Tag Archives: Conditions and Diseases

Straight, No Chaser: Electrical Injuries and Lightning Strikes

General Health and Wellness, Health Prevention, , , , , , ,

Electricalinjurydanger

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

electrical_burn_to_foot

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

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

electrical injury lineman

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

electricalpediatricburns_3

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

electrical-equipmentfrayed

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

electrical-injury-power lines

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

electricalgolferinjury

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

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

electricalgolfinjury

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

electrical lip-burn

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

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

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: When Your Jaw Pain Could Be a Heart Attack

Cardiology/Heart, Head/Eyes/Ears/Nose/Throat, Dental, , , , , , , , , ,

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

 jaw referred pain

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

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

jaw-pain

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

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

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

 heart-symptoms

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

Head/Eyes/Ears/Nose/Throat, Trauma, , , , , , , , ,

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

 brokennoserepair

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

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

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

 nasalfractureclots

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

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

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

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

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

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

Given that noses are a prominent part of our faces, be mindful to take simple protective measures when engaged in activities that could lead to broken noses. These are simple. Use protective headgear, seat belts and car seats, and avoid bar fights (or any other type of fight for that matter). That is a small price to pay for protecting your appearance!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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: Heat Illnesses Awareness (Heat Exhaustion, Heat Cramps, Heat Stroke)

Endocrine/Metabolic, Environmental, Neurology, Health Prevention, , , , , , , , , , ,

heatawarenessday-logo

Heat Awareness Day occurs the last Friday in May instead of the first weekend in July because prevention is better than cure. Once the rains calm down across America, it’s predictable what will happen next: heat, more heat and all heat, and you’d better be ready. The way things work, we just have to deal with it. Unlike when the weather is cold, and you can just add layers, when it’s extremely hot, it seems unescapable. So we sweat, get fatigued and even cramp up. Surprisingly there appears not to be much thought given to the notion that heat cramps are an early sign of a life threatening condition, even though many of us have had loved ones die from heat related illnesses.
When a loved one dies, families often ask “Is there something I could have done?” Usually I give you information. Today’s Straight, No Chaser will  give you information and power to act if needed. There are several varieties of heat-related illness, and you would do well to be aware of them, because you can make a difference if someone’s suffering in the heat.

heat-sickness-signs

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

heatstroke2.1206

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

heat_stroke_prevention

1) Take special caution during the following conditions

  1. 95 degrees is high risk, regardless of the humidity
  2. 85 degrees and 60% or above humidity
  3. 75 degrees and 90% or above humidity

heat_maintips

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

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

Please be mindful that it is hotter in July, and unfortunately lives are lost every year to the heat. That said, it doesn’t have to be July for you to get a heat-related illness. If you can’t avoid the exposure, at least have a plan for managing the heat and acting on any mishaps. The life you save may be your own.
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: Bacterial Vaginosis – No, That’s Not a STD

Genital/Urinary, Obstetrics and Gynecology, , , , , , , , , , , , , , ,

BV1

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

bv anyone

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

bv thrush

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

bv causes

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

Genital/Urinary, Infectious Disease, Obstetrics and Gynecology, , , , , , , , , , , ,

Today, Straight, No Chaser will present two phrases that you may not have previously heard: The Great Mimicker and MSM, and that means we’re discussing what has historically been a devastating disease: syphilis. Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease between the Americas and Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.
syphilis1
Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…
syphilis2Syphilis-hands
Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.
Syphilis3
Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The microorganism causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
Prevention and Treatment Considerations: Advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. Remember that treating syphilis at any point can prevent the most severe complications that lead to death.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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: STDs – Multidrug Resistant Gonorrhea

Genital/Urinary, Infectious Disease, Obstetrics and Gynecology, , , , , , , , , , , , , ,

Gonorrhea threat

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

 gonorrhea

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

 PHIL_3766

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

 condom

Of course, this also creates and reinforces the urgency of practicing safe sexual behaviors. Straight, No Chaser has multiple postings on safe sex and best practices of preventing sexually transmitted infections. Here is a summary post for your review. Of course you can type any topic in the search engine for greater ability to explore these topics.
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: Healthcare Disparities

General Health and Wellness, Public Health, Health Prevention, , , , , , , , , , , , , , , , ,

Disparities

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

 disparities_infant-mortality

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

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

 disparitydm

The following disparities were also reported:

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

disparityuninsured

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

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 Spectrum and Specter of Autism

Mental Health, Pediatrics/Kids Health, , , , , , , , , ,

autism_month_moving

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

 ASD

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

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

Autism_awareness

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

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

Other typical symptoms include the following:

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

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

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

If you have a loved one with suggestive symptoms, please arrange for early evaluation. The team involved will often have to address speed, psychiatric and neurological needs. Screening, early evaluation and treatment across the spectrum of symptoms offers the best opportunity for those affected to approximate a normal life.

Straight, No Chaser: The Rapid Explosion of Autism Diagnoses – A Good or Bad Thing?

Mental Health, Pediatrics/Kids Health, , , , , , , ,

autism-hands

Sometimes it’s really good to be a physician, especially when it comes to care of children. Just yesterday I saved myself a few thousands of dollars in costs by being able to address a situation at home. I can recall two instances in which poorly qualified, non-physician professionals tried to label my children with specific diagnoses. After my then three-year-old son defended himself from a child trying to take a toy from him, one consulting counselor suggested that I pay $200/hour to get him help for his “aggressive tendencies.” (His “symptoms” remarkably disappeared when I removed him from the environment.) When my otherwise normal daughter displayed signs of delaying speaking, another “professional” immediately wanted to label her autistic. In case you’re wondering, I’m not the guy who marches into everyone’s office and announces that I’m a physician. It’s much more interesting to observe the difference in the first and second conversations (you know, the one after they discover you know something…).
Regarding autism, it is a condition that strikes fear into the heart of many, not just because of the condition itself. It’s the lack of knowledge about the condition. It’s the uncertainty about whether a newborn child will be affected just because we’re having children at older ages. It’s the possibility that common environmental exposures could be contributing to the increase in the condition.

autism-in-toddlers

I’m going to approach this two-part series on autism in reverse order. Instead of simply discussing the basics about autism, I’m going to discuss the recent increases in autism rates. It is very important that you read past the headlines on this. Hopefully you’ll come to a better understanding.
In March of 2012, the Centers for Disease Control and Prevention (CDC) estimated that one of 88 eight-years-olds would have one of the various forms of autism spectrum disorder. Another CDC study that was just released reveals that autism rates now affect one of every 68 eight-year-old children. This is a 30% increase in just two years!
Many of you are aware of some of the controversial claims about possible causes of autism. Regardless of the believability of unproven claims, it is entirely probable that some good has come from shining a spotlight on autism. It is without question that the enhanced attention has resulted in more attention being paid to children with suggestive symptoms. This recent trend in more aggressive diagnoses is resulting in more attention being given to those in need with better outcomes over the long haul.
There is no cure for autism. This may be true and depressing, but it doesn’t have to be. Generally, interventions tend to focus on eliminating symptoms and producing desired outcomes (such as those that will increase independent living and functioning). Coordination of strategies is important, so the use of multiple professionals working as a team is common. The good news is, for many children, symptoms improve with early treatment and with age.  Those with one of the forms of autism will usually continue to need services and supports throughout their lives, but many are able to work successfully and live independently or within a supportive environment. Also, please note: The earlier the diagnosis is made and treatment is started, the better one’s outcome is likely to be.
I have just understated a point that I will take a few words to revisit. There is no cure for autism. Please don’t fall prey to claims of therapies and interventions that promise a quick fix. These claims are invariably are not supported by scientific studies. They are acting on your hopes and preying on your fears. The details of treatment strategies are further discussed at www.sterlingmedicaladvice.com.
The next post will focus on the diagnosis and symptoms of autism.
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: Irritable Bowel Syndrome

Gastrointestinal, Mental Health, , , , , , , , , ,

irritable_bowel11

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

ibs sx

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

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

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

ibs

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

IBS-STRESS-management

How is IBS treated?
Though IBS does not have a cure, the symptoms can be treated with changes in eating, diet, and nutrition, medications, probiotics and therapies for any mental health issues. Details on management of IBS can be obtained at www.sterlingmedicaladvice.com.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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: Public Health Has Saved More Lives Than Medical Care

General Health and Wellness, Public Health, , , , , , , , , , , , , , , , , , , , , , , , , , , ,

healthweek

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.
public health
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 20th century. In this post I’d like to review the “Ten Great Public Health Achievements in the 20th 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.

Top10AchievementsPH

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.

Public_Health_Ounce

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.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Athlete’s Foot (Tinea Pedis)

General Health and Wellness, Skin/Dermatology, , , , , , , ,

 athletesfoot1

Athlete’s foot is one of those topics that everyone seems to know a little about but not enough to really understand. If your level of knowledge is “scaly, itchy rash on the feet = go to the pharmacy,” you need to empower yourself with some Straight, No Chaser answers to these frequently asked questions about athlete’s foot.
What puts me at risk for athlete’s foot?

athletes_foot_toe

  • If you frequently wear socks that are or become moist
  • If you frequently wear tight shoes
  • If you have diabetes, lupus, chronically take steroids or have another illness that lowers your immunity
  • If you’re male
  • If you’re with someone in the midst of a fungal infection and share bed sheets, carpeting, rugs, or shoes with them
  • If you’re barefoot while exposed in public areas such as showers, saunas or swimming pools

What causes athlete’s foot?
Tinea pedis (aka athlete’s foot) is a fungal infection. Tinea is the same family of fungi that produces the conditions known as jock itch and ringworm.
What are the symptoms of athlete’s foot?
Athletes foot-1
Look for a dry, scaly rash that most often is noticed between your toes. It produces itching and burning. It can progress to include blisters and/or ulcers.
Is athlete’s foot contagious? How is it spread?

athletesfootrisks

Athlete’s foot is very contagious and is usually spread by floors, clothes, towels, bed sheets or rugs. Your hands can play a role in spreading it as well. Picking at the lesions with your hands can infect them and further spread the fungus to your groin or your nails.
What should I do to prevent athlete’s foot? 
Try these simple tips.

  • Wear clean socks that you change regularly or anytime they become wet.
  • Keep your feet dry. Regarding prevention, barefoot and dry is infinitely better than covering your feet with sweaty socks.
  • Avoid vinyl or rubber shoes, as these retard ventilation and promote fungal growth.
  • Don’t wear the same shoes every day. They need to dry out.
  • Don’t share shoes.
  • Wear shower shoes or waterproof sandals in public places.

When should I see a doctor? How can athlete’s foot be treated?
athletes-foot1
Here are some principles to care for and treat athlete’s foot.

  • If you have diabetes or a lowered immunity, see a physician immediately upon onset of athlete’s foot.
  • If you have athlete’s foot and develop pronounced or prolonged redness, swelling, warmth, fever or drainage, you should see a physician as soon as possible.
  • If you have normal immunity, it is reasonable to try an over-the-counter medication; these come in lotions, ointments, powders or sprays.
  • If you have athlete’s foot resistant to self-help efforts after a few weeks, you should see a physician.

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: Foot Corns and Calluses

General Health and Wellness, Skin/Dermatology, , , , , , ,

Corns and callous 3
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.
Corn

  • 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.

Callus3-300x284

  • 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.

Corns_and_Calluses
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.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Ingrown Toenails

Infectious Disease, Skin/Dermatology, , , , , ,

ingrown-nail
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.

ingrown_toenail

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.

Straight, No Chaser: Understanding Asthma – Toothpicks and Snot (Part 2 of 2)

Medical Treatment, Respiratory/Lungs, , , , , , , , , , ,

asthma_treatments_496958

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:

asthmatriggers

  • 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.

AsthmaHispanic

  • 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.

asthma-inhaler-techniques-15-638
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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From the SterlingMedicalAdvice.com Health Library: “My Doctor Said I Was a High-Risk Asthmatic. What Does That Mean?”

General Health and Wellness, Respiratory/Lungs, , , , , , , , , ,

asthmarisk

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

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: Understanding Asthma – Toothpicks and Snot (Part 1 of 2)

Respiratory/Lungs, Health Prevention, , , , , , , , , ,

 

asthmaBasics-enHD-AR1

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

  • 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.
  • Exacerbations 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.

Asthma Symptoms Word Circle Concept with great terms such as coughing wheezing and more.
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.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

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

Gastrointestinal, Surgical Care, , , , , , , ,

 
appendicitis
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

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.

appy rlq

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.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress
 

Straight, No Chaser: Kidney Stones (Nephrolithiasis)

Genital/Urinary, , , , , , , , , , ,

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.

 kidney_stone_s6_treatment

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).

kidney-stone-pain-areas

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.

 kidney-stone

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.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

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