Tag Archives: Conditions and Diseases

Straight, No Chaser: Avoiding Mosquito-Bourne Diseases

July 27, 2017Infectious Disease, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, dengue fever, japanese b encephalitis, malaria, mosquito, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, west nile virus, yellow feverJeffrey Sterling, MD

Sometimes things occur so frequently that you become sensitized to the real danger they present. This thought occurred to me when I saw Bill Gates talking about efforts to eliminate the various threats posed by mosquitoes. Yes, mosquitoes.

Including the damage humans inflict on each other during times of war, mosquitoes are responsible for more human suffering than any other organism on earth. Well over one million humans die every year from diseases transmitted by mosquitoes, and with worldwide travel having increased as it has, the risk is greater than ever. Even if you don’t know the diseases caused by mosquitos, you may have heard of them.

Malaria

West Nile virus

Dengue fever

Yellow fever

Japanese B encephalitis

Getting into the specifics of these various diseases is beyond the scope of this particular post. What I’d like for you to appreciate is this list comprises various diseases with deadly consequences.
Furthermore, you’re not defenseless. There are steps you can take to lessen your risks. In the interest in making this manageable, I’m going to focus on the “Ds of mosquito prevention”, because as is the case with most things, prevention is more effective than attempting to cure a disease once it is obtained.

Dusk and Dawn: Try to steer your activity away from the times when mosquitoes are most active.
Drain: Get rid of standing water around your home. This is where mosquitoes will lay eggs.
Dress: During those times when mosquitoes are most active, wear clothing that covers as much of your skin as practical.
DEET: Use mosquito repellent. Repellents containing up to 30% DEET are effective. Additionally, picaridin, oil of lemon eucalyptus and IR3535 are effective, according to the Center for Disease Control and Prevention (CDC).

Here are a few other simple tips.

Cover doors and windows with screens to keep mosquitoes from entering your home.
Keep infants indoors or use mosquito netting over carriers.
If you have a water garden, stock it with mosquito-eating fish, such as gambusia, goldfish, guppies or minnows.
If you’re traveling, be aware of peak exposure times and places, and schedule around these times if possible. Avoid outbreaks.

Being just a bit more sensitive to the risks mosquitoes pose could be an important component of your overall health strategy. Be smart, and be healthy.

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: Stop, The Life You Save May Be Your Own – Snake Bites

July 25, 2017General Health and Wellness844-SMA-TALK, Antivenom, Behind the Curtain, Conditions and Diseases, health, health care provider, postaday, Rattlesnake, Snake, snake bit, snake bites, Snakebite, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, triangular heads, Venomous snake, Wound, wound cleaningJeffrey Sterling, MD

So you’ve been snake bitten. What will you do next?
First things first. Stay calm. Call 911. Realize that most snake bites are non-venomous (A really quick tip regarding the likelihood of a venomous snake: most have triangular heads.). Here’s 10 additional steps to take while waiting for your help to arrive.
5 Things To Do

Protect yourself. Get out of the snake’s striking distance. It should be trying to get away from you as well.
Lie down. Keep the wound below the level of the heart.
Be still. Activity simply facilitates spreading of any venom present.
Cover the wound with a loose, clean dressing. Immobilize the extremity if possible.
Remove all restrictive clothing and jewelry from the area, because the area will swell.

5 Things Not to Do

Try to suck out venom.
Try to cut out the area bitten.
Apply any constrictive dressings.
Apply any cold or ice packs to the wound site.
Run to help.

If you’re lucky enough to have a snake bite kit, you’ll simply follow those instructions, which are a modified version of the instructions I’ve just given.
You will need to be seen by a health care provider for consideration of the following:

Anti-venom may be needed.
Tetanus immunization may be needed.
Appropriate wound cleaning will be needed.
Antibiotics for skin infection may be needed.

Straight, No Chaser: Your Questions About Human Bites

July 23, 2017Infectious Disease, Medical Treatment, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Bite, Bite marks, Bites and Stings, Boxer's fracture, cat bite, Conditions and Diseases, Dracula, health, human bite, Infection, laceration repair, metacarpal bone, pinky finger, puncture wound, Snake bite, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Wound, Wounds and InjuriesJeffrey Sterling, MD

A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5^th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.

3) Is a human’s mouth really dirtier than a goat’s mouth?

It’s correct to say the bacteria in a human’s mouth cause more disease.

4) Is a bite the same as a puncture wound

The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).

5) I received a bite and didn’t get stitched up. Why?

This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.

6) Why didn’t Dracula ever get Hepatitis or HIV?

Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for a while in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.

Straight, No Chaser: Human Bites

July 22, 2017Infectious Disease, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Bite, Bites and Stings, Biting, Cellulitis, Conditions and Diseases, Hangnails, health, human bite, Infection, Mike Tyson, Open wound, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Tetanus shot, There are 72 Hours in a Day, Wound, Wounds and InjuriesJeffrey Sterling, MD

I have had weird experiences with humans biting humans, as have most physicians. There are several different types of human bites, which can range from harmless to surgically serious. However, as an emergency physician, knowing the dangers of the bacteria inhabiting your mouth, I tend to assume the worst until proven otherwise. Your first quick tip is to do the same.

Maybe it’s where I’m located, but I tend to see way more “fight bites” than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who “won” the fight being the one who has to come in for medical treatment. He cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize, the structures in the hand (tendons, blood vessels, muscles, and bones) are highly concentrated. He also doesn’t know that they are confined to a very limited space and seeding an infection in that tight space makes things really bad really quick. This guy is very dangerous because he tends to deny ever getting into the fight, ascribing the injury to something else (like punching a tree)—at least until I ask him why a tooth is inside his hand.

Then there’s the “Yes, he bit me” variety, where the teeth were the aggressor that engaged the victim instead of the fist engaging the tooth. Think of the Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears, and other unmentionables)! Children, as another example, sometimes bite and need to learn to stop that behavior. Biting is sometimes seen in sexual assault, physical abuse, self-mutilation, or with mentally handicapped individuals.

A third type is the ‘We love too much!’ variety of bites. These may include hickeys that actually break the skin. Other examples of “friendly” bites are folks biting off their hangnails, fingernails, and toenails and create skin infections. Yes, it happens more than you’d think, and no, you don’t have to be a vampire.
The commonality to all of these scenarios is saliva that found its way through the skin. Because of the virulence of the bacteria contained within the saliva, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness, fever, and possible pus from the wound develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, get evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop. In fact, these bites require immunization for tetanus.
Bottom line: There’s no reason not to get evaluated if you develop those signs of infection, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.

So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies like peroxide, alcohol, and anything else that burns. Those agents make things worse by damaging the skin more than they “clean” the area.
2) Apply ice—never directly to the wound—but in a towel. Use for 15 minutes on and then 15 minutes off.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
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: Amnesia and Severe Memory Loss

July 15, 2017General Health and Wellness, Geriatrics/Elderly Care, Mental Health, Neurology844-SMA-TALK, amnesia, Conditions and Diseases, memory loss, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey 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.
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 Gunshots and Stab Wounds

June 30, 2017Trauma844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Gunshots, Stab wounds, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

There has been a lot going on the news this entire year related to trauma, particularly gunshot wounds. This Straight, No Chaser answers your questions related to penetrating injuries from bullets and stabs.

Your Top Five Questions

1. Why don’t we remove the bullets every time?

Removing bullets may cause more damage than leaving them in the body. Sometimes it’s not worth the effort.
2. What’s with the tubes that go in the chest?

Chest tubes are used to treat a pneumothorax (a collapsed lung). The problem is there’s air in the space between the lung and the chest wall. This can interfere with normal breathing and may be life threatening. The tubes go through the chest wall to release the air from that space, thus allowing re-expansion of the lungs.
3. Why would doctors ever need to slit someone’s throat to save his or her life?

That describes either a cricothyrotomy or a tracheostomy, and it’s not “slitting” the throat as much as it is creating an opening in the airway to permit airflow. This is usually necessary because of some airway obstruction at the upper throat (foreign body in the throat, etc.) with an inability to clear it. This procedure is only done to save a life.
4. Why would you die from a wound to the thigh?
Fractures of certain bones and laceration of certain blood vessels might cause so much blood loss that you could bleed to death. Infection and blood clots are additional considerations that could be life-threatening. We’ll spare you the pictures.
5. What about gunshot or stab wounds to someone pregnant?
Penetrating trauma to the abdomen is typically less fatal to the mother than to a fetus because the fetus is literally acting as a shield. In the event any wound has placed the mother’s life at risk or the mother has died from the wound, under certain extreme circumstances, an emergency C-section may be performed to save the baby.
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: Electrical Injuries and Lightning Strikes

June 25, 2017General Health and Wellness, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, electrical injury, lightning strikes, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

As I watch lightning lighting up the sky, it makes me wonder if anyone out there is unlucky enough to be getting struck. The annual probability of being struck by lightning is approximately 1 in 280,000, which is a lot more frequent than makes me comfortable. Today’s Straight, No Chaser addresses concerns and frequently asked questions on electrical injuries.
Why is getting shocked a big deal?
The human body conducts electricity very well, meaning when an external current is attached to us, it runs through the body with ease. This provides a lot of opportunity to cause damage. That damage in the wrong place can kill.
How does getting shocked cause damage?
There are three different paths by which electrical current (“getting shocked”) can cause damage.

On the way in and out, electrical current is likely to cause burns to the skin (thermal burns, aka entry and exit wounds).
An electrical current can cause destruction to several tissues, including muscles and nerves.
As electrical currents reach the heart, they can be disruptive to the heart’s electrical current, even causing it to stop.

What are some common causes of electrical injuries?
The dangers are all around you and in many instances occur because you don’t respect the power and danger of the electricity you use.

If you have a job involving machinery or working with electricity, you can’t afford to get comfortable, because that’s when mistakes and injuries occur.

If you have electrical outlets that aren’t childproofed, then it stands to reason that eventually someone might place a metal object into that outlet, receiving a shock – or worse.

If you have electrical appliances with worn, frayed and exposed wiring and you come in contact with the wire while it’s plugged in, you will be shocked.

You live near a high-voltage power line? Beware of flashing electric arcs, which are looking for somewhere to land.

Thunder and lightning outside? Don’t be the golfer or other nature-lover wielding metal or otherwise unnecessarily exposing yourself to a rather large bolt. When you hear the thunder, the lightning is closer than you may think, relatively speaking.

What are the types of injuries I may receive?
Symptoms related to electrical injuries are numerous and varied. Here are a few examples.

Burns are common. The skin is likely to be pierced and burned on the way in and on the way out, producing “exit wounds” from the burn. Additionally, your sweat can be converted to steam and produce burns that way. Children who bite something with an active electrical current can receive a burn to the lip and experience delayed yet significant bleeding from the lip.

The parts of the body that rely heavily on electric current are likely to be involved and damaged. This means you may experience the symptoms of a heart attack, an irregular heartbeat, numbness and tingling in your arms or legs from nerve damage or abnormal contractions of your muscles, which you’ll perceive as spasms and pain.
Similar effects on the brain may produce seizures and/or altered mental status.
The blast caused by an electrical injury can rupture a lung or your eardrums. Lung failure, shortness of breath and difficulty hearing may result.
The jolt caused by an electrical injury can sufficiently throw you such that secondary injuries can occur, including broken bones.
Combinations of the above mechanisms can produce additional symptoms such as headache, visual disturbances and problems swallowing.
Death may occur. Fortunately, even with the “ultimate” electrical injury (a lightning strike), 90% of victims still survive.

A separate Straight, No Chaser will address treatment and prevention considerations related to electrical injuries. In the meantime, look before you get shocked.

Straight, No Chaser: Straight Talk About Vasectomies

June 24, 2017Genital/Urinary844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, Vas deferens, VasectomyJeffrey Sterling, MD

A couple’s conversation about having a vasectomy can either be a tense one or it can be a display of trust and cohesion. The decision by a man to have a vasectomy can be a soul-searching “moment of truth.” In this Straight, No Chaser, let’s look at seven of the issues surrounding vasectomies. At the end there’s an illustration of the procedure. Yes, it involves a clip.
A vasectomy is a surgical procedure that involves cutting the tube (the vas deferens) that carries sperm from the scrotum to the testes. The vasectomy prevents sperm from leaving the testes so that the man can’t impregnate a woman.

Issue 1: Why would you want it?
The answer to this is relatively straightforward. You’d want a vasectomy if you don’t want any, or any more, children. This is a form of sterilization.
Issue 2: When would it be a good option?
If you’re in a relationship and both partners agree that you’ve either had all the children you want or don’t want the risk of having any children, a vasectomy would be a reasonable option. Other considerations may include if you can’t use other forms of birth control, if pregnancy would be medically unsafe, or if the risk of genetic disease or a birth defect in your offspring is greater than you’re willing to accept.
Issue 3: When wouldn’t it be a good option?
This gets a little dicey and relates to levels of instability, either in your relationship or other personal situations. A decision to have a vasectomy to please your partner or salvage a relationship may not be the best choice. If you’re young or unmarried, you are subject to many life changes that may prompt reevaluating whether you really want a child. For example, if you marry/remarry, children may become more important than they currently are. A vasectomy is a surgical procedure with risks. A decision to have it done as a convenience (e.g., because you are unreliable or don’t want to use other forms of birth control) is irresponsible.
Issue 4: How successful is the procedure?
Vasectomies are very successful and have a failure rate of approximately 1 in 2,000. Comparatively speaking, the analogous procedure in females (tubal ligation) has a failure rate of 1 in 200-300. Typical failure rates are due to having sex too soon after the procedure. It takes time for existing sperm to be cleared from both ends of the vas deferens; that existing sperm can still impregnate a woman. This is a major reason why men should wait a week after the surgery and until the sperm count has been documented to be zero in the seminal fluid. To a much lesser extent, rare spontaneous reconnection of the clipped portions of the vas deferens may produce failures.
Issue 5: What complications exist?
Vasectomies are generally very safe, and the complications associated with it are those seen with any surgery. These include pain, swelling and infection. Remember, as we just discussed, the circumstances under which post-vasectomy pregnancies can occur.
Issue 6: What happens should I choose to have it reversed?
It is important for men considering a vasectomy to read and fully understand the next sentence. If you have a vasectomy, you should not consider it reversible. That said, you can spend a lot of money for a microsurgical reversal procedure that is successful about 50% of the time if done within 10 years of the vasectomy and approximately 25% of the time if done after 10 years. Be advised that such reversals are associated with a higher level of birth defects.
Issue 7: About what other considerations should I be concerned?

Men seemingly are most often concerned about post-vasectomy ability to have an erection or orgasm. Vasectomies do not diminish a man’s ability to have either.
You should be concerned about the spread of sexually transmitted infections (STIs), which a vasectomy does not prevent. A false sense of confidence may exist after a vasectomy knowing that pregnancy is extremely unlikely, but that has nothing to do with STIs. In fact the greater inclination to have unprotected sex after a vasectomy may put men at greater risk for transmitting or receiving STIs.
Vasectomies do not increase the risk of testicular or prostate cancer.

Most men are satisfied with vasectomies, because most men who have vasectomies do so in the context of a stable and healthy relationship. Men who are most likely to seek reversals do so in the context of unexpected life events (e.g., new partner/marriage with a desire for kids). Sometimes their reconsideration is in response to a tragedy. If you are considering a vasectomy, please only do so after a solemn view of the rest of your life. If you believe it to be stable, you will likely be satisfied with the outcome.
The following clip (click the link) is courtesy of the National Institutes of Health and demonstrates the logistics of the various approaches to the procedure. Feel free to leave any comments or ask any questions you may have.
Vasectomy
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: Erectile Dysfunction, Part Two – Causes

June 22, 2017General Health and Wellness, Genital/UrinaryBehind the Curtain, Conditions and Diseases, Erectile dysfunction, health, Hypercholesterolemia, Men's Health, Substance abuse, There are 72 Hours in a Day, Western pattern dietJeffrey Sterling, MD

In my last post on erectile dysfunction (ED), I gave a simplistic way to understand and address it. However, the truth of the matter is the overwhelming majority of cases of ED are not related to stress or other psychological issues. First, some sense of ‘reasonable’, expected performance should be established, especially as one ages (as discussed here). Beyond that, you should know that approximately 90% of ED cases involve an underlying medical concern, including, but not limited to, the following:

Diabetes

High blood pressure

Changes/disease to your blood vessels

Low testosterone

Kidney disease

Smoking

Alcohol and Drug abuse

Obesity and High cholesterol

Effects of your medications

Therefore, today’s message is simple and brief, but I’d suggest it’s probably more important than you have previously thought. You should consult your physician if and when you or your partner’s sexual performance becomes an issue. You may actually discover something that will not only save his performance, but his life.
Finally, in the next post we will review the wide variety of treatment options for ED.
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: Erectile Dysfunction, Part One

June 21, 2017General Health and Wellness, Genital/UrinaryBehind the Curtain, Conditions and Diseases, Erectile dysfunction, Erection, health, Heart disease, Impotence, Men's Health, There are 72 Hours in a Day, Western pattern dietJeffrey Sterling, MD

It seems appropriate to follow-up a post on age-related changes in your genitourinary system with a discussion on erectile dysfunction (ED). The nature of the topic is such that I’m going to approach this in two different ways. Today, I’ll give you a functional, overly simplistic view of ED and tomorrow, I’ll look at it from more of a clinical orientation, because there really are nuances involved. So keep in mind the lead picture. There are many medical and psychological issues that can lead to problems having erections. I’ll get into that more tomorrow.
In many ways, your health is related to the quality of your blood flow, both in quantity (successful circulation to tissues) and quality (relative absence of toxins we ingest and deliver throughout). This is true for the brain (mental health, absence of strokes), the heart (stamina, absence of heart disease/attacks), and your penis (sexual function, lack of impotence), as well as every other organ.

Excluding truly medical considerations, the two surest ways I know to be a sexual stud (without implants or being of a certain age) are to have a legitimately healthy ego (psychologic health) and more importantly, to be in good physical shape and otherwise healthy. However, for now, given that an erection simply results from strong blood flow to the penis, your overall health better enables that process (the first time as well as if you want multiple contiguous encounters). Everything being equal, the best way for a guy to be able to have sex for whatever you define as a ‘sufficient’ period of time (besides being of a certain young age) is to maintain good cardiovascular health by spending that physician-recommended 20-30″ or more at a time on a treadmill, bike, running, etc.

Drugs like Viagra, Cialis, etc. are really nothing more than drugs that lower blood pressure (and resulting demands by other bodily organs on your blood), such that your penis’ call for an erection is otherwise unimpeded. Sounds good? The risk is varying forms of a ‘steal syndrome’, where that blood isn’t being distributed to your heart and brain, which could result in a heart attack or stroke. That’s why you must “ask your doctor if you’re healthy enough for sex” before using…
Bottom line: practice for good sex and stamina during sex by working out. It’s just another benefit to being healthy.
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 Jaw Pain Could Be a Heart Attack

June 12, 2017Cardiology/Heart, Head/Eyes/Ears/Nose/Throat, Dental844-SMA-TALK, Acute coronary syndrome, Conditions and Diseases, heart attack, jaw pain, Myocardial infarction, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, temporomandibular joint syndrome, There are 72 Hours in a Day, TMJJeffrey Sterling, MD

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

If exertion exacerbates the pain, this makes the heart more likely as a cause.
If rest does not relieve the discomfort, this makes the heart more likely as a cause.
Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain.

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
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: Broken Noses (Nasal Fractures)

June 9, 2017Head/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, There are 72 Hours in a Day, 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!
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: Heat Illnesses Awareness (Heat Exhaustion, Heat Cramps, Heat Stroke)

May 25, 2017Endocrine/Metabolic, Neurology, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, heat cramps, heat exhaustion, Heat illness, heat stroke, LeBron James, rehydration, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Heat Awareness Day occurs the last Friday in May instead of the first weekend in July because prevention is better than cure. Once the rains calm down across America, it’s predictable what will happen next: heat, more heat and all heat, and you’d better be ready. The way things work, we just have to deal with it. Unlike when the weather is cold, and you can just add layers, when it’s extremely hot, it seems unescapable. So we sweat, get fatigued and even cramp up. Surprisingly there appears not to be much thought given to the notion that heat cramps are an early sign of a life threatening condition, even though many of us have had loved ones die 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 special 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.
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: Bacterial Vaginosis – No, That’s Not a STD

May 3, 2017Genital/Urinary, Obstetrics and GynecologyBacteria, Bacterial vaginosis, Behind the Curtain, Centers for Disease Control and Prevention, Conditions and Diseases, health, Human sexual activity, Infection, Microorganism, PH, Sexual partner, Sexuality, Sexually transmitted disease, There are 72 Hours in a Day, Vagina, Vaginitis, Women's HealthJeffrey Sterling, MD

I try to give you straight talk but never crudely. As I’ve discussed conditions involving the genitalia, I’ve been mindful of the reality that large numbers of you have been affected by sexual transmitted diseases/infections (aka STDs/STIs), and I will always be respectful of that consideration. That doesn’t mean I’m sugar-coating your information, it just means I am aware that you’re suffering and concerned by different scenarios.

One of those is bacterial vaginosis. There is an age after which women invariably start discovering that various things they do can disrupt the appearance, smell and content of their vaginal fluid. It’s certainly human nature to wonder if something has gone terribly wrong. Let’s pick up our Doctor-Couple conversation from earlier…
Patient: Yep! I have this grayish/whitish discharge that only happens after sex. And sometimes it itches around there. And it burns when I pee! No rashes or that other stuff, though.
Doctor: Ok. Let’s examine you…

All humans have various microorganisms that normally reside inside us at relatively low levels; different microorganisms inhabit different part of the body. They’ve set up a delicate balance (like an ecosystem, if you will) that, once settled doesn’t disturb us (their hosts) at all. If external or internal circumstances disturb that balance such that one set of organisms is disproportionately affected, overgrowth of the other organisms may occur. Many of you will recognize this as happening when you get a ‘yeast’ infection. It’s also what occurs when you develop bacterial vaginosis (BV). BV is the most common vaginal infection in the U.S. It’s more likely to be seen when you start having unprotected sex with a new partner, have multiple sex partners, are pregnant or douche (therefore, women who are not sexually active can have BV also). By the way, you don’t get BV from toilet seats or swimming pools.

The question everyone always has is “What’s the role of sex, especially sperm, in it?”. That’s asked because BV is often noticed after unprotected sex that includes ejaculation. Here’s where you learn the difference between ‘sexually transmitted’ and ‘sexually associated’. It is unclear what role sex has in the development of BV, but common thoughts include alterations in the pH of the vaginal fluid based on interactions with sperm/semen. It is known that the pH of women become more alkaline (less acidic) after exposure to semen, and that environment produces compounds causing the ‘fishy smell’. Yes, that’s real. We even have a real thing call a ‘whiff test’ as part of making the diagnosis.
The good news is BV is easily treated. The bad news is it needs to be treated, and it can recur even if it’s treated. Remember, it’s just an overgrowth syndrome. There are complications to not getting BV treated, especially if you’re pregnant. This makes it especially important that medication be taken to completion, even though you may feel better prior to that. Male partners do not need to be treated.
So this couple gets ‘off the hook’, even though they may decide to start using condoms. Next we will focus on the risks of various sexual activities. Stay tuned.
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: STDs – Syphilis, The Great Mimicker

April 30, 2017General Health and WellnessBehind the Curtain, Conditions and Diseases, Disease, health, Infection, Men who have sex with men, MSM, Rash, Reproductive Health, Sexually transmitted disease, Symptom, Syphilis, There are 72 Hours in a Day, TuskegeeJeffrey Sterling, MD

Today, Straight, No Chaser will present two phrases that you may not have previously heard: The Great Mimicker and MSM, and that means we’re discussing what has historically been a devastating disease: syphilis. Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease between the Americas and Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.

Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…

Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.

Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The microorganism causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
Prevention and Treatment Considerations: Advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. Remember that treating syphilis at any point can prevent the most severe complications that lead to death.
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: Healthcare Disparities

April 23, 2017General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, colorectal cancer, Conditions and Diseases, death rates, Diabetes, healthcare disparities, HIV, Hypertension, immunizations, infant mortality, Influenza, life expectancy, Obesity, periodontitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

In large part, this blog exists to inform individuals of all backgrounds about the risks that lead to abnormal health outcomes. Our hope is that once you discover the risks, you’ll be sufficiently equipped and incentivized to take the simple steps provided to improve your health.
Disparities are abnormal outcomes of a different variety. Disparities in healthcare lead to premature development of disease and death. The culprits are often insufficient access to care, culture barriers, habits and even discriminatory practices. It is critical for all involved, i.e., individuals, healthcare planners and practitioners, to understand these causes so that everyone can adjust habits and apply resources to combat this health hazard affecting both individuals and communities.
For the last 25 years of my career, I’ve had the unfortunate privilege of addressing this topic in national forums, including before the National Urban League, before the National Medical Association, recently, in the NAACP’s The Crisis magazine and in Straight, No Chaser to extent that our service provides you with the information that can make a difference in your lives. Unfortunately for some, it’s almost never that easy.

As a statement of fact, according to the Center for Disease Control and Prevention (CDC) Health Disparities & Inequalities Report  of 2013, African-Americans suffer global health disparities that result in the following outcomes.

Life expectancy: In 2011, the average American could expect to live 78.7 years. The average African-American could only expect to live 75.3 years, compared with 78.8 years for the average White American.
Death rates: In 2009, African-Americans had the highest death rates from homicide among all racial and ethnic populations. Rates among African-American males were the highest for males across all age groups.
Infant mortality rates: In 2008, infants of African-American women had the highest death rate among American infants with a rate more than twice as high as infants of white women.

The following disparities were also reported:

Heart disease and stroke: In 2009, African-Americans had the largest death rates from heart disease and stroke compared with other racial and ethnic populations, with disparities across all age groups younger than 85 years of age.
High blood pressure: From 2007-2010, the prevalence of hypertension was among adults aged 65 years and older, African-American adults, US-born adults, adults with less than a college education, adults who received public health insurance (18-64 years old) and those with diabetes, obesity or a disability compared with their counterparts. The percentages of African-Americans and Hispanics who had control of high blood pressure were lower compared to white adults.
Obesity: From 2007-2010, the prevalence of obesity among adults was highest among African-American women compared with white and Mexican American women and men. Obesity prevalence among African-American adults was the largest compared to other race ethnicity groups.
Diabetes: In 2010, the prevalence of diabetes among African-American adults was nearly twice as large as that for white adults.
Activity limitations caused by chronic conditions: From 1999-2008, the number of years of expected life free of activity limitations caused by chronic conditions is disproportionately higher for African-American adults than whites.
Periodontitis: In 2009-2010, the prevalence of periodontitis (a form of dental disease) was greatest among African-American and Mexican American adults compared with white adults.
HIV: In 2010, African-American adults had the largest HIV infection rate compared with rates among other racial and ethnic populations. Prescribed HIV treatment among African-American adults living with HIV was less than among white adults.
Access to care: In 2010, Hispanic and African-American adults aged 18-64 years had larger percentages without health insurance compared with white and Asian/Pacific Islander counterparts.
Colorectal cancer: In 2008, African-Americans had the largest incidence and death rates from colorectal cancer of all racial and ethnic populations despite similar colorectal screening rates compared to white adults.
Influenza vaccination: During the 2010-11 influenza season, influenza vaccination coverage was similar for African-American and white children aged six months to 17 years but lower among African-American adults compared with white adults.
Socioeconomic factors: In 2011, similar to other minority adults aged 25 years or older, a larger percentage of African-American adults did not complete high school compared with white adults. A larger percentage of African-American adults also lived below the poverty level and were unemployed (adults aged 18-64 years) compared with white adults of the same age.

Identifying disparities is a good start. However, to reduce them it is necessary to identify and implement solutions, both individually and institutionally. To this end, we will explore best practices in future Straight, No Chaser posts. Feel free to ask any questions you have on this topic.

Straight, No Chaser: The Spectrum and Specter of Autism

April 18, 2017Mental Health, Pediatrics/Kids Health844-SMA-TALK, asperger, autism, autism spectrum disorder, Behind the Curtain, Conditions and Diseases, PDD-NOS, persuasive developmental disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Autism. Small word. Big effects on families. Previously, we discussed the scope and recent explosion of autism diagnoses. Here we delve into the disorders. Autism spectrum disorder (ASD) isn’t a disease as much as it is a range of disorders characterized by neurological effects affecting one’s development. These effects include communication difficulties, social impairments and restricted, repetitive, and stereotyped behavioral patterns. There is a wide variation in the expression of ASD and cases may be mild or severe. ASD occurs in all ethnic, socioeconomic and age groups. You may have seen or heard of variations of ASD, particularly the following:

Autistic disorder (aka autism, classical ASD): This is the most severe form of ASD.
Asperger syndrome: This diagnosis may be given to children with autistic behaviors who retain well-developed language skills.
Childhood disintegrative disorder: Childhood disintegrative disorder is diagnosed in children who had developed normally and then suddenly deteriorated (typically between three to 10 years old), showing marked autistic behaviors.
Pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS): This is a diagnosis given to those children with some symptoms of an ASD but not enough to be diagnosed with classical autism.

Although the cause of ASD is not known, it’s likely that both genetics and environmental factors play a role. Brain abnormalities in those affected suggest that ASD could result from the disruption of normal brain development early in fetal development. This notion is supported by the consistent discovery of defects in genes that control brain growth and that regulate how brain cells communicate with each other. The presence of certain environmental factors can further influence the expression of the function of these genes.
It is important to note the theory that parental practices are responsible for ASD has long been disproved.
Furthermore, twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, there is up to a 90% chance the other twin will be affected. Evidence also suggests that certain emotional disorders (e.g., bipolar disorder) occur more frequently than average in the families of people with ASD.

Regarding symptoms, the hallmark feature of ASD is impaired social interaction, which may be manifested in several ways:

Babies with ASD may focus exclusively on one item for inordinately long periods of time, completely ignoring other people or objects.
A child with ASD may appear to have developed normally, then suddenly withdraw and become indifferent to social activity.
Children with ASD may fail to respond to their names and often avoid eye contact with other people.
Children with ASD often have difficulty interpreting what others are thinking or feeling because they can’t understand social cues (e.g., tone of voice or facial expressions) and don’t watch other people’s faces for clues about appropriate behavior.
Those with an ASD may lack empathy.

Other typical symptoms include the following:

Repetitive movements such as rocking or twirling
Self-abusive behavior such as biting or head-banging
Delayed speech
Speaking in a sing-song voice while limiting speech to a small group of favorite topics
Referring to self by name instead of “I” or “me”
Inability to play interactively with other children
Epilepsy (seizure disorder), seen in approximately 20-30% of children with ASD

Of course, you don’t want to wait long to get a child evaluated. Here is a laundry list of signs that an evaluation is necessary.

no babbling or pointing by age one
no single words by 16 months or two-word phrases by age two
no response to name
loss of language or social skills
poor eye contact
excessive lining up of toys or objects
no smiling or social responsiveness
impaired ability to make friends with peers
impaired ability to initiate or sustain a conversation with others
absence or impairment of imaginative and social play
stereotyped, repetitive, or unusual use of language
restricted patterns of interest that are abnormal in intensity or focus
preoccupation with certain objects or subjects
inflexible adherence to specific routines or rituals

If you have a loved one with suggestive symptoms, please arrange for early evaluation. The team involved will often have to address speed, psychiatric and neurological needs. Screening, early evaluation and treatment across the spectrum of symptoms offers the best opportunity for those affected to approximate a normal 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.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

The Rapid Explosion of Autism Diagnoses – A Good or Bad Thing?

April 17, 2017Mental Health, Pediatrics/Kids Health844-SMA-TALK, autism, Behind the Curtain, CDC, Centers for Disease Control and Prevention, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Introduction

In this post, we discuss autism diagnoses and look and the recent jump in frequency.

The Fear Associated with Autism

Regarding autism, it is a condition that strikes fear into the heart of many, not just because of the condition itself. It’s the lack of knowledge about the condition. It is the uncertainty about whether a newborn child will be affected just because we’re having children at older ages. It’s the possibility that common environmental exposures could be contributing to the increase in the condition.

I’m going to approach this two-part series on autism in reverse order. Instead of simply discussing the basics about autism, I’m going to discuss the recent increases in autism rates. It is very important that you read past the headlines on this. Hopefully you’ll come to a better understanding.

The Uptick in Autism Diagnoses

In March of 2012 (the most recently updated dataset), the Centers for Disease Control and Prevention (CDC) estimated that one of 88 eight-years-olds would have one of the various forms of autism spectrum disorder. Another CDC study that was just released reveals that autism rates now affect one of every 68 eight-year-old children. This is a 30% increase in just two years!

Many of you are aware of some of the controversial claims about possible causes of autism. Regardless of the believability of unproven claims, it is entirely probable that some good has come from shining a spotlight on autism. It is without question that the enhanced attention has resulted in more attention being paid to children with suggestive symptoms. This recent trend in more aggressive diagnoses is resulting in more attention being given to those in need with better outcomes over the long haul.

Is There a Cure?

There is no cure for autism. This may be true and depressing, but it doesn’t have to be. Generally, interventions tend to focus on eliminating symptoms and producing desired outcomes (such as those that will increase independent living and functioning). Coordination of strategies is important, so the use of multiple professionals working as a team is common. The good news is, for many children, symptoms improve with early treatment and with age. Those with one of the forms of autism will usually continue to need services and supports throughout their lives, but many are able to work successfully and live independently or within a supportive environment. Also, please note: The earlier the diagnosis is made and treatment is started, the better one’s outcome is likely to be.

I have just understated a point that I will take a few words to revisit. There is no cure for autism. Please don’t fall prey to claims of therapies and interventions that promise a quick fix. These claims are invariably are not supported by scientific studies. They are acting on your hopes and preying on your fears. The details of treatment strategies are further discussed at www.sterlingmedicaladvice.com.

The next post will focus on the diagnosis and symptoms of autism.

Follow us!

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

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

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

Straight, No Chaser: Irritable Bowel Syndrome

April 16, 2017Gastrointestinal, Mental Health844-SMA-TALK, Behind the Curtain, colitis, Conditions and Diseases, irritable bowel syndrome, nervous colon, spastic bowel, spastic colon, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The irony of the name “irritable bowel syndrome” (IBS) is found in the connection between stress (in some cases, irritability) and symptoms. This can become a vicious cycle. You care about this condition because once you or your loved ones become afflicted, the symptoms involved present an uncomfortable mix of physical and mental discomfort. As you read this Straight, No Chaser, do so with a mind toward overcoming the anxiety associated with and possibly causing symptoms.
What is irritable bowel syndrome (IBS)?
IBS is a gastrointestinal (digestive tract) disorder. The gastrointestinal (GI) tract isn’t damaged but symptoms are caused by changes in how the GI tract works. It is important to note that IBS is a group of symptoms that occur together, not a disease. At different points in the past, IBS was called colitis, mucous colitis, spastic colon, nervous colon, and spastic bowel.
How frequent is IBS?
In most studies, estimates of the frequency of IBS range from 10-15 percent. IBS affects about twice as many women as men, and it is most often found in people younger than age 45.

What are the symptoms of IBS?
The most common symptoms of IBS are abdominal pain, often described as cramping. This is typically accompanied with changes in bowel habits. Other symptoms of IBS may include bloating, constipation or diarrhea, passing mucus or feeling that a bowel movement is incomplete.
To specifically meet the criteria for a diagnosis of IBS, the pain or discomfort will be associated with at least two of the following three symptoms:

bowel movements that occur more or less often than usual
stool that appears less solid and more watery, or harder and more lumpy, than usual
bowel movements that improve the discomfort

What causes IBS?
The causes of IBS are not well understood. Current medical evidence points to a combination of physical and mental health problems.

How is IBS diagnosed?
There is no test to diagnose IBS; it’s not a disease. Your physician will make the diagnosis based on a complete history, a physical exam and exclusion of other diseases. Although some symptoms will have been present for at least six months, IBS is diagnosed when abdominal pain or discomfort has been present at least three times a month for three consecutive months without other disease or injury that could explain the pain.

How is IBS treated?
Though IBS does not have a cure, the symptoms can be treated with changes in eating, diet, and nutrition, medications, probiotics and therapies for any mental health issues. Details on management of IBS can be obtained at www.sterlingmedicaladvice.com.
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: Living The 72 Hours Life – Free Giveaway Included!

April 6, 2017Health Prevention72 Hours Life, 844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Straight, No Chaser and the many other resources found at Sterling Initiatives (www.jeffreysterlingmd.com) have always been about empowering you to live your best life through better health (www.sterlingmedicaladvice.com), better access to information (SMA TALK / www.docadviceline.com), or better implementation strategies (www.sterlinginitiatives.com). We’ve brought you Straight, No Chaser daily for over three years and have even taken you Behind the Curtain. All the way, the goal is to provide services and accurate information that helps you sort through the clutter.

These considerations have been advanced and expanded in our latest effort. Allow us to introduce you to The 72 Hours Life (www.72HoursLife.com). We have assembled a phenomenal team to extend the same principles you’ve enjoyed in Straight, No Chaser to the other aspects of your life, including work, financial, personal and spiritual. The goal is living your best life, but the means is greater productivity and efficiency.
Here’s some of what we have in store for you:
Books:

On April 15^th, we will release There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life. This manual will provide a road map for approaching the necessary tasks in your life.
On May 1^st, we will release The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days. The workbook will facilitate your assessing your current level of performance and provide you with tips, activities and other tools to help you implement the strategies espoused in the main text.
The 72 Hour book series will continue with other topics of interest.

Web Community:

We have created an amazing experience for you at www.72HoursLife.com and want to invite you to experience it. The web community is set up to offer you a completely interactive, if not “gamified” experience in becoming more productive. The website offers the following with an eye toward productivity, success and community:

Activities
- The website takes your through 72 days of reflections and activities, and it offers you tips and resources to allow you to practice and build upon your skills.
Forum
- Join thousands of other like-minded participants, or create your own group, in the pursuit of thinking through and discovering solutions to your productivity challenges.
- Enjoy the Open Houses being held by our star-studded group of efficiency experts and contributors.
Articles
- Learn from the unique perspectives of a broad variety of individuals sharing their approaches to productivity across work, finances, relationships, health/fitness and other aspects of life.
Training
- Enjoy individual consultations on your goals through the website.
- Sign up for strategy sessions on your specific projects.

Symposia and Workshops:

Personal productivity training workshops will be offered at multiple locations throughout the world.
Corporate training and consultations will be offered for executives and employees.

The 72 Hours Life isn’t about just working harder. It’s about becoming more efficient as a means toward uncluttering your life. Once you’ve accomplished that, you will be more successful in reaching your professional goals and having more time to enjoy the more pleasurable aspect of your life. Join the community. You’ll get everything you put into back out several-fold. Our goal is the same as it’s always been – to help you live a better, healthier, more fulfilled life.
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!
Preorder 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 www.72hourslife.com. Receive introductory pricing with preorders!
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

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