Tag Archives: Conditions and Diseases

Straight, No Chaser: Public Health Has Saved More Lives Than Medical Care

April 5, 2017General Health and Wellness, Public Health844-SMA-TALK, asbestosis, Behind the Curtain, black lung disease, Centers for Disease Control and Prevention, Conditions and Diseases, coronary heart disease, diphtheria, family planning, goiters, homophiles, immunizations, infant mortality, Influenza, measles, motor vehicle collision, pellagra, polio, rickets, rubella, Sexually transmitted disease, silicosis, smallpox, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, tetanus, vaccinationsJeffrey Sterling, MD

When I tell most people I have a degree in public health, the typical response involves an assumption that public health involves caring exclusively for the indigent. I guess if you watched the news you could get that impression as well. Public health is the discipline dedicated to optimizing care for populations. Over the course of my career, I’ve cared for a lot of patients as a physicians, and I’ve actually saved a few lives. However, the work I’ve done as a public health professional has affected millions. The opportunity to work in public health is extremely gratifying.

In fact, according to the Centers for Disease Control and Prevention (CDC), the field of public health has been responsible for adding 25 years to the life expectancy of U.S. citizens over the 20^th century. In this post I’d like to review the “Ten Great Public Health Achievements in the 20^th Century.” Hopefully, this will cause you to reflect on how these discoveries, innovations and habit promotion affect your life and provide you opportunities to live a healthier life. These are being presented in no particular order.

Control of infectious diseases: The combination of hand washing, improved sanitation and appropriate use of antibiotics has saved untold millions. Examples of once prominent diseases being much better controlled include cholera, tuberculosis and even sexually transmitted infections.
Decrease in deaths from heart disease and stroke: The combination of risk modification, symptoms recognition and early treatment has contributed to a reduction in death rates by over 50% in the last four decades.
Family planning and contraceptive services: Innovations include barrier contraception to prevent pregnancy and transmission of HIV and other STDs, pre-pregnancy screening and counseling, promotion of smaller family size, longer intervals between children and the development of prenatal assessment.
Food safety and healthier food production: Food safety has involved reduction in contaminated food sources, better portion control, improvement of nutrition and appropriate components of meals. Fortification of foods has nearly eliminated once prominent diseases such as rickets, goiters and pellagra.
Fluoridation of drinking water: Multiple benefits exists including better infectious control and prevention of tooth decay. It’s estimated to have reduced tooth decay and loss by 40-70% since its inception in the 1940s.
Healthy mothers and babies: It is astounding that infant mortality rates dropped 90% and maternal mortality rates dropped 99% during the last century. The combination of better prenatal care, technological advances and better hygiene and nutrition all have played an important role.
Motor vehicle safety: Seat belts, child safety seats, motorcycle helmets, speed limits, air bags, safer highways and reduction in drinking and driving have all led to substantial reductions in deaths from motor vehicle crashes.
Recognition of tobacco as a health hazard: Today there are more former smokers than current smokers and untold million of lives have been saved since the 1964 Surgeon General’s report on the health risks of smoking.
Vaccinations: It wasn’t long ago in history when epidemics of measles, polio and influenza were killing tens of thousands of people annually. Rubella, tetanus, diphtheria, Hemophilus and other diseases have been brought under control. Smallpox has been eradicated as a disease due to immunizations.
Workplace safety: Elimination of workplace health hazards such as black lung (coal workers’ pneumoconiosis), silicosis, asbestos poisoning and reductions in injuries related to occupational hazards have reduced fatal occupational injuries by approximately 40% in the last 30 years.

These efforts don’t occur by accident and shouldn’t be taken for granted. Public health is a clear example of important, appropriate and effective societal collaboration for the betterment of us all. Next time you see a public health professional, give her or him a pat on the back. More importantly, take the time to review the above listing and be sure you’ve incorporated the items into your life.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Foot Corns and Calluses

March 25, 2017General Health and Wellness844-SMA-TALK, Behind the Curtain, callus, Conditions and Diseases, corns, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition)Jeffrey Sterling, MD

It’s really not my intention to be corny or callous here, but it’s almost in the name. This Straight, No Chaser looks at two very common problems of the feet.
First things first: even though “you know it when you see it,” let’s be clear what we’re describing, because although both corns and calluses can result from pressure and/or friction such as that occurring from tight-fitting shoes, loosely fitting high-heeled shoes or not wearing socks. However, there are differences between the two.

Corns are painful, smaller lesions that typically have a hard center with inflamed skin surrounding it. The presence of this inflamed skin suggests corns will hurt when pressure is applied. Corns usually aren’t seen on weight-bearing parts of the foot (although they can be), so if this is happening on the sides or toe of your toes, it is likely a corn.

Calluses are typically larger and usually painless lesions, although they can have a range of sizes. They usually develop on the soles of your feet, especially under the heels or balls, on your palms, or on your knees. Calluses vary in size and shape and are often larger than corns.

In short, if your feet have any type of raised, hard lesion, any thickened, dry or scaly skin, or area of tenderness or pain with or without these symptoms should be a cause for concern.
Perhaps the most important considerations for you are to know what you can do to address these conditions yourself and when to see your physician.
Here are some self-help efforts you may attempt at home to prevent and address those corns and calluses. If you’re diabetic, you shouldn’t be attempting to treat these conditions on your own because of the increased incidence of infection and risks of amputation.

Moisturize. Keeping your skin soft prevents much of the friction that can be at the root of corn and callus formation. Moisturizing also facilitates removal of thickened skin. This can involve soaking as well as using lotions.
Avoid tight shoes and wear comfortable socks. This will help you prevent and address corn or callus issues. Here’s a simple tip: your shoes are too tight if you can’t wiggle your toes.
Use pads. Simple over-the-counter pads can cushion the impact between shoes and your skin.
Thin affected areas. After bathing or other moisturizing efforts, tough skin can be removed with objects such as an emery board, nail file or pumice stone.

Here are some cues that your corn or callus needs to be addressed.

If you have diabetes, vascular disease or have been otherwise told that you have poor blood flow
If your pain is beyond your ability to control it on your own

Medical treatment for corns and calluses will involve optimizing the preventive mentioned previously, use of shoe inserts and consideration of medicinal and surgical options. The medical and surgical options aren’t necessarily first-line thoughts, but they are more likely to be considered if additional foot issues exist. As is often the case, your best option is prevention.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Ingrown Toenails

March 25, 2017Infectious Disease, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Conditions and Diseases, ingrown toenails, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

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

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

Don’t bite your nails. Doing so just adds the risk of really bad types of bacteria to the mix for when the infection occurs.
Don’t cut your toenail so short that you can’t see some of the white tips. Be sure to let the corners extend past the skin.
Don’t wear excessively tight shoes that literally smash your toes onto themselves.

Here’s a final note: if you’re diabetic or have another cause of a compromised immune system, these infections can spread rapidly and extend into the bone – these infections are very serious. In some cases this has led to amputated toes. If an ingrown toenail happens to you, I’d suggest getting seen sooner rather than later.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Understanding Asthma – Toothpicks and Snot (Part 2 of 2)

March 22, 2017Medical Treatment, Respiratory/Lungs844-SMA-TALK, Asthma, Behind the Curtain, Chronic obstructive pulmonary disease, Conditions and Diseases, Emergency department, health, Inflammation, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

As we move into discussing asthma treatment, remember that asthmatics die at an alarming rate. I mentioned yesterday (and it bears repeating) that death rates have increased over 50% in the last few decades. If you’re an asthmatic, avoid taking care of yourself at your own peril. Your next asthma attack could be your last.
The other thing to remember is that asthma is a reversible disease – until it’s not. At some point (beginning somewhere around age 35 or so), the ongoing inflammation and damage to the lungs will create some irreversible changes, and then the situation’s completely different, possibly predisposing asthmatics to other conditions such as chronic bronchitis, COPD (chronic obstructive pulmonary disease) and lung cancer. This simply reiterates the importance of identifying and removing those triggers.
Given that, let’s talk about asthma control as treatment. Consider the following quick tips you might use to help you reduce or virtually eliminate asthma attacks:

Avoid cigarette smoke (including second hand smoke) like the plague!
Avoid long haired animals, especially cats.
Avoid shaggy carpets, window treatments or other household fixtures that retain dust.
If you’re spraying any kind of aerosol, if it’s allergy season, if you’re handling trash, or if you react to cold weather, wear a mask while you’re doing it. It’s better to not look cool for a few moments than to have to look at an emergency room for a few hours or a hospital room for a few days.
Be careful to avoid colds and the flu. Get that flu shot yearly.

If and when all of this fails, and you’re actually in the midst of an asthma attack, treatment options primarily center around two types of medications.

Short (and quick) acting bronchodilators (e.g. albuterol, ventolin, proventil, xopenex, alupent, maxair) functionally serve as props (‘toothpicks’, no not real ones, and don’t try to use toothpicks at home) to keep the airways open against the onslaught of mucous buildup inside the lungs combined with other inflammatory changes trying to clog the airways. These medications do not treat the underlying condition. They only buy you time and attempt to keep the airways open for…
Steroids (e.g. prednisone, prelone, orapred, solumedrol, decadron – none of which are the muscle building kind) are the mainstay of acute asthma treatment, as they combat the inflammatory reaction and other changes that cause the asthma attack. One can functionally think of steroids as a dump truck moving in to scoop the snot out of the airways. The only issue with the steroids is they take 2-4 hours to start working, so you have to both get them on board as early as possible while continuing to use the bronchodilators to stem the tide until the steroids kick in.

If you are not successful in avoiding those triggers over the long term, you may need to be placed on ‘controller’ medications at home, which include lower doses of long-acting bronchodilators and steroids.
So in summary, the best treatment of asthma is management of its causes. Avoid the triggers, thus reducing your acute attacks. Become educated about signs of an attack. When needed, get help sooner rather than later. And always keep an inhaler on you. It could be the difference between life and death.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Understanding Asthma – Toothpicks and Snot (Part 1 of 2)

March 21, 2017Respiratory/Lungs, Health Prevention844-SMA-TALK, Asthma, Behind the Curtain, Conditions and Diseases, health, Lung, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Asthma concerns me. I’ve had many close friends and family suffer with the disease. In fact, a very good friend died of an attack while in medical school, because he didn’t have his inhaler with him. In other words, this is somewhat personal. I’ve probably given more lectures on asthma than any other topic over the years, and I can say without hesitation that relative to how much we know about its prevention and treatment, I can’t think of another disease where we underperform as much as with asthma management. According to data from the National Institutes of Health, over the last few decades the death rate has increased by over 55%. The prevalence rate has increased by 75%, and among African-Americans the hospitalization rate has increased over 35%. The good news is asthma can be controlled and effectively treated. In this primer, we’ll discuss quick tips to improve the health of the asthmatic in your life.
The encouraging thing about asthma is that if you understand what causes it, you understand how to treat it. Here’s what you need to know about what causes asthma. For the purposes of discussion I am simplifying matters for general consumption.

Asthma is a result of certain triggers, causing inflammation to your airways over a long period of time with the occurrence of attacks (intermittent exacerbations). These triggers can be thought of as allergens. Examples of these triggers include cigarette smoke, dust, aerosols, cold air, long-haired animals (especially cats), seasonal pollens, and exercise (in some).
These triggers create a state of inflammation and hyperresponsiveness in the lungs, leading to the excessive production of mucus within the lungs’ various airway branches. If bad enough this will lead to complete obstruction of the airways. In other words you’ll stop breathing, and you will die without assistance and/or reversal.
Exacerbation of asthma include breathlessness, chest tightness, coughing, and wheezing. Basically, because you have the functional equivalent of snot in your lungs, your airways are narrowed, and you’re having difficulty breathing. After all, it’s harder to breathe snot than air. Now imagine how your lungs feel when you’re adding cigarette smoke to that mix.

Let’s get logical. Asthma management is theoretically straightforward if you can pull it off. Prevention is treatment. I used to describe this as “Kill the Cat.” (This blog neither supports, advocates, nor is responsible for the harming of any animals resulting from this information.) In short, if you identify the triggers that precipitate your asthma attacks and then remove yourself from that environment, you will dramatically reduce, if not eliminate, your attacks. This is often described (incorrectly) in kids as “growing out of their asthma.” No one grows out of it, and you don’t cure asthma; asthmatics just stop having attacks because they’re not around the triggers.
In Part II, we discuss asthma management. In case you’re wondering, that’s where the toothpicks come in.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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The Meaning of High Risk Asthma

March 20, 2017General Health and Wellness, Respiratory/Lungs844-SMA-TALK, Asthma, Behind the Curtain, Bispebjerg, Conditions and Diseases, health, Pregnancy, Respiratory Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Introduction

This post answers a question related to the meaning of high-risk asthma. Read this post for basics about asthma triggers and symptoms. Read this post for basics about asthma control and treatment.

High-Risk Asthma Kills

If you have an asthmatic in your life, it’s important to know that asthmatics die. The risk of death is higher in certain asthmatics. If you or your loved one is in this subset of asthmatics, you really must be diligent in avoiding those triggers that cause asthma attacks. You must also be attentive and consistent in taking your ‘controller’ medicines.
These circumstances define a high risk asthmatic:

A history of sudden severe asthma attacks
Prior need to be intubated (placed on a respiratory aka breathing machine)
Prior admission to a hospital ICU (intensive care unit)
Greater than one admission or two ER visits in the past year
An ER visit within the last month
Needing to use two or more inhalers per month
Current or recent oral steroid use
Illicit drug use
Concomitant cardiopulmonary or psychosocial disease

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Straight, No Chaser: Appendicitis – When a Little Something Causes a Lot…

March 13, 2017Gastrointestinal, Surgical CareAbdomen, Abdominal pain, Appendicitis, Behind the Curtain, Conditions and Diseases, health, Inflammation, Ovarian cyst, SurgeryJeffrey Sterling, MD

There’s not much that causes as much legitimate angst in parents as a child with appendicitis. In case you don’t know what the fuss is all about, the appendix is a 3 1/2 inch pouch on the edge of the large intestine near the right lower part of your abdomen. It’s actually like a long, skinny skin tag that (as best as we know) has no purpose other than to seemingly get inflamed, rupture and require surgery. The problem with it is that it’s a pouch (Pouches are bad things in the body. They always seem to twist or otherwise get blocked, leading to problems. This happens with aneurysms and hemorrhoids, twisting otherwise occurs with torsion of ovarian cysts or the testes. These stories don’t end well.). This particular pouch has the misfortune of being filled with stool, so if it gets sufficiently blocked or inflamed to the point where it ruptures, your abdomen will contain loose stool, which as you can imagine will cause a nasty infection rapidly (This is called peritonitis.). Appendicitis is a surgical emergency, because left untreated, the peritonitis caused by rupture will lead to septic shock.

Appendicitis is very common, occurring in one of fifteen individuals, usually between ages 10-30. It is more dangerous in the young and old, because they are both less able to describe symptoms and more likely to have abnormal presentations. Both of these scenarios lead to delayed diagnosis and treatment, which as you might imagine, doesn’t give patients the best opportunity for good outcomes.

Symptoms classically involve abdominal pain, followed by nausea, vomiting and fever, although other symptoms involving the digestive and urinary systems may be present. Often, the pain begins near the umbilicus (belly button) and seemingly migrates to the right lower portion of the abdomen. The pain may lead to a ‘board-like’ feel of the abdomen. This is a bad sign when it happens.

The below video is a virtual depiction of appendectomy surgery via a technique known as laparoscopy. Use your discretion in choosing to view.

Treatment involves surgery (an appendectomy) in the overwhelming majority of cases. Your job is to maintain a high level of suspicion and remember a few very important pearls of wisdom. First is seek medical attention without delay. Also, don’t eat, drink or take any medicine if you think this is what’s going on. Surgery requires an empty stomach, and certain medicines may mask the pain (leading to diagnostic difficulties) or facilitate early rupture of the appendix. In case you were wondering, there’s no definitive way to prevent appendicitis, but it is less frequent in those on high fiber diets. Score another point for fruits and vegetables.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Kidney Stones (Nephrolithiasis)

March 11, 2017Genital/Urinary844-SMA-TALK, Behind the Curtain, Calcium, Conditions and Diseases, kidney stones, lithotripsy, nephrolithiasis, oxalate, phosporus, Sterling Medical Advice, Straight No Chaser, urolithiasisJeffrey Sterling, MD

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

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

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

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

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

How are they treated?
There’s no uniform treatment for kidney stones. In the short-term (i.e., a presentation to your doctor’s office or an emergency room), your pain and vomiting will be addressed. Dependent on the size and composition of your stones, or based on the effects the stones are having on your body, the stones may be broken up or removed by a specialist.
How are they prevented?
Knowing your risks and making adjustments in your diet are important steps to preventing and avoiding kidney stones. Staying hydrated is perhaps the one step you can take most easily to get the biggest yield.
What else do you want us to know?
If you have a history of kidney stones or certain other conditions (e.g., migraines and certain types of abdominal pain), you run the risk of becoming comfortable (figuratively speaking) with your symptoms. What I mean by this is sometimes the diagnosis of kidney stones is incorrect, even if you have a history of kidney stones. Unfortunately, in this example, the consequences can be deadly. More to follow…
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Insomnia – You Are Not Getting Sleepy

March 9, 2017Sleep844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Hypersomnia, Insomnia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a Straight, No Chaser series on sleep disorders.

So the pendulum swings from hypersomnia to insomnia. Talking about insomnia makes me, well, tired. You know what the problem is. You either can’t fall asleep or you can’t stay asleep. You’re tired when you wake and throughout the day. Lack of sleep saps your energy and your productivity.
Insomnia really isn’t very cool to deal with, either as a person or as a physician. Patients are frustrated and sometimes cranky from being tired, or they can be extremely nervous and stressed, which will perpetuate a vicious cycle.

Unfortunately, there are many mental factors that can disrupt your ability to sleep. Medical professionals tend to think of insomnia in two forms for purposes of evaluation. Either the insomnia is the main problem (primary insomnia), or it’s secondary to another condition (secondary insomnia) such as reflux, uncontrolled asthma, arthritis or other pain syndromes. It could be due to medications, depression or just stress. It could be due to some undiagnosed condition, such as cancer, an enlarged prostate (making you have to get up to urinate throughout the night), thyroid disease or sleep apnea. Then there’s the caffeine (coffee/tea), nicotine (cigarettes) and drunk scene (alcohol).

The thing is, whether acute, intermittent or chronic, any type of insomnia really is an inconvenience and can even be incapacitating. Before you subject yourself to a million dollar medical workup, just remember: If it’s secondary insomnia, and you know (for example) that your pain is keeping you awake, try dealing with the primary issue. Alternatively, if it’s primary insomnia, there are a lot of things you might try. In fact, consider this my Top Ten Tips presented in the order you might consider implementing them.

Adhere to good diet and exercise habits, which make your body perform as it should and which will clean up a lot of potential problems that will affect sleep.
Avoid naps during the day. You want to be good, tired and ready to sleep when night comes.
Develop the habit of only using your bed for sleep or sex. That conditions your body to be ready to sleep when confronted with the stimulus of your bed.
Get your snoring partner some help if s/he is part of what keeps you awake. Check here for tips to deal with snoring.
Try not to eat for several (3-4) hours before you sleep. Nothing says “no sleep” like heartburn all night. (By the way, this is the real reason you shouldn’t eat after a certain hour – not concerns about your weight.)
Avoid nighttime stimulants (e.g., cigarettes, coffee, tea and exercise close to the time you want to sleep, if this proves to be a problem).
Don’t drink and sleep. Although alcohol is a sedative, it’s also on the “don’t do” list, because it can cause restless sleep and interrupt the sleep cycle.
Find a way to relax before sleep. Consider a bath, sex, a book or soothing music … or all of them.
Set the alarm for the morning. Then hide your clock. You don’t need to have a clock to remind you that you aren’t sleeping all night.
Use “white noise” for background if you’re bothered by other sounds.

Here’s a bonus tip: If you fell asleep during the reading of this post, keep it for future reference.
As Edward R. Murrow used to say (well before I was born): good night and good luck.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Why Are You So Sleepy (aka Hypersomnia)?

March 8, 2017Sleep844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Hypersomnia, Insomnia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a Straight, No Chaser series on sleep disorders.

Are you one of those individuals who is always tired and sleepy? You take iron, you exercise and you’re getting sleep at night. However, you’re still tired! What’s that about?
Hypersomnia (i.e., excessive sleepiness) is characterized by prolonged nighttime sleep and/or recurrent bouts of excessive daytime sleepiness or prolonged nighttime sleep. This is not the variety of sleepiness due to physical or mental exhaustion or insufficient sleep at night. Hypersomnia makes you want to nap repeatedly during the day. Ironically, even if you do take a nap or even after you sleep overnight, you’re still fatigued.

The functional importance of this is somewhat obvious. Hypersomnia interrupts your life, your work, your ability to normally interact with others. Symptoms are what you might expect from someone not getting enough sleep. Here’s a typical list:

restlessness
anxiety and irritation
decreased energy
slow thinking
slow speech
loss of appetite
hallucinations
memory difficulty
loss the ability to function in family, social, occupational, or other settings

Hypersomnia is difficult. It takes time to realize you’re affected beyond just regular fatigue. It’s also difficult to pin down the cause. Consider the following potential groups of causes:

Physical causes may include damage to the brain (e.g., from head trauma) or spinal cord, or from a tumor.
Medical and mental/behavioral health causes may include obesity, seizure disorder (epilepsy), encephalitis, multiple sclerosis and other sleep disorders (e.g., sleep apnea, narcolepsy).
Mental/behavioral health causes may include depression, drug or alcohol use.
Medications or medication withdrawal may cause hypersomnia.

Unfortunately, treatment is symptomatic and often requires some degree of trial and error. For some individuals, stimulants, antidepressants and other psychoactive medications are effective. For others, behavioral changes appear to be more effective.
Any disruption in the quality or amount of sleep warrant investigation. Discuss your concerns with your physician if you have the opportunity. You always have the option of discussing with your SterlingMedicalAdvice.com expert consultant.
Special thanks go to the Hypersomnia Foundation for use of the lead logo for this posting. Please visit their website at http://hypersomniafoundation.org for more information on their efforts to combat this condition.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Narcolepsy – The Sleep Attack

March 6, 2017General Health and Wellness, SleepBehind the Curtain, Cataplexy, Conditions and Diseases, Excessive daytime sleepiness, health, Narcolepsy, Sleep apnea, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a Straight, No Chaser series on sleep disorders.

When you hear about narcolepsy, it’s usually in the context of some joke, but it’s a horrifying condition. Looking at the lead picture, imagining blacking out while driving a car. A diagnosis of narcolepsy should prompt certain lifestyle changes. Narcolepsy is a chronic sleep disorder that causes overwhelming daytime drowsiness and is characterized by an extreme tendency to fall asleep whenever in relaxing surroundings.

To better understand this condition, let’s look at certain truths of narcolepsy.

Narcolepsy doesn’t happen just because you’re tired.

Narcolepsy is a brain disorder. The part of your brain that regulates your cycle of being awake vs. being asleep is disturbed. The drop attack is not fading into sleep. It is an irresistible shut down. Now, narcoleptics do suffer from severe sleepiness throughout the day, but the sleep attacks aren’t predictable based on how tired one is.

Narcoleptics have severe disruptions of the activities of daily living.

Just remembering that this is a drop attack will help you appreciate the danger of narcolepsy. It can occur at any time during any activity. The unpredictability of the condition renders it very dangerous to the sufferer, and it makes performing at work, at school, in social and in many other settings very difficult.

Narcoleptics are likely suffering from other sleep disorders.

Understand that narcolepsy is a disruption of the sleep/wake cycle. That disturbance can manifest in other ways, including poor sleep quality and frequent nighttime waking. However, narcoleptics do not tend to spend more total time asleep during the day than unaffected individuals.

In addition to the sleep attacks, the main symptoms are excessive daytime sleepiness and cataplexy.

Cataplexy is a sudden voluntary muscle loss while one is still awake—the horror before the horror, if you will. Individuals feel limp and/or unable to move. Other symptoms may include hallucinations and an extension of the cataplexy to outright paralysis before and after the episode. Now the drop attacks themselves typically last seconds to minutes and result in a temporary feeling of refreshment before the sleepiness phenomenon reoccurs.

There’s no special rhyme or reason to who suffers from narcolepsy.

Narcolepsy occurs the world around and in men and women at a roughly equal rate. It typically occurs in children through young adulthood, but it can occur at any age. Surprisingly, it often is underdiagnosed. Don’t let that happen to you. With any form of a blackout or sleep attack, please get evaluated and be sure to ask if the episode could have been narcolepsy.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: When Back Pain Could Be Life Threatening

February 22, 2017Neurology, Orthopedics/Bones844-SMA-TALK, Behind the Curtain, Cauda Equina Syndrome, Conditions and Diseases, low back pain, sciatica, spinal stenosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition)Jeffrey Sterling, MD

Back pain hurts, but there are various causes of that pain that will kill or cripple you. Here’s some information on some diseases that present with back pain representing life-threats. Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards. Forewarned is forearmed.
Let’s start where we left off on post discussion general low back pain and identify what I was talking about….
Here are a few clues to help you hone in on whether your back pain requires emergency attention. Remember pain and pathology (serious disease) are two different considerations. I’m describing medical emergencies here and admittedly being overly simplistic.

Direct blow to your back: Think Fracture
- The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back. It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy. That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
Fever and new onset back pain: Think Spinal Epidural Abscess
- A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones. It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood. Antibiotics for about a month and/or surgery may be required.
Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
- There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies. CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects. This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs. Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
New onset back pain after age 65: Think Cancer
- There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer. The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement. Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present. It could represent a significant advancement of disease.
Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
Night-time back pain: Think Metastatic Cancer.
- Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
Sudden sexual dysfunction: See Cauda Equina Syndrome above
Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
Unexplained new weight loss and new onset back pain: Think Cancer
- There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
Work-related back injuries
- This isn’t as much a life-threatening consideration as it is a limb and career-threatening one. Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed. Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs. I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future. The take home consideration here is to use these cues to know when to get rapidly evaluated. Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Sciatica

February 19, 2017Neurology, Musculoskeletal System844-SMA-TALK, Behind the Curtain, Conditions and Diseases, low back pain, sciatica, spinal stenosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition)Jeffrey Sterling, MD

My pain has a name, and it’s sciatica. There’s always a sense of relief in patients when a name is given to a medical sign or symptom. This Straight, No Chaser places sciatica in context among various problems of the low back and gives you basic information for you to use in seeking solutions.
What is sciatica?

This is important for you to understand. Sciatica is a symptom, not a diagnosis. Sciatica is any of various clinical presentations that result from any injury to or inflammation of the sciatic nerve. The sciatic nerve is a large nerve that extends from the lower back and travels down the back of each of your legs. This nerve provides muscle control and sensation to various parts of your thighs, legs and soles of your feet.
What are the symptoms of sciatica?

Once you know the distribution of the sciatic nerve, the symptoms are pretty self-evident. Simplistically, a nerve is just an electrical conductor sending signals down its distribution. The typical symptoms of sciatica include the following:

Pain (e.g. pins and needles, burning or aching)
Weakness (can progress to an outright inability to move)
Numbness
Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

After sneezing, coughing or laughing
After walking or bending backwards
At night
When standing or sitting

What causes sciatica?

If you ever get diagnosed with sciatica, your immediate next question should be “What’s next?” Be reminded, sciatica is caused by something causing irritation, inflammation or injury to the sciatic nerves. Here are some common and/or important causes of sciatica; feel free to ask your physician if these actual diagnoses are being considered if you’re told you have sciatica.

Bruise or fracture to one of your pelvic bones
Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
Infection (a rare but important cause in those with new fever and back pain)
Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
Pregnancy
Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news).

How is sciatica treated?
If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

In some cases, no treatment is required and recovery occurs on its own.
Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
Reduced and limited activity is best for the first few days. Bed rest is not recommended.

For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Low Back Pain

February 18, 2017Neurology, Orthopedics/Bones, Musculoskeletal System844-SMA-TALK, Behind the Curtain, Conditions and Diseases, low back pain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

For many, low back pain begins with a slip and subsequently becomes a slippery slope that never seems to end. This Straight, No Chaser will help you understand why you’re having pain.
Lower back pain is a tricky subject for an emergency physician, and it’s seen everyday. In fact, over 40 million Americans suffer from various forms of chronic low back pain. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.

Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):

Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

2. Strains
Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.
3. Fractures
A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.
4. Arthritis and Normal Deterioration (aging)
There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.
Here are a few clues to help you hone in on whether your back pain requires emergency attention:

Direct blow to your back
Fever and new onset back pain
Loss of control of your bowel movements or bladder function
New onset back pain after age 65
Numbness and tingling in both of your legs
Nighttime back pain
Sudden sexual dysfunction
Weakness and/or loss of motion or sensation in your legs
Weight loss and new onset back pain
Work related back injuries

What can you do to prevent or reduce the pain at home?

Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
Wear low-heeled shoes whenever you can, ladies!
Learn how to stretch your back.

Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
Sleep on your side. Try a pillow between your knees.
Walk. Did you know walking is the best (and easiest) exercise for your back?

Straight, No Chaser: The Tragedy of Septic Shock

January 26, 2017Cardiology/Heart, General Health and Wellness, Infectious Disease, Medical Treatment844-SMA-TALK, Behind the Curtain, Blood pressure, Conditions and Diseases, health, Intensive-care unit, Septic shock, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

There are bad days and then there are really bad days. In many ways, the occurrence of septic shock is a culmination of a lot of bad things that can happen to you. Septic shock is the condition your body finds itself in as a result, progression and complication of a serious infection. This infection overwhelms your body, producing a massive inflammatory reaction, bringing many complications along. These complications include a significant drop in your blood pressure and can also include organ failure, most notably of the heart and lungs. Septic shock doesn’t occur to just anyone. It most often occurs in those with weakened immunity in one form or other (elderly, immunocompromised, diabetics, recent surgery, infection or prolonged hospital stay, burn victims, newborns and the pregnant), and it is the single most common cause of death in intensive care units in the U.S. The most common cause of septic shock is pneumonia, but urinary tract and abdominal infections are also major causes.
Signs and symptoms are routine and include low blood pressure, confusion or other signs of altered mental status, fever, chills and a fast heart rate, weakness, shortness of breath and noticeably diminished urination. Don’t focus on that list, though. Septic shock is a situation where your physician will know it when s/he sees it. If something like this happened at home, you’d recognize that something horrible was wrong, and you’d find yourself in an emergency room.

In terms of treatment, the ‘when’ is just as the important as ‘how’. The earlier this is diagnosed and treatment is started, the better chances of survival are. And let there be no doubt. Life is in the balance with this condition. Treatment simultaneously seeks to hold the patient up and support him/her while the underlying condition is being addressed. This is when the big guns are pulled in, including major antibiotics, intravenous fluids to rehydrate you, medications to support and enhance blood pressure and possible use of a breathing machine (ventilator) to ensure optimal oxygenation. Even surgery may be necessary to remove dead abdominal tissue, burn tissue or an abscess that may be the source of an infection.

The truth is septic shock carries a death (mortality) rate of 50%. It is always a bad situation and is best viewed as a medical miracle when survived as opposed to a treatment failure when death occurs. I can only wish you and your family the best if you find yourselves in this situation. Time is tissue.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Treatment of Food Poisoning

December 28, 2016Diet 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 ChaserJeffrey 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.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Understanding Food Poisoning (Foodborne Illness)

December 27, 2016Detoxification, Diet and Nutrition, 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, 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. Contaminations 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.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: The Holiday Heart Syndrome

December 23, 2016Cardiology/Heart, General Health and Wellness844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey 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!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Questions About High Blood Pressure (Hypertension)

December 8, 2016Cardiology/Heart, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, high blood pressure, Hypertension, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

1. How do I know if I have high blood pressure?
You know by the numbers. Consider these defining blood pressure levels.
Normal – Systolic: < 120 mmHg, Diastolic: < 80 mmHg
At risk (pre-hypertension) – Systolic: 120–139 mmHg, Diastolic: 80–89 mmHg
High Systolic – Systolic: 140 mmHg or higher, Diastolic: 90 mmHg or higher
If you don’t already have a diagnosis of hypertension and are anywhere at or above the pre-hypertension stage, get checked by your physician.
2. But when should I get go to the emergency room for high blood pressure?
I’ll always want to see you if your bottom number (diastolic blood pressure) is at or above 110-115, regardless of whether you appropriately take your medication. Don’t look for symptoms to guide you. High blood pressure is called “the silent killer.”
3. If I do have high blood pressure, will I be placed on medication?
I really hope not, but honestly, approximately two-thirds of individuals in the U.S. who have high blood pressure are poorly controlled – even on medication. This means medication will be necessary for most. That said, theoretically, medication should be viewed as necessary only when necessary and only when other measures don’t work. You should discuss this with your individual physician and make every effort to improve your diet and exercise regimens. If and when you’re placed on medication, the choice of medication will be based on your age, sex, ethnicity, mobility, existing health profile and other considerations.
4. You mentioned I could have a heart attack or stroke from this? How would I know if that’s happening?
Check here for Heart Attack Recognition and here for Stroke Recognition where I discuss signs and symptoms. Remember, time is tissue, meaning you must not delay if you develop these symptoms.
5. What else can I do?
Be healthy! Don’t smoke. Limit alcohol intake. Lower your stress level. This is only a broken record if you’ve received the message and have implemented the recommendations.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Low Blood Sugar (Hypoglycemia)

November 21, 2016Endocrine/MetabolicBehind the Curtain, Blood sugar, Conditions and Diseases, Diabetes, Diabetes mellitus, Endocrine Disorders, Glucose, health, Insulin, PancreasJeffrey 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.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

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