family Physicians, and other professional societies, noted that influenza activity across the nation remains high overall and is likely to continue for weeks.” The letter discussed “the potential of antiviral drugs to reduce influenza symptoms, prevent serious complications, and keep high-risk patients out of the hospital.”

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The influenza vaccine doesn’t necessary prevent you from getting “the flu.” It’s a mixture of what is predicted to be the most common strains for the upcoming year. As noted, this year the influenza strains causing infections are so varied that this year’s vaccine is approximately 23% effective. Does that mean you shouldn’t get it? That’s not the message at all. The influenza vaccine does a very good job of preventing you for dying from “the flu,” and as noted above, certain populations are having an especially difficult time. Be reminded that there were approximately 35,000 deaths from influenza last year alone.

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So you ask, what can we do in the face of a less than optimally performing vaccine? This Straight, No Chaser reviews some of the better options left for you to engage in preventive strategies. It is always the case that an ounce of prevention is better than a pound of cure.

flu treatment options

The best way to avoid the flu is prevention. Consider utilizing these healthy habits before you ever get exposed:

  • Wash your hands frequently with warm soapy water. You know when they’re dirty. Most certainly wash your hands before you use them to eat or put anything else in your mouth.
  • If you can’t wash your hands, use an alcohol-based hand sanitizer.
  • If your hands are dirty and neither soap nor sanitizer is available, still rinse and dry your hands with warm water if you can.
  • Use disinfectant to clean surfaces.
  • Avoid unnecessarily touching your eyes, nose, or mouth.
  • Politely limit close contact with people who are ill, coughing and sneezing.
  • When coughing or sneezing use the bend of your elbow or a facial tissue to help cover your nose and mouth. Learn to avoid coughing or sneezing into your hands.
  • When you become sick, stay home. It’s the proper thing to do to avoid spreading your infection to others.

Vitamin-C

Vitamin C, echinacea and zinc have long been touted to prevent colds and influenza. There are no studies confirming or refuting this claim. Despite assurances that these and other herbal medicines are safe alternatives because they’re “natural”, the active ingredients in them are the same as found in certain prescription medicines. Thus they too may interact with other medications and worsen certain medical conditions. Given this, you should discuss your use of supplements with your physician or pharmacist prior to use.

Flu prevention take 3

Another level of defense for you involves use of certain antiviral prescription medications. If you are exposed to someone (e.g. a family member) with influenza, and especially if you begin having flu-like symptoms, immediately contact your physician to discuss taking medicines to prevent catching the flu. Such medications include Tamiflu® (generic name: oseltamivir), Relenza® (generic name: zanamivir), Flumadine® (generic name: rimantadine) and Symmetrel® (generic name: amantadine). If you make the request more than 24-48 hours after the onset of symptoms, you likely won’t be given the medication, since it isn’t likely to be effective outside of this timeframe.
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Straight, No Chaser: Your Questions About Measles – Could You Recognize It?

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The Centers for Disease Control and Prevention (CDC) calls measles, a virus that lives in the nose and throat, the “most deadly of all childhood rash/fever illnesses”. About 90% of those who are not immune will become infected if they come close to an infected person, according to the CDC. An estimated 20 million people worldwide contract measles each year. In the US, the CDC typically expects only 220 cases. Last year there were 644, a nearly two-decade high. Yes, this was due to a marked drop in immunization rates in certain parts of the country.
In discussing the recent measles outbreak, one of the most common responses I received was “So? What’s measles anyway?” It has been that long since measles has been a problem in the United States. Let’s talk about common questions related to measles.
What causes measles? The medical term for measles is rubeola, and it’s caused by a virus.

What are the symptoms I’d see? To the layperson, measles most often presents as a full body rash with cold/flu-like symptoms, such as a fever, cough and runny nose. Your doctor is also looking for red eyes (conjunctivitis) and small reddish spots inside the mouth (known as Koplik’s spots).
Is measles contagious? It’s highly contagious to those not immunized. According to the Center for Disease Control and Prevention, 90% of those not immunized will contract measles if exposed to someone with it.
How is it spread? It’s spread through the air. This means sneezing, coughing and kissing.

Measles-immunization

Why don’t I ever see measles? Measles has been contained in the U.S. since the introduction of the measles vaccine over 50 years ago. It is amazing to think that there are still 20 million cases still occurring around the world annually.
How is measles prevented? Immunization! The immunization is approximately 99% effective in preventing infection in the face of exposure. Infants are generally protected from measles for 6 months after birth due to immunity passed on from their immunized mothers. For most others, the measles vaccine is part of the measles-mumps-rubella immunization (MMR) or measles-mumps-rubella-varicella immunization (MMRV) given at 12 to 15 months of age and again at 4 to 6 years of age. Additional considerations exist in the face of an outbreak.

 measlesvaxsideeffx

What are the side effects of the vaccine? Unless you have an underlying health condition and/or have a reduced immunity, the most common reactions include the following:

  • fever 6-12 days after vaccination (in about 5%-15% of those vaccinated)
  • an incidental (and non-allergic, non-contagious) rash. This goes away on its own and occurs in about 5% of vaccine recipients.

What’s the treatment of measles? Given that measles is a virus, there is no specific medical treatment (as is almost always the case with viruses). Supportive treatment is important and involves fluids and rest for what is expected to be a two-week period. Something like Tylenol or children’s ibuprofen can be given for fever or pain (but never give aspirin to a child).

 measles101

What are the common complications? 30% of cases of measles involve complications. Complications include simpler conditions such as otitis media (those pesky ear infections), croup and diarrhea.
This all sounds pretty benign. Why not just get the disease and avoid the vaccination? Because children can die from measles. Unfortunately, measles also has more serious considerations such as pneumonia (which occurs in approximately 1 of 20 cases) and a serious brain infection called encephalitis (which occurs in approximately 1 of 1000) cases. Measles also causes pregnant women to have miscarriages, premature births or low-birth-weight babies.
How do people die from measles? Pneumonia is the complication most often causing death. For every 1,000 children who acquire measles, 1 or 2 will die.
What’s the Vitamin A connection with measles? Vitamin A has been found to decrease complications and death in those infected with measles. It should be considered, especially in those hospitalized with complications of measles or those who have compromised immune systems and acquire measles.
If I had measles as a child and get exposed to the disease again, am I in danger? No. Surviving a measles infection provides one with life-long immunity. Of course, your take home message is most of this isn’t a consideration if you simply get immunized.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd. Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser In the News: Measles Outbreaks and Not Getting Vaccinated

A case of measles was just confirmed in suburban Chicago. Here’s a cautionary tale to those who rely on non-medical sources to guide their health decisions. 

measlesuscases

The measles vaccine became available in 1963. Prior to then, the virus causing measles infected approximately 500,000 Americans a year. On average, this resulted in 500 deaths and 48,000 hospitalizations per year. Universal administration of the measles vaccine in the United States was so effective that measles was officially deemed “eliminated” – meaning there had been no sustained outbreaks in the subsequent 50 years and no homegrown outbreaks since 2000.

By now, most everyone is aware of medically-unfounded controversies related to vaccine administration. The fear-mongering and isolated reports of adverse reactions, the frequency of which fall into statistic insignificance (with all due respect to anyone actually affected), have led to a not insignificant fall in the national immunization rate. Although the premise of herd immunity is meant to shield the population from outbreaks (roughly meaning that if a certain percentage of the population is immunized, then the entire population is virtually immunized), enough people are now exposed that significant occurrences of measles are being seen. Last year, cases of measles were reported in approximately 20 states. This represents the most measles cases in 20 years. The largest outbreak occurred  in Ohio, and a large outbreak notably occurred around Disneyland (which subsequently led to cases in many states across the country).

nonmedical vaccine exemptions

Ninety percent of new cases of measles have been seen among those who have not been vaccinated.

The reasons cited by these individuals for not getting vaccinated include philosophical, religious or other personal reasons for not using vaccines. High rates of nonmedical vaccine exemptions are enough to cause an outbreak. There needs to be an exposure.

vaccine preventable outbreaks

According to the Center for Disease Control and Prevention’s National Center for Immunizations and Respiratory Diseases, the proverbial match that started the flame was exposure to infected travelers. Most notable was a cluster resulting from the Philippines, which experienced an outbreak in October 2013. It appears that unvaccinated Amish missionaries brought back measles while overseas.
This is an example of what would be expected to occur if individuals not immunized are exposed to the disease. Of course those immunized are protected in this same scenario. This is not an example of the cure being more harmful that the disease. Get objective, factual information about your health decisions. Consider the source, the inherent bias and consequences both for your action and inaction. The many diseases for which immunizations are offered are not to be taken lightly. Part of the equation for deciding to implement mass immunization programs involves substantial consequences (including death) resulting from exposure to those not immunized. The choice remains yours. Just remember: You can have your opinions, but you can’t wish them into being medical facts.
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Straight, No Chaser: Updated Circumcision Recommendations, Risks and Benefits

Circumcision prevalence

This past week, the Centers for Disease Control and Prevention (CDC) released new draft recommendations for healthcare providers on parental and patient counseling on the decision on whether to circumcise. This Straight, No Chaser reviews those recommendations and the logic behind it. It is of note that these recommendations are a step away from prevailing medical thought.

As a medical professional, circumcision has long been one of those things that has made me go hmmm…. If your religious beliefs include this as a ritual or ceremony, fine. I get it, and I have no criticism at all. No disrespect is intended. Otherwise, circumcision has largely been a procedure looking for an indication. Quick, tell me what other elective surgical procedure or harmful activity of any type is allowed on children, much less newborns? While I’m waiting for you to think about an answer that doesn’t exist, let’s recap the procedure and the medical logic behind it.

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As you know (and many men are painfully aware – pun intended), circumcision is the surgical removal of the skin over the glans (tip) of the penis. Over the last 30 years, the rate of males receiving the procedure has dropped from 64.5% to 58.3%, according to the National Center for Health Statistics. Worldwide about 30% of males are circumcised, and of those receiving it, the religious influence is largely present. 69% of those being circumcised are Muslim and 1% are Jewish (Circumcision is part of religious rituals in both religions).

circumcision hiv risks

Let’s cut to the chase (no pun intended): Here are the best arguments for circumcision.

  • It helps prevent certain infections (e.g. yeast and UTIs – which most males aren’t especially prone to anyway).
  • The cells of the inner surface of the foreskin may provide an optimal target for the HIV virus (This is theoretical and not conclusively decided in the medical literature. In any event, this is NOT the same as saying uncircumcised males do or are more likely to contract HIV.). Even more importantly, this is NOT the same as saying uncircumcised males fail to be sufficiently protecting by use of condoms and other means of safe sex.
  • Circumcised males have a lower rate of penile cancer (which is very low under any circumstances).

Now, there are emergency indications for circumcision, but that really isn’t the topic of discussion here. The one I’ve had to address (twice in twenty years) is an inability to readjust a foreskin that too tightly adhered to the shaft of the penis (paraphimosis). Obviously, that’s a medical emergency and not something frequently seen enough to justify universal circumcision any more than a much higher rate of appendicitis would warrant universal and elective removal of everyone’s appendix.

circumcision table

Here are criticisms of the decision to have circumcision.

  • Any surgical procedure has complications, and that should be taken seriously. That said, the complication rate for circumcision is very small and includes bleeding infection and pain.
  • Circumcision is a violation of a child’s body and is unnecessary and disfiguring. The foreskin might not be cut the appropriate length, might not heal properly and may require addition surgery because the remaining foreskin incorrectly attaches to the end of the penile shaft.

Honestly, both the risks and benefits are quite overstated, with exceptions for certain parts of the world with exceedingly high HIV rates. Circumcision doesn’t appear to be a medically necessary procedure, but it isn’t an especially dangerous one. Interestingly, the American Academy of Pediatrics’ latest comment on circumcision is that the benefits of circumcision outweigh the risks, which stops short of recommending routine circumcision for all. Even that equivocal smacks of conflict of interest, given who’s performing the procedure at a significant cost to the consumer. Again, this appears to be a procedure looking for an indication – but…
The CDC appears to be going agains the grain with its latest comments. Their new message is pretty clear: the benefits of the procedure — including reducing one’s risk of acquiring HIV, herpes virus, and human papillomavirus — outweigh the harms. They even go as far as to suggest that adolescents and adult males consider the procedure. Of course, it must be said that the CDC’s focus is on the prevention and control of disease, as opposed to the American Academy of Pediatrics, whose focus is children and their health. This is a subtle yet important decision while likely has played out in the extra consideration given by the CDC.
If I was having this conversation in Africa, where the sexually transmitted infection rate is substantially higher and can be significantly reduced by circumcision, I’m sure I’d be more firmly on board with circumcision. If my Jewish or Muslim friends and colleagues were asking my medical advice on the safety of getting the procedure done as part of their religious ceremonies, we’d be having a different conversation. However, we’re not, and for the population in general, it’s safe to say that – various preferences (for various reasons) aside – there’s no compelling reason to recommend circumcision on all newborn males. It just feels like a recommendation to do so is giving in to the notion that we can’t be trusted to have safe sex.

circumcision questions

The CDC officials emphasize that the choice is still left to patients, the document suggests the parents of newborn boys, as well as heterosexually active men of all ages, be told about those benefits, which is reasonable but somewhat leading. If you’re a parent of a newborn, and I tell you there’s a small risk of HIV, HPV and penile cancer in your child if they don’t get circumcised, am I really giving you a choice or burdening you with guilt?
And that’s medical straight talk. Oh, and guys – sorry about the lead picture. That wasn’t a good day.
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Straight, No Chaser: Prescription Pain Killer (Opioid) Abuse

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One of the more challenging aspects of emergency medicine is pain management. Emergency departments are filled with patients suffering from terminal and chronic diseases, including cancer, lupus and sickle cell anemia. Unfortunately they are also frequented by drug-seeking patients with manufactured complaints meant to obtain prescription pain medications, particularly opioids.

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Opioids are among the strongest medications that will be prescribed by your physician. You know these drugs well. They include codeine, hydrocodone (e.g., Vicodin), morphine and oxycodone (e.g. OxyContin and Percocet). Other opioids include remedies for cough and diarrhea, including codeine preparations and diphenoxylate (Lomotil), respectively.

 opioid increase

The US Centers for Disease Control and Prevention (CDC) notes marked increases in unintentional poisoning deaths over the last 25 years. Opioid pain medication abuse, often in combination with alcohol or other medications are a major reason for this increase. You may or may not be surprised to know that approximately 10% of high school seniors have used opioids in the last year for non-medical purposes. At the other end of the age spectrum, elderly patients prescribed these medicines for various reasons often find their supplies pilfered.

opioid HS students

You know at least half of the reason why, based on the pleasurable acute effects of opiates. Acute effects of opioids involve relieving pain by dulling the intensity of pain signals headed toward the brain (according to our brains, that tree in the forest with no one around doesn’t make a sound). Basically, if the brain doesn’t receive the signals coming from painful stimuli, you don’t know you’re having pain. Opioids also stimulate pleasure centers within the brain, additionally helping us to ignore sensations of pain. Other acute effects include nausea, drowsiness and constipation.
The other half of the story regarding acute effects of opiates often involve the consequences of snorting or injecting medications meant to be taken orally, or misusing/abusing prescribed medication even if taken orally. Opioids also lead to depressed breathing (respirations), which facilitates coma and death – particularly when used while drinking alcohol.
Long-term effects of opioids are often not thought of by those looking for a high, but they are devastating. In addition to developing tolerance (decreasing effects if taking the same dose over time) and addiction (cravings and inability to function without ongoing drug use), opioids are associated with spontaneous abortions and births of low birth weight babies.

rehabilitation

One of the reasons to avoid getting started down the road of becoming addicted to opioids is ending the addiction is difficult. The withdrawal syndrome includes vomiting, diarrhea, involvement leg movements, restlessness, insomnia, muscle and bone pain and cold flashes. Many individuals attempting to end addiction find themselves relapsing due to the severity of withdrawal symptoms. That said, good treatment options exist for combatting opioid addiction. These include both medications and behavioral therapies that have been proven effective.
There is a time and place for strong pain management. When this is the case, get the medicine you need. Just be aware that there’s a very slippery slope involved with opioids, and a level of caution should be applied when deciding to take pain medications. Feel free to contact your SMA expert consultant for any questions you may have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
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Straight, No Chaser In The News: Ebola Virus – Likely Not Coming Soon To a City Near You

ebola

We must be doing something right when so many of you are asking about Ebola virus. I say that because of the incredibly high probability that neither you nor I will ever see a case of Ebola. In the news is an outbreak of the Ebola virus in West Africa. In this Straight, No Chaser, we will discuss the threat and spread of Ebola, and in a subsequent post, we will review the disease itself.
The basis of concern of diseases such as Ebola is we have become a global community. Worldwide travel now imports and exports diseases in a way not previously common, exposing far-flung populations to seemingly esoteric and rare conditions. The concept that a deadly disease such as Ebola virus is simply a plane ride away is a scary one.

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According to the Center for Disease Control and Prevention (CDC), Ebola has infected 1,323 people and killed 729 people in the current outbreak, which includes Liberia, Guinea and Sierra Leone. The Director of the CDC has described this outbreak as follows: “This is a tragic, painful, dreadful, merciless virus. It is the largest, most complex outbreak that we know of in history.” Notably, as the World Health Organization (WHO) has mobilized medical attention and support to those in need, some of those providing care have become infected. As such…
Your concerns are straightforward:

  • Is Ebola “coming” to my country?
  • Can I become infected by the Ebola virus?

Focusing on the United States, the answers to both questions are yes, but the risk of your becoming infected are so remote that you should simply understand how to avoid the threat. Furthermore it is important to understand that bringing an infected American home for treatment (as is occurring in Atlanta) is not the same as exposing the population to the disease.

ebola_virus

And so, here are some quick facts for your consideration:

  • Ebola virus is not transmitted like the cold or flu. It requires significant exposure to blood or bodily fluids.
  • Prior to that contact, you’d be most likely be aware of its presence. Those infected with Ebola are so ill so quick that it’s obvious.
  • The chances of an infected and unrecognized person infected with Ebola making it to the U.S. through commercial air travel are infinitesimal.
  • Over $100 million in medical support is being provided by the WHO and CDC to combat this outbreak.
  • Medical management of Ebola is not especially complicated once identified.
  • It is estimated the current outbreak will be defeated within 3-6 months.

What should you do? Continue the same diligence you should be applying to your health everyday.

  • Engage in healthy habits, including hand washing and maintaining a level of health to support a vibrant immune system.
  • Avoid risky behaviors involving transfer of blood and other bodily fluids.
  • Get prompt medical attention for those appearing sick, particularly after recent travel to areas affected by disease outbreaks.

We end this post with another two thoughts from the Director of the CDC:

  • “Although it will not be quick and it will not be easy, we do know how to stop Ebola.”
  • “Ebola poses little risk to the U.S. general population.”

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook atSterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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Straight No Chaser In The News: Your Teens Have Healthier Habits Than You

teenagers1

Your teens are healthier than you. From the department of good health news – on some very important measures, somehow it seems as if our youth have actually received and read the memo on health. According a recent survey from the Centers for Disease Control and Prevention (CDC), several measures of health have improved significantly in the teen population – with a few important exceptions.

teenhealth

These improvements include the following.

  • Cigarette smoking. Cigarette smoking among U.S. high school students has reached an all time low. Teen smoking is down to 15.7%. It was just over 15 years ago (in 1997) that the rate was 36.4%. Unfortunately, this still translates to 2.7 million high school students who smoke.
  • Armed trauma. The proportion of students threatened or injured with a gun, knife or other weapon on school property has dropped to 6.9%, from a peak of 9.2% in 2003. In the presence of so many school shootings, a ray of hope exists.
  • Fist fights. The proportion of students involved in fist fights was reported at 25%, which is down from 42% in 1991. The number of students having had a fight at school within the last year sits at 8%, which is down from 16%.
  • Soda consumption. 27% of teens had at least one soda daily, down from 34% in 2007.
  • TV viewing. 32% watched three daily hours of TV, down from 43% in 1999.
  • Other: Overall, teens are drinking less alcohol and are having less sex with more birth control use by females.

And now, the not so good news…

  • Condom use: Condom use is declining among the sexually active, being reported at 59%, down from a peak of 63% in 2003. Remember, HIV and other sexually transmitted diseases/infections haven’t gone away at all; we’ve just gotten better in controlling them. Now is not the time to get comfortable.
  • Texting and driving: 41% of those who drove admitted to texting or e-mailing while driving. This is bad anyway you look at it.
  • Cigar and other forms of smoking: Cigars are now as popular as cigarettes with high school boys. Cigars were smoked by 23% of 12th grade boys in the month before the survey. Smokeless tobacco use hasn’t changed since 1999, holding at about 8%. Other surveys have shown increases in e-cigarette and hookah use.
  • Computer time: 41% of teens report using a computer for non-school reasons at least three hours a day, up from 22% in 2003. Apparently this is where the TV time has gone.

What this really means is (wait for it!) your teens are educable. Discuss these topics with them and why it’s important to make healthy decisions. Of course it helps if you model the behavior.
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Straight, No Chaser In the News: The Measles Outbreak and Not Getting Vaccinated

Here’s a cautionary tale to those who rely on non-medical sources to guide their health decisions. 

measlesuscases

The measles vaccine became available in 1963. Prior to then, the virus causing measles infected approximately 500,000 Americans a year. On average, this resulted in 500 deaths and 48,000 hospitalizations per year. Universal administration of the measles vaccine in the United States was so effective that measles was officially deemed “eliminated” – meaning there had been no sustained outbreaks in the subsequent 50 years and no homegrown outbreaks since 2000.

By now, most everyone is aware of medically-unfounded controversies related to vaccine administration. The fear-mongering and isolated reports of adverse reactions, the frequency of which fall into statistic insignificance (with all due respect to anyone actually affected), have led to a not insignificant fall in the national immunization rate. Although the premise of herd immunity is meant to shield the population from outbreaks (roughly meaning that if a certain percentage of the population is immunized, then the entire population is virtually immunized), enough people are now exposed that significant occurrences of measles are being seen. This year, cases of measles have already been reported in 18 states. This represents the most measles cases in 20 years. The largest outbreak is occurring in Ohio.

nonmedical vaccine exemptions

Ninety percent of new cases of measles have been seen among those who have not been vaccinated. The reasons cited by these individuals for not getting vaccinated include philosophical, religious or other personal reasons for not using vaccines. High rates of nonmedical vaccine exemptions are enough to cause an outbreak. There needs to be an exposure.

vaccine preventable outbreaks

According to the Center for Disease Control and Prevention’s National Center for Immunizations and Respiratory Diseases, the proverbial match that started the flame has been exposure to infected travelers. Most notable has been a cluster resulting from the Philippines, which experienced an outbreak in October 2013. It appears that unvaccinated Amish missionaries brought back measles while overseas.
This is an example of what would be expected to occur if individuals not immunized are exposed to the disease. Of course those immunized are protected in this same scenario. This is not an example of the cure being more harmful that the disease. Get objective, factual information about your health decisions. Consider the source, the inherent bias and consequences both for your action and inaction. The many diseases for which immunizations are offered are not to be taken lightly. Part of the equation for deciding to implement mass immunization programs involves substantial consequences (including death) resulting from exposure to those not immunized. The choice remains yours. Just remember: You can have your opinions, but you can’t wish them into being medical facts.
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Straight, No Chaser: The Rapid Explosion of Autism Diagnoses – A Good or Bad Thing?

autism-hands

Sometimes it’s really good to be a physician. I can recall two instances in which poorly qualified, non-physician professionals tried to label my children with specific diagnoses. After my then three-year-old son defended himself from a child trying to take a toy from him, one consulting counselor suggested that I pay $200/hour to get him help for his “aggressive tendencies.” (His “symptoms” remarkably disappeared when I removed him from the environment.) When my otherwise normal daughter displayed signs of delaying speaking, another “professional” immediately wanted to label her autistic. In case you’re wondering, I’m not the guy who marches into everyone’s office and announces that I’m a physician. It’s much more interesting to observe the difference in the first and second conversations (you know, the one after they discover you know something…).
Regarding autism, it is a condition that strikes fear into the heart of many, not just because of the condition itself. It’s the lack of knowledge about the condition. It’s the uncertainty about whether a newborn child will be affected just because we’re having children at older ages. It’s the possibility that common environmental exposures could be contributing to the increase in the condition.

autism-in-toddlers

I’m going to approach this two-part series on autism in reverse order. Instead of simply discussing the basics about autism, I’m going to discuss the recent increases in autism rates. It is very important that you read past the headlines on this. Hopefully you’ll come to a better understanding.
In March of 2012, the Centers for Disease Control and Prevention (CDC) estimated that one of 88 eight-years-olds would have one of the various forms of autism spectrum disorder. Another CDC study that was just released reveals that autism rates now affect one of every 68 eight-year-old children. This is a 30% increase in just two years!
Many of you are aware of some of the controversial claims about possible causes of autism. Regardless of the believability of unproven claims, it is entirely probable that some good has come from shining a spotlight on autism. It is without question that the enhanced attention has resulted in more attention being paid to children with suggestive symptoms. This recent trend in more aggressive diagnoses is resulting in more attention being given to those in need with better outcomes over the long haul.
There is no cure for autism. This may be true and depressing, but it doesn’t have to be. Generally, interventions tend to focus on eliminating symptoms and producing desired outcomes (such as those that will increase independent living and functioning). Coordination of strategies is important, so the use of multiple professionals working as a team is common. The good news is, for many children, symptoms improve with early treatment and with age.  Those with one of the forms of autism will usually continue to need services and supports throughout their lives, but many are able to work successfully and live independently or within a supportive environment. Also, please note: The earlier the diagnosis is made and treatment is started, the better one’s outcome is likely to be.
I have just understated a point that I will take a few words to revisit. There is no cure for autism. Please don’t fall prey to claims of therapies and interventions that promise a quick fix. These claims are invariably are not supported by scientific studies. They are acting on your hopes and preying on your fears. The details of treatment strategies are further discussed at www.sterlingmedicaladvice.com.
The next post will focus on the diagnosis and symptoms of autism.
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