Tag Archives: Conditions and Diseases

Straight, No Chaser: Questions About Color Blindness

November 14, 2016Ophthalmology/Eyes844-SMA-TALK, Behind the Curtain, color blindness, color deficiency, Conditions and Diseases, cones, nystagmus, retina, rods, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

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

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

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

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

What can be done about it?
There is no cure for color blindness, although acquired forms are best addressed by treating the underlying source. You may be given special eyewear that improves color detection.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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: Diabetes Basics and the Importance of Education

November 7, 2016Diet and Nutrition, Endocrine/Metabolic, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Diabetes, Diet, exercise, health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

Let’s take a moment to discuss prevention and treatment. There are different types of diabetes, but the risk of one form of diabetes in particular can be reduced by – you guessed it – diet and exercise. In fact, diet, exercise and medications are the three legs of the diabetes treatment stool regardless of type. Some patients require regular insulin injections and others require pills. Still others who are successful with diet and exercise are able to markedly reduce, and in some instances eliminate medications.
If you’re a diabetic, make an investment in your education. It could not only save your legs or eyes, but it may just save your life. I welcome your questions and comments.
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: Keys to Mental (Un)Health and (Un)Happiness

October 3, 2016General Health and Wellness, Mental Health844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

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

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

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

Now your results may vary but probably won’t. I’m not make judgements, just sharing the data. Life choices have consequences. Choose wisely!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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 Your Headache is Life-Threatening

September 15, 2016Neurology, Health Prevention844-SMA-TALK, arteriovenous malformation, AV malformation, Behind the Curtain, Carbon monoxide poisoning, Conditions and Diseases, encephalitis, meningitis, Migraine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, Subarachnoid bleed, temporal arteritisJeffrey Sterling, MD

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

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

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

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

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

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

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

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

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

September 13, 2016General Health and Wellness, Mental Health, Neurology844-SMA-TALK, Behind the Curtain, chronic fatigue syndrome, chronic pain syndrome, Conditions and Diseases, fibromyalgia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

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

September 12, 2016General Health and Wellness844-SMA-TALK, Behind the Curtain, chronic pain syndrome, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

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

In a previous post, I commented on patients equating preference or side effects with allergies, and several readers have asked for clarification (e.g. “Why isn’t that side effect the same as an allergy?). An example that relates to pain is some patients’ preference of various narcotics. For some, morphine routinely makes many people itch. This is an expected side effect and is not the same as an allergic reaction. Morphine also makes some patients feel “bleh,” especially when compared with such medicinal options as Dilaudid or Demerol which are more “happy drugs.”
Even so, these drugs have different effects that would make a physician choose one over the other. For example, morphine is actually a drug of choice for pain exacerbations associated with sickle cell anemia due to its effects at the cellular level, so in many cases, physician will prefer to use morphine despite patient preference. In any event, your job is simply to have the conversation with your physician. Don’t claim an allergy if one doesn’t exist; simply discuss the reasons why one medication seems to work better than the other. You likely will find a much more receptive audience taking this approach.
Feel free to ask 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: Life Begins (To End) at 40 (Unless It Doesn’t) – The Cerebrovascular System (Your Brain)

September 9, 2016General Health and Wellness, Mental Health, Neurology, Health Prevention844-SMA-TALK, Behind the Curtain, Blood vessel, Brain, Cerebrovascular disease, Conditions and Diseases, health, Neurological Disorders, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, Transient ischemic attackJeffrey Sterling, MD

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

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

Challenges: Unlike many of the other systems I’ve discussed, the effects of these changes on our brain health status can be drastic, ranging from slight discomfort to death, and they involve major physical as well as social components. The social implications of these effects can be just as severe as the physical, as those suffering become less functional both mentally and physically. Unfortunately, in varying degrees stroke survivors become or perceive themselves to be a burden to others. Social interactions are doubly inhibited: internally, the patient is less able to interact; and externally, family, friends, and others may be less interested in interacting with them. This is sad, but true (think about the lives of the stroke survivors you may know…).
Solutions: The alternatives are twofold: after the fact, education is essential by a loved one’s support group and community, otherwise a stroke becomes a different type of life sentence. Physical and occupational therapy save lives and the quality of lives. Continuing to value and show value to your loved ones can make all the difference in the world. Before the fact, again, it’s preventive measures such as diet and exercise that have been shown to decrease or even prevent strokes. I cannot overemphasize how vital diet, exercise and the avoidance of toxins are to your long-term health.
Feel free to ask 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: Tips to Limit Your Risk of Contracting The Most Deadly Diseases

August 26, 2016General Health and Wellness, Health Prevention844-SMA-TALK, Asthma, Behind the Curtain, Cancer, Cardiovascular disease, Chronic bronchitis, Conditions and Diseases, Diabetes, emphysema, Heart attacks, MVA, MVC, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, StrokesJeffrey Sterling, MD

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

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

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

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

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

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

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

Chronic lower respiratory diseases

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

Stroke – Learn early detection.

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

Accidents

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

There is no fountain of youth. Your cure won’t be found in a bottle, a fad or any other quick fix. It really is about diet, exercise and risk management. The choices you make matter. Remember, although these tips were focused on prevention, early detection and treatment at the time of crisis give you the best chance to survive. Learn early detection of heart attacks and strokes, learn CPR, get screened for cancer and learn how to survive car crashes. It’s not that hard.
Feel free to ask 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 Fainting is Deadly

July 31, 2016Cardiology/Heart, Neurology844-SMA-TALK, anemia, arrhythmia, Behind the Curtain, Conditions and Diseases, fainting, Hypoglycemia, panic attacks, seizures, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, vasovagal syncopeJeffrey Sterling, MD

1. So can faints be deadly?

Potentially. There are three separate sets of considerations. The brain can’t survive very long without adequate oxygen. Whatever caused that faint, if it continues to deny oxygen to the brain, can lead to seizures, strokes and death. The process that caused the faint could be deadly in and of itself. Such things would include heart attacks, strokes, seizures due to bleeding inside the brain. Significant injuries may occur after the faint. Someone who falls may subsequently suffer a head or neck injury, which could be deadly, independent of the cause of the faint. It’s worth mentioning that it’s an especially odd behavior that people seem to travel to the bathroom when they feel dizzy. All things considered, it’s better to faint in your soft bed or surrounding carpeted floor than on the hard tile of a typical bathroom with even harder sinks, toilets and tubs in close proximity.
2. My doctor always warns me about high blood sugars. You mentioned low blood sugars as a cause of faints. Am I putting myself in danger if I’m taking sugar and my sugar level is already high?
If you know all of that, yes. More often, you know none of that. Here’s the deal. Both a high and low glucose (blood sugar) count can cause altered mental status, fainting and coma. If your glucose level is especially high, say 900, and you drink some orange juice, it won’t make much of a difference. If your glucose level is 0, and you are given some orange juice, your life just got saved. In other words, it’s medically worth the risk if you don’t know what the glucose level is.
3. Can a loved one really take my breath away?
Yes. Overstimulation can lead to syncope in a variety of ways as mentioned previously.
4. What’s with the goats?
If you’re referring to Tennessee fainting goats, they exist. The goats don’t actually faint. When startled, they become stiff to the point of being unable to move their legs. Subsequently, the terrified goats can’t run and just topple over. Here you go.

Feel free to ask 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: You’re Way Too Comfortable With Fainting

July 30, 2016Cardiology/Heart, Neurology844-SMA-TALK, anemia, arrhythmia, Behind the Curtain, Conditions and Diseases, fainting, Hypoglycemia, panic attacks, seizures, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, vasovagal syncopeJeffrey Sterling, MD

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

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

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

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

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

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

July 29, 2016General Health and Wellness, Infectious Disease, Public Health, Health Prevention844-SMA-TALK, anthrax, Behind the Curtain, Conditions and Diseases, dengue, E. coli, ebola, lyme disease, malaria, plague, Rabies, Rocky Mountain Spotted Fever, salmonela, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, toxoplasmosis, west nile virus, zoonosisJeffrey Sterling, MD

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

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

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

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

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

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

Feel free to ask 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: Avoiding Mosquito-Bourne Diseases

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

Straight, No Chaser: Your Questions About Human Bites

July 26, 2016Infectious 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, Wound, Wounds and InjuriesJeffrey Sterling, MD

The votes are in, and it appears that Jaws (from James Bond fame) found the previous post, well… biting. Here’s your questions and answers about human bites:
1) If human bites are so dangerous, why do women love Dracula so much?

Seriously? Let’s just ascribe it to the neck being an erogenous zone and move on…

2) What’s a Boxer’s Fracture?

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 awhile 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 25, 2016Infectious 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, 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.
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: Stop, The Life You Save May Be Your Own – Snake Bites

July 24, 2016General 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, 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: Amnesia and Severe Memory Loss

July 14, 2016General Health and Wellness, Geriatrics/Elderly Care, Mental Health, Neurology844-SMA-TALK, amnesia, Conditions and Diseases, memory loss, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

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

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

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

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

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

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

Your job is to remember to be attentive to changes in your or your loved ones’ behavior. The earlier you get assistance, the better one’s quality of life will remain.
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: Your Questions About Gunshots and Stab Wounds

June 29, 2016Trauma844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Gunshots, Stab wounds, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey 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.
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: Straight Talk About Vasectomies

June 27, 2016Genital/Urinary844-SMA-TALK, Behind the Curtain, Conditions and Diseases, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, 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.
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: Erectile Dysfunction, Part Two – Causes

June 25, 2016General Health and Wellness, Genital/UrinaryBehind the Curtain, Conditions and Diseases, Erectile dysfunction, health, Hypercholesterolemia, Men's Health, Substance abuse, 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.
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: Erectile Dysfunction, Part One

June 24, 2016General Health and Wellness, Genital/UrinaryBehind the Curtain, Conditions and Diseases, Erectile dysfunction, Erection, health, Heart disease, Impotence, Men's Health, 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.
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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