Tag Archives: Conditions and Diseases

Straight, No Chaser: Heat Related Illnesses (Heat Exhaustion, Heat Cramps, Heat Stroke)

June 7, 2014Endocrine/Metabolic, Environmental844-SMA-TALK, Conditions and Diseases, heat cramps, heat exhaustion, Heat illness, heat stroke, LeBron James, rehydration, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

In the midst of all the memes and joking around the cramping LeBron James had during the first game of the NBA Finals, there appears not to be much thought given to the notion that heat cramps are an early sign of a life threatening condition, and many of us have had loved ones who have died from heat related illnesses.
When a loved one dies, families often ask “Is there something I could have done?” Usually I give you information. Today’s Straight, No Chaser will give you information and power to act if needed. There are several varieties of heat-related illness, and you would do well to be aware of them, because you can make a difference if someone’s suffering in the heat.

For starters, I really want you to become mindful of Heat Stress, which is the earliest complex of problems arising from excessive heat exposure. Heat stress is that strain and discomfort you get (usually during outdoor exertional activity) that reminds you that you’d be better off inside (assuming it’s cooler inside). You may notice such symptoms as cramping, a prickly-type rash, swelling and a sensation that you want to lose consciousness. If you must remain outdoors due to work, or choose to (playing sports or enjoying the sun), hydration means everything. It really is true that in some instances if you’re not actively urinating, you’re not drinking enough fluid. (This is the level at which LeBron James was suffering, and it really does beg the question as to why he was allowed to suffer on the sidelines instead of being taken to the locker room, iced down and given intravenous fluids.)
Ok, so you’ve ignored both me and your body, and you’re still outdoors, not rehydrating enough. Heat exhaustion may occur next, and it’s defined by ongoing body salt and fluid losses. Now you’re feeling faint, thirsty, anxious, weak, dizzy, you want to vomit and may have a headache, and your body temperature starts to climb. I see a lot of these patients, usually because once you get wobbly, your employers or co-workers are getting concerned, which is good, because at this point, you are actually in danger.

Or maybe you didn’t come to see me when you had the chance, and you’ve collapsed outdoors, to be found and brought in. This is Heat Stroke, and is defined by changes in your mental status, increases in your temperature and disruption of your bodily functions, including a loss of ability to sweat and a loss of your kidney and liver’s abilities to detoxify your body the way they normally do.
Well, in case you’re feeling good about yourself because you’re too smart to exert yourself outdoors, all I’ve been describing is ‘Exertional’ Heat Stroke. The more deadly form of heat related illness is ‘Classic’ Heat Stroke. This is the type that captures the headlines every year in places like Chicago, New Orleans, Miami and Houston. Classic Heat Stroke is seen in those with underlying disease, bad habits or the elderly. I’m talking about the obese, alcoholics, meth and/or cocaine users, folks with thyroid or heart disease or on certain medications like diuretics or beta-blockers. These folks can get the same symptoms simply by not being able to escape the heat. They may actually just be sitting around in a less than optimally air-conditioned home.
So that’s what you’re up against. And yes, many people die from this. By the way, you’re not protected from the heat related illness just because you’re in shape. Let’s end with some 2 tips (one for prevention and the other for assessment and treatment) to help you Beat the Heat.

1) Take caution during the following conditions

95 degrees is high risk, regardless of the humidity
85 degrees and 60% or above humidity
75 degrees and 90% or above humidity

Here, you want to remove yourself from that environment. You need to keep plenty of fluids around. You need to visit an environment where there’s adequate air conditioning. Dress very lightly.
2) If symptoms of heat related illness short of mental status changes occur, think “Check, Call, Care, Cool”

Check – look for those signs and symptoms I mentioned earlier
Call – call 911 immediately. Better to have it and not need it than need it and not have it.
Care – Lie in a cool place, elevate the legs, place cool, wet towels on the body (especially in the armpits and groin), and drink cool fluids. If mental status changes occur, or if the heart or lungs appear to give out, cool by any means necessary while waiting for the ambulance. This could include ice bath, ice packs, fans or cold water, but don’t drown someone trying to put them in a tub of water if you can’t handle them. Don’t forget to remove those layers of clothing.

Please be mindful that it is hotter in July, and unfortunately lives are lost every year to the heat. That said, it doesn’t have to be July for you to get a heat-related illness. If you can’t avoid the exposure, at least have a plan for managing the heat and acting on any mishaps. The life you save may be your own.
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Straight, No Chaser: What Would You Do If Your Tongue Suddenly Swelled? Learn About Angioedema

June 3, 2014Endocrine/Metabolic, Head/Eyes/Ears/Nose/Throat, Skin/Dermatology844-SMA-TALK, anaphylaxis, angioedema, Conditions and Diseases, epinephrine, epipen, hypersensitivity reaction, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, urticariaJeffrey Sterling, MD

Here at Straight, No Chaser, we want you to know how to prevent disease and injury because that’s a lot easier than the alternative. However, if and when the time comes, you should also have a few tools in your arsenal to stave off a life-threatening situation. One of the more scary examples of needing help is acute swelling of your tongue, sometimes so much so that your airway appears as if it will be blocked.
The most common cause of acute tongue, lip or throat swelling is called angioedema. This is an allergic reaction and occurs in two varieties.

A life-threatening allergic reaction (anaphylaxis) sometimes occurs shortly after an exposure to substance such as medicine, bee or other insect stings or food. It can throw your entire body into a state of shock, including involvement of multiple parts of the body. This can include massive tongue swelling, wheezing, low blood pressure resulting in blackouts and, of course, the rash typified by hives (urticaria).
Sometimes lip, tongue and/or throat swelling may be the only symptoms. This is more typical of a delayed reaction to certain medications, such as types of blood pressure medications (ACE inhibitors and calcium channel blockers), estrogen and the class of pain medication called NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen)

With any luck, you would already know you’re at risk for this condition, and your physician may have prompted you to wear a medical alert bracelet or necklace. In these cases, your physician may have also given you medicines and instruction on how to take them in the event you feel as if your tongue is swelling and/or your throat is closing. These medicines would include epinephrine for injection, steroids and antihistamines such as Benadryl. As you dial 911 (my recommendation) or make your way to the nearest hospital, taking any or all of these medications could be life-saving. By the way, those are the among the same medicines you’ll be treated with upon arrival to the emergency room. In severe cases, you may need to be intubated (i.e. have a breathing tube placed) to maintain some opening of the airway.

If the swelling is (or assumed to be) due to any form of medication, symptoms will improve a few days after stopping it. If the swelling in this instance becomes severe enough, treatment may resemble that of the life-threatening variety.
There are few things better than cheating death. If you’re at risk, carry that injectable epinephrine (e.g. an Epi-pen). If you’re affected, take some Benadryl and/or steroids if you’ve been taught what dose to take, and most importantly, don’t wait to see if things improve. Get evaluated, get treated and get better!
I welcome your questions and comments.
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Straight, No Chaser: Amnesia and Severe Memory Loss

June 2, 2014General Health and Wellness, Geriatrics/Elderly Care, Mental Health, Neurology844-SMA-TALK, amnesia, Conditions and Diseases, memory loss, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

In a previous post, we discussed forgetfulness and mild memory loss. We’ve also discussed Alzheimer’s disease and dementia. If you noticed and remember (no pun intended), we didn’t discuss amnesia. Amnesia is unusual memory loss. Normal aging does not lead to dramatic memory loss. This is qualitatively different.
It is normal to have forgetfulness associated with the aging process. Many of us will notice learning new information requires more time and seems more difficult.

This is not the memory loss of amnesia. In amnesia, you’ll likely not remember new occurrences and/or some past memories. You may forget recent or new events (or periods of time). You may forget memories within an event and compensate by creating “new memories” (this is called confabulation). You may have difficulty forming new memories or learning new information. Interestingly, amnesia may be transient, otherwise temporary or permanent.
Allow me to reiterate. Amnesia is not part of a normal aging process but is part of a disease in one or severe areas of the brain responsible for creating, storing and retrieving memories. If you see or think you are experiencing this level of symptoms, you need to get medically evaluated.

Courtesy of the National Institutes of Health, here is a partial list of causes of memory loss. Many of these causes have Straight, No Chaser posts related to them. If you have questions, type the topic into the search box for more information or feel free to ask your www.sterlingmedicaladvice.com or 844-SMA-TALK expert consultant any questions you may have.

Alcohol or use of illicit drugs
Not enough oxygen to the brain (heart stopped, stopped breathing, complications from anesthesia)
Brain growths (caused by tumors or infection)
Brain infections such as Lyme disease, syphilis, or HIV/AIDS
Brain surgery, such as surgery to treat seizure disorders
Cancer treatments, such as brain radiation, bone marrow transplant, or after chemotherapy
Certain medications
Certain types of seizures
Dementia
Depression, bipolar disorder, or schizophrenia when symptoms have not been well controlled
Dissociative disorder (not being able to remember a major, traumatic event; the memory loss may be short-term or long-term)
Drugs such as barbiturates or benzodiazepines
Electroconvulsive therapy (especially if it is long-term)
Encephalitis of any type (infection, autoimmune disease, chemical/drug induced; this is inflammation of a certain part of the brain)
Epilepsy that is not well controlled with medications
Head trauma or injury
Heart bypass surgery
Illness that results in the loss of, or damage to, nerve cells (this is called neurodegenerative illness), such as Parkinson’s disease, Huntington’s disease, or multiple sclerosis
Long-term alcohol abuse
Migraine headache
Mild head injury or concussion
Nutritional problems (vitamin deficiencies such as low vitamin B12)
Permanent damage or injuries to the brain
Transient global amnesia
Transient ischemic attack (TIA)

Finally, if you are supporting an individual with such challenges at home, you already know they need a lot of attention and support. Here are a few tips to assist.

Show familiar objects, music, or photos.
Get in the habit of writing things down. Write down when the person should take any medication. Write down any important tasks needing to be completed.
Show patience with the situation and avoid the tendency toward anger and frustration.
When it gets to the point to when help is needed completing the activities of daily living, or safety or nutrition is a concern, you may want to incrementally consider home health care, then extended care facilities, such as an assisted living facility or a nursing home.

Your job is to remember to be attentive to changes in your or your loved ones’ behavior. The earlier you get assistance, the better one’s quality of life will remain.
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Straight, No Chaser: Your Questions About Measles (Rubeola)

May 31, 2014General Health and Wellness, Infectious Disease, Pediatrics/Kids Health844-SMA-TALK, Conditions and Diseases, enchephalitis, health, immunization, measles, MMRV, pneumonia, rubeola, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, vaccination MMR, Vitamin AJeffrey Sterling, MD

In discussing the recent measles outbreak, the most common response 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.

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! 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.

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).

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.
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Straight, No Chaser In the News: The Measles Outbreak and Not Getting Vaccinated

May 30, 2014General Health and Wellness, Infectious Disease, Public Health, Health Prevention844-SMA-TALK, amish, CDC, center, Conditions and Diseases, measles, measles vaccine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, VaccinationJeffrey Sterling, MD

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

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.

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.

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: Stroke Recognition

May 29, 2014General Health and Wellness844-SMA-TALK, cerebrovascular accident, Conditions and Diseases, CVA, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, thrombolytics, TIA, Transient ischemic attackJeffrey Sterling, MD

This content of this post is so simple yet important that it really warrants taking up space in a few of your brain’s cells. Most of us know someone who has suffered from a stroke. With recent improvements in treatment, it’s really unfortunate when debilitating consequences occur simply because signs and symptoms weren’t recognized and/or brought in for treatment soon enough.
Let’s talk about strokes, aka Cerebral Vascular Accidents (CVA) and Transient Ischemic Attacks (TIA), and specifically about recognition and treatment. If you don’t remember anything else here, commit the mnemonic FAST to memory. (Details follow.)
A stroke (CVA) is an insult to some part of your brain, usually due to an inability of the blood supply to deliver needed oxygen and nutrients to that part of the brain. The brain actually approximates a “body map,” so depending on what part of your brain is affected, different parts of your body will be predictably affected. Technically, a stroke isn’t a stroke until the symptoms have been there for more than 24 hours; until then and/or if the symptoms reverse within that timeframe, the same scenario is called a TIA or a “mini-stroke.”

Think FAST, Act Faster

Here’s how the layperson can recognize a possible stroke:

Face: Ask the affected person to show you his/her teeth (or gums). In a stroke the face often droops or is otherwise noticeably different.
Arms: Ask the person to lift and extend the arms so the elbows are at eye level. In a stroke one side will often be weak and drift downward.
Speech: Ask the person to say any sentence to you. In a stroke the speech will slur or otherwise be abnormal.
Time: If any of the above occur, it’s recommended that you call 911 immediately, but if it’s my family, I’m getting in a car and going to the nearest MAJOR medical center—not the nearest hospital, which is where the ambulance will take you. There are important differences in hospitals when it comes to stroke treatment (which you won’t know offhand), because some are designated stroke centers and others are not. Friends, this is not the situation where you should wait hours or overnight to see if things get better. Time is (brain) tissue.

It is VERY important that you act on any of the above symptoms (F-A-S) within three (3) hours of symptom onset. Important treatment options are available within the first several hours of symptom onset that are otherwise unavailable.
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Straight, No Chaser: Diabetes Basics and the Importance of Education

May 28, 2014General Health and Wellness844-SMA-TALK, Conditions and Diseases, Diabetes, Diet, exercise, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Diabetes is a disease in which education is vital. For a diabetic, knowing the disease well allows him or her to better prevent long-term consequences of the disease. It also allows the diabetic to make real-time adjustments when sick or otherwise in danger acutely. In Straight, No Chaser, we’ve provided a series of posts meant to empower diabetics (and you can review any or all of them via the search box on the right). Remember, it all should start with a basic understanding of the disease.
We eat, and the process of digestion is for the purpose of converting food into glucose (sugar) that’s used by our body for energy. The blood delivers the glucose to different organs of the body where the cells take it up for use. In order for that process to work, an organ that’s part of the digestive tract called the pancreas has to produce a hormone called insulin. Insulin facilitates the glucose getting from the blood to inside the cells. Diabetes is a disease where insulin isn’t being made by the pancreas or isn’t working optimally.
Now think about what happens when you’re not getting sugar into your cells. It’s as if you’re starving (because physiologically, you might as well be). You get symptoms such as weight loss, hunger, fatigue and excessive thirst. Because your cells don’t have energy, they aren’t functioning well. In fact, blood and nerve vessels lose significant function, resulting in significant vision loss and lack of sensitivity in your extremities. Anyone who’s been a diabetic for about 10 years know this because you’re wearing glasses and because you’ve lost a fair amount of sensation, especially in your feet. There are other symptoms that are variations of the same theme, including excessive urination, dry skin, increased infection rate and slower healing from those infections – all due to poor function of your blood vessels.
Sometimes diabetes is a disease that happens to you because of unlucky genetics (or simply a family history). Other times it is a disease that you find. Risk factors for developing diabetes includes obesity, older age, and physical inactivity. Gestational diabetes (i.e. that occurring during pregnancy) is an entirely different conversation.

Let’s take a moment to discuss prevention and treatment. There are different types of diabetes, but the risk of one form of diabetes in particular can be reduced by – you guessed it – diet and exercise. In fact, diet, exercise and medications are the three legs of the diabetes treatment stool regardless of type. Some patients require regular insulin injections and others require pills. Still others who are successful with diet and exercise are able to markedly reduce, and in some instances eliminate medications.
If you’re a diabetic, make an investment in your education. It could not only save your legs or eyes, but it may just save your life. I welcome your questions and comments.
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Straight, No Chaser: Questions About High Blood Pressure (Hypertension)

May 27, 2014General Health and Wellness844-SMA-TALK, Conditions and Diseases, high blood pressure, Hypertension, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

High blood pressure (hypertension) is so prevalent and such a consequence of the way we live that you must already have an understanding of some basic principles if you care at all about your health. Feel free to offer your own questions or comments.

1. How do I know if I have high blood pressure?
You know by the numbers. Consider these defining blood pressure levels.
Normal – Systolic: < 120 mmHg, Diastolic: < 80 mmHg
At risk (pre-hypertension) – Systolic: 120–139 mmHg, Diastolic: 80–89 mmHg
High Systolic – Systolic: 140 mmHg or higher, Diastolic: 90 mmHg or higher
If you don’t already have a diagnosis of hypertension and are anywhere at or above the pre-hypertension stage, get checked by your physician.
2. But when should I get go to the emergency room for high blood pressure?
I’ll always want to see you if your bottom number (diastolic blood pressure) is at or above 110-115, regardless of whether you appropriately take your medication. Don’t look for symptoms to guide you. High blood pressure is called “the silent killer.”
3. If I do have high blood pressure, will I be placed on medication?
I really hope not, but honestly, approximately two-thirds of individuals in the U.S. who have high blood pressure are poorly controlled – even on medication. This means medication will be necessary for most. That said, theoretically, medication should be viewed as necessary only when necessary and only when other measures don’t work. You should discuss this with your individual physician and make every effort to improve your diet and exercise regimens. If and when you’re placed on medication, the choice of medication will be based on your age, sex, ethnicity, mobility, existing health profile and other considerations.
4. You mentioned I could have a heart attack or stroke from this? How would I know if that’s happening?
Check here for Heart Attack Recognition and here for Stroke Recognition where I discuss signs and symptoms. Remember, time is tissue, meaning you must not delay if you develop these symptoms.
5. What else can I do?
Be healthy! Don’t smoke. Limit alcohol intake. Lower your stress level. This is only a broken record if you’ve received the message and have implemented the recommendations.
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Straight, No Chaser: Pubic Lice (Crabs)

May 21, 2014General Health and Wellness844-SMA-TALK, Centers for Disease Control and Prevention, Conditions and Diseases, crabs, pubic lice, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Unfortunately, there’s no pleasant way around this topic. I hope you’re not crabby.

There is a story of legend in the medical community regarding the trends to start waxing or shaving pubic hair. It involves crabs (pubic lice). Back in the 1920s, when the clear preference for appearance involved a full “bush,” this was often accompanied with the frequent presence of pubic lice, particularly in the brothels of Las Vegas. Women took to shaving in an effort to relieve themselves from the presence of the lice. However, the newly shaved appearance apparently wasn’t good for business; as a result, these women began wearing pubic toupees.
So why am I telling this story? The toupees were made of beaver hair. That’s the origin of that terminology, in case you didn’t know. On to common questions about pubic lice.

What are pubic lice? Pubic lice (aka crabs) a parasitic insects found in the genital and pubic areas of humans.

Where are pubic lice found? By definition, pubic lice are predominantly found in the genital and pubic areas in one’s hair. However, pubic lice have also been found in other areas of the body with coarse hair, such as the armpits, beard, eyebrows, eyelashes, legs and mustache. In fact, pubic lice on the eyebrows or eyelashes of children are regarded as a prompt to search for sexual abuse. It also is of note that lice on the scalp are head lice, which is a different consideration than pubic lice.
Whom do pubic lice infect? Anyone and everyone seem to be affected. Pubic lice are seen all over the world across all races, classes and ethnicities. Public lice are not seen in animals. Pubic lice are most commonly seen in adults, are considered to be a sexually transmitted disease (infection, aka STD or STI) and should prompt a search for other STDs. There have been occasional cases of spread through contact with articles such as bed linens, clothing or towels, but this is extremely rare. Lice can’t live away from the warmth of a human body very long, and their feet don’t allow for walking on or attaching to smooth surfaces, so they generally are limited to staying on their hosts.
Can I get public lice by sitting on a toilet? This commonly expressed concern is quite overstated. As noted, lice can’t live away from the warmth of a human body very long, and their feet don’t allow for walking on or attaching to smooth surfaces, so they generally are limited to staying on their hosts.

What do pubic lice look like? Pubic lice have three forms: the egg (also called a nit), the nymph, and the adult.

Nit: Nits are lice eggs. When seen, they are usually found firmly attached to the hair shaft. They are oval and usually yellow to white. Pubic nits hatch in about 6–10 days.
Nymph: The nymph is a young, immature louse that just hatched from the nit. Pubic lice nymphs take about 2–3 weeks after hatching to mature into adults capable of reproducing. To live, a nymph must feed on blood.
Adult: The adult pubic louse resembles a miniature crab. Pubic lice have six legs; their two front legs are very large and look like the pincher claws of a crab. Pubic lice are tan to grayish-white in color. Females are usually larger than males. In can’t you’re thinking that doesn’t matter to those infected, it should because females lay eggs, continuing the cycle that causes human discomfort. To live, lice must feed on blood. If the louse falls off a person, it dies within 1–2 days.

What are the signs and symptoms of pubic lice? The symptoms of pubic lice infestation include genital itching, visible lice eggs (nits) or visible crawling lice.
How is a pubic lice infestation diagnosed? The diagnosis of pubic lice is simply made by visualizing a louse or nit (egg) in the pubic hair or elsewhere. It is more common to need a magnifying glass to identify lice or eggs.
How are pubic lice treated? We will go into the treatment of pubic lice in some detail in an additional Straight, No Chaser. It’s too important to simply give a quick answer on this.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Straight, No Chaser: Animal Bites

May 20, 2014General Health and Wellness844-SMA-TALK, cat bite, cat scratch fever, Conditions and Diseases, dog bite, human bite, shark bite, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We love our pets, and animals in general. Is there one about which a movie hasn’t been made? In most cases they are sources of entertainment, if not love. Unfortunately, they are still animals, and on occasions instincts kick in. When this occurs, we find ourselves in danger. Today’s post reviews the dangers of various animal bites.

Bow-Wow Ows
Dogs bite almost five million people yearly, resulting in 800,000 visits to a healthcare provider. Injuries are highest for kids between ages five and nine.
Most dog bites are to the upper extremities. (Imagine yourself reaching out, petting or slapping a dog.) However, in kids most injuries are to the head and neck. (They’re smaller.) Here are some tips to avoid getting bitten.

If you’re considering bringing a dog into your family, remember that dogs or dog breeds with histories of aggression are inappropriate in households with children. (I’m talking to you, pit bull owner.) Also, spend time with a dog before committing. If your kids are afraid of any individual dog, hold off. That fear may create cues the dog will pick up on and create a self-fulfilling prophecy. Spaying/neutering a dog actually reduces aggressive tenderness (no puns necessary).
Once you’ve acquired a pet dog, please never leave infants or young children alone with the dog.
Train your dogs, focusing on submissive behaviors. Do not wrestle or otherwise become overly aggressive with your dog. If your dog develops aggressive tendencies, either get better training or remove the pet from the household before it’s too late.
Don’t disturb your pet if sleeping, eating or caring for puppies. Also, avoid staring down your or any dog.
Do not approach an unfamiliar dog.
Regarding dogs you don’t know, don’t pet any new dog without allowing it to see your hand and smell you beforehand. Do not run away screaming from a dog; in fact, if you’re approached by an unfamiliar dog, your best move is to remain motionless. If you trip or fall over, roll into a ball and lie still.

Mee-Ow Ows
In general, cat bites and scratches are much worse than dog bites. Cat bites and scratches are more of the puncture wound variety, seeding and walling off very infectious bacteria deep inside of you, which then grow and cause infections. (Dog bites are more of the ripping, tearing variety, which poses different problems, but they aren’t as dangerous from an infectious disease standpoint.) Cat bites cause skin and blood infections. You’ll know this by warmth, redness, pain and pus from the wound site. Below is a depiction of an infected cat bite wound.

Fever may also be present if the infection is severe enough, and yes, cat bites can be fatal if untreated. You may have heard of “cat-scratch fever.” It’s a real phenomenon. Forget the lead picture; here’s a real picture of cat-scratch fever.

All bite wounds should immediately be washed under high pressure running water, but you want to avoid any scrubbing. Applying pressure to bleeding wounds is important. Time is also important. Both cat and dog bites need to get evaluated. Expect to receive antibiotics in the vast majority of cases. Some bites will require stitches; others will not. That’s a decision for the medical professionals. Treatment may include tetanus and rabies vaccines. Get in and be seen, especially with cat bites/scratches, which can cause loss of life and limb if not dealt with rapidly and effectively.

By the way, since this is my blog, I’ll just say stop it with letting your dogs lick you and kiss you in the mouth. That’s just nasty (and that’s medically speaking). Don’t you know where their mouths have been?

The Big Yow Wow! Ow
Shark bites are the things of legends, thanks to movies like Jaws and The Deep Blue Sea, which gives the impression that sharks are serial human killers. In fact, there are about 100 shark attacks worldwide yearly, with about 15-20% of attacks being fatal. I doubt that most Straight, No Chaser readers will be shark bait anytime soon, but the first thing I will mention that’s important to know is unlike other attacks by potential predators, playing possum doesn’t work with sharks. Fight back and fight dirty, attacking the eyes and gills. Apparently, sharks like easy food. In case you’ve ever wondered, sharks aren’t biting you because they’re hungry but because they’re curious. They don’t encounter humans often and similar to how a baby puts about anything in its mouth, sharks will take an “exploratory bite.” The typical human who swims frequently enough to be in shark infested waters isn’t obese enough to keep sharks’ interest and be a focus of their diets, particularly with so many other options. The other curiosity about sharks is after that first nibble, they tend to back off and wait for prey to die before returning for the kill. They don’t seem to like fighting wounded and aggressive victims. Rather lazy, I’d say.
The real danger in shark bites is the amputation. Single bites of arms and leg can cause enough blood loss and subsequent infection to kill you, just like any other amputation. Obviously a bite to your skull, chest or abdomen can kill instantly. Treatment primarily involves aggressive fluid resuscitation and other life-supportive measures, along with assessment of infection risk with antibiotics as necessary.

The Most Dangerous Animal of Them All
I’ll blog on human bites as a separate topic; it’s that frequent and important. For now, understanding that the human mouth is especially dirty and dangerous should hold you over. (Yes, it gets a lot worse than the above picture.) In the meantime, pay attention to your household pets and use the tips mentioned to avoid infection.

Straight, No Chaser: Introducing "Superbugs" – Multidrug Resistant Gonorrhea

May 16, 2014General Health and Wellness844-SMA-TALK, Conditions and Diseases, ectopic pregnancy, healthcare disparities, HIV, human immunodeficiency, infertility, multidrug resistant gonorrhea, neisseria gonorrhea, Pelvic inflammatory disease, PID, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This post is the first of two that identifies relatively new and massive occurrences in medicine. Today we discuss multidrug resistant gonorrhea. That’s right. There are new strains of gonorrhea emerging and spreading, as if the existing strains weren’t devastating enough already.
The development of multidrug resistant gonorrhea has occurred. Gonorrhea has affected humans for centuries, and the organism causing it has been identified for over one hundred years. According to the Center for Disease Control and Prevention (CDC), there were over 300,000 cases of gonorrhea in the U.S. alone in 2011. It is estimated that over 800,000 infections are currently present (On a tangential note, this represents another significant cause of health care disparities; Blacks are 17 times more likely to be affected that Whites. This isn’t just due to behavioral patterns. In fact, it’s largely due to the asymptomatic nature of gonorrhea and the relative lack of access to care among Blacks, impacting ability to get treated).
Gonorrhea has proven itself to be especially wily. We’ve had access to effective antibiotics against it since the 1930s. Still, it continues to plague us. In the 1940s, the 1970s, and again in the 1990s, gonorrhea mutated and developed immunity to treatments that had been effective. In addition most cases of gonorrhea don’t cause symptoms, allowing itself to be spread in a “stealth” manner (Read: get checked).

Even more so than other instances of gonorrhea resistance, this instance poses especially concerning dangers. Treatment of multidrug resistant gonorrhea infections (particularly those resistant to the standard of care medicine ceftriaxone) will be much more complicated that it had been previously. Specifically, there is no ready replacement on standby that can be administered in emergency rooms, offices and clinics as easily as a simple shot of ceftriaxone is. Our most recent magic bullet is going by the wayside. Other available treatments also have varying degrees of emerging resistance and thus are likely to be sporadically ineffective. Until on-site testing is put in place that allows determination of susceptibility to various treatment regimens, patients infected with gonorrhea will run the risk of receiving medicines that are no longer effective. Current and future treatment regimens will involve the use of more than one medicine and higher doses of medicine than had previously been effective.

This brings to mind two important points. Gonorrhea is not just an infection that affects sexual organs. It produces devastating consequences throughout the body, including the facilitation of human immunodeficiency virus (HIV) transmission (i.e. the presence of gonorrhea makes acquiring HIV easier). It also causes serious reproductive complications in women, such as pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. It causes eye infections in newborns (they pick it up from mom) and infected persons who rub their eyes or otherwise place their fingers in their eyes without appropriate hand washing. Either failure to get treated or receiving ineffective treatment is a precarious situation.

Of course, this also creates and reinforces the urgency of practicing safe sexual behaviors. Straight, No Chaser has multiple postings on safe sex and best practices of preventing sexually transmitted infections. Here is a summary post for your review. Of course you can type any topic in the search engine for greater ability to explore these topics. The next post addresses a “Superbug” that means to kill you. Thank you for your ongoing (and increasing!) readership.

Straight, No Chaser: Swimmer's Ear (Acute Otitis Externa)

May 14, 2014General Health and Wellness844-SMA-TALK, Conditions and Diseases, malignant otitis externa, osteomyelitis, Otitis externa, Otitis media, pseudomonas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, swimmer's earJeffrey Sterling, MD

It’s that time of year. Whether you’re getting purified in Lake Minnetonka (obscure pop culture reference alert) or your local watering hole, as the weather warms, a lot of people end up with swimmer’s ear. This is the time of year when certain bacteria and other organisms have their day in the (dirty) water and are waiting to infect you.

Acute otitis externa (aka swimmer’s ear) is an infection or inflammation of the outer ear and ear canal. It is a different infection that those inner ear infections that kids seem to get all the time; that would be otitis media. Those two infections may occur at the same time, although it isn’t likely. Otitis externa isn’t just caused by polluted water; anything that causes inflammation or infection can cause it. For example, otitis externa may be a consequence of a bite or scratch to the ear or a foreign body in the ear (yet another reason to inserting cotton swabs or other objects into the ear).

If you develop acute otitis externa, you’ll know it. Symptoms include itching and pain, pus-like drainage from the ear and hearing loss. Unlike those inner ear infections, in otitis externa you may notice the pain is pronounced when you pull on the outer portion of the ear.
The interesting thing about treatment of otitis externa is it isn’t that complicated and usually gets better promptly. What is complicated about it is failure to get treated can result in some serious complications. Treatment is accomplished by giving antibiotic eardrops. Some of you who have have swimmer’s ear may recall the use of an ear wick to facilitate the drops making their way to the end of the ear canal. Other treatments may include oral antibiotics, topical steroids, pain medication and vinegar eardrops (the acid in the vinegar works to prevent further growth of bacteria).
Regarding you placing vinegar in the ear yourself: it is often stated that mixing one drop of white vinegar with one drop of alcohol and placing this into the ear can help. My advice to you is regardless of any home remedies or over-the-counter measures you take, you should get evaluated because of the risk of complications if not adequately treated. Placing any object – even fluid – in your ear presents additional risks, particularly in those rare instances in which the eardrum has ruptured. I subscribe to the old adage that you shouldn’t place anything in your ear smaller than your elbow.

Regarding complications, because of the aggressive nature of the bacteria causing acute otitis externa (named Pseudomonas), things can take a dramatic turn for the worst.

Infectious acute otitis externa may spread to other areas including the skull bone, causing an infection known as osteomyelitis.
In those with reduced immunity, diabetics or the elderly, the infection may become severe and life threatening. This is called malignant otitis externa.

Protecting yourself from swimmer’s ear isn’t that difficult. It mainly requires you to think about the possibility, mostly when you’re getting water in your ears.

Avoid swimming in polluted water.
Avoid placing any objects such as cotton swabs in your ears. It’s ok and helpful to use earplugs when swimming.
Ensure water doesn’t get into your ears when bathing, shampooing or showering. Thoroughly dry the ear after exposure to moisture.

We welcome any questions you may have.

Straight, No Chaser: Ingrown Toenails

May 11, 2014Skin/Dermatology844-SMA-TALK, Conditions and Diseases, ingrown toenails, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The overwhelming majority of cases of ingrown toenails I see come from people chewing on their toenails. So the really, really Quick Tip is keep your feet out of your mouth. If only it was that simple.
Ingrown toenails themselves aren’t the problem. The resulting skin infection and pain are what bring you in to the emergency room. The ingrown toenail is caused by the nail burrowing into the skin of the toe instead of growing out and over it. I’ve always found it interesting that people wait so long for such things, but in this instance, if you are going to wait, there actually are things you can do to potentially make it better. You’ll know you need to do this if you have a red, swollen, painful toe and especially short toenails.

Soak your feet two-three times a day for 15 minutes at a time.
Attempt to lift the nail by placing cotton or dental floss under the toenail after you soak. The goal is to get that nail corner above the skin.
Wear open-toed shoes. This is not the time when you’d want to have any pressure on your toes.
Place a topical antibiotic on the area.

Have you ever seen a bad ingrown toenail get removed? If you have, you’ll likely agree that it’s a deterrent to having another one. Treatment usually involves lots of local anesthesia (i.e. needles) and partial manual removal of the toenail. It’s not a good day when this has to happen. By the way, the above picture is what your toe looks like after repair!
So, you can avoid this fate. Just follow a few simple steps to avoid it in the first place.

Don’t bite your nails. As discussed in the human bites blog post, you’ve just added really bad bacterial to the mix for when the infection occurs.
Don’t cut your toenail so short that you can’t see some of the white tips. Be sure to let the corners extend past the skin.
Don’t wear excessively tight shoes that literally smash your toes onto themselves.

Here’s a final note: if you’re diabetic or have another cause of a compromised immune system, these infections can spread rapidly and extend into the bone – these infections are very serious. In some cases this has led to amputated toes. If an ingrown toenail happens to you, I’d suggest getting seen sooner rather than later.

Straight, No Chaser: Keloids

May 9, 2014Skin/Dermatology844-SMA-TALK, Conditions and Diseases, hypertrophic scars, keloids, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Have you ever seen a keloid? Do you suffer from keloids? Do you know someone with them and wonder what’s occurring? Here are some answers.
Some people, more commonly African-Americans, Asians, Latinos and those with a family history of keloids, suffer from abnormal skin growths. These growths typically occur during one’s skin healing after an injury. Keloids are simply overgrowths of scar tissue.

The problem is keloids can be quite scary and scary-appearing. In severe instances, keloids can not only occur after an injury but also after any insult to the skin. This can include severe injuries such as burns, lacerations, surgical scars or trauma, but it can also result from simple insults such as acne, chickenpox, scratches or puncture wounds (such as seen with medication administration, vaccines or ear-piercing).

Keloids can be quite scary in their appearance. At first glance, they are often confused with cancerous skin growth. They take on multiple appearances and colors, and they are often tender and easily irritated. They are not easy to disguise. In fact, sun exposure may cause ongoing tanning to the area, making the deformity even more pronounced. Therefore, it’s important to cover keloids and use sunblock over the involved area when exposed to the sun for the first six months after development of one (or up to 18 months in children).
There’s an unfortunate “Catch-22” with keloids. Once formed, they often don’t need to be treated unless you want to reduce the size or have other cosmetic concerns. Many of the variety of treatment options used to treat keloids can actually cause a larger one to form, particular if it involves cutting or other irritation to the skin. However, in many cases, treatment is quite successful.

Here are some of the various treatments available for keloids. Discuss these options with your physician or Sterling Medical Advice expert consultant if you are considering having modifications to existing keloids.

Cryotherapy (freezing the area)
Injection of steroids
Laser therapy
Radiation therapy
Silicone gel or patches
Surgical reduction or removal

Straight, No Chaser: Broken Noses (Nasal Fractures)

May 8, 2014Head/Eyes/Ears/Nose/Throat, Trauma844-SMA-TALK, Conditions and Diseases, nasal fracture, rhinoplasty, saddlenose deformity, septal hematoma, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, TraumaJeffrey Sterling, MD

It’s curious how many patients with broken noses come into the emergency room smiling. Usually they’re kids whose parents “just want to be sure.” In these cases not much happens. The kids love to see the pictures of their x-rayed faces, and, as long as nothing more serious has also occurred, they come back for a follow-up after the swelling has gone down.
At the other end of the spectrum, a broken nose may be part of a devastating facial injury. In that case it’s very unlikely that anyone is smiling, and there are other symptoms accompanying the nose injury.

A broken nose (aka nose fracture or nasal fracture) is the most common facial fracture, and it describes one or a combination of the following:

There’s either a break in the cartilage or bone over the bridge of the nose.
There’s a break in the structure that divides the nostrils, called the septum.
There’s a break in the sidewall of the nose.

Signs and symptoms typically include a bloodied nose, difficulty breathing through the nose, deformed nose, pain, swelling and/or bruising around the eyes.

$nasalfractureclots$

There are serious concerns that either may result from or appear together with a broken nose.

Sometimes a collection of blood forms inside the nose. Failure to identify this can lead to further destruction of nasal cartilage, an abscess developing within the nose or the development of a permanent deformity causing breathing difficulty.
The nose structure itself can collapse if not repaired, particularly in the presence of retained blood.
Due to the nature of the force involved, neck injuries are often present with nose injuries.

If you have a broken nose, none of the above serious concerns should be a surprise. You should have symptoms that suggest the possibility of dangerous complications. Thus, it becomes important for you to know how to respond in the presence of a potentially broken nose.

Breathe through your mouth.
Lean forward to keep blood from going down the back of your throat.
Apply ice packs or other cold compresses to your nose without applying excessive pressure. This will reduce swelling.
Use acetaminophen (Tylenol) for pain. Other over the counter remedies may contribute to further bleeding.
Don’t manipulate or try to straighten your nose. Doing so could dislodge blood or spinal fluid being kept in check.
If a potentially serious injury has occurred, or if the injury involved a lot of force, avoid movement. A neck injury could be worsened with additional movement.

Here are some clues that you should make your way to an emergency room after a potentially broken nose injury:

Clear fluid is draining from the nose.
You have difficulty breathing.
Neck pain is present or a large amount of force was delivered to the face.
There is significant facial or nasal deformity.
You have uncontrollable bleeding.
You see a bulge inside either nostril.

Given that noses are a prominent part of our faces, be mindful to take simple protective measures when engaged in activities that could lead to broken noses. These are simple. Use protective headgear, seat belts and car seats, and avoid bar fights (or any other type of fight for that matter). That is a small price to pay for protecting your appearance!

Straight, No Chaser: Kidney Stones (Nephrolithiasis)

May 5, 2014Genital/Urinary844-SMA-TALK, Calcium, Conditions and Diseases, kidney stones, lithotripsy, nephrolithiasis, oxalate, phosporus, Sterling Medical Advice, Straight No Chaser, urolithiasisJeffrey Sterling, MD

In the ER setting, women are vicious when it comes to how men handle pain. It’s really humorous to see the female nurses’ attitudes change when a large or otherwise studly man crumbles at the notion of receiving an injection or having an IV line started. I’m pretty comfortable saying without fear of being biased that women in general hold the upper hand on men in the pain game. As only a few thousand of them have told me over the years, “Until men start having babies, you’ll never experience what we go through and can tolerate.”
Actually, that’s not true, or at least the women who populate the emergency rooms I’ve frequented have started changing their stories. It appears that the pain of a kidney stone is on par with or greater than the pain of childbirth, according to a large majority of the female patients with whom I’ve discussed this.
Kidney stones are among a few diagnoses that an emergency physician can just walk into a room and diagnosis to a high degree of medical certainty within seconds. (Don’t try this at home, because it’s about more than just the pain.) Once you’ve had one, you’ll go out of your way to avoid another one, which is another way of saying you should avoid them in the first place. Here are some questions and answers about kidney stones to steer you away from getting them and toward treatment if you do.

What are they and how do I get them?
Kidney stones are hard, solid particles that congregate in the kidney and proceed down the urinary system with the intention of being eliminated through your urine. Too often (meaning even once) they become lodged somewhere along the way. It’s amazing how much trouble they cause, given their size. The overwhelming majority of them are smaller than the blacks in the center of your eyes (your pupils).
There is a pretty impressive variety of ways that someone can get stones, but here are some simple considerations that increase the probability of getting a kidney stone.

You have a family history of kidney stones.
You have frequent and recurrent urinary tract (“bladder”) infections.
You have an existing blockage of your urinary tract.
You have various medical conditions that alter substances in your urine. (Stones are most often causes by excessively high levels of calcium, oxalate and phosphorous in your urine. These substances aren’t likely to cause problems at regular levels. Conditions that increase these levels increase the risk of stones.)
You eat certain foods that are high in sodium or animal protein.
You are obese or are gaining weight.
You don’t drink enough fluid.
You take certain medication (those that increase those substances mentioned earlier).

What are the symptoms?
Symptoms may not be present, depending on the size of the stone. However, when symptoms are present, they’re typically severe.

You may have a sharp pain in (most typically) one side of your back or abdomen, between the level of your chest and hips.
You may have blood in your urine.
You may have pain while urinating.
You may nausea and vomiting associated with these pains.

How are they treated?
There’s no uniform treatment for kidney stones. In the short-term (i.e., a presentation to your doctor’s office or an emergency room), your pain and vomiting will be addressed. Dependent on the size and composition of your stones, or based on the effects the stones are having on your body, the stones may be broken up or removed by a specialist.
How are they prevented?
Knowing your risks and making adjustments in your diet are important steps to preventing and avoiding kidney stones. Staying hydrated is perhaps the one step you can take most easily to get the biggest yield.
What else do you want us to know?
If you have a history of kidney stones or certain other conditions (e.g., migraines and certain types of abdominal pain), you run the risk of becoming comfortable (figuratively speaking) with your symptoms. What I mean by this is sometimes the diagnosis of kidney stones is incorrect, even if you have a history of kidney stones. Unfortunately, in this example, the consequences can be deadly. More to follow…

Straight, No Chaser: When Your Headache is Life-Threatening

May 4, 2014Neurology, Health Prevention844-SMA-TALK, arteriovenous malformation, AV malformation, Carbon monoxide poisoning, Conditions and Diseases, encephalitis, meningitis, Migraine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, Subarachnoid bleed, temporal arteritisJeffrey Sterling, MD

All headaches are not created equal. Earlier we discussed migraines, but there’s a lot more to headaches than those. In fact, when you come to an emergency room with a history of migraines and tell us you’re having a migraine, we aren’t thinking about migraines first. The ER is all about the life-threats.

The lead picture suggests items to avoid if you’d like to improve your prognosis for headaches in general and especially certain ones like brain aneurysms. In other words, alcohol, cocaine and cigarettes increase your risk for life-threatening causes of headaches.

Secondary headaches are those related to some other illness or condition that produces headaches as a symptom. These are much more common causes of headaches than migraines. They’re even more important because they could represent life-threatening conditions. So we’ll put aside the headaches caused by things like panic attacks and hyperventilation, influenza, dental pain, sinusitis, ear infections, eye strain, dehydration, hangovers, hunger and “brain-freeze.” (Yes, “ice-cream headaches” are a real thing!) Today we’ll point you to some conditions about which you should be concerned. (I’m intentionally leaving out especially uncommon ones and otherwise esoteric conditions. I wouldn’t want to encourage any hypochondriacs out there.)

AVM (arteriovenous malformation): an abnormal formation of blood vessels inside your brain
Concussions and post-concussive syndrome
Brain aneurysm: a ballooning of one of your brain’s arteries that can steal blood away from needed areas

Brain tumor
Carbon monoxide poisoning: from breathing exhaust fumes
Encephalitis/Meningitis: inflammation and/or infection of different components of your brain
Subarachnoid and other intracranial hemorrhage: bleeding inside various parts of the brain

Stroke
Temporal arteritis: inflammation of an important forehead artery with potentially devastating consequences to your sight

Given that I’ve blogged on several of these already (you can always enter the term in the search box on the right for more details), I’m going to focus on the symptoms that may suggest your headache is different enough to get evaluated for a possible life-threat.
Consider this a “headache plus this symptom = go to the emergency room” list.

Altered mental status
Confusion
Difficulty standing or walking (different from baseline)
Fainting after a headache
High fever, greater than 102 F to 104 F (39 C to 40 C)
Nausea or vomiting that’s not hangover related
Numbness, weakness or paralysis on one side of your body
Slurred speech
Stiff neck
Vision disturbances (blurred or inability to see)
Worse headache of your life

Unfortunately, defenses go down in (and when evaluating) those with a history of headaches. This places you at additional risk. Even if you have had headaches before, if you have new symptoms or something seems different about a new episode, the decision to get evaluated could save your life.

Straight, No Chaser: Here's When Your Sore Throat Needs Antibiotics – The Centor Criteria

May 2, 2014General Health and Wellness, Head/Eyes/Ears/Nose/Throat, Infectious Disease844-SMA-TALK, Affordable Care Act, Centor criteria, Conditions and Diseases, exudates, lymphadenopathy, Sterling Medical Advice, Straight No Chaser, strep throat, Streptococcal pharyngitisJeffrey Sterling, MD

I enjoy giving you tips that provide insight into what your physician is thinking. Some of these considerations are so simple that you can use them at home. In many examples, these can help you understand what to expect or even if a physician’s visit is even necessary.

For example, in revisiting sore throats, the big concern is whether you have strep throat. Not all sore throat are strep throat – in fact most aren’t. There’s scratchy throats from trauma, cigarette smoking and viruses, just to name a few non-strep throat causes of sore throats. As such, not all sore throats require antibiotics – in fact most don’t. However, all cases of strep throat require antibiotics. To not receive antibiotics for an actual strep infection can have devastating consequences, as discussed in this post.
Physicians use a set of criteria (the Centor criteria), based on clinical signs and symptoms, to identify the probability that your sore throat is strep throat. In case you’re wondering “Why not just do a test?”, the answer is those rapid tests done in the ER are very inconsistent and often inaccurate. Think about it this way: how still are you when someone’s sticking that swab in the back of your throat? Really, how persistent is your doctor or nurse in getting that swab all the way to the back of your throat? Many rapid strep tests are negative in the presence of real infection because the swab never got to the right area.

The criteria only involve four considerations. One point is assigned for each positive consideration.

History of fever above 101.4
Tonsillar exudates (those white patches you can see in the back of your throat)
Tender anterior cervical adenopathy (the swollen, tender “knots” in your neck found just about under the angle of your jaws)
Absence of cough (because the presence of a cough implies something else is occurring)

It’s worth noting that physicians may assign additional consideration to their decision to treat or not. If you’re less than 15, strep throat is more likely, and if you’re older than 44, it’s less likely.
The purpose of all this is it directs the need for testing and treatment.

0 or 1 points – No antibiotic or throat culture necessary, as the risk of strep infection is less than 10%.
2 or 3 points – You should receive a throat culture. You will be treated with an antibiotic if the culture is positive. The risk of strep infection here is 32% in the presence of three positive criteria and 15% in the presence of two.
4 or 5 points – You should receive antibiotics. The risk of strep. infection is approximately 56%.

Whether you use this information for a better understanding of what your physician is doing on to empower you in utilizing the healthcare system, it’s good to know. Now get back to avoiding strep throat in the first place!

Straight, No Chaser: Simple Questions About Sore Throats

May 1, 2014Head/Eyes/Ears/Nose/Throat, Infectious Disease, Medical Treatment844-SMA-TALK, Conditions and Diseases, mononucleosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, strep throat, Streptococcal pharyngitisJeffrey Sterling, MD

Sore throats. So common. So simple. So sore. Here are a group of frequently asked questions to help you sort out the whys and what next considerations for you and your family.
How do I catch a sore throat?
You only “catch” them when the cause is an infection. Routine measures such as regular hand washing, covering your mouth when sneezing or coughing and keeping your hands out of your mouth go a long way to protecting you from infectious causes of sore throats.

Is a sore throat the same thing as tonsillitis?
Tonsillitis is one of many causes of sore throats. Causes can include infections, smoking, allergies and trauma to the back of your throat. Yes, bad singing can hurt more than someone else’s ears.
So what do I need to know about tonsillitis?
First you should know what and where the tonsils are. Besides being preferred landing spots for ice cream, the tonsils are the tissue located on both sides of the back of your mouth, as highlighted in the picture above. Tonsils are a common site for infection.
How is tonsillitis treated?
The treatment of sore throats in general is based on the cause. Tonsillitis can be caused by either bacterial or viral infections. Viruses do not respond to antibiotics, whereas bacteria do. Tonsillectomies are not needed in most people with tonsillitis. If you get severe tonsillitis often enough, or if you’re having breathing problems, you doctor may consider it.

Is strep throat the same as tonsillitis?
No. Strep throat is a sore throat caused by a specific type of bacteria (Streptococcus).

What is mono?
Mononucleosis (aka mono, the kissing disease) is a viral infection that causes sore throat. One clue that is very suggestive of the presence of mono is gland swelling in the back of your neck, as noted in the above picture.
Are sore throats dangerous?
It depends on the cause. If untreated, strep throat can result in dangerous disease of the kidney (called glomerulonephritis) or the joints and heart (called rheumatic fever). The complications of mononucleosis can be more serious that the disease, including splenic enlargement and rupture, as well as hepatitis (inflammation to the liver).
How does my doctor determine the cause of my sore throat?
Some physicians rely on clinical signs and symptoms. Others will obtain a throat culture or a rapid strep test. These tests are especially important if the decision is being made not to treat, because of the complications mentioned for untreated strep throat. Regarding mono, diagnosis may be confirmed with a blood test.
How are sore throats treated?
If your sore throat is caused by bacteria, you will receive an antibiotic. If it’s caused by a virus, you won’t. Antibiotics are ineffective against viruses. Just as occurs with other viruses such as the common cold, sore throats caused by viruses will go away on their own in 7-10 days.
Regarding specific treatment considerations:

If you have strep throat, your doctor will need to know if you’re allergic to penicillin.
No one under age 18 should take aspirin. Acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Motrin, Advil) or naproxen (e.g., Aleve) can be given for relief of pain and/or fever.
If allergies are the cause of the sore throat, avoiding the causes is the most important consideration. Additional medicine for symptom relief is available.
Yes, gargling with warm salt water is effective. Place one teaspoon of salt in eight ounces of water.
Sucking on hard candy, throat lozenges, ice cream or frozen foods (e.g., popsicles) can help.
Drink plenty of fluids, warm or cool.
A humidifier is helpful for easing scratchy throats.

Another Straight, No Chaser post will address a simple way to figure out if your physician is likely to give you antibiotics for your sore throat.

Straight, No Chaser: Extracting Ticks and Preventing Tick Bites

April 30, 2014General Health and Wellness, Infectious Disease, Health Prevention844-SMA-TALK, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, tick borne diseasesJeffrey Sterling, MD

Springtime is the beginning of the outdoor season for many. Whether you’re camping, hunting, playing paintball, hiking or engaged in other activities in the woods or tall grass, you need to be alert to the presence of pesky mosquitoes and ticks.
This Straight, No Chaser will discuss prevention and removal of ticks. An additional post will discuss tick-borne diseases.
Tick-borne diseases are seen more often between April and September, because people are more inclined to be outdoors during the warmer months. Preventative activities are necessary whenever you’re outdoors.

Try the following preventative measures:

In general, ticks are found in areas with high grass and in leafy mounds. Avoid these areas, and stay on trails that are well outlined when possible.
Wear clothing that covers as much of your body as practical.
Wear clothing that is pretreated for tick control. These products contain permethrin. Protect your pants, boots and socks. Also treat your tent if you are camping.
If you’re using repellent (which you should), use 20-30% DEET. Apply repellent generously and avoid getting it in the eyes, mouth and hands.

Prevention also includes steps you take once you’re literally out of the woods.

As soon are you arrive home, bathe and/or shower.
View (or have someone else view) your body for ticks. Be sure to check the hair and in body crevices, such as under your arms, within the belly button, armpits and the backs of the knees, the front of the elbows, around the waist and groin, and around the ears.
Once you’ve cared for yourself, check your gear and any pets that accompanied you. Ticks can attach to your pets or other items taken on the retreat, then get on you later. Take the time to look everything over.
Furthermore, once washing your clothes, tumble them in a dryer set on high heat for an hour. This will kill any remaining ticks.

The simplest way to remove a tick that is attached to you is to use tweezers, which should be part of what you take with you when headed to the woods.

Grasp the tick as close to your skin as possible.
Pull upward with steady, even pressure, and do not twist, bend or jerk the tick.
If you break off the tick’s mouth and leave it in the skin, go back and take out the individual parts with tweezers. If you are unsuccessful, do not dig into the skin. Do the best you can to clean the area; the skin will heal.
After removing whichever part of the tick you can, use soap and water, alcohol or and iodine scrub to clean the area of the tick bite.

Avoid and ignore folk tales that involve doing anything to the tick other than extracting it. Without going into details, using paint or fire doesn’t help and can make matters worse.

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