Tag Archives: Conditions and Diseases

Straight, No Chaser: Urinary Tract Infections (UTIs)

December 27, 2017Genital/Urinary, Infectious Disease844-SMA-TALK, Behind the Curtain, Conditions and Diseases, cystogram, cystography, E. coli, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, ultrasound, urinary tract infections, UTIsJeffrey Sterling, MD

Ladies, have you ever been told that you get “bladder infections” because you didn’t wipe front to back instead of back to front? Men, have you ever been told that this could be a sign that your prostate needs to be examined? This Straight, No Chaser answers simple questions on urinary tract infections (UTIs). With over 8 millions cases and 100,000 hospitalizations a year due to these, it’s information you should know.

What is a urinary tract infection (UTI)? Is it the same as a bladder infection?
What these questions really ask is “What is the urinary tract?” The body’s drainage system serves to remove excess fluid and bodily waste. It includes the following organs:

The kidneys serve to filter blood and produce approximately 1-2 quarts of urine per day as a result of this process.
The ureters are tubes extending from the kidneys to the bladder, carrying filtered urine within them.
The bladder is the pouch within which you store urine until you’re ready to release it.
The urethra is a tube at the bottom of the bladder through which urine gets expelled.

A UTI is an infection anywhere along this path. Infections at different parts of the urinary tract can display different symptoms and have different complications.
What causes a UTI?
Bacteria are the most common cause of UTIs, particularly those that live in the bowel (such as E. coli) and are within or in close proximity to the vagina. Under most circumstances the body is very effective at removing bacteria and other microorganisms from the urinary tract (urinating just washes them out!), but some of us are at increased risk due to diminished defenses or other circumstances in which these microorganisms can grow.

Why do women get UTIs, and it seems like men don’t?
It is true that women get UTIs about four times more frequently than men, but anyone of any age or sex can be infected. Here are some reasons why.

Women have a shorter urethra, which makes it easier for bacteria to reach the bladder.
Also, the opening of a woman’s urethra is near the vagina and anus, where bacteria live.
Women who use a diaphragm are also more likely to get UTIs than women who use other forms of birth control.
The male prostate produces secretions that slow bacterial growth.

Are there other risk factors for UTIs?
Yes. Others at higher risk for UTIs include the following.

those having diabetes or have lowered immune systems
those habitually needing a tube to drain their bladder
those with urinary tract abnormalities that block the flow of urine
those with spinal cord injuries or other nerve damage

Additionally, once a man has a UTI, it’s more likely he’ll have the problem again because the bacteria are extremely difficult to reach once they set up shop in the male prostate.
Are UTIs serious?
Unless you describe the annoying symptoms as serious, most UTIs are not serious. However, UTIs can lead to severe complications if left untreated, including the following:

Long lasting or recurrent kidney infections can cause permanent damage and scarring to the kidneys, which can create insufficient kidney function and produce high blood pressure and other problems.
Kidney infections can enter the blood stream and become life threatening.

What are the signs and symptoms of a UTI?
You should see your physician if you develop any of the following signs or symptoms:

A burning sensation with urination
Bloody, cloudy, dark or otherwise discolored urine
Fever or chills
Foul-smelling urine
Frequent or urgent need to urinate, regardless of the amount actually expressed
Pain in your back or side below the ribs

How are UTIs diagnosed?
UTIs are diagnosed based both on symptoms and a lab test. Many of you have experienced your urine being sent to a lab from the emergency room or your doctor’s office. Based on a combination of symptoms, the presence of bacteria and white blood cells that have accumulated to fight the infection, the diagnosis will be made. If you have frequent infections, infections that don’t respond well to treatment, atypical presentations or are sick enough to be hospitalized, your urine may be cultured in an effort to grow the bacteria causing your symptoms. This allows more precise treatment regimens to be given. In other circumstances, tests may be done to check the normalcy of your urinary tract, including an ultrasound or CT scan. Further details on when and why this would be done is available on www.sterlingmedicaladvice.com.
An additional Straight, No Chaser will discuss prevention and treatment options for UTIs.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
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Straight, No Chaser: Treatment of Food Poisoning (Foodborne Illness)

December 24, 2017Diet and Nutrition, Gastrointestinal, Infectious Disease844-SMA-TALK, Behind the Curtain, ceralyte, Conditions and Diseases, food poisoning, Gastroenteritis, Oral rehydration therapy, oralyte, pedialyte, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

The vomiting, diarrhea, fever, abdominal cramps and all around bad feelings you may get with food poisoning is extremely unpleasant. We’ve previously discussed preventative measures you can take to minimize your risks, but you should also want to know what measures to take in the event you actually develop food poisoning. Of course, with over 250 different illnesses related to various forms of food poisoning, there’s a wide variety of treatment, some of which means to treat the specific disease (and its cause) and others that only treat the symptoms.
I always tell patients that although the vomiting and diarrhea are dramatic nuisance symptoms, the real concern is the risk of dehydration from these fluid losses. Given the body is approximately two-thirds water, altering that balance can lead to disturbances of many of the body’s functions and increase the risk of more serious infections. Thus the key to treatment is staying ahead of fluid and electrolyte losses that occur. Perhaps you’re wondering “How can I do that if I’m vomiting?” Here are five very important principles for you to remember.

First things first: if you have severe diarrhea, your favorite sports drink is not the cure. The composition of fluids and electrolytes in your stool is different from in your sweat, so these drinks don’t optimally replace your losses.

I want you to become familiar with oral rehydration therapy/solution (ORT). It’s how most of the rest of the world first treats fluid losses from vomiting and diarrhea. You may have heard of Ceralyte, Oralyte or Pedialyte, all of which are examples. ORT represents the best possible fluid for you to take and is readily available without a prescription at your local pharmacy or grocery store.
Here’s the deal with staying hydrated: you can’t hold a lot on your stomach. You need to dial back as much as possible so that you can tolerate something. That’s why you sip on chicken soup instead of steak when you’re sick. You’re likely to have more success keeping down teaspoons of fluid at a more frequent interval (say, every few minutes) than trying to chug a lot of fluid all at once.
Preparations of bismuth subsalicylate (Pepto-Bismol is a common example) can reduce the duration and severity of simple diarrhea.
If you have diarrhea and cramps with a fever or bloody stools, you should not take antidiarrheal medication without an evaluation by a physician. Even if they make you feel better, these medicines can make your food poisoning much worse.

Here’s one other point that you should understand as you’re going into your doctor’s office or the emergency room: don’t expect to receive an antibiotic to treat your vomiting and diarrhea. Most of these episodes are caused by viruses, which are self-limited and will resolve within two to three days. Furthermore, viruses don’t respond to antibiotics. In fact, efforts to use antibiotics in many of these cases only contribute to antibiotic resistance later on when you actually need them. Antibiotic resistance is discussed in detail in this Straight, No Chaser post.

Finally, here are symptoms that should prompt you to see your physician.

Bloody stools
Diarrhea lasting more than 3 days
High fever (oral temperature over 101.4 F)
Signs of dehydration, such as a decrease in urination, a dry mouth and throat, and dizziness with standing
Vomiting with inability to keep down liquids

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Understanding Food Poisoning (Foodborne Illness)

December 23, 2017Detoxification, Gastrointestinal844-SMA-TALK, Behind the Curtain, Campylobacter, Centers for Disease Control and Prevention, Conditions and Diseases, E. coli, Food and Drug Administration, food poisoning, foodborne illness, Staph, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, vibrio, YersiniaJeffrey Sterling, MD

We make a decision with everything we place into our mouths. We also exhibit a large amount of trust that the food we eat is safe. Most of the time that’s true, but unfortunately sometimes it’s not. Here are some questions and answers to understanding the scope of food poisoning.
How frequent is food poisoning?
According to 2011 data from the U.S. Centers for Disease Control and Prevention (CDC), every year in the U.S. approximately 1 in 6 Americans (almost 50 million people) gets sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases.

What causes food poisoning?
Over 250 different foodborne diseases have been described, most of which are infections. The most common foodborne illnesses are caused by norovirus and by the bacteria Salmonella, Clostridium perfringens, and Campylobacter. Staph Aureus (yes, that Staph) is another prominent but less common cause of food poisoning. Poisonous chemicals or other harmful substances can cause foodborne diseases if present in food.
What are the most common symptoms of food poisoning?
Even though there are many different foodborne diseases, they share a commonality of entering your system through your gastrointestinal tract. As a result, the first symptoms are caused and expressed from there and typically include nausea, vomiting, diarrhea and abdominal cramps.

Why do foodborne diseases seem to occur in outbreaks?
Actually, the overwhelming majority of cases of food poisoning don’t occur in outbreaks, but of course you wouldn’t know that because having diarrhea is not something people typically will tell you… When outbreaks occur, it’s because a group of people happened to eat the same contaminated item. This would explain how instances of groups of friends or strangers could have been involved. Contamination that occur closest to the food supply’s distribution result in the widest outbreaks. Look at the above picture. If contaminated food from the producer makes it all the way through the distribution chain, individuals in multiple states could end up with the same infection.

What foods are most associated with foodborne illness?

Foods that mingle the products of many individual animals: Raw milk, pooled raw eggs and ground beef have increased risk because contamination in any one of the multiple animals involved can contaminate the entire mixture.
Raw foods of animal origin: Foods such as meat, poultry, shellfish, eggs and unpasteurized milk are the most likely foods to be contaminated.
Raw fruits and vegetables: Washing reduces but doesn’t eliminate pre-existing contamination, such as that occurring from the fresh manure that fertilizes vegetables. Furthermore, water itself may be contaminated.
Shellfish: Because “filter-feeding” shellfish strain microorganisms from the sea over many months, they are particularly likely to be contaminated if there are any in the seawater.

An additional Straight, No Chaser will discuss treatment options. Refer to this post for preventative tips.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: The Holiday Heart Syndrome

December 21, 2017Cardiology/Heart, General Health and Wellness844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

There’s something about the holiday season and flickering. We’re all aware that Christmas lights are meant to do so, but did you know that your heart is more inclined to flicker and flutter this time of year (sorry, but I’m not talking about mistletoe)? In a previous Straight, No Chaser, we discussed a mental consideration concerning the holiday season: the increased rate and risks of depression, known as The Holiday Blues. Unfortunately, health issues associated with the holidays don’t stop there. There are defined physical risks associated with the holidays as well. The disturbing aspect of today’s topic is you’re not immune to this even if you’re otherwise healthy.

Holiday heart syndrome is a real condition and has been described as such since the 1970s. It’s the result of eating and drinking alcohol too much (with or without excessive caffeine intake and a lack of sleep), which is exactly what we’re inclined to do this time of year. The combination of these indulgences places an undue level of strain on the heart, which causes the heart to develop an abnormal rhythm, most commonly atrial fibrillation. Interestingly, certain foods, alcohol and caffeine all have direct effects on the heart, and indirectly they can also affect the heart through increase of certain hormones (such as epinephrine) that stimulate the heart.
Curiously, holiday heart syndrome is notable for its occurrence in those without existent heart disease but can be especially concerning in uncovering existing disease or exacerbating disease in those having it. For example, someone with underlying cardiovascular disease featuring microclots can have such clots dislodge during an episode of atrial fibrillation, causing a stroke.
Fortunately, by far the common course of holiday heart syndrome is benign. The abnormal heart rates will slowly resolve as the levels and effects of alcohol and/or other substances decline. That said, the risk is such that you don’t just want to sleep off an occurrence.
The symptoms you’d have are pretty obvious, given that you’d have been eating and drinking to excess. You’d also note that your heart was racing and perhaps pounding, as if it was attempting to jump out of your chest. Heart rates in the 120s are pretty typical for holiday heart syndrome (a normal heart rate is between 70-100 beats per minute). This tidbit is important to know; if your heart rate is higher than this, something more serious could be occurring. Under either circumstance, you need to be evaluated and treated in the emergency room setting with hydration and observation of the heart rhythm and rate.

The lessons here are pretty straightforward:

Holiday heart syndrome suggests that indulgences that occur during the holidays can cause symptoms. By no means does it suggest that these symptoms are restricted to the holidays. Overindulgence in food and drink can cause abnormal heart rhythms at any time, including weekends, spring break, birthday or other celebrations, as well as holidays.
You’d be particularly interested in knowing that the combination of vodka and the energy drink Red Bull have been shown to make these symptoms more likely to occur.

Following alcohol-related abnormal heart rhythms, it is advisable for patients to avoid significant exertion because the excessive stimulation that raises epinephrine levels can precipitate recurrent and possibly more serious episodes. Most patients without underlying heart disease should be able to gradually resume full physical activity over the next few days. Once everything is back to normal, most patients do not require further therapy if they refrain from alcohol use. Patients with underlying heart disease, heart disease that’s discovered during evaluation, or those with severe symptoms on presentation (e.g., blackouts or simultaneous low blood pressure) may be candidates to receive certain heart medications.

At the end of the day, Holiday Heart Syndrome is yet another example of the virtue of enjoying life in moderation. Failure to do so can turn the holidays into the most dangerous time of the year. Cheers!

Straight, No Chaser: Questions About High Blood Pressure (Hypertension)

December 8, 2017Cardiology/Heart, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, high blood pressure, Hypertension, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey 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.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Questions About Color Blindness

November 11, 2017Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, color blindness, color deficiency, Conditions and Diseases, cones, nystagmus, retina, rods, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Have you ever found yourself at school, work or elsewhere and discovered that you were wearing different colored socks or pants than you’d thought? If so, you may be experiencing color blindness.

 
A person with color deficiency may not be able to see the number 5 among the dots in this picture.
What are the main symptoms?
Classic color blindness involves difficulty in seeing colors and the brightness of colors, coupled with an inability to differentiate between shades and other variations of similar colors. Usually the perception of red and green or blue and yellow are affected. There can be a lot of variation in symptoms, ranging from mild to complete and including greater or lesser difficulty in bright or dim light.

Why does it occur?
In the back of your eyes, you have two different types of cells affecting your ability to detect light. One of these is called cone cells; these detect color. Of these, there are three types: those that detect red, green and blue. Our brain perceives color based on degrees of input from these cells. Any absence or malfunction in these cells can produce color blindness. It stands to reason (and is true) that different degrees of color blindness could result from the extent of malfunction to these cells.
Who is at risk?

Most people with color blindness are born with it.
One of 10 males has some form of color blindness.
Women seldom suffer from color blindness, but those that do are likely to pass it to their sons.
Color blindness is more common among those of Northern European heritage.
Certain drugs, most notably plaquenil (a drug used to treat rheumatoid arthritis) can cause color blindness.
Certain medical conditions, including Alzheimer’s, Parkinson’s, alcoholism, glaucoma, leukemia and sickle anemia increase the risk of acquiring color blindness.

Are there other symptoms?
Except in the most severe form, color blindness does not affect the sharpness of vision. In rare instances one may experience poor vision, light sensitivity, involuntary rapid eye movement and visualization of everything as shades of gray. These symptoms aren’t likely to occur suddenly, so you’d have ample opportunity to see an ophthalmologist (eye doctor) prior to this level of malfunction.

What can be done about it?
There is no cure for color blindness, although acquired forms are best addressed by treating the underlying source. You may be given special eyewear that improves color detection.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Questions about "Lazy Eye" (Amblyopia)

November 10, 2017Ophthalmology/Eyes844-SMA-TALK, amblyopia, Behind the Curtain, cataracts, Conditions and Diseases, hyperopia, lazy eye, myopia, ptosis, Sterling Medical Advice, SterlingMedicalAdvice.com, strabismus, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

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

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

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

Strabismus: misalignment of the eyes

Cataracts: clouding of the front part of the eye

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

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

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

How is lazy eye treated?

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

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

Is this the same as eye drooping or lid lag?

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

Feel free to ask your SMA expert consultant any questions you may have on this topic.Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Low Blood Sugar (Hypoglycemia)

November 7, 2017Endocrine/MetabolicBehind the Curtain, Blood sugar, Conditions and Diseases, Diabetes, Diabetes mellitus, Endocrine Disorders, Glucose, health, Insulin, Pancreas, There are 72 Hours in a DayJeffrey Sterling, MD

In a previous post, I provided an overview of diabetes. Everyone knows about diabetes, and most understand how dangerous diabetes is over the long-term. However, as an emergency physician, I’m more concerned with what will kill you immediately, and on that front, low blood glucose (sugar) is usually much more concerning. I want you to know up front that a low enough blood glucose will kill you – now. As we say in the ER, a high glucose level will hurt you and may kill you, but a glucose level that goes to zero means ‘Cancel Christmas’.
Therefore I will start with a simple statement. Any diabetic (or individual known to have low glucose levels) with altered mental status needs to be given juice or if they can handle it, some soft food to chew on. If they’re in the midst of a high sugar reaction, it won’t make much of a difference, but if that glucose level was zero, you’ve just saved a life. Now let’s briefly discuss symptoms and causes.

Low glucose levels can present many different ways including dizziness, jitteriness, numbness, tingling, blackouts, seizures and other symptoms. However, it’s usually the confusion or other change in mental status that’s most predominant and concerning. Just remember, this is not something about which you should wait around to see if it gets better.
Regarding causes, unintentional overdosing of insulin or oral medication (particular the sulfonylureas class of medicines) are especially concerning and common. Sometimes a family member, particularly a child, may take such a medicine to disastrous effects. Beyond that, heavy alcohol consumption on an empty stomach is another common cause due to its effects on the liver (Alcohol locks glucose stores in the liver, preventing release to the blood; as a result you have less to use.).
Other causes are more exotic and fortunately less common; they will be evaluated upon arrival to the hospital when a rapid response isn’t seen with simple administration of glucose. Dysfunction of certain organs (the adrenal and pituitary glands, the liver due to hepatitis, or tumors of the pancreas – the organ that produces the insulin that drives glucose into your cells – can cause problems with regulating either glucose itself or insulin. These conditions can drive your blood glucose dangerously low.
So, the causes are varied, but the message is simple. Be careful with insulin administration, remember to check those blood sugar levels and act promptly in the face of mental status changes. Usually I note that time is tissue, but in this example, you’ll run out of time before your tissues are damaged.

Feel free to ask your SMA expert consultant any questions you may have on this topic.Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Diabetes Basics and the Importance of Education

November 3, 2017Diet and Nutrition, Endocrine/Metabolic, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Diabetes, Diet, exercise, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey 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.
Feel free to ask your SMA expert consultant any questions you may have on this topic.Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
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Straight, No Chaser: Tetanus (Lockjaw)

October 27, 2017General Health and Wellness, Infectious Disease, Neurology, Skin/Dermatology844-SMA-TALK, Behind the Curtain, clostridium tetani, Conditions and Diseases, lockjaw, rictus sardonicus, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, tetanusJeffrey Sterling, MD

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

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

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

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

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

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

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

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
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Straight, No Chaser In The News: New Public Health Consequences & Lessons from Puerto Rico – Leptospirosis

October 12, 2017Infectious Disease, Public Health844-SMA-TALK, Behind the Curtain, Conditions and Diseases, leptospirosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

This is a post on a public health matter, not a political one. Please appreciate the difference. Three weeks after Hurricaine Maria rendered the nearly 3.5 million US citizens living in Puerto Rico without normal living conditions, there has been a sudden uptick – a tripling, actually – in the death count. Oddly, the major cause of this surge is not from the over 100 individuals who still remain unaccounted for after all this time. This situation is an illustration of the fundamental roles of government in a society and the consequences that occur when those roles are abdicated or aren’t performed competently.
You may not know that for most of recorded history, diarrhea and dehydration was the world’s number one cause of death. As a public health consideration, the ability to purify water has saved more lives than any other initiative, including antibiotics, immunizations and medical procedures. The situation in Puerto Rico is a stark reminder of what it looks like when citizens don’t have access to clean water; in up to a third of the Puerto Rican population, there still is no access to water, prompting them to drink from local streams and whatever other sources they can access.

The issue here is a disease called leptospirosis. Leptospirosis is a particularly nasty disease that is not uncommon in tropical locations and tends to show up after huge rainfalls. The disease is notable for being spread by drinking water contaminated by animal urine, especially rodents (rats) and even domestic pets that may have gotten into the native water. Symptoms sound like it’s a serious disease; they may include headache, vomiting, high fever, and jaundice (yellow pigmentation). The disease can include liver failure, kidney failure, bleeding from the lungs and infections of the brain. Death rates from this disease alone can reach thirty percent (30%). This is a horrible disease to have and a horrible way to die, even before considering that prevention – simply meaning access to fresh water – is the best cure.

Given that many deadly infectious diseases, including leptospirosis and a host of presumably upcoming mosquito-borne illnesses, can take several weeks to incubate and cause symptoms of a disease, one can assume things will get worse before they get better. In the meantime, there are at approximately 19,000 federal, civilian and military personnel assisting Puerto Rico. Can someone take the time to spread out some water, penicillin and doxycycline, which by the way only costs $1/day?
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Keys to Mental (Un)Health and (Un)Happiness

October 2, 2017General Health and Wellness, Mental Health, Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Straight, No Chaser is mindful that there are multitudes of us excessively happy and unhappy. Everyone has thoughts about the keys to happiness, but we can objectify the conversation and identify what’s most likely to make you unhappy and lead to depression. You may find this hard to believe, but outside of medical causes of psychiatric illness and factors outside of your control, there are actually three choices we make that most commonly adversely impact your happiness and good mental health. Take it for what you will, but the data is what it is. Stay away from these circumstances, and you’re less likely to be unhappy. Sometimes it’s about addition by subtraction.

Health Problems: People who are sick or have significant illness in their families generally aren’t happy. Although this may seem obvious and perhaps unfair, given that some illnesses and conditions are inherited or occur haphazardly, be mindful of the things you can control. Of course, this gets to the negative effects of obesity and smoking. More so than any other health-related activities/conditions, these will eventually lead to deteriorating health and subsequent unhappiness.

Job Problems: You don’t have enough to do with your time? Yep, an idle mind is the Devil’s workshop, as the saying goes. It should be pointed out that neither too much work nor the wrong type of work (i.e., low job satisfaction) seems to promote happiness. On average, people change careers seven times during their lifetimes. It’s often due to a search for happiness and actually is a good thing to do to avoid being stuck in a bad situation. Follow the job you love, and you’re more likely to be both happy and successful.

Relationship Problems: You make bad relationship choices? Well there’s one specific choice that is shown to be most likely to reduce your happiness—choosing a neurotic partner. What’s neurotic? For one particularly disruptive example, think about the so-called Drama Queen/King. A neurotic partner responds emotionally to events that wouldn’t affect most people, and their reactions tend to be more intense than normal. They’re more likely to interpret minor frustrations as hopelessly difficult. Their negative emotional reactions persist for unusually long periods of time. In short, if you want to be really unhappy, become attached to such a person. They will negatively affect your world, keeping you embroiled in drama and unhappiness, no matter how good the financial, physical, or other parts of your relationship.

Now your results may vary but probably won’t. I’m not make judgements, just sharing the data. Life choices have consequences. Choose wisely!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: When Your Headache is Life-Threatening

September 17, 2017Neurology844-SMA-TALK, arteriovenous malformation, AV malformation, Behind the Curtain, Carbon monoxide poisoning, Conditions and Diseases, encephalitis, meningitis, Migraine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, Subarachnoid bleed, temporal arteritis, There are 72 Hours in a DayJeffrey 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.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Fibromyalgia

September 14, 2017General Health and Wellness, Mental Health, Neurology844-SMA-TALK, Behind the Curtain, chronic fatigue syndrome, chronic pain syndrome, Conditions and Diseases, fibromyalgia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Previously, Straight, No Chaser has discussed the frustration of uncertainty some patients have with having symptoms and not being given a diagnosis (much less a cure). Imagine if that uncertainty arose in the context of excruciating pain lasting for what seems like all day. There was a time when this was the case to a much greater extent, and then several medical conditions gained recognition and/or prominence. Some of these include chronic pain syndrome, chronic fatigue syndrome, temporomandibular joint syndrome (TMJ syndrome), endometriosis, inflammatory bowel disorder, vaginismus, vulvodynia and still other conditions. Today’s Straight, No Chaser addresses one such condition, fibromyalgia.

The symptoms of fibromyalgia include muscle pain and fatigue. This pain may take one of several typical forms, including headaches, painful menstrual periods and – most interestingly – “tender points.” Tender points are specific places on the body that hurt when you apply pressure. These can occur most anywhere but usually involve the extremities, neck, back, hips and shoulders. Other symptoms include numbness and tingling in your hands and feet, difficulty sleeping and morning stiffness. In some cases a condition called “fibro fog” occurs, in which clouding of thinking and memory occurs. It shouldn’t be a surprise that these other symptoms often result in clinical depression.
Unfortunately, fibromyalgia is a condition, not a disease that we can attach to a specific cause. However, there are several diseases to which fibromyalgia has been linked. In short, many stressful life conditions and events can serve as triggers for this disorder. Some of the more notable conditions and triggers include ankylosing spondylitis (aka spinal arthritis), motor vehicle crashes, rheumatoid arthritis and systemic lupus erythematosus (aka lupus). So many such triggers exists that now over 5 million Americans have been labeled with the diagnosis. Interesting, 80-90% of those so diagnosed are women, most during middle age.
Given the absence of an identified cause, treatment is mostly symptomatic, attempting to address the pain and other things that disrupt one’s activities of daily living. More importantly, once affected, you need to implement the lifestyle changes that have been shown to help, including improving diet, exercise, getting enough sleep, changing one’s work and home environments, and taking medications as prescribed.
I would be remiss (and not very Straight, No Chaser), if I didn’t address the controversies surrounding fibromyalgia. Given the absence of a defined cause, many patients suffering from fibromyalgia and similar disorders are often perceived to be drug seeking, particularly in emergency departments. It is very frustrating for physicians to care for patients they can’t “fix.” Although drug-seeking patients do exist, multiple medical studies have shown that inadequate treatment of pain remains one of the great faux pas of medicine. It is an equal disservice to give in to a patient’s request for pain medication as a routine matter without the benefit of a full evaluation. There are many defined medical conditions that present with pain. More deliberate and vigorous evaluations can not only put a more definitive name to the pain but can lead to better outcomes for those patients.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Your Questions About Chronic Pain and Management

September 12, 2017General Health and Wellness844-SMA-TALK, Behind the Curtain, chronic pain syndrome, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Chronic pain and its management are complicated topics, both for sufferers and those who care for them. Thank you for your feedback on the previous post and appreciating the spirit in which the information was provided. There were many interesting questions presented, and I’d like to address two topics raised in some detail.
You don’t have to be a drug seeker to be drug addicted.

Here’s a point many chronic pain patients don’t think about that emergency room (ER) staffs have to. Even if you’re not a drug seeker, you can still be physiologically addicted to drugs. Of course your ER physician cares about your mental intent, but s/he has to be cognizant of the possibility or reality that your body might be addicted. One reason this is especially relevant is the development of tolerance, which is an important sign of addiction.
Specifically, tolerance is the phenomenon by which those physiologically addicted to a substance don’t get the same effect by giving what had previously been an effective dose. So what? This means over time you will require increasing amounts to get an effective amount of relief (i.e. equivalent to previous effects).
So… as a patient suffering from pain, you’re focusing on the fact that you’re not relieved of your pain. Your ER staff is focused on the reality that increasing amounts of certain pain medications (i.e. narcotics) come with increasing amounts of side effects, more notably respiratory depression, meaning a high enough dose can knock out your ability to breath and will kill you. This is a major reason why there are limits as to the amounts and frequency of what will be given to you in an ER setting. Once you’ve been given a certain amount, many physicians will simple stop giving additional amounts regardless as to how you feel – unless we are able to specifically discuss your cases with your primary or pain management physician, who may explain your circumstance and help decide if additionally amounts are needed. This also explains why you’re more likely to get “better” treatment during regular business hours than in the middle of the night; those conversations with other members of the team are important.
The allergy vs. adverse drug reaction question:

In a previous post, I commented on patients equating preference or side effects with allergies, and several readers have asked for clarification (e.g. “Why isn’t that side effect the same as an allergy?). An example that relates to pain is some patients’ preference of various narcotics. For some, morphine routinely makes many people itch. This is an expected side effect and is not the same as an allergic reaction. Morphine also makes some patients feel “bleh,” especially when compared with such medicinal options as Dilaudid or Demerol which are more “happy drugs.”
Even so, these drugs have different effects that would make a physician choose one over the other. For example, morphine is actually a drug of choice for pain exacerbations associated with sickle cell anemia due to its effects at the cellular level, so in many cases, physician will prefer to use morphine despite patient preference. In any event, your job is simply to have the conversation with your physician. Don’t claim an allergy if one doesn’t exist; simply discuss the reasons why one medication seems to work better than the other. You likely will find a much more receptive audience taking this approach.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Life Begins (To End) at 40 (Unless It Doesn’t) – The Cerebrovascular System (Your Brain)

September 10, 2017General Health and Wellness, Mental Health, Health Prevention844-SMA-TALK, Behind the Curtain, Blood vessel, Brain, Cerebrovascular disease, Conditions and Diseases, health, Neurological Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, There are 72 Hours in a Day, Transient ischemic attackJeffrey Sterling, MD

Last but not least, in the last part of this series, let’s talk about your brain. But first a summary comment. Life after 40 poses both opportunity and obstacles. 35 to 40 is either the age when your lifestyle begins to catch up with you, or the work you’ve put in begins to pay off. For those who’ve lived life smartly and healthily, 40 really is the new 30. For those who’ve lived life less diligently, 40 may as well be 60, and your health probably reflects that. It’s really not that difficult. Diet, exercise, don’t smoke and alcohol in moderation keeps a body strong. Now to your brain…

Changes: As you age, cholesterol based blockages (plaque formation) inside the arteries and hardening of the arteries in the blood vessels that supply the brain is called cerebrovascular disease, and it causes strokes. These changes begin in earnest at about age 35. Prior to the complete blockage of the blood vessels, the brain is deprived of adequate blood flow (and oxygen) resulting in less than optimal brain functioning, such as confusion, disorientation, memory loss and ‘mini-strokes’ (TIAs). Strokes may result in paralysis, speech disorder, and sensory deprivation in varying degrees.

Challenges: Unlike many of the other systems I’ve discussed, the effects of these changes on our brain health status can be drastic, ranging from slight discomfort to death, and they involve major physical as well as social components. The social implications of these effects can be just as severe as the physical, as those suffering become less functional both mentally and physically. Unfortunately, in varying degrees stroke survivors become or perceive themselves to be a burden to others. Social interactions are doubly inhibited: internally, the patient is less able to interact; and externally, family, friends, and others may be less interested in interacting with them. This is sad, but true (think about the lives of the stroke survivors you may know…).
Solutions: The alternatives are twofold: after the fact, education is essential by a loved one’s support group and community, otherwise a stroke becomes a different type of life sentence. Physical and occupational therapy save lives and the quality of lives. Continuing to value and show value to your loved ones can make all the difference in the world. Before the fact, again, it’s preventive measures such as diet and exercise that have been shown to decrease or even prevent strokes. I cannot overemphasize how vital diet, exercise and the avoidance of toxins are to your long-term health.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Tips to Limit Your Risk of Contracting The Most Deadly Diseases

August 22, 2017General Health and Wellness, Health Prevention844-SMA-TALK, Asthma, Behind the Curtain, Cancer, Cardiovascular disease, Chronic bronchitis, Conditions and Diseases, Diabetes, emphysema, Heart attacks, MVA, MVC, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, Strokes, There are 72 Hours in a DayJeffrey Sterling, MD

It is interesting and, even more, curious to hear everyone obsess over how esoteric and rare conditions can potentially kill you. Word to the wise: Common things happen commonly. I’m going to make this a very simple post (with links to previous Straight, No Chaser posts covering the individual topics in greater detail). Let’s help you extend your life expectancy by offering very simple tips (three to five for each) to prevent and combat the five most common causes of death. This list is by no means comprehensive, but if you follow the achievable steps mentioned, you’ll be much better off than if you don’t.

According to the Center for Disease Control and Prevention (CDC), here are the five most common causes of death in the United States for the year ending 2010. (It takes awhile to compile data, but these are basically the leading causes year after year.) I’ve also included the number of annual deaths per condition.

Heart disease (e.g., heart attack): 597,689
Cancer (all cases): 574,743
Chronic lower respiratory diseases (e.g., asthma, COPD, emphysema, chronic bronchitis): 138,080
Stroke (cerebrovascular diseases): 129,476
Accidents (unintentional injuries): 120,859

Heart disease – Click here to learn early recognition of heart attacks.

Stop smoking and exposing yourself to second-hand smoke.
Exercise daily. Walk at least two miles each day. It’s a final common denomination of other problems and is a major contributor to cardiovascular disease. You want your LDL (“bad cholesterol” levels) low and your HDL (“good cholesterol” levels) high. If your LDL and/or overall levels are high, it’s an immediate prompt to reduce your belly, change your diet and exercise more.
Limit your calories. Never supersize anything. Eat only until you’re full. Learn about healthy plate sizes.

Cancer – Cancer warrants a special comment to get screened! Early detection is the key to survival!

Don’t use tobacco in any form.
Eat more fruits and vegetables and less red meat.
Become physically active: strive for at least 30 minutes of moderate to vigorous activity at least five days a week.
Limit sun exposure and avoid tanning. (Skin cancer is the most common of all cancers.)
Limit alcohol intake to one to two drinks/day (women and men, respectively).

Chronic lower respiratory diseases

Stop smoking and exposing yourself to second-hand smoke.
Get your home tested for radon.
Follow workplace guidelines for workplace exposures to particles known to cause cancer.

Stroke – Learn early detection.

Control your blood pressure. This is the most important risk factor in stroke prevention. High blood pressure increases your risk for a stroke four-fold.
Control your blood sugar levels. Diabetics have a 1.5 times higher risk of stroke.
Control your cholesterol.
Stop smoking. Smoking increases your risk for a stroke between 1.5-2.5 times above the risk of non-smokers.
Control your weight through diet and exercise, which is bundled in each of the first three considerations.

Accidents

Learn CPR.
Wear safety belts (shoulder and lap) every trip. Seat belts reduce auto crashes by approximately 50%.
Stop all distracted driving (drinking, cell phone use, eating, etc.).
If you’re going to swim, and even if you know how to swim, take a formal lesson that focuses on life-saving maneuvers.
Install smoke and carbon monoxide detectors in your home.

There is no fountain of youth. Your cure won’t be found in a bottle, a fad or any other quick fix. It really is about diet, exercise and risk management. The choices you make matter. Remember, although these tips were focused on prevention, early detection and treatment at the time of crisis give you the best chance to survive. Learn early detection of heart attacks and strokes, learn CPR, get screened for cancer and learn how to survive car crashes. It’s not that hard.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: When Fainting is Deadly

July 31, 2017Cardiology/Heart, Neurology844-SMA-TALK, anemia, arrhythmia, Behind the Curtain, Conditions and Diseases, fainting, Hypoglycemia, panic attacks, seizures, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, vasovagal syncopeJeffrey Sterling, MD

1. So can faints be deadly?

Potentially. There are three separate sets of considerations. The brain can’t survive very long without adequate oxygen. Whatever caused that faint, if it continues to deny oxygen to the brain, can lead to seizures, strokes and death. The process that caused the faint could be deadly in and of itself. Such things would include heart attacks, strokes, seizures due to bleeding inside the brain. Significant injuries may occur after the faint. Someone who falls may subsequently suffer a head or neck injury, which could be deadly, independent of the cause of the faint. It’s worth mentioning that it’s an especially odd behavior that people seem to travel to the bathroom when they feel dizzy. All things considered, it’s better to faint in your soft bed or surrounding carpeted floor than on the hard tile of a typical bathroom with even harder sinks, toilets and tubs in close proximity.
2. My doctor always warns me about high blood sugars. You mentioned low blood sugars as a cause of faints. Am I putting myself in danger if I’m taking sugar and my sugar level is already high?
If you know all of that, yes. More often, you know none of that. Here’s the deal. Both a high and low glucose (blood sugar) count can cause altered mental status, fainting and coma. If your glucose level is especially high, say 900, and you drink some orange juice, it won’t make much of a difference. If your glucose level is 0, and you are given some orange juice, your life just got saved. In other words, it’s medically worth the risk if you don’t know what the glucose level is.
3. Can a loved one really take my breath away?
Yes. Overstimulation can lead to syncope in a variety of ways as mentioned previously.
4. What’s with the goats?
If you’re referring to Tennessee fainting goats, they exist. The goats don’t actually faint. When startled, they become stiff to the point of being unable to move their legs. Subsequently, the terrified goats can’t run and just topple over. Here you go.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer 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 new 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.72hourslife.com. Receive introductory pricing with orders!
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: You’re Way Too Comfortable With Fainting

July 30, 2017Cardiology/Heart, Neurology844-SMA-TALK, anemia, arrhythmia, Behind the Curtain, Conditions and Diseases, fainting, Hypoglycemia, panic attacks, seizures, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, vasovagal syncopeJeffrey Sterling, MD

Don’t faints seem mysterious? It’s as if your computer crashed and had to reboot. Although we never seemingly figure out why computers are so crazy, fainting (syncope) is reducible to a common denominator: something causes a decrease in blood flow to your brain. Recall that oxygen and other needed nutrients are carried in blood, so even a temporary stoppage or shortage of blood flow shuts things down. Now extrapolate that to strokes and comas, which are often due to serious and prolonged causes of blockage to the blood vessels supplying the brain. This is a prime example of why good blood flow and good health are so important. The brain is a highly efficient, oxygen and energy-guzzling organ. Shut it down for even a few seconds, and bad things start to happen. Consider fainting a warning sign.

I’m going to start by offering some Quick Tips to help if you find yourself around someone who has fainted. Then, I will get into the weeds of why these things happen for those interested. I’m doing this so you can check these and determine where your risks may be.

Call 911. Make sure the person is still breathing and has a pulse. If not, start CPR.
Loosen clothing, especially around the neck.
Elevate the legs above the level of the chest.
If the fainter vomited, turn him/her to the side to help avoid choking and food going down the airway (aspiration).
A diabetic may have been given instructions to eat or drink something if s/he feels as if s/he is going to faint. If you know this, a faint would be a good time to administer any glucose gel or supplies advised by a physician. Prompt treatment of low blood sugar reactions is a life-saver. Discuss and coordinate how you can perform this effort on behalf of your friends and family with their physicians.
If it’s possible that the faint is part of some heat emergency (heat exhaustion or heat stroke).

Actually, faints are caused by all kinds of medical problems. I list a few notable causes below, but whether the front end difficulty is with the heart pumping, the nerves conducting, or the content of oxygen or energy being delivered, the end result is the same.

Decreased nerve tone (vasovagal syncope): This is the most common cause of faints, and contrary to what you might think, it happens more often in kids and young adults than in the elderly. Understand that your nerves actually regulate blood flow (analogous to a train conductor telling the heart to speed up or pump harder or not). Changes in nerve tone can result in errant signals being sent, transiently resulting in low flow.
Diseases and conditions that affect the nervous system and/or ability to regulate blood pressure: Alcoholism, dehydration, diabetes and malnutrition are conditions that may depress the nervous system. Alternatively, coughing, having a bowel movement (especially if straining) and urination may abnormally stimulate the system. In the elderly and those bedridden, simply standing can cause fainting due to difficulty regulating blood pressure. In this case, standing causes a sharp drop in blood pressure.
Anemia: A deficiency in blood cells can lead to a deficiency in oxygen delivery to the brain.
Arrhythmias (irregular heart beats): Inefficiency in your heartbeat leads to unstable delivery of blood to the brain.
Low blood sugar (hypoglycemia): Low energy states can deplete the body of what it needs to operate effectively, leading to low blood flow.
Medications (especially those treating high blood pressure): anything that lowers the heart’s ability to vigorously pump blood around the body can leave the brain inadequately supplied, leading to a blackout. Let’s include illicit drugs and alcohol in this category.
Panic attacks: Hyperventilation caused by anxiety and panic upset the balance between oxygen and carbon dioxide in the brain, which can lead to fainting spells.
Seizures: Here’s a chicken and egg scenario. A prolonged faint can lead to a seizure, and seizures lead to periods of unconsciousness, during and after the seizure. The lack of oxygen is a common denominator.

Straight, No Chaser: Sealed with a (Wrong Type of) Kiss – Zoonotic Diseases

July 29, 2017General Health and Wellness, Infectious Disease, Public Health, Health Prevention844-SMA-TALK, anthrax, Behind the Curtain, Conditions and Diseases, dengue, E. coli, ebola, lyme disease, malaria, plague, Rabies, Rocky Mountain Spotted Fever, salmonela, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, toxoplasmosis, west nile virus, zoonosisJeffrey Sterling, MD

It’s interesting how we take animals for granted. Many of us touch and handle them, play with them. Some people keep their pets in their faces, allowing them to kiss and lick them. Do you ever think about where they’ve been and whether they are ill and contagious? Would you be surprised if I told you that approximately 60% of the bacteria, viruses and other microorganisms that cause human disease originates from animals?

That’s right. There are many diseases that animals have that can be transmitted to humans. These groups of diseases are called zoonoses. It’s at least worth giving it some thought; many of these diseases don’t even require direct contact with the affected animal. Even more concerning is the fact that about 75% of newly emergent infectious diseases affecting humans are of animal origin.
We spend a lot of time in places where infected animals and insects may exist. Besides exposures in relatively exotic areas such as farms, woods, nature parks and petting zoos, simpler environments such as pet stores, fairs, schools and childcare facilities may also prove to be risky.

Many different types of animals pose these risks, including rodents, amphibians, live poultry, reptiles, insects and an assortment of domestic and wild animals. Here are a few examples (but not an exhaustive list) of how disease may spread that have been particularly common in the news of late.

Many animals carry rabies, including bats, raccoons, foxes, skunks, wolves, coyotes, cattle, monkeys, mongooses and dogs.
Reptiles such as turtles, iguanas and snakes can transmit Salmonella, a prominent cause of food poisoning.
Handling your cat’s kitty litter (or otherwise handling stool) can transmit toxoplasmosis, an infection that can be deadly to those with weakened immune systems or to unborn children.
West Nile has been in the news every year this millennium, causing over 1.5 million infections in humans since 1999.
Deer and deer mice carry ticks that can lead to Lyme disease, a bacterial infection involving a rash, fever, chills, body aches and possible arthritis, neurological and cardiac disorders.
Other common infections caused by these exposures include anthrax, dengue, Ebola hemorrhagic fever, E. coli infection, malaria, Plague and Rocky Mountain spotted fever.

If you’re a good pet owner (and otherwise healthy), you shouldn’t have to worry about this much. Simple steps such as keeping your pets’ shots up to date, keeping their play areas clean, avoiding direct contact with wildlife and maintaining basic hygiene measures such as hand washing after contact sufficiently lowers your risk. Here are a few additional tips:

Keep tabs on your kids to ensure they wash their hands properly and avoid thumb-sucking, eating and pacifier use after animal contact and before cleaning up.
Use insect repellents that contain 20% or more DEET on the exposed skin and be generous with it when in risky areas.
Use products that contain repellents (such as permethrin) on your clothing and gear, such as boots, pants, socks and tents.
Look for and remove ticks from your and your children’s bodies.
Limit mosquito breeding grounds around your home by getting rid of items that hold still water.

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